Faults found in Caymans air ambulance ops
The Auditor General of the Cayman Islands has released a Public Interest Report on the management of air ambulance services in the region. In the report, Auditor General Alastair Swarbrick highlights concerns about how air ambulance services are managed, including ‘the unlicensed operation of a ground handling service for air ambulances operating at Owen Roberts International Airport’.
The Auditor General of the Cayman Islands, a British Overseas Territory located in the western Caribbean Sea, has released a Public Interest Report on the management of air ambulance services in the region. The investigative work was performed by the Office of the Auditor General (OAG) after concerns about the service were identified during an audit in 2011 on the Management of Overseas Medical Services, said the OAG.
In the report, issued on 25 June, the Auditor General, Alastair Swarbrick, highlights a number of concerns about how air ambulance services are managed, including ‘the unlicensed operation of a ground handling service for air ambulances operating at Owen Roberts International Airport’.
The objective of the report is to inform the Islands’ Legislative Assembly about the provision of air ambulance services procured by Cayman Islands National Insurance Company (CINICO) and the licensing environment in the Cayman Islands, as well as to determine whether appropriate management practices are in place to ensure that these services are provided in a cost-effective manner and that the regulatory agency for such services, the Cayman Islands Airport Authority (CIAA), is performing effectively. CINICO paid out some US$814,623 for 71 emergency air evacuations in the fiscal year to 30 June 2012, said the OAG.
Among the report’s findings are that despite government companies being required by law to conduct a public tender for contracts over $50,000, when CINICO held a public tender in April 2012 to contract a case management company to carry out ‘overseas case management’ the tender did not include the ‘network access and air ambulance procurement services’ that were part of the contract.
The OAG also found that the Health Services Authority, which initiates air ambulance transfers by co-ordinating with medical authorities and the case management company, has no documented procedures for how it deals with the provision of air ambulance services, ‘resulting in uncertainty and lack of consistency for how this work is to be carried out’. Listing an example of this, the report states: “The procedure followed by the Referrals Office for air ambulance transfers to Jamaica … indicates that only the Air Ambulance Broker is used for such transfers. However, CINICO informed us that the [case management company] is also used for about half of its air ambulance transfers to Jamaica.”
A further fault found by the OAG is the lack of a contract between CINICO and the Air Ambulance Broker to set out the relationships between the parties and the obligations and responsibilities of the Broker for acquiring air ambulance services. Without a contract in place, there is ‘uncertainty as to how and on what basis the air ambulances are selected and if value-for-money’, and ‘potential liability exposure to CINICO if liability insurance is not carried for the services provided’.
The report also raises concerns surrounding ground handling fees of $900 that the Air Ambulance Broker charges to CINICO for each air ambulance that lands at Owen Roberts International Airport, stating that there is no contract between CINICO and the Air Ambulance Broker relating to these charges; air ambulance companies are permitted to ‘self-handle’ at the airport by the Civil Aviation Authority and do not require the services of the Broker; and the Broker does not hold a permit or licence from the Cayman Islands Airport Authority to operate as a ground handler at the airport. The report continues: “The Air Ambulance Broker is not licensed to carry on the activities of an agent to procure air ambulances or ground handling services on behalf of CINICO by way of a trade and business licence. The Air Ambulance Broker is licensed only to carry on the trade or business of ‘air ambulance charters’, which it doesn’t do.”
In conclusion, the report says that operations relating to the provision, costs and oversight of air ambulance services have not been managed effectively, resulting in uncertain value-for-money for services solicited through the Air Ambulance Broker. Swarbrick writes: “We believe that the practice of utilising the services of a non-contracted Air Ambulance Broker, if continued, represents an unmanaged risk to the Government in the event of a catastrophic incident because of the lack of prudent management of public resources.”