News Release: HAMILTON, – The Hamilton Medical Centre – Burnaby Urgent Care and Medical Imaging (HMC) is pleased to announce that on April 8, 2021 the Supreme Court of Bermuda overturned the refusal of the Bermuda Health Council to grant “Standard Health Benefit” (SHB) to HMC.
The Judicial Review application was brought by HMC and medical centre director Dr Jay Jay Soares. The granting of SHB as a result of the Supreme Court ruling means that HIP and FutureCare patients will now be able to have the costs of medically necessary scans such as MRI, CT, and X-ray reimbursed by their insurers when carried out at the HMC. This decision will put an end to certain private sector monopolies.
The decision of the Supreme Court comes at the end of a process with the Bermuda Health Council that began over two years ago in March 2019. After repeated delays on the part of the Bermuda Health Council and two appeal hearings (the first of which the Bermuda Health Council admitted breached HMC’s right to a fair hearing), HMC’s application for SHB was wrongfully refused. The Supreme Court has now put right that injustice.
The Judicial Review application by HMC relied upon a number of grounds that were upheld in the Court’s ruling.
First, the Court held that the Bermuda Health Council’s Appeals Panel failed to provide adequate reasons for its refusal of HMC’s appeal.
Second, the Court held that the decision making of the Bermuda Health Council’s Appeals Panel lacked impartiality for fair decision-making. Further, the Judge held that there was procedural unfairness in the participation of Bermuda Health Council’s CEO, Dr Ricky Brathwaite, who the Judge noted “was involved in every step of the application process”.
Third, the Court held that the Bermuda Health Council’s Appeals Panel took into consideration irrelevant considerations and fourth, that the Bermuda Health Council had fettered its discretion on several grounds.
Very importantly, the Court held that it was “the height of unfairness” for the Bermuda Health Council to extend the SHB approval for others who had been approved in previous years while applying a more rigorous standard to HMC’s application. The Judge held that this approach by the Health Council was “rigid and inflexible” and resulted in a situation that “… was not a level playing field by any stretch of the imagination”, running afoul of the Council’s own guidelines of affordability and quality.
Finally, the Court held that the Bermuda Health Council had acted irrationally and unreasonably for a number of other reasons. The Court held that for the Bermuda Health Council to treat the HMC application for SHB approval as a “Mid-Year Application” (and hence apply stricter standards than applied to renewals by incumbent providers) was one which “… no sensible person who had applied his mind to the question could have arrived at” and an application of “flawed logic”.
Dr Soares stated: “We are extremely grateful to the Court for granting our Judicial Review applications in respect of what we have always maintained were the Bermuda Health Council’s unfair decisions, and are pleased to be able to offer the standard healthcare benefit. Logic, fairness and commitment to justice has been restored to this process solely thanks to the judicial review, the only recourse available to us on this matter.
“The ruling is indisputably a win for the Hamilton Medical Center, but most importantly, this is a judgment in favour of HIP and FutureCare patients, who stand to benefit the most by having coverage at our state-of-the-art facility.”
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