The following is the letter sent to all senators and MPs by the Bermuda Medical Doctors Association:

To whom it may concern as a matter of urgency:

I write this letter in an effort to bring clarity to what is now a healthcare crisis in Bermuda! As a Bermudian, specialist physician in this beautiful island we all call “home”, I am deeply troubled; along with most of my fellow physicians, many other health practitioners, pharmacists, insurers, allied health professionals, and most importantly the thousands of individuals labelled as “patients”. The recent Bermuda Health Council Amendment Act 2024 passed in the House of Assembly on May 3, 2024 has creating more problems instead of solving them. I implore that we please halt the passing of further legislation and redress under legal advisement.

Bermudians understand our history, cultural diversity, resiliency, and entrepreneurial spirit to solve difficult problems by making the necessary connections while working together to seek the proper solutions. This Act in its current form fails to demonstrate honest collaboration and the penalties imposed suggest poor strategic planning regarding healthcare, and limited understanding of health policy.

Yes, all stakeholders want Quintuple Aim aspirations in Bermuda’s Healthcare system: improved patient experience, better outcomes, lower costs, clinician well-being, and health equity; and most are willing to strive for excellence regarding use of health data. However, the lack of full stakeholder engagement; especially with regards to getting input from subject matter experts in clinical medicine such as physicians, or the wealth of others actually treating patients is ignorance at its worst, and disingenuous at best.

Although the 2023 National Digital Health Strategy and Bermuda Joint Strategic Needs Assessment of Health are excellent documents with great objectives, and our goal towards Universal Health Coverage (UHC) is a worthy aspiration, there remains significant trepidation about proceeding with this Act in the current iteration.

Multiple critical steps have yet to be completed, and would be recommended in order to ensure successful initiation of any new healthcare strategic planning process. We need a full disease registry and interoperability of electronic health records before proceeding with this legislation and UHC.

Furthermore, there is already the ability to obtain valuable data insights from the Bermuda Health Council (BHEC), and BHB. Giving the Minister of Health or BHEC sole discretion to request more under the guise of improving population health with the threat of fines and imprisonment can be seen as threatening to physicians’ and healthcare providers’ business.

Cybersecurity and patients’ privacy is also a legitimate concern, and a recent survey of providers and patients highlighted this along with significant mistrust in the Government. The feelings on island right now include: frustration because it lacks community support, confusion because it lacks proper leadership, no confidence because it lacks direction, stagnation because it lacks resources, uselessness because it lacks structure, and irrelevance because of poor timing.

It is obvious that the five rules for SMART goals were under-utilised when creating this ambiguous legislation. It should be more specific, measurable, attainable, realistic, and timely. Senators, please reject this Act, and MPs listen to the voice of your constituents.

The Bermuda Health Council Amendment Act 2024 will set a dangerous precedent to allow the BHEC to regulate physicians. Who will be regulating the BHEC if either patient privacy details and/or private healthcare business financial information is cyberattacked or obtained without consent?

The Bermuda Medical Council (BMC) should continue to be the entrusted regulatory authority for physicians including licensure, and under current law it is a criminal offence, and considered fraud for anyone to impersonate a physician or “doctor” in the true sense of that word.

The Bermuda healthcare system encompasses purchasers, insurers, providers, and suppliers. Every dollar spent on healthcare represents an expense to the purchasers and income to the healthcare industry. The economic complexities and the loss of a clear identity amongst these four actors has resulted in tensions in healthcare on island. All will have to deliver on transparency and accountability in delineating an ideal data strategy. Interoperability must be in place to make strengths outpace weaknesses, and minimize threats to develop opportunities.

Yes, some changes will be necessary regarding the Standard Health Benefit (SHB), with review and enhancement of the insurance marketplace, assistance to provide coverage for the uninsured and under-insured, and further expansion to fully integrated care pathways from prenatal care to palliative care.

With a focus on best practice standards, and clinical guidelines (which should be established first to ensure understanding of what we will be measuring), it is believed that the journey forward will be better.

“No wind favours the ship that has no charted course.” We cannot afford a shipwreck of our healthcare system.

The Bermuda Health Council Amendment Act 2024 should be rejected in its current form by the esteemed senators on September 27, 2024!

The Premier and all the Honourable MPs will then have an opportunity to involve all the valuable stakeholders to create the needed and robust healthcare legislation Bermuda deserves. That can make us the pinnacle of the world for health and wellness!

There is a better way to navigate this journey by bringing all to the table. Physicians are ready, along with all those with an authentic nature to lead by example. A leader is one who knows the way, goes the way, and shows the way. Let Bermuda demonstrate to the world by becoming the leader in creating a 21st-century healthcare system that makes us proud again.

I think the Bermuda Parliament deserves admiration instead of embarrassment, so let us do better and get this right for the sake of our island.

This letter will be eventually shared island wide; so the entire community can create the necessary energy to drive us to peak performance in health! The vision to agree follows:

“Let’s create a healthcare system that is true, noble, right, pure, lovely, admirable, excellent, and praiseworthy!” To paraphrase the Bible verse in Phillipians 4:8.

ELWOOD I L Fox, DO, MBA, FAAPMR

President of BMDA