ENT doctors paid $84,000 per month

Eighty-four thousand dollars a month—that was the sum being paid to three doctors to operate an ear, nose and throat (ENT) clinic at the North Central Regional Health Authority (NCRHA) to avoid the outsourcing of such services from private facilities.   

But not even this could prevent the institution from racking up the hefty $1.6 million medical bill after deceased pensioner Bhawandaya Lutchman was sent to Medical Associates Hospital and had to undergo a $4,500 tracheotomy at the facility. At the time Lutchman was transferred to Medical Associates, the doctors—Dr Wendell Dwarika, Dr Naushad Mohammed and Clyde Tilluckdharry—were each being paid the sum of $28,000 a month for ENT services, apart from their monthly salaries.

In 2000, the North West Regional Health Authority (NWRHA) contracted the company, ENT Associates, to perform surgeries at both the Port-of-Spain General Hospital (PoSGH) and the Eric Williams Medical Sciences Complex (EWMSC). At the time of the agreement, Dr Dexter Shim, along with Dwarika, Tilluckdharry and Mohammed were all partners in the company.

However, following the renewal of the agreement, only three doctors were contracted. The contract was for a period of two years and has been renewed each year until recently.

Patients being sent to private facility
According to the initial agreement, both children and adults were expected to be provided with ENT services. Outlined in the terms and conditions was the setting up of three ENT units at the EWMSC and PoSGH, and provisions to continuously provide the services. The agreement listed a first and second schedule to be performed by ENT Associates. (See Table)

Khan looking for answers
The question remains, why wasn’t the tracheotomy performed on Lutchman at the NCRHA? Meanwhile on Friday, Health Minister Dr Fuad Khan confirmed that he was aware of the agreement to pay the doctors to operate the ENT clinic both at EWMSC and PoSGH. Khan blamed the lack of communication for the exorbitant bill racked up at the expense of taxpayers.

Saying that the onus was on the person on duty to contact one of the three ENT doctors, Khan explained, “They were supposed to call out the ENT doctors who were being paid to do such surgeries. If you have ENT doctors at NCRHA and they were not called out to perform the surgery, then somebody would have to explain and tell me who was responsible for referring the patient to Medical Associates. I have some questions of my own that need to be answered.” Several attempts to contact the NCRHA acting chief executive officer Collin Bissessar proved futile.

The first schedule listed:

• To run two clinics at EWMSC, each lasting one four-hour session
• To run three clinics at PoSGH
• To run eight operating sessions, of which two will be performed at EWMSC and six at PoSGH, in accordance with the schedule to be agreed upon between the parties
• To provide on-call cover for both hospitals, after the patient has been seen by the first-call house officer provided by the authority
• Establish specialist training/updating in advanced surgical skills
• Provide advice on—
(i) The establishment of an audiology department
(ii) School screening for children with hearing loss
(iii) Environmental noise screening services
• Advise on the establishment of a speech therapy department
• Establish special surgical lab (temporal bone/functional endoscopic sinus surgery)
• Prepare general-practitioner educational programmes
• Prepare public education programmes aimed at educating the public in the social and preventative aspects of ENT

The agreement stated that the first seven functions were expected to commence immediately, while the other services were to be implemented over an 18-month period. The second schedule included the purchasing of the following instruments and equipment:
• Four headlights for clinic and instruments at EWMSC
• Zero degree, four millimetre Hopkins telescope
• Video-laryngoscope

The equipment was estimated to cost US$15,000 to US$20,000.