OAG finds air ambulance risk

| 02/07/2013

Alastair-Swarbrick.jpg(CNS): In his latest public interest report Auditor General Alastair Swarbrick has raised a number of worrying concerns regarding the air ambulance service, pointing to potential health risks for patients as well as risks to the public purse due to a failure in procedures among most of the government agencies involved. With 71 medical evacuations via the government health insurance company, CINICO, in the financial year ending 30 June 2012, costing government US$814,623, Swarbrick highlights unlicensed operation of a ground handling service, uncertainty over medical personnel, political interference, no proper public tendering and a failure to document proper procedures by the HSA, CINICO and the CIAA.

“This service is critical to the healthcare of the people of the Cayman Islands and I hope my report will provide the impetus for the necessary improvements,” he said.

Swarbrick told the media last week that he believed there were significant problems regarding handling and value for money, and because of the health risks to patients it was a very important area for the local authorities to address.

Listing a catalogue of issues regarding the failure to follow procedures, he also points to the interference of the former premier, McKeeva Bush, who had, according to the report and previous indications from board minutes and other recently leaked documents, imposed restrictions on the Cayman Islands Airport Authority board, limiting ground handling licenses  to only three companies without “a rationale or reason provided”, the report states.

The former managing director informed the auditor general that he had "recommended the licencing of all companies operating at the airport, but was precluded from doing so by the direction of the former premier."

Swarbrick's audit team found that there was uncertainty whether a nurse or other medically trained professionals were involved in the selection of airambulances and the medical teams. The audit office also raised concerns over the potential liability to CINICO because of questions regarding the insurance carried by the service providers.

The issues come in the wake of growing concerns over what has been happening at CIAA over the last few years in relation to the board and management at Owen Roberts International and the major conflicts of interest that have been exposed in the last few months.

Swarbrick revealed last week that the unnamed air ambulance broker in the report, which was also acting as the unlicensed ground handler at the airport, was Executive Air, a firm owned by Marjorie Bodden that historically provided an ambulance service but which now acts as an agent.

“The Operations relating to the provisions, cost and oversight of air ambulance services have not been managed effectively, resulting in uncertain value for money or services solicited through the Air Ambulance  Broker,” Swarbrick wrote in the report. “We believe that the practice of utilizing the services of a non-contracted Air ambulance Broker, if continued, represents an unmanaged risk to the government in the event of a catastrophic incident because of the lack of prudent management of public resources,” the auditor warned in yet another damning report regarding the mismanagement of public resources.

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  1. Anonymous says:

    What about free market competition to ensure value for money and a lower cost of living for our health services and the insurance costs for those health services. Monoplies are not economical healthy or beneficial to the community. It is time to to end the corrupt control and strangle hold that Executive Air has on the country and open up the market to competition. There is no reason why Island Air and others cannot offer these services more competitively.

    Remember that influence, circumvention, favours and intervention to gain a business advantage is corruption and it MUST stop if we are to create a transparent, non corrupt economic culture for our country.

  2. Anonymous says:

    I certainly can not believe the AGs claim that the current Air Ambulance Ground Handler is not Licenced to carry on this business.

    My wish is thathe is proven wrong in this case and made to pay for his bungling. Of course he could be correct, but I really doubt this.

  3. Anonymous says:

    It is of course an offence to operate any business in the Cayman Islands without a current licence. Money earned without a licence is therefore the proceeds of crime and banks and others in receipt of it may strictly be engaged in money laundering.

  4. Anonymous says:

    I believe that any longstanding practices need to be examined objectively from time to time, not surprisingly such scrutiny is going to reveal either the need for changes due to modernization or improvement in process and efficiency! For an example of this, any one of us can look at what we are doing today, compare how we did it 25 years ago and note the difference! The AG’s office is probably our best tool to determine compliance with the existing rules. Having said that, sometimes there are good reasons for not changing something that works, it then behooves responsible parties (not the AG) to ascertain what should be changed andwhat should be preserved.

    In the case of the Air ambulance facility, in my opinion, there ought to be a local provider for the majority of cases,  as more and more medical cases requiring an air-ambulance are being sent to places other than the USA from whence most air-ambulance providers hail, a Cayman based service would avoid the cost of empty positioning flights, that fact alone would reduce the expense to Cinico considerably.

    Clearly there is the need for licensing to assure compliance with regulations, but the service as it exists today goes far beyond that! Anyone thinking that the current “ground handler” of the majority of ambulance flights is not providing value for money is mistaken!  Many Customers can attest to the personalized service they have benefitted from which could in no way be categorized as being part of a ground-handler’s duty and is often provided out of human kindness or compassion! (try to define that with legislation)

    Personally, I would like to see the relevant authorities assist the current provider in complying and perhaps modernizing rather than creating a contentious confrontational environment because the provider senses that their livelihood is being threatened. Further, there ought to be dialogue that could assist a local entrepreneur to enter the business of providing the service!    

    • Anonymous says:

      This only cost $11,500 per evac last year, whats the problem with that. How do you think we could run a plane for a year, with a crew etc for less than $1m per year? Just search what it costs to rent a plane from Miami to Cayman, trust me this is fairly cheap. The last thing we need is another government department….

      • Anonymous says:

        The reason the cost looks "cheap" is because the annual figure likely includes the medevac transfers to GCM from the Sister Islands, which CAL bills CINICO for.  As you rightly say, if you chartered a plane, it would undoubtedly cost more, and it certainly would when you add in the cost of the accompanying medical staff and medical equipment carried on board, not forgetting the airport transfers.

    • Anonymous says:

      We are British/Caymanians.  In 2007 my husband (a medical doctor) and I (a pilot) spent a great deal of our personal time, an enormous amount of effort and many thousands of dollars organizing the operational and physical components of an on island Cayman Air Ambulance service.  We had even secured Airport land to hanger and house the aircraft and operation. 

      We partnered with a well respected global Air Ambulance operator, had many meetings with Government Ministers, Administration,  CINICO, the HSA, CIAA, CAL, local Insurance companies, local Maintenance, US Air Ambulance operators, TPA providers, went on ISBAO and other courses.  We even arranged a presentation for officials, showcasing one of the brand new aircraft of our preferred type (B200) in Cayman.   It made front page news at the time.  Our (British) Global Air Ambulance partners and I were even invited to Ms. Bodden’s home, where we discussed the venture.   I even wrote and submitted to the CIAA the lengthy requisite Operations  Manual. 

      The amount of work, time and money we spent on this was phenomenal. 

      Our British partners were insistent at the time that they would only partner with us for the service. 

      However, after both we and our partners instructed local legal professionals to finalize arrangements, the silence was deafening.

      • Anonymous says:

        You obviously are not part of the tribe.  In other words you spent your money on everything but the "consultant fee".

      • Anon says:

        Ah so it go in Cayman, Ma'am. Unfortunately. We must do what is best for our political supporters and not for the public at large.

  5. Anon says:

    Politics. Margie has been doing this thing for donkey years because she is a Caymanian. No government has ever said she should be scrutinised because she is a Caymanian. That's it. Plain and simple. Can it be done better and cheaper? Jesus Christ, stop your foolishness, Margie has been doing this for donkey years. It doesnt matter whether it can be done better and cheaper, so long as a Caymanian gets her money.

    • Anonymous says:

      I’m a little confused, are you saying that because it’s been run by a Caymanian for ‘donkeys years’ that it should be left alone or are you being a little sarcastic? Genuine question, just not sure from your post which side of the fence you’re on..

      • Anonymous says:

        The poster is clearly being sarcastic and expressing a frustration many have had over the monopolisation of the air ambulance service for "donkey years".

        • Anonymous says:

          That’s cool, that was my first thought but I would have been more sarcastic just to get a point across !

        • Anonymous says:

          Oh, so you are one too that wants to compete with her? No way Bo Bo, Ms Margie is hard to com pete with. The service that you get from her will not be competitive.

      • Anonymous says:

        The writer by no means are being sarcastic. Every Caymanian appreciates the services of Ms Margie and her dear husband. She like her sister is two of the most professional workers in the Cayman Islands, always willing to go the extra mile. I have watched Margie over the years and thought to myself what a dedicated woman. I even told her before that she without training seems to be as knowledgeable as a Doctor.Margie you have the Caymanian people behind you all the way and whatever help you need you can have it. Petitions to be signed or whatever. She has personally been good to my family on a few occasions and this is why I can speak out so boldly for her today. Someone or some persons just perhaps want a piece of the pie.

  6. Chris says:

    The Auditor General doing his job is one thing however diplomacy and tact need to be used.

    Oftentimes auditors draw flawed conclusions which could be avoided if they only took the time to clarify a matter prior to publishing a final report. These errors could be damning to the entities, senior managment and in some cases private businesses.

    Factually incorrect audit reports causing reputational risk can lead to law suits.

    The findings of these reports should be presented to the organisations in question with recommendations. The organisation should be permitted to immediately take corrective action, accept or challenge the recommendations.

    Only then should these reports be published, otherwise every report appears to be the Auditor General beating up on some entity without the entity being able to first respond.


    • Anonymous says:

      I believe the A-G and his department always do submit these reports to the entities being audited for their comments and these are included in the final reports. I suspect some entities just don't respond -too busy, too stressed, just stepped away from my desk, in a meeting etc etc.

  7. Anon says:

    The key word is “potential”. He is not confirming that air ambulances are properly or improperly equipped.

    He is saying that this may be a potential issue.

  8. Fun Fact says:

    Although I am a supporter of the AG overall I must question his claim that the current service presents "potential health risks for patients".

    What medical qualifications does he have to assess and confirm that an air ambulance is properly equipped and staffed to provide services at the required standard?

    • anonymous says:

      you've misunderstood the AG. His claim has nothing to do with the staff and equipment on these air ambulances. Read it again.

  9. Diogenes says:

    The Governor is not the same thing as the Governor in Council.  I agree with you – put the blame where it lies, but its not at the Governor's door.  As for the AG exceeding his remit – his remit is to expose waste of public money and unacceptable risk to the public purse.  Surely single sourcing contracts of the size of the TPA without any form of competitive tender is a major concern.  Fact that smaller service providers are breaking the trade and business law is perhaps smaller by comparison, but once you say its all right because they are "hard working Caymanians" where do you draw the line?  Why bother having a trade and business law if obeying it is optional.  

  10. Caymanian Ebanks says:

    At times the AG seems to go too far. The Licensing of these Companies should be through the CAA not the CIAA. If the CAA gives authority for a flight even an Air Ambulance into the island they must have a handling agency. It is recognised that there are 3 and Miss Margie who does the air ambulances. No issue but since she has been doing it well for decades let her. Give her the license and done.

    As for the Conflict of Interest at the CIAA Board weren’t all Board Members appointed by Governor in Council? If the Governor did not know about Mr Arch and Mr Flowers he was seriously remiss. Put the blame where it lies.

    Don’t forget there is Mr Thompson as Chairman of Planning who owns the largest hardware company on the Island. Not to mention the other contractors on that Board. As for Dr Tomlinson as Chair the Medical Board. He licenses his own hospital. Clearly the best people were sought for the position based on their qualifications and experience.

    I worked at KX for years. Back when Mr Jim was around. The scheme at the airport was protect Cayman Airways. That to me is still important. But not when I see blantant excess everywhere. Suggest you look there Mr AG. Not to mention the money misappropriated from the CIAA. Isn ‘t that more important than upsetting hard working Caymanians who are simply working as they always have or doing what they were asked to by Governor in Council?

    • Anonymous says:

      Of course, if we have been doing something inefficiently for years and in a manner which protects profit streams for capital owning families  then  we should leave things be.

    • Anonymous says:

      There is a right way and a wrong way to do things. You seem to disregard most of the objections of the Audittor General on the basis that the Planning Board and other boards are also conflicted in the decisions of these boards. “Two wrongs dont make a right”. The government boards are chosen by the politicians and McKeeva was renowned for choosing board member who he could control and who had conflicts of interest.

      • J Salasi I. -111? says:

        07:58 sah all governments including present one have appointed and reappointed men with conflicts. flowers was on during the POm administration wasn’t he.

      • Anonymous says:

        New govt—new political appointments –look at the new boards for the aviation depts–PPm doing same as UDP — payback —same old crap

    • Anonymous says:

      The AG is doing exactly what he is supposed to do. An auditor does not apportion blame or decide what the laws, regulations or internal rules are relating to a specific function. An auditor's job is to review a function in the light of the laws, regulations and rules that apply to it and to highlight areas where remedial action is required. So what the auditor hassaid is that, in these areas, you are not in compliance with your own laws, regulations or rules, so you need to take action to remedy that. It is for the organisations involved or the relevant authorities to take whatever action is needed to bring themselves into compliance and to decide who is to "blame".

    • Rorschach says:

      Doing what we have always done is what has gotten in this mess in the first place…

    • Anonymous says:

      For the purpose of learning why the AG has highlighted concerns in the article, please see comments below.

      Your reasoning is way off the mark of Good Governance!

      Caymanian Ebanks 2

    • Anonymous says:

      Caymanian Ebanks I absolutely do not agree with you that "since she has been doing it well for decades let her. Give her the license and done." This is the kind of idiotic thinking that has caused us to be groppling to deal with our current problems. If the company is as good as claimed and everything is above board then I am sure that the broker will have no issue with following due process and meeting legal requirements.

  11. Anonymous says:

    In the early 2000's a new Chief Medical Officer at the HSA saw that the air ambulance broker was not adding any value aka taking money for doing nothing valuable. He tried to remove the broker (among other dead wood) and got himself fired for his efforts. He then sued the government for wrongful dismissal given that one of his mandates was to make the HSA more efficient and cost effective.


    Good luck to the auditor general. He and FOI commissioner are starting to clean things up.

    Someday, a new generation of ethical and competant Caymanians take the reins of governance. I hope that day comes soon to put this place right. It is the only way that Cayman can prosper in the long term.

  12. Anonymous says:

    Political interference, the biggest problem all around in the Cayman Islands. How about if the AG decides this expense is unwarranted for us all to pay for, that it comes out of the politician who corruptly forced their hands own pocket?

    • Hoping for better days says:

      Political interference is a world issue. Every country deals with it. Sadly we too fall into the same boat.