As reported in Body & Soul last week, local obstetricians are now employees of the Bermuda Hospitals Board (BHB).While the partnership solved the problem of whopping insurance premiums — they were to go as high as $400,000 a year per obstetrician, it has presented problems for other healthcare providers.Bermuda Cancer and Health Centre as well as independent ultrasound facility Sonoview Imaging Ltd — said they’ve seen a significant decrease in clients as a result of the new arrangement.“A number of patients who attend our facility for mammograms and ultrasound have been very upset that they have been told by their obstetrician and gynaecologist, that they will now need to have their mammogram at KEMH (King Edward VII Memorial Hospital) or Ultimate Imaging,” said Tara Soares, Director of Bermuda Cancer and Health Centre.Ultimate Imaging, a digital imaging company in Hamilton, formed an equity partnership with BHB early last year under the specially formed holding company BHB Healthcare Partners Limited.As facilities like Bermuda Cancer and Health and PFR Sonoview Imaging are independent of BHB, obstetricians employed by the hospital are contractually not allowed to refer their patients to them.“Physicians who are employed by BHB are expected to utilise our support services, where available and where appropriate,” a hospital spokesman explained. “This helps us with economies of scale overall, and recognises that the hospital is funding the physicians’ wages.”But Bermuda Cancer and Health Centre and Sonoview Imaging Ltd argue that this stance denies the patient’s right to choose.“We are very concerned about restricting any patient’s choice to approved locally accredited facilities as we believe it limits a patient’s opportunity to have cancer and other diagnostic assessments at the facility of their choosing and under the care of specialist doctors that are not available at other local health facilities, such as Dr David Green, the breast specialist at Bermuda Cancer and Health Centre,” said Ms Soares.“We want to ensure the patients have a right to be proactive in their health choices which will ultimately lead to them having a final say in where they choose to have their ultrasounds performed,” said Jerome Reid, co-owner of Sonoview Imaging LtdThere is also concern that lack of choice will not drive improvements in service and quality and might even see them deteriorate.Mr Reid said: “Six years ago it was not unusual to wait two three weeks for an ultrasound.”Those wait times are now down to a day or two.These shorter wait times not only provide for quicker action to be taken in the case of a problem, but they also greatly reduce the mental and emotional stress that occurs when waiting for test results.A healthcare professional from a different discipline charged that these problems have arisen because the hospital is trying to have the monopoly on health services in the Island.“They are looking to put sub-agencies out of business. The hospital has become one mega juggernaut revenue getting facility,” the person said.But the hospital disputes this allegation.“We believe competition is a positive force and we certainly are not looking to put anyone out of business where there is need for the service,” a hospital spokesperson said. “Indeed, in our current economic climate, we believe there are opportunities to collaborate as a system to ensure best value for the IslandAnd KEMH Chief of Obstetrics, Dr Dale Wilmot added: “Although there are voiced concerns about the referral requirements required by the employed obstetricians, BHB is listening and will continue to collaborate and cooperate to refine the solution.”