BHeC ordered to reconsider doctor’s demand for health benefits services – The Royal Gazette



Created: Nov 23, 2021 07:59 AM

Dr JJ Soares of Hamilton Medical Center (file photo)

A doctor welcomed an interim decision that allowed his clinic to continue providing services as part of standard health care delivery.

JJ Soares said the Court of Appeals ruling meant that an application for SHB status for Hamilton Medical Center, where he is medical director, would again be considered by the Bermuda Health Council.

Dr Soares added: “Until then, my current standard health benefits approval will remain in place and I look forward to demonstrating to the board of health that Hamilton Medical Center should remain the premier provider of imaging services in the region. standard health delivery framework. that it has been shown.

In 2019, Hamilton Medical Center applied for approval to offer services under the SHB, which would allow FutureCare or HIP coverage for diagnostic services.

But the BHeC refused the request because it said it feared the clinic would “refer itself” to patients and provide unnecessary treatment.

Dr Soares challenged the decision, but a BHeC appeal committee upheld the denial last September.

Dr Soares appealed the decision to the Supreme Court on the grounds that BHeC had acted unfairly and unreasonably.

Junior judge Larry Mussenden overturned the BHeC decision in April and ordered Dr Soares’ request approved.

But the BHeC went to the Court of Appeal to try to overturn Judge Mussenden’s decision.

Ben Adamson, lawyer for BHeC, argued that the organization’s denial of the SHB status application was reasonable and taken to avoid higher costs to patients and taxpayers.

Sir Christopher Clarke, the president of the appeals court, issued an interlocutory – or provisional – ruling last Friday.

He said that, among the tribunal’s preliminary findings, it was found that the September 2020 Appeal Board decision “cannot stand” because an “impartial and informed observer” would conclude that there was a possibility. that the committee be biased.

Sir Christopher explained that the conclusion was based on the testimony of Ricky Brathwaite, Director General of BHeC, that he had been involved “at all stages of the proceedings”.

But he said the appeals judges also felt it was not appropriate for Judge Mussenden “to take it upon himself to substitute his own decision for that of the September 2020 appeal committee.”

Sir Christopher said the court should make orders or give directions on how the appeal will be handled, as well as any relief for Dr Soares or the medical center and the future conduct of their SHB claims.

He added that the judges ruled that the appeal should be adjourned without a resumption date set pending the review by the BHC of an “annual” application filed in June 2020 by Dr Soares and his clinic.

Sir Christopher underlined that this would not be subject to the “mid-year” conditions of application.

The court heard earlier that the conditions included a demonstration that the services would be “budget neutral” or “technically, cost reduction”.

He pointed out that Judge Mussenden’s decision had not yet been overturned.

Sir Christopher said: “The tortuous history of the various applications must end.

“The best way to do this is for the full year application to be properly considered as such.

“If this is done and the request is accepted, there will be, we understand, no problem arising from the fact that the request is for the year 2021-2022, which is not so far from expiration, since, if granted, BHeC, under its current policy, will treat Dr Soares / HMC as an incumbent supplier whose status will remain that of the year 2022-2023.

“If the application is unsuccessful, it will have failed after consideration of a full year application.”

Sir Christopher added: “When, or at least not before, the BHeC has rendered its decision on the full year’s request, the appeal will be reinstated for hearing and this tribunal will decide exactly on the order to be made.”

Dr Soares said he was “satisfied” that the decision of the BHeC Appeal Board of September 2020 has been overturned.

He added, “I also note that following the Court of Appeal ruling, the Board of Health will now consider my pending application for 2020 to provide services as part of the standard healthcare delivery. “

The board of health declined to comment on the court ruling.

• He is The Royal Gazette ‘s policy of not allowing comments on stories relating to court cases. As we are legally responsible for any defamatory or defamatory comments made on our website, this decision is for our protection and that of our readers.


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