Report recommends UHWI governance overhaul

A government-appointed committee is calling for the elimination of an arrangement in which the chairman of the University Hospital of the West Indies’ (UHWI) medical committee sits on the institution’s board while the CEO does not, according to a report released Tuesday.

That structural inversion is a key recommendation in a 34-page review that identified “chronic and egregious” governance failures at the Caribbean’s oldest teaching hospital and called for sweeping legislative, financial and institutional reform.

The current CEO is Fitzgerald Mitchell, while the chairman of the medical committee is Dr Carl Bruce, also the medical chief of staff

“There is no provision in the 1948 UHWI Act for the CEO to be a board member. The consequence of this anachronism is that while the chair of the Hospital Medical Committee is expected to report to the CEO under the PBMA (Public Bodies Management and Accountability Act), the (UHWI) Act requires the CEO to report to the chair as part of the CEO’s general reporting relationship to the board,” the report stated.

It added: “The anomaly must be eliminated and the scope of responsibility for both positions needs to be clearly articulated.”

The report by the Institutional Review Committee was presented to Health and Wellness Minister Dr Christopher Tufton following a review triggered by a damning Auditor General’s report published in January. Tufton had given the committee, chaired by Howard Mitchell, past president of the Private Sector Organisation of Jamaica, four months to complete its work.

At a news conference on Tuesday, Mitchell said the board structure is a “cardinal sin”. According to him, the hospital is in a “critical state… ICU”.

He also said the report is not about prosecuting anyone but how to improve the transparency, accountability and service delivery of the hospital. "This is an opportunity to turn the page on what has happened over ... many decades. And take it back to the standard of performance, and the reputation that the University Hospital of the West Indies had when people older than everybody,  [used to] refer to it as UC."

For his part, Tufton said the report was presented to Cabinet on Monday. "I think it's a good report. I support the recommendations of the report," he said, adding that the discussion to follow should focus on how to make the recommendations work.

The committee proposed five broad recommendations, including amending the 1948 University Hospital Act, strengthening financial management, improving oversight by both the Government and The University of the West Indies (UWI), and engaging an independent international body to support board operations.

It said the 1948 UHWI Act, amended once in 1962, served the hospital and Jamaica “reasonably well” but “needs to be revised.” It also said the 18-member board is “too large and its composition is not well aligned to the institution’s financing reality.”

The review committee raised further concerns about the overlapping roles of the CEO and the chairman of the Hospital Medical Committee. It said the “chairman of the medical committee should not hold a seat on the board,” and recommended that the law be amended to ensure the CEO is a board member.

It noted that “Since the CEO does not serve on the board .... a reporting relationship from the person occupying a board position to the CEO creates obvious potential for conflict” and is “a highly unusual organisational scenario for an upward management reporting relationship to exist between a non-board member and a board member.”

It said the lack of clarity has allowed the chairman to assume responsibilities typically reserved for the CEO, including “driving the institution’s strategic vision, procuring equipment and hiring staff.”

The committee warned that this blurring of roles undermines accountability frameworks under the Public Bodies Management and Accountability Act, which it said requires that public bodies have a CEO to whom all staff report directly or indirectly.

Meanwhile, the committee concluded that the UHWI had been operating “as if it is an institutional orphan,” saying it has “resisted the governance framework emanating from its public sector lineage, while not absorbing governance practices from its university heritage.”

“Its seeming orphan status has been facilitated by the actions and omissions of each of its parent entities, the GOJ (Government of Jamaica) and The University of the West Indies,” the report said.

The committee found that both the Government and the UWI had faithfully appointed board representatives over the years but had “not engaged in active and robust oversight,” suggesting each may have assumed the other bore primary responsibility.

The Auditor General’s report that prompted the review identified significant weaknesses in governance and accountability, particularly in relation to procurement compliance.

Among the breaches cited were the absence of procurement documentation for 51 contracts amounting to $521 million; misuse of the hospital’s tax-exempt status to import goods worth $23 million for private companies; and the splitting of contracts to circumvent procurement thresholds.

In response, the UHWI board referred the matters to the Jamaica Customs Agency and the Jamaica Constabulary Force for investigation and established an internal accountability committee. The Integrity Commission is also probing the issues.

The review committee described those responses as “generally appropriate and comprehensive,” but cautioned that management replies “did seem in their details to be somewhat pro forma and similar in vein to previous reports, which largely went unimplemented.”

It also flagged UHWI’s tax debt to the Tax Administration of Jamaica of more than $40 billion, comprising unpaid statutory deductions inclusive of penalties and interest. The hospital has also been running monthly deficits of up to $300 million.

The report noted that the UHWI, unable to qualify for a Tax Compliance Certificate (TCC), had been using the TCC of its related private arm, the Tony Thwaites Wing, to clear imports, a practice discontinued only after the Auditor General’s findings.

It further identified serial delays in filing financial statements as a major issue obscuring the hospital’s financial position, noting that as recently as 2015, a health minister tabled 11 years of overdue annual reports.

“The mindset of both the board and staff will have to be receptive to the recommended changes,” the committee concluded, adding that only a deliberate cultural shift will ensure the recommendations are effective.

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