Talking Point: Surgeon accuses Board

A Harvard-educated surgeon has accused the Bermuda Hospitals Board of hounding patients who owe medical bills but can’t afford to pay.

Dr. Christopher L. Johnson, an American plastic and reconstructive surgeon, says there are many patients on the island who can’t afford treatment and don’t qualify for financial assistance from the government.

He’s aware of at least 20 people who could not afford medical costs and have consequently faced legal complications, triggered by the Bermuda Hospitals Board (BHB), he says.

The board, through a spokeswoman’s statement, denied those assertions, releasing a detailed explanation of financial options of patients.

The board says there are extensive processes in place designed to assist patients if they have trouble paying. 

Uninsured patients are seen by a credit clerk to discuss options. Cash-strapped patients can qualify for financial assistance, which would mean their medical accounts would not be referred to an outside debt collector. Others are referred to the appropriate government agencies.

For those uninsured patients who don’t receive financial assistance, they  are provided with a special payment agreement that details a repayment plan in a series of instalments. 

Such files are sent to the hospital’s credit department. If the patient is late in paying in such cases, according to the board, the in-house collector will make contact and see if their circumstances have changed.

 If there’s no change or if they can’t be found, the file is sent to an outside collector. 

Once there, “they will operate within the confines of the law to collect the outstanding balance”, according to the board, which added “no individual is denied medical care because of the inability to pay immediately”.

Dr Johnson is not having any of that. He asserts that instead of working with such patients, the hospital takes some to court, where they could face fines or even jail time.

“The way the economic situation has turned out, in many cases, doctor offices demand co-payment for patients,” he told us. “The stopgap should be the hospital, but what we started to discover was that patients were being … threatened with jail by the hospital if they didn’t have money. Legally, the law is that you can be thrown in jail if you don’t pay your bills. 

“Magistrates’ court is able to pursue that avenue. The creditor in this case — BHB — they’ve been doing that.”

Dr. Johnson said governmental financial assistance on the island is great “if you’re completely down and out” but there are a number of people who don’t qualify because they’re not completely destitute or they live with their parents. This pool of people, he says, is underserved by Bermudian health care.

“I’m not going to say health care is failing, I’m going to say that the Bermuda Hospitals Board has lost its way… [what they do] is not compassionate.”

Dr. Johnson has launched a free medical clinic on Mondays and Wednesdays to help patients who wouldn’t be able to afford medical care otherwise.

“There isn’t anything unique about what I’m doing because most doctors, those that aren’t on the salary of the hospital, we treat patients for free every day. We write off any number of patients.”

Such services, he says, should be provided by the publicly subsidized hospital “that was never meant to be for-profit”.

Dr. Johnson says the law should be changed so that patients with outstanding bills cannot be taken to court. 

He also says the now-closed indigent clinic should re-open or the government should subsidize physicians in the community who are currently dealing with the part of the populace who can’t afford the out-of-pocket expenses of medical visits.

“I see this as a civil rights movement,” he said. “For me, until such time the hospital is able to live up to its remit, we will take care of these people. We’ll sacrifice. We’ll make it work.”

The hospitals board urges anyone with a complaint to “contact us through our Patient Advocate Office. We look forward to positive dialogue and collaboration with community physicians to ensure the island’s medical needs are met”.

There is a “robust process in place for dealing with any issue raised by patients or their families”, according to the statement.

The board said it is focused on providing the best quality patient care and welcomed any provision of additional primary care in the community that could provide out-of-hours support for patients with primary care issues who don’t need emergency or urgent care services.