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A Tale of 2 Hospitals

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A Tale of 2 Hospitals November 2, 2007 The Speaker, The House of Assembly The Hon. Stanley Lowe, OBE, JP, MP Sessions House 21 Parliament Street Hamilton HM 12 Dear Honourable Speaker, I have the honour to present a Special Report of the Ombudsman for Bermuda’s Own Motion Systemic Investigation into Allegations of Discrimination Involving Medical Professionals at King Edward VII Memorial Hospital. This Report is submitted in accordance with Sections 24(2)(a) and (3) of the Ombudsman Act 2004 which provides:- Annual and special reports 24(2)(a) Where any administrative action that is under investigation is in the opinion of the Ombudsman of public interest; then the Ombudsman may prepare a special report on the investigation. 24(3) The Ombudsman shall address and deliver his annual report and any special report made under this section to the Speaker of the House of Assembly, and send a copy of the report to the Governor and the President of the Senate. Yours sincerely, Arlene Brock Ombudsman for Bermuda TABLE OF CONTENTS 1. PROLOGUE.......................................................................................1 a) The Investigation ...............................................................................2 b) Definitions of Success ......................................................................4 c) Principles and Methods ....................................................................5 2. FINDINGS.......................................................................................10 a) Documentary Review .......................................................................10 b) Statistics Derived from Submissions and Interviews...................12 c) Some Examples ................................................................................16 3. SYSTEMS GOVERNANCE ......................................................19 a) Competition .....................................................................................19 • The OR Theatre ...................................................................................19 • The Department of Anaesthesia...............................................................21 b) Work Permits....................................................................................33 c) The Political Shadow.......................................................................37 4. CLINICAL GOVERNANCE....................................................39 a) Credentialing ...................................................................................39 • UK vs US ...........................................................................................39 • Differential Hospital Response .................................................................50 b) Critical Incident Reports ................................................................56 c) Disciplinary Process........................................................................59 d) Administrative Competence ............................................................71 5. EPILOGUE.......................................................................................74 a) Conclusion ........................................................................................74 b) The Hospital as a Metaphor for Bermuda .....................................79 6. APPENDICES.................................................................................82 a) Recommendations............................................................................82 b) CURE Definitions..............................................................................92 c) Process..............................................................................................96 d) Responses.......................................................................................106 1. PROLOGUE “THE” Hospital – collectively: Bermuda Hospitals Board (BHB); King Edward VII Memorial Hospital (KEMH – medical health care); Mid-Atlantic Wellness Institute (MWI – mental health care) At The Hospital: • “90% of the doctors are very good, very • “This situation has made Black doctors nice, very collegial, etc. There is a small very nervous. They are wondering who proportion who behaves badly if they are the next victim is going to be. It’s very chastised. They write to the press and easy – in medicine everyone encounters they get politicians on their side and problems. The more cases you do the they create difficulties and problems. more likely you will run into issues or And there are a number who feel that they complications that raise questions.” [BB] can behave entirely as they please.” [WE] 1 • “The hospital is the last bastion of racist institutions in Bermuda.” [BB] • “I want to believe that there are a large number of people who do not want race • “You need to get rid of people who promote to be an issue. Wonder if a lot of problems racism, actively or passively, consciously are as a result of small groups who want or unconsciously, expressed or unexpres- sed. We need to get rid of them.” [BB] to perpetuate the fight because it is to their advantage.” [WB] • “There’s a notorious but untouchable group of doctors who make routine attacks “If you’re going to rant and rave and • on black doctors…who’s next?” [BB] accuse people of discrimination and jump up and down, you won’t get very far.” [WB] • “The hospital has to first of all recognize itself that racism does exist. It’s not a • “The hospital is in danger of lodging question of what degree it is, it does exist. itself into two sections: the non-Bermu- Sit down and say we’re not going to hold dians and the Bermudians.” [WB] you responsible for anything that may have happened in the past, but we can • “I hate rumour and innuendo. I hate collectively just move forward.” [BB] hints that racism exists and that it has affected decisions at the hospital.” [WE] • “On a scale of 1-10 (with 10 being the highest possible polarization), the entire hospital • “There are some doctors whose primary is a 6; the operating room is a 9.” [BE] focus is medicine and providing quality • “Blacks always have to prove themselves.” [BB] care – they wear blinders to what’s going on around them.” [WB] • “It’s a Tower of Babel.” [BB] 1 [BB] = black Bermudian; [WB] = white Bermudian; [WE] = white expatriate; [BE] = black expatriate; [EA] = expert advisor 1 THIS IS...A TALE OF TWO HOSPITALS Note: This Report is structured a bit differently than the norm. It is written in two columns. The column on the right presents analysis and commentary. The column on the left allows readers to 'hear' people’s percep- tions – in their own words. Boxes throughout the Report detail examples or research. 1.a) The Investigation “We all use the hospital – 1 Young or old, black or white, expatriate, Bermudian, male, female, rich either on the way in or on or poor – almost all of us have used or visited the hospital. Its mission, the way out.” [BB] location, capacity and culture have immediate meaning to us all. “There are many deficiencies 2 Therefore, repeated rumblings, rumours and negative media over the here. There is a general lack years cause real concern. The tensions seem at odds with and detract of collegiality – committees from the mission of the BHB to act as “a committed team of are disappointing.” [WB] professionals working in partnership with patients, their families, clients and the community to provide high quality health care services that meet their needs and expectations”. “I get a sense that there are 3 Last year, three complaints alleging racism amongst medical two camps – when you practitioners (clinicians, physicians) at KEMH were lodged with our challenge us, we will use the office. Complainants were adamant that the issues were not limited to race card.” [WB] themselves. Rather, they insisted that their complaints represented systemic, long-standing problems that spawned and perpetuated toxic relationships amongst physicians. Moreover, they alleged that the BHB had neglected to address these issues adequately. “We try our best to work 4 Although discriminatory actions and procedures are forms of together because we’re small. “maladministration” as defined by the Ombudsman Act 2004, racial We may not like what the discrimination is a protected category under s.2(2)(a)(i) of the Human other may say about us, but Rights Act 1981. I therefore first contacted the Human Rights in general we tend to work together and help each other Commission (“HRC”) to see if it was able to conduct a systemic if there’s problems. We can investigation. It was not possible. One of the complainants was referred call on each other, there to the Ombudsman by the HRC. aren’t any real obstacles to us working together.” [BB] 5 Accordingly, I launched this investigation to find out whether there is evidence of “maladministration”. That is, were any administrative actions of the hospital: 2 • inefficient, improper, negligent, unreasonable; • based wholly or partly on a mistake of law or fact or irrelevant grounds; • unfair, oppressive or improperly discriminatory; or • based on procedures that are unfair, oppressive, arbitrary, unreasonable or improperly discriminatory. 6 As Bermuda’s single medical facility for acute care, the hospital serves the entire population of almost 65,000 people. It is also one of the largest employers on the island with a diverse staff of 1,200 (spanning both KEMH and MWI). KEMH sees some 30,000 emergency visits per year, 7,000 elective surgery procedures a year in the Operating Room (“OR”) and over 6,000 Outpatient visits.
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