fp Turks and Caicos

The Following is a submission to the Inquiry provided by Minister Floyd Hall in defense of the Southern Health Network Contract.

7 February 2009
Prepared by:     Floyd Hall, Deputy Premier, Minister of Finance
For:        Mr. Oliver Smith, Attorney at Law
 
Report on the Issuance of the Southern Health Network Contract

The Turks & Caicos Islands Government contracted BDC Advisors LLC to evaluate the process of rebuilding its Health System.  During its presentation to the Minister of Health on the 4 November 2004, version 1.0, it was recommended that the TCI Government develop a relationship with a reinsurance company to cap the cost of its treatment abroad program (pg.11 of report).  Also in the report (on pg. 12) it recommended that consideration should be given to whether the TCI Government should outsource the referral contracting or maintain in house this task.

In correspondence to the Minister of Health on the 6 January 2005 (report included) Dr. Anderson of BDC Advisors observed that there were many uncertainties about current data on health care activities and expenditure in TCI; however, in spite of the uncertainty the current trajectory of the health system cost was unsustainable. The report further stated that consideration ought to be given to a component of healthcare insurance.

As a result it was agreed that TCI ought to look at various healthcare systems in the region and as a result Bermuda and Cayman were offered as examples for consideration.
A team was organized from TCI to visit Grand Cayman to evaluate their HealthCare System.   A series of e-mails to this effect were exchanged between Dr. Dave Anderson and me between the 8 -16 August 2005 scheduling meetings for this visit.  Copies of these e-mails are enclosed for your reference. 

The team left the TCI on 17 August and returned on 19 August 2005 and comprised of:

Arrangements were made for the group to meet with:

During our discussions with Mr. Delroy Howell and his group from First Financial Insurance Brokers Ltd, it was proposed by MR. Howell that the following services could be made available to the Government of the TCI:

• Preparation of a Claims History for our country to secure adequate reinsurance coverage for TAP
• Payment of bills in advance to vendors
• Establishment of a representative office in South Florida
• Provide case management of patients
• Organize medical visits and facilitate accommodation and transportation for patients

In this regard, Mr. Howell indicated that he would submit a proposal to the TCI Government capturing the points listed above and that this proposal would be forwarded to the Minister of Health and the PS and Director of Health.

Due note should be taken that the other groups under consideration for this business did not offer to provide or were not capable of providing the services aforementioned. In the case of Trinity, they were a very small operation providing at the time only emergency air ambulance service.  They operated from a home office and were not a TAP operator.  If they had gotten the business from the TCI it would have been their very first attempt at providing TAP services and they did not have the ability of meeting the comprehensive TAP services required of our country.

CMN was based in Canada and merely served as a processing center for the TCI bills from the vendors in South Florida.  At the time this service was under consideration, the TCI was not satisfied with the performance of CMN and was determined to have them replaced as a TAP provider. 

• The reasons at the time were that:
• They did not have an office in South Florida to provide hands on attention
• No active case management was provided to our patients
• They were not prepared to pay our bills in advanced and be reimbursed for the service
• They were not able to provide us with a claims history to enable us to obtain reinsurance

It is so ironic that in Mr. Howell’s Company obtaining the contract for the TCI, they were the only entity vetted to any degree for the provision of insurance service relating to our TAP by our technical people and our independent consultant.  The other two entities had no insurance component at all.  It should also be noted too that the only reason why the reinsurance aspect never took effect is that Southern Health Network never received the full support of the Ministry of Health to enable the claims history to be completed.  Had this been done, we would now have our catastrophic cost for TAP services capped.

Much has been made of the Company, Southern Health Network, being incorporated weeks before the contract was issued by the TCI.  This was merely done to facilitate the management of the TCI business and to compartmentalize the risk associated with that.  It was purely a management decision to have the activity structured in that manner.  Southern Health Network is affiliated with First Financial Insurance Brokers Ltd which was formerly incorporated as Quik Care Limited 12 August 1999 in the Cayman Islands.  In fact this group of Companies has been in the business of providing this type of service for almost ten years.  (A copy of Quik Care Ltd certificate of incorporation is enclosed)

You will also find enclosed the resumes and certification of the complement of staff at Southern Health Network for your review:

Michelle A Chung
Shelly Marzouca
Jacqueline A. Broomes

Bachelor of Arts Degree, Middlesex University
English National Board for Nursing, Midwifery and Health Visiting
Advanced Diploma in Accident and Emergency Nursing, Middlesex University
Middlesex University School of Health and Social Sciences Certificate

Teresa A. Redmond
Diploma of Higher Education, University of North London
English National Board of Nursing, Midwifery and Health Visiting – Adult Nursing
English National Board for Nursing, Midwifery and Health Visiting – Accident and Emergency Nursing

The guarantees provided to the various vendors in South Florida for the Turks & Caicos are from Mr. Howell’s health insurance company, First Financial Insurance Brokers Ltd, which as stated earlier has been in operation for almost ten years with a respectable claims to earnings ratio as a track record.  This claims to earnings ratio was realized through the prudent management of their health insurance business which was a deciding factor in persuading the TCI to have them manage our TAP affairs.  Enclosed you will find the following in respect of First Financial Insurance:

A copy of the License for First Financial Insurance Brokers Ltd dated 27 January 2005, previously registered as an Insurance Broker ino. Quik Care Limited on 12 February 2003
Copy of license renewal for First Financial Insurance Brokers Ltd dated 15 April 2008
A copy of the list of licensed insurance brokers of the Cayman Islands as of 30 September 2008
 
You will also find enclosed extracts of various minutes attesting to the active case management by SHN of our account and incidents where the administrative staff in TCI Government Medical Department going contrary to that advice and Cabinet’s instructions.  A cursory look at the various comparative bills submitted by Trinity Air Ambulance and the bills that SHN were able to negotiate with other comparable air ambulance service is very telling as well.  As much as 40% discount in savings has been realized by SHN over Trinity in some cases.  Please bear in mind when looking at this that it is the same Trinity that was amongst the two service providers that were being considered for the TCI TAP business.

It is unfortunate and perhaps regrettable that the SHN proposal was not considered by the Tender’s Board.  But the fact that this happened was in no way intended to circumvent the process.  In my mind I was convinced that the Board would have simply agreed to have the Company considered with the other two companies and that Cabinet would have arrived at the same conclusion in any event.  In fact the proposal put forward by SHN was more comprehensive than any of the other two entities.  The evidence submitted will show that the other two simply wrote one page letters of expression of interest in the TAP business and neither one was vetted by the process that SHN went through. To elevate Trinity Air Ambulance as a TAP provider to SHN would be wrong.  They simply did not have no experience whatsoever as a TAP provider.  The only engagement the Turks & Caicos Islands medical representatives had with Trinity at the time was with their air ambulance service.  And the services provided by CMN was marginal at best and was causing considerable embarrassment to our country as at the time vendors in the USA were refusing to accept our patients as they could not rely on CMN for payment of our bills.

I am convinced that I have acted in the best interest of the Turks & Caicos Islands in advising Cabinet to award the contract to SHN.  I believe that improved service delivery and considerable cost savings were realized as a result of it.  That notwithstanding, I do understand how on the face of it a reasonable person could expect that my personal relationship with the principal of SHN to have been declared; and because of that, I do regret not doing so as the good work of this Company has been called into question and they do not deserve that.