Costly misdiagnosis

WESTERN BUREAU:

If the oversight committee instituted to monitor the Cornwall Regional Hospital’s [CRH] restoration work had been properly informed and equipped to do its job, the Type A facility’s rehabilitation may have gone more smoothly at far less cost.

That’s the view of the committee’s former chairman, Professor Archibald McDonald.

Last month, the Ministry of Health and Wellness announced the $10.5 billion price tag for the restoration work at the CRH, which was sparked by the presence of noxious fumes first reported in 2016. The current cost of the work, which is now slated for completion in March 2025, is double a previous estimate of $5.8 billion.

But, for Professor McDonald, who was appointed chairman of the CRH’s restoration oversight committee in 2018 and resigned in 2022, the committee had little to do because they had little to work with.

“I think that, in terms of the oversight committee, our terms of reference were reasonable. But, in the latter years of my tenure, we had great difficulty getting the information we needed to function. The terms of reference were not changed, they remained the same, but, on a day to day basis, it was very difficult to get the information the committee needed to function,” McDonald told The Sunday Gleaner on Friday.

“That is part of the reason why I had to exit the position, because it was becoming meaningless. To function, the committee had to get information from the project management team which reports to the Ministry of Health, and it could not get that information. So we were really marking time and getting free lunch. That is the way it was.”

DISCUSSIONS MISPLACED

McDonald’s declaration underscored an admission from Health Minister Dr Christopher Tufton during a press conference on Friday where he acknowledged that his ministry had not had any clear direction on how to fix the persistent issues affecting the CRH.

Tufton said that his ministry’s attempt to balance the health needs of the populace with the need to identify and fix the building’s issues resulted in rushed decisions that impacted the rehabilitation work.

“The discussions around cost overruns are, I think, misplaced, and I am prepared to say that it is not necessarily because of malice, but because of how the process has evolved over time. Impressions may have been created that we could fix it by fixing an air quality issue, putting in an AC, when, rightfully, unless we fix the leaking pipes, the moisture content would always be high and you would always have mould in the wall. That narrative had to shift with in-depth analysis,” said Tufton.

“What we have is a moving target and an adjustment that, I appreciate, would have created some credibility issues in terms of how people perceive the problem and what the solution was. In other words, sometimes it would have appeared that we were not sure what we were doing,” Tufton added.

“I am prepared to say that, yes, we were unsure in many cases, because the process was a process that sought to address a crisis while recognising the crisis of serving the people at the same time, and that dual approach created a lot of rushed conclusions and decisions.”

The current rehabilitation work at the CRH, which was built in 1974 and is the only Type A hospital in western Jamaica, is being carried out by engineering firm M&M Jamaica, which signed a $1.6 billion contract with the Ministry of Health last November to undertake the project.

The $10.5 billion price tag is intended to include Phase 3 of the redevelopment work, to facilitate rehabilitation of the hospital’s 10 floors and procurement of furniture, information technology supplies, and medical equipment. Phase 3 will also entail putting back the drywall, partitions, electrical sections, plumbing and air-conditioning ducts, and returning of varying equipment and painting.

‘START OUT ON THE WRONG FOOTING’

The irony of Tufton’s admission is further underlined by the fact that the Opposition Spokesman on Health Dr Morais Guy had predicted in early 2021 that the hospital’s rehabilitation would in fact cost upwards of $10-12 billion, which the minister scoffed at.

During McDonald’s four-year tenure as chairman of the CRH oversight committee, the body had proposed several price tags and deadlines for the completion of the CRH’s restoration work, which would include cleaning of mould and correction of moisture issues, the installation of a new ventilation system, and the removal of mechanical, electrical, plumbing and information technology installations.

The proposed costs included $3.5 billion and then $4 billion in 2019, an increase from 2018’s initial projected $2 billion budget, with suggested timelines for completion to include August 2019, December 2020, and between late 2021 and early 2022.

However, in December 2020, Tufton dismissed claims from McDonald that the CRH’s renovation could be completed by the first quarter of 2022 if the Government were to speed up administrative procedures which were said to be responsible for delaying the project.

At that time, McDonald had argued that documents from the CRH restoration’s project manager had to go through several rounds of signatures before reaching the Ministry of Health’s permanent secretary, followed by lengthy waiting periods of up to several months before being returned to the project manager.

While he could not speak to the reason for the current $10.5 billion cost to rehabilitate the CRH, McDonald told The Sunday Gleaner that misdiagnosis of the hospital building’s problems would naturally result in the restoration cost going up once the actual issues were properly identified.

“If you start out on the wrong footing, then it’s not a surprise that the cost has escalated. When I left the chairmanship, I believe they were at $5 billion, and I can only say to you that it escalated from the word ‘go’, because they found out that they had to do additional things to make the building watertight. It was misdiagnosed, as the problem was not properly assessed, and, when that happens, it is always a situation where money is spent which should not have been spent,” said McDonald.

UNREASONABLE TERMS OF REFERENCE

The job of leading the oversight of the restoration project eventually fell to McDonald’s immediate successor to the chairmanship, Dr Jeffrey East, in March 2022. However, less than a year after his appointment, East resigned last month, citing lack of clarity concerning the terms of reference which were included on the documents he signed at the time he took the chair.

Speaking with The Sunday Gleaner on the matter of his chairmanship, East admitted to being blindsided by his appointment, while at the same time describing the oversight committee as an ill-equipped lay volunteer group.

“I didn’t get a chance to look at the terms of reference, nothing at all. We don’t have the technical capacity to make assessments as to whether the Government is getting value for money, and to make recommendations on changes in project implementations, or strategies to improve the effectiveness and efficiency of the project. That can’t be a reasonable terms of reference for a lay volunteer committee,” East said on Friday.

“In retrospect, what I should have done was ask for at least two weeks to make a decision as to whether I had the capacity to do it and whether the terms of reference were reasonable, but I didn’t want to embarrass anybody at that point because the announcement had already been made. Now, having had a chance to look at the terms of reference, these terms can’t be fulfilled by what is essentially a lay committee, because that is what we are,” East added.

“I don’t want to give the impression that I stepped down because of any peeve, or because the project is not going properly. I just don’t think that some of these terms of reference are appropriate, not at this point in the rehabilitation project.”

The Ministry of Health has not yet decided on a replacement for East, although The Sunday Gleaner understands that discussions are currently underway to find a suitable candidate for the post.

In the meantime, McDonald voiced the hope that the work at the CRH will be completed soon, despite the procurement issues which may arise.

“The elected representatives of the people put certain laws in place, talking about procurement laws and so forth, and it adds to the cost. To buy a nail, with the amount of hoops you have to go over and go through, it is enormous, and anybody who has been involved in any kind of real estate project knows that, the longer the project takes, the more expensive it becomes,” said McDonald.

“That is a huge part of the cost you are looking at, but I do hope they move on now, because the people of Jamaica, not just western Jamaica, need the CRH to be restored.”

christopher.thomas@gleanerjm.com