British administrator David Hill was the man at the helm of BHB for much of the period during which management decisions at the hospital are now being questioned.But critics have questioned which senior executives had the final say in policy decisions, whether or not the hospital’s Board was ever consulted on certain issues, and whether or not administrators were subjected to political interference.Mr Hill took up his post as Chief Executive Officer in November 2006 and held the position for more than five years, until April 2012, when he returned to the UK. Nine months after Mr Hill came to the Island, American Donald Thomas was appointed as the hospital’s Chief of Staff and held the position until he was suspended in July 2012.According to Ombudsman Arlene Brock, who interviewed hospital staff as part of her remit to oversee a review of the hospital completed earlier this year by Howard Associates, the two men “were often viewed as an indelible pair”.“[Howard Associates] knew at least from our very first meeting that one of the primary reasons for their review entails the tenures of and decisions made by the former CEO and Chief of Staff,” Ms Brock said in her report into the review.“There were questions about what decisions had been made, by whom and by what authority — especially decisions with financial implications for the BHB.“The former Chief of Staff, far more than the former CEO, became a lightening rod attracting criticism from the media, political quarters, the new patient advocacy group, staff and others. By all accounts these men worked closely with and supported each other. With respect to their work and decision-making, it is unclear what information was passed on to the whole Board and to relevant subcommittees and which decisions were rubber-stamped or challenged.”Ms Brock added that, although Dr Thomas was answerable to Mr Hill, “ the former Chief of Staff was widely considered to be the real, actual and sometimes single power base of the hospital”.“It appeared that he had been given carte blanche to run the hospital. Eventually, several people (both staff and families of patients) expressed a lack of confidence about his actions and alleged personal agendas.“To be fair, several of our interviewees credited the former Chief of Staff with good crisis management and with enticing Bermudian doctors to work back home early in his tenure. After his first year or two, his authority and influence seem to have grown beyond the bounds of good governance with the cooperation of the former CEO and, it appears, the acquiescence of the then-Board.”In his letter to Health Minister Patricia Gordon Pamplin, BHB chairman Jonathan Brewin also highlighted questions over Dr Thomas’s performance, including staff concerns about “his refusal to follow the express direction of the CEO, in particular on the hiring of doctors”.According to Ms Brock, current CEO Venetta Symonds, who was Deputy CEO under Mr Hill, believed she was cut out of some decision-making.“Upon taking the reins in April 2012, the CEO was of the view that she had not been privy to the agendas and reasoning underlying a number of decisions such as significant bonus contracts for doctors for which she would now be responsible,” Ms Brock wrote.“In addition, she was not clear about the reasons behind skyrocketing costs despite a relatively stable population.”And concerns that the Board was also being bypassed were supported by Howard Associates in its review.“A problem we identified with the last administration and Board was the way information was presented to the Board,” it said in its report.“Much too often, in the past, the information did not come to the Board in the right way. Requests for action were presented without proper background information or time for the Board to prepare. It required an immediate decision.”Exactly who was in charge of running the Island’s hospitals was a question asked by former Shadow Health Minister Louise Jackson back in 2008.Mrs Jackson raised the issue after leaked documents showed that an informal ‘Saturday group’, whose members included then-Premier Ewart Brown, then-Health Minister Michael Scott and BHB CEO David Hill, was meeting to discuss hospital business. Mrs Jackson said that the meetings amounted to political interference, an allegation that Mr Hill denied.In the past seven years there have been five chairmen of the Bermuda Hospitals Board and six Health Ministers.The Royal Gazette has e-mailed Mr Hill, who is now the head of a hospital in Norfolk, UK, several times in the past week asking for a reaction to the criticisms. No response was received by press time last night.This newspaper also e-mailed former Health Ministers Zane DeSilva and Walter Roban, who held the portfolio for much of the time that Mr Hill and Dr Thomas were employed at the hospital. No response was received by press time last night.The Royal Gazette was unable to contact Dr Thomas for the purposes of this article.l BHB open letter see pages 10 and 11