Leaky law

THE decades-old law governing the operations of the University Hospital of the West Indies (UHWI) has become so outdated that it created loopholes which allowed parts of the facility’s governance framework to become a highway for abuse.

Chairman of the Government-appointed UHWI Institutional Review Committee Howard Mitchell says the body is calling for sweeping reforms to the 1948 University Hospital Act, which must be modernised to close accountability gaps and bring the hospital’s governance structure in line with present-day realities.

The proposed legislative overhaul forms one of the centrepiece recommendations from the committee’s review into governance failures at UHWI following a recent auditor general report on operations at the hospital.

The government-appointed committee was mandated to examine the weaknesses identified in the auditor general report and recommend reforms aimed at improving governance, accountability, and the hospital’s long-term operations.

Speaking during a press conference on Tuesday, Mitchell said the legislation governing the institution was crafted for a very different era and had failed to evolve alongside Jamaica’s modern governance and accountability requirements.

“As just an example, the legislation prescribes in Section 14 that the board of management of the hospital may import items into the island without paying customs duties… There is very little restriction on that. It doesn’t specify what kind of items, it doesn’t specify conditions upon which that importation can be effected. It leaves the imagination that presumably those items would be for the use of the hospital. So that is an area… because when you leave a door open, over time it becomes a highway, and that has happened, and we need to address that urgently,” he explained.

The committee concluded that the law, which established the hospital’s governance structure nearly eight decades ago, no longer reflects the realities of operating a modern public teaching hospital.

Among the concerns identified were the oversized board structure, overlapping appointments, unclear operational authority, weak oversight systems, and ambiguity surrounding the responsibilities of the Government and The University of the West Indies (UWI).

Mitchell argued that the hospital’s dual governance arrangement — shared between the Government of Jamaica and The UWI — helped create confusion over accountability and decision-making authority.

“The legislation may have been acceptable at the time and appropriate at the time, but it has created a confusion between board oversight and operational roles, and that is a cardinal sin in management. The board governs, the management manages, and we have seen situations where that line has been crossed,” said Mitchell.

The committee also found that uncertainty surrounding UHWI’s status as a public body contributed to years of non-compliance with government procurement and financial reporting rules.

Mitchell said some officials had operated under the belief that because the hospital was partly controlled by The UWI, and functioned outside the traditional public health system, it did not have to fully comply with Jamaica’s public sector accountability framework.

Professor Alvin Wint, emeritus professor of international business at The UWI and a member of the review committee, revealed that as recently as 2023 there were still attempts to seek legal clarification on whether UHWI qualified as a public body under Jamaican law.

“One of the things that, quite frankly, we were struck by as a committee, and I think the chairman mentioned it, is that as recently as 2023, prior to Mr [Patrick] Hylton’s movement into the chair, is that the legal officer from UHWI writes to a private law firm to have a determination as to whether or not the UHWI is a public body. This was very striking, because if you look at the legislation around public bodies, it is, in our view as a committee, absolutely crystal clear because a public body is defined as an entity that has a statutory act under the Jamaican legislation and is under the control of the Jamaican Government,” he added.

Wint said that misunderstanding contributed to a culture in which compliance with the Public Bodies Management and Accountability Act was often treated as optional.

Among the committee’s recommendations are reducing the size of the hospital’s board, introducing term limits for some appointments, urgently hiring a corporate secretary, strengthening procurement oversight, and reorganising the hospital’s operational structure to better suit the demands of a modern teaching hospital.

The committee also recommended clarifying the authority of hospital management over The UWI clinical personnel assigned to the institution, while strengthening strategic management and governance systems that reviewers said had deteriorated over decades.

Health and Wellness Minister Dr Christopher Tufton signalled that the Government intends to move quickly on legislative reform as the Cabinet had already discussed the matter and backed the process.

“That’s a Government of Jamaica, Ministry of Health mandate, and we intend to put whatever systems are in place to immediately commence a review of the legislation in keeping with modern times and the mandate of the institution,” Tufton said.

He added that the review was part of a wider effort to restore public confidence in UHWI following the auditor general report and the controversy that followed its release.

“There is a confidence issue that we need to resolve. We need to bridge that gap and we need to show that we are willing to confront the issues, to face them head on, and to do something about them,” Tufton said.

Motor vehicles entering and leaving University Hospital of the West Indies’ main entrance