Health Min­is­ter Dr Fuad Khan has read the ri­ot act to heads of all re­gion­al health au­thor­i­ties (RHAs) in­struct­ing that the out­sourc­ing of med­ical ser­vices is to cease im­me­di­ate­ly. Fail­ure to com­ply would re­sult in the min­istry's re­fusal to pay the med­ical bills. Khan, Sun­day Guardian learnt, is­sued the di­rec­tive last week, warn­ing heads of de­part­ments that if his in­struc­tions are not fol­lowed, they would have to pay the bills from their own pock­ets.

This fol­lows the ex­or­bi­tant $30 mil­lion bill that is now owed to the Com­mu­ni­ty Hos­pi­tal of Sev­enth-Day Ad­ven­tists in Co­corite. The bill, Sun­day Guardian learnt, was brought to the at­ten­tion of the Health Min­is­ter last week. Pay­ment is be­ing re­quest­ed for med­ical ser­vices per­formed on pa­tients over the last two years. The pa­tients were re­ferred from pub­lic health in­sti­tu­tions.

The min­is­ter's di­rec­tive comes days af­ter he an­nounced that his min­istry was ex­plor­ing the op­tion of out­sourc­ing med­ical ser­vices to as­sist with the back­log of cataract cas­es. How­ev­er, Khan ex­plained, the cost to per­form the eye surg­eries would be de­ter­mined by his min­istry and not the pri­vate in­sti­tu­tions.

Khan: It's ridicu­lous

Khan de­scribed the med­ical bill as ab­solute­ly ridicu­lous, in­sist­ing there would be reper­cus­sions if his di­rec­tive is ig­nored. "I am fed up of speak­ing! If they ig­nore my di­rec­tive, I am go­ing to make them pay the bills from their own pock­ets. I have told them if any­body breaks my rule, I am go­ing to deal with them per­son­al­ly.

"Imag­ine, we are still ow­ing Com­mu­ni­ty Hos­pi­tal $30 mil­lion and we have been pay­ing. What is hap­pen­ing is ab­solute­ly hor­ri­ble! This has been go­ing on for the last eight to ten years and I am say­ing the out­sourc­ing of med­ical ser­vices has to stop now. We sim­ply can­not con­tin­ue like this," the frus­trat­ed min­is­ter lament­ed.

Khan said records showed the ma­jor­i­ty of re­fer­rals came from the North Cen­tral Re­gion­al Health Au­thor­i­ty (NCRHA). "I have put my foot down and now I am get­ting flak for the di­rec­tive. They are an­gry with me say­ing that peo­ple are go­ing to die. What I have dis­cov­ered is that they are out­sourc­ing in­ten­sive care treat­ment when pa­tients could be treat­ed in­ter­nal­ly.

"We owe sev­er­al pri­vate in­sti­tu­tions mon­ey in the north, south, east and west. You know how much things I could do with $30 mil­lion? It is just ridicu­lous." Khan said pre­lim­i­nary checks showed that pa­tients were re­ferred to the Com­mu­ni­ty Hos­pi­tal for neu­ro­sur­gi­cal ser­vices that could have been per­formed at the NCRHA.

"What was hap­pen­ing at NCRHA and oth­er in­sti­tu­tions is if a pa­tient was ad­mit­ted for hit­ting his head on the ground he was re­ferred to Com­mu­ni­ty Hos­pi­tal. The prop­er checks were not be­ing done and what we dis­cov­ered was pa­tients were be­ing kept for sev­er­al days and the bill con­tin­ued es­ca­lat­ing.

Khan said, "We have to pay this (ex­or­bi­tant bill) for sim­ple neu­ro­sur­gi­cal ser­vices. If I could hire a neu­ro­sur­geon at the cost of $30,000 to $90,000, it would be cost-ef­fec­tive. I have in­struct­ed all the RHAs that there is to be no out­sourc­ing at any pri­vate in­sti­tu­tion. We have to per­form all med­ical ser­vices in-house.

"The chal­lenge I am fac­ing is if I al­low the med­ical in­sti­tu­tions to do par­tial out­sourc­ing, they end up do­ing to­tal out­sourc­ing. I am build­ing my in-house ca­pac­i­ty to the point that we would have to deal with the prob­lem in­ter­nal­ly. We need to save mon­ey if we have to hire peo­ple to come in to do the op­er­a­tions and to run the sys­tem."

Khan said his de­ci­sion, which is deemed harsh by some, was prompt­ed af­ter an ex­ec­u­tive from the San Fer­nan­do Gen­er­al Hos­pi­tal opt­ed to re­fer a pa­tient to a pri­vate fa­cil­i­ty at St Clair. "The ex­ec­u­tive mem­ber took it up­on him­self to re­fer the pa­tient from San Fer­nan­do to St Clair for med­ical ser­vices. I told him out­right that he had to pay the bill from his own pock­et. It is very easy for the in­sti­tu­tions to out­source med­ical ser­vices be­cause they are not pay­ing for it."

Khan said last week he al­so warned of­fi­cials at the San­gre Grande Hos­pi­tal that those who failed to com­ply with his di­rec­tive would feel. "I told the of­fi­cials if they out­source they would have to pay the bill be­cause I am strength­en­ing the in-house ca­pac­i­ty at the med­ical in­sti­tu­tions.

Once they are al­lowed to out­source, they con­tin­ue with no re­gard to what cost is in­curred be­cause they do not have to pay for it. Pa­tients stay on ven­ti­la­tors for days and then every­thing gets out of hand. This non­sense has to stop now!" At­tempts to con­tact of­fi­cials from the Com­mu­ni­ty Hos­pi­tal and NCRHA chair­man Ash­win Shar­ma proved fu­tile.