By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

An ex-health minister is warning The Bahamas could "pay a terrible price" for failing to fully finance National Health Insurance (NHI) with the sector's woes also extending to "critical surgeries" in Freeport.

Dr Duane Sands, the Free National Movement (FNM) chairman, told Tribune Business the outstanding payments owed to doctors and other NHI providers are one issue exposing "the serious challenges" facing the Government in adequately funding the public healthcare sector even as it forecasts a $75.5m fiscal surplus for the upcoming 2025-2026 Budget year.

Apart from NHI, he asserted that vendors and suppliers to the Public Hospitals Authority (PHA) - which oversees the Princess Margaret (PMH) and Rand Memorial hospitals, as well as the Sandilands Rehabilitation Centre - are also "carrying accounts receivables of varying consequences" as a result of not being paid in full and/or on time.

Dr Sands, who was minister of health as recently as the former Minnis administration, said this, in turn, is causing cash flow, liquidity and other financial challenges for these vendors, while Freeport's Rand Memorial Hospital has implemented a two-week "emergency mode" in its operating theatre because of "safety risks" to surgical procedures caused by "overwhelming" challenges.

However Dr Michael Darville, minister of health and wellness, told Tribune Business he was "fully aware" of the situation at the Rand Memorial and that himself and his officials are "on top of" what he described as "environmental challenges" with the operating theatres. These, he said, have been caused by a combination of "malfunctioning" air conditioning units and an ant infestation.

And, addressing concerns over delayed and partial payments to PHA and other public healthcare sector vendors, Dr Darville said the Government had last year made good progress in identifying the financing and budgetary "shortfalls".

As a result, the Ministry of Health and Wellness has seen its recurrent (fixed-cost) spending budget increased by $22.37m for the upcoming 2025-2026 fiscal year, taking this from $332.747m in 2024-2025 to $355.12m, while the Public Hospitals Authority (PHA)'s taxpayer subsidy has expanded by $15.4m - growing from $232.456m in 2024-2025 to $247.856m.

Dr Darville spoke after Tribune Business obtained a June 18, 2025, letter addressed to all surgeons and visiting surgeons by Dr Vincent Burton, chair of the Rand Memorial Hospital's operating theatre clinical management team, alerting them to the two-week "emergency mode" for the facility.

Revealing that he and the management team had conducted "a comprehensive review of current challenges" in the Rand Memorial's operating theatre on June 17, 2025. "It was unanimously agreed that the volume and complexity of ongoing issues have become significantly overwhelming, posing risks to the safe and efficient delivery of surgical services," Dr Burton wrote.

"As such, the committee has recommended the immediate implementation of emergency mode in the operating theatre for a period of two weeks, effective immediately. This temporary measure is intended to stabilise operations and prioritise critical surgical cases during this period."

Dr Burton did not specify the "issues" that caused 'emergency mode' to be implemented until end-June/early July, but Dr Sands, himself a surgeon, suggested that this had resulted from staff and medicine shortages, plus the absence of a back-up anesthetic machine. He suggested that this, and the NHI payment situation, "speaks to the challenge of funding; particularly in the healthcare sector".

"There are a number of vendors, the people that supply the services, that have serious challenges with cash flow with NHI and the PGA being two of the largest," the ex-minister said. "When you look at the physicians, the laboratories that have contracts with the NHI Authority, you now have to go back and, while they are not saying it exactly in this language, it's 'we don't have the money to pay you'.

"At the PHA, vendors are simply not getting paid and, as a result, they are carrying accounts receivables with varying consequences - shortages of medicine, challenges with ambulances being on the road, the slowdown in the delivery of services. When we look at the ability of the Rand Memorial Hospital to provide surgical services, just now they've had to shut down the operating room."

Dr Darville, though, yesterday told Tribune Business that three of the Rand Memorial hospital's operating rooms are "back up and going" after the challenges were addressed. "I'm fully aware of the situation," he said. "We have been experiencing some environmental challenges in the operating theatre in Grand Bahama and it has to do with two things.

"There was a malfunctioning air conditioning unit and we began to see the presence of ants in the operating theatre. Three of the operating theatres are back up and going. We're on top of it, trying to work it out." Dr Darville said exterminators had been called in to destroy the suspected ant nest below the operating theatre's floor, "and we are in the final stages of addressing that" to ensure a sterile, clean environment.

As for the public healthcare sector's funding, Dr Darville added: "If I could say this: What we have done in this year's Budget is we looked at where the shortfalls were with the PHA and, if you really assess it, you can see [in my ministry's] recurrent expenditure there's a $22m increase. That's really to cure some of the shortfalls.

"A lot of our programmes are being expanded... and we've revised the allocations for other things. This year we learned a lot of where the shortfalls are, and what we are seeing with the use of the hospital for chronic non-communicable diseases. A lot of adjustments were made in the finance.

"Coming from one Budget period to the next, there are some shortfalls to address. NHI, we have some challenges. We believe the increase in the Budget, the increased allocation, will prevent that from happening in this Budget cycle."

Dr Sands, though, suggested that the failure to pay doctors and other NHI providers on time threatens to undermine a scheme which supposed to help prevent PMH's accident and emergency unit from "bursting at the seams" as a result of being overwhelmed by patients with non-communicable diseases such as diabetes, hypertension and heart disease.

With the primary, community-level care offered by NHI physicians viewed as key to treating such illnesses, the former minister said of the payment delays: "I think it should be quite concerning, given the serious challenges we have that need to be addressed.

"We have one of the worst sets of, worst constellations of, non-communicable diseases, and these were intended to be addressed by primary care and secondary care services delivered through NHI. That was also supposed to reduce [the burden] on acute care facilities.

"If NHI is unable to deliver on that promise, we pay a terrible price... When we have 600-700 people on dialysis being funded by the people of The Bahamas, or the Government of The Bahamas, and many of them are there because of inadequate primary care, this issue of NHI is a huge problem moving forward," Dr Sands added.

"There's supposed to be a surplus coming. If you have a surplus still coming, how is it you are so challenged to make good on your Budget commitments? These are items in the Budget that have been approved and yet they are challenged to make ends meet.

"Just a few weeks ago the minister stood up and talked about providing free prescription drugs to many thousand new patients. How can that be possible when you are not paying your existing bills? There's a serious disconnect between what is being over-promised and under-delivered." And Dr Sands also questioned how, in the current climate, the Government can fund NHI's catastrophic care expansion.

Noting that NHI providers have a legitimate expectation of being paid in full, and on time, for services they are contractually obligated to deliver, the ex-health minister said the delayed payments were forcing some to take on larger and extended overdrafts as they financially carry the scheme.

"There are many, many persons who have said to me personally that it is causing a financial strain and, in many circumstances, the strain is so severe that persons are having to take on lines of credit that they have never had to before because, in part, they are owed large sums of money by NHI," Dr Sands said.