BHB response to 27 November Royal Gazette article

Friday 27 November 2020: BHB’s CEO & President, Dr Michael Richmond, wishes to strongly refute the headline in The Royal Gazette on Friday 27 November, and reassure the public that its hospitalist programme, which employs fully trained doctors who have been working on the frontlines of the pandemic this year, has been appropriately directed and managed. It has, in fact, achieved a 3% cost improvement compared to the same period last year.

Dr Richmond comments: “The Royal Gazette article that ran today includes grave and untrue allegations. Additionally, The Royal Gazette omitted from its published story parts of BHB’s response, which makes it seem as if issues raised were not responded to.

“The allegation in the headline that this is a ‘scam’ is both misleading and malicious, and is not a full representation of the hospital’s response.  The omission of parts of our response from the article that addressed the allegations makes this feel like an unjustified attack not only on the hospital but on our frontline professional medical staff.

“This year we experienced the first global pandemic in 100 years that has claimed nine lives and infected well over 200 people in Bermuda. The hospital and all its staff have been working under extreme duress and yet, despite this, BHB’s inpatient medical service – which includes the hospitalists and medical officers overseeing care for all inpatients – incredibly only went over the planned budget for this period by 2.74%. This budget was set before we knew there would be a pandemic. Furthermore, this is $86,000 less or a 3% improvement on the same period in 2019. This highlights that the new scheduling approaches that we were trialling this year, which had hospitalists undertaking more 12 hour shifts, is working.

“I would add that, after a further review today, since March there have been ten instances when there have been authorised variations to the planned schedule to ensure the highest level of patient care and safety were maintained. This is not something that happens frequently – certainly not an ongoing ‘scam’ that The Royal Gazette alleges. The dates in July were scheduled 12 hour shifts planned due to the workload and the pressure in this month was explained in our statement to The Royal Gazette, but was not included in the story.

“It was also inferred that concerns were reported to the Deputy CEO and CFO but went unaddressed. The complaint about hospitalist scheduling was made to them originally in a meeting with the BPSU in July. A review of schedules for hospitalists and medical officers was added to the workplan for cost savings and this review was explained in our original statements to The Royal Gazette.

“I am disappointed that two anonymous sources are quoted as making unfounded allegations, but we continue to look at improvements to our efficiency, and welcome all ideas on this.  I have full confidence in how this service is run, and furthermore great appreciation and gratitude for the workload managed by the management and team this year given the extreme challenges we have faced.”

Responses from BHB The Royal Gazette did not publish:

BHB did respond to questions about the times hospitalists filled in when a medical officer was not able to carry out the overnight shift. We explained that the schedules do not give the full picture about the issues the hospital was facing during the pandemic. As a department that has been short-staffed during this intense and challenging time, the team managed amazingly to ensure we could care for our patients. The following response was sent to The Royal Gazette, but was not included in the article regarding dates from 3 April to 15 July that the journalist had asked BHB to look into:

“Through April and May we were seeing an increasing number of COVID-19 patients in the hospital, and from June through to July we experienced a significant surge in demand following the relaxation of lockdown. These patients were very unwell, some of them having delayed seeking care due to the lockdown and fears about being in hospital during the pandemic. Comparing the full month of June to July, we saw an increase from 350 admissions to 450, a month on month increase of about 100 people, or 29%.”

We would add, that in March, the hospital was in full response mode to the pandemic as we began to see COVID-19 patients in Emergency and inpatients who tested positive and had to scale up our capacity significantly and prepare for infectious and potentially very sick patients. Our physicians were in the vanguard of these preparations.

Allegations about hospitalists leaving their post were reviewed. The Royal Gazette went ahead and quoted allegations extensively, but did not print the response we sent to them:

“There is no evidence of the misconduct alleged by the anonymous source in the hospitalist group. Our hospitalists have specific duties of care for their cohort of patients which must be met as part of their contracts. There is professional discretion to allow hospitalists to work remotely in certain circumstances once all on-site and direct patient care duties are attended to, though they still must respond within time frames established by the medical staff for emergent, urgent and routine requests.”

Furthermore, we sent detailed information to The Royal Gazette about the scheduling review that is already underway. We were disturbed by the journalist in his editorial comments claiming “Concerns about the practice were raised with BHB management in July, but have yet to be tackled.” We did provide details of the review that is underway. Here is the full response that was sent to The Royal Gazette:

“BHB regularly reviews use of overtime throughout the organisation and has started work on reviewing hospitalist and medical officer schedules. This work is being undertaken in partnership with KPMG, who provide benchmarking and experience from overseas hospitals to help us find the most efficient way to provide the most effective service. Work already is well advanced for reviewing and updating schedules for nursing – our biggest professional group. Meetings started this month on schedules for medical staff, including hospitalists and medical officers.

“While this is recent work, the cost of staffing and use of overtime is a constant area of focus for BHB, even more so as we try to respond to the financial impact of the COVID-19 pandemic. Changes to the hospitalist and medical officer schedules had been made this year as a first step to improved patient care as well as reduce double-time/overtime expenditures. This included more scheduled 12 hour shifts for the hospitalists.”

Finally, as had been included in an official response to the journalist, there is at least one on-site hospitalist at KEMH 24 hours a day. This was explained in more detail to the journalist – that there is a hospitalist on-site overnight who oversees admissions in ED and covers all the inpatient wards. It is highly questionable therefore why the journalist repeats misinformation that they are only ‘on call’ and medical officers are on their own.

We remain, as noted in the BHB quote to The Royal Gazette, open to improving all our processes, including scheduling to ensure we running as efficiently as possible. It is upsetting and damaging for healthcare professionals when a published story in The Royal Gazette is so unbalanced, and attacks the professionalism and integrity of those who have been working tirelessly on the frontlines of care to ensure BHB could prepare to safely care for all those in need through the pandemic.

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