A catalogue of poor management decisions at KEMH helped cause health costs to rise without necessarily improving standards, it has been alleged.In his letters to Health Minister Patricia Gordon Pamplin and the public, BHB Chairman Jonathan Brewin said that former hospital administrations failed to conduct due diligence during the hiring of controversial former Chief of Staff Donald Thomas, needlessly created the subsidiary HPL, and failed to follow a proper pay structure for physicians, which resulted in some doctors being “sufficiently overpaid”. Other criticisms included a failure to impose controls on the number of procedures carried out at the hospital and a community-wide lack of focus on healthcare for seniors.The Board’s claims have been supported in part by an independent consultancy firm which submitted a review of the running of the hospital last month, and also by the Ombudsman Arlene Brock.In his letters, Mr Brewin claimed that there were a number of “legacy issues” that the new Board needed to address, including the 2007 appointment of Dr Thomas.Dr Thomas was suspended in July 2012 and an inquiry into his performance was launched after concerns were raised about his management style. (See separate story.)Mr Brewin was also critical of the setting up of the subsidiary Healthcare Partners Ltd, claiming that it was not needed and “introduced unnecessary structures and does not conform to good governance”.“Governance was not adhered to, for example the HPL board did not meet,” Mr Brewin said, adding that “there was poor management of the businesses in HPL”, and that one of the contracts was “commercially disadvantageous and therefore not in BHB’s interests”.And Mr Brewin also questioned the salary structure for doctors which “had been set through individual contracts agreed through the Chief of Staff Office without, in our opinion, appropriate oversight”.“Some physicians were paid at an appropriate rate, others were below benchmark and certain individuals were significantly overpaid,” Mr Brewin said.The chairman also questioned decisions to increase the number of services provided by the hospital which he claims drove healthcare costs up, and condemned a community-wide focus on senior care.“This has led to increasing numbers of seniors left in the hospital with nowhere to go. This is costly for the hospital and Bermuda, and results in poor quality care.,” he said.Independent consultant Howard Associates began a five-month review of hospital governance last November. Among its conclusions, it claimed that “HPL has not been well managed by BHB since its inception” and that “there were not enough management checks and balances and controls” on physician contracts which “represents a failure of governance at BHB”.Ombudsman Arlene Brock, who oversaw the Howard Associates review and interviewed hospital staff, concurred that the findings were “consistent with the information that we obtained in our due diligence interviews”.In her report on Howard Associates’ work, she wrote: “Even in our brief interviews, people had a lot to suggest: Tackling overutilisation of tests and medical bonuses, electronic record-keeping and reducing top layers of senior jobs.”And she also questioned why Morbidity and Mortality Rounds were still not “routine or robust in Bermuda”, even though it had been agreed six years ago that M&M was “one of the most important tools for clinical governance”.Howard Associates also criticised the hospital’s move to employ hospitalists, saying that the BHB “transitioned too rapidly to the new model” which resulted in “strained relations with the community physicians” in the last five years.It argued that the BHB “over the past few years was focused too much on revenue generation and not enough on quality of patient care”.And the consultant said that former Board members lacked medical expertise, and said the BHB needed to “become more transparent and to reach out more effectively to all parts of the community”.