Plans for the construction and operation of two renal dialysis centres have come to a grinding halt since the Government is holding its hand in giving consent for the assignment of land leases.Parties involved have threatened legal action against the North Central Regional Health Authority (NCRHA) and the South West Regional Health Authority (SWRHA).
The contract was signed on May 6, 2010, between the last administration and a special purpose company called Comprehensive Nephrology Services Ltd (CNSL), formed between Biomedical Technologies Ltd and British-based company Fresenius Medical Care, which is the majority shareholder.Fresenius Medical is the world's largest integrated provider of products and services for people undergoing dialysis.
Attorneys representing CNSL and its affiliates stated in a March 26 letter that since the execution of the master contract in 2010, CNSL had undertaken several activities and expended close to $7 million.
Among some of the work done were approvals by Town and Country Planning, the Ministry of Works and the T&T Fire Service; signing of a memorandum of understanding with the Fresenius Institute of Dialysis Nursing for the recruitment of experienced staff; retaining of a firm based in the United States to provide nurses; the completion of official site surveys, geo-technical studies, final site boundaries and architectural designs.
Attorneys advised that clause 35.3 of the master contract required the consent of the NCRHA for CNSL to assign the master contract but this did not preclude an assignment of the leases to a third party for the purpose of creating interest, that is, by way of mortage.Ansa Merchant Bank was hired to finance the project.The sites chosen for the centres were at the Eric Williams Medical Sciences Complex (EWMSC) and the San Fernando General Hospital.
Health Minister Dr Fuad Khan said the issue was now coming out because he was questioning certain aspects of what he called "a billion-dollar contract."He said, "I am questioning certain parts of the contract. You will now hear all of this going on because they (stipulations) are not fulfilled but I have to be careful of what I say because this is going to become a legal matter."It is going to be a legal matter because a lot of major players are involved in this and it's a billion-dollar contract."
Sunday Guardian learnt that the project was tendered four times and each time in favour of the joint venture partnership.
Contract being reviewed
The number of people receiving dialysis treatment jumped from 278 in January 2005 to 741 in May 2010.Currently, treatment can be accessed free at the Sangre Grande Dialysis Centre, EWMSC, the two hospitals and in Tobago. The Government also subsidises treatment at several private institutions. The two proposed centres were to be designed and outfitted to provide haemodialysis and peritoneal dialysis.
Sunday Guardian received information about the developing legal matter and also claims that there was a proliferation of dialysis centres operating without proper regulations.However, Khan said there was the possibility that certain entities were trying to create a problem to embarrass his ministry and the Government.He said there were legal stipulations in the contract which had not been executed and that concerns were now being raised because he started to question "certain legal aspects of the contract."
Khan said, "Who it is wants the contract to continue...they are trying to say this is not the way to go but I rather give a lot of people in Trinidad and Tobago the ability to develop dialysis centres as they do in London than have two major players take everything off the small people of the country."He said he was trying his best to protect his ministry and the Government "because of a certain financial matter."He said he knew exactly how the information landed in the hands of this media house and why.
"I know exactly how you got that information and why."It seems to be a pressure on me or the ministry to run scared and give the contracts to these people but I am doing it the correct way and that's what I have to do," he said in an interview on May 3.Khan said the move was a direct attack to frighten the Government into "making us give them the contract."
Govt has to grant permission
A source told the Sunday Guardian that the Government has to grant permission to the builder of the centre the right to mortage the property so that the builder can finalise the funding to build the project."It is as simple as that.
"This is a public private partnership where the Government hires a private sector entity to do a project usually for critical services like health, water, transportation, electricity...to do that, the Government has to pay them a fixed amount of money for the volume for the price of the service they offer but to do that the private sector entity needs to raise funding to build whatever it is they're building, whether it is a road, a hospital or in this case a dialysis centre."
The source said for the private sector entity to go to a financial institution to raise money it must have certain things like a good contract, but must have hard assets to provide the financial institution with some type of collateral for the project.
CNSL director: Centres willbenefit people of T&T
A director of CNSL who spoke under anonymity said the project was now in abeyance. He said several letters had been written to the relevant parties butno responses were forthcoming. He said the only thing hampering the project right now was the assignment of the leases.
In an interview on Friday, the director said, "What this project brings to the country, apart from benefitting the patients who require dialysis..it is bringing to the country best practice in terms of protocol, in terms of standards, and procedures."Fresenius is ISO certified."We are going to raise the bar and have an ISO certified institution delivering quality health care but also transferring a lot of technology, training of nursing staff, and really trying to raise the bar in terms of standards of performance."
He said $6,982,057.56 had been spent to support the project. Offices were opened, a consultant from Fresenius was hired, designs were completed and approved by the NCRHA and SWRHA."Everything was put in place for construction to begin."In the contract, there's a provision where the lease can be assigned."Our financier is Ansa Merchant Bank and they are giving us the money with our own collateral."
He said, however, because they were taking a loan from the bank to build the building the bank has to be assigned the building.The problem now is that they are not being granted permission to assign the lease to the bank.He said, "So many people are suffering and dying and this is a project that will bring relief to so many citizens and their families."He said it will cost about $100 million for construction of the two centres. He said gross revenues would be $100 million a year over a ten-year period.
"It will pay for several services. There will not be a dialysis centre alone but a laboratory, pharmacy, operating theatre, imaging service, vascular access, so it's not just a centre where the patient comes to be dialysed."Every cost will be paid for."Centres are monitoredKhan dismissed any notion that private dialysis centres were operating without regulations and not following standards.He said it was "completely erroneous" and claimed people were trying their best to create a problem or a situation.
He said, "I think it is completely erroneous because what I believe is happening is that the people who want to...who got contracts one day or two days–this was a week before the elections in May 2010–they are trying their best to create a problem or a situation."Bad talking other dialysis centres will not help, he said.He said the centres were functioning well and a full analysis of the area was carried out.
"The centres are monitored by the ministry and I am in the process of getting people to do on-the-spot checks at these centres."It's not to say we were allowing it to go carte blanche.""We are enforcing standards. That is a total fabrication and is meant to deceive and make the ministry look bad," he said.He said he was hoping that the Health Services Accreditation Authority Bill will be passed in the Parliament with a special majority to give more teeth.
He said people who wished to establish centres would have to apply and be checked by the ministry to make sure they adhered to proper procedures and standards.He said hundreds of patients received dialysis. The cost was roughly $1,000, but he said some people charge $1,500 and that was the going rate.He said to see a decrease in the need for dialysis he was trying to push healthy lifestyles and eating habits in young people.
He said the reason why there was a need for dialysis was that people were living longer and getting older and that they did not take care of their illnesses like diabetes and hypertension.