Tufton calls for law changes to tackle hospital ‘social cases’

Jamaica will have to change its laws and policies to address the perennial problem of patients remaining in public hospitals long after they are medically discharged, Health and Wellness Minister Dr Christopher Tufton has warned.

Tufton, who has raised concerns about the number of social cases at hospitals across the island on numerous occasions in recent years, reiterated yesterday that the situation is consuming scarce beds and resources needed by acutely ill patients.

According to the minister, the Government is “hamstrung” by existing legislation that prevents hospitals from simply discharging people who have nowhere else to go.

“We really have to do more to address this. We are hamstrung by legislation. The Public Health Act doesn’t allow us to put people out, and that would be inhumane in cases where they have nowhere else to go,” Tufton said, as he urged the relatives of these individuals to retrieve them from the facilities.

According to the minister, some 239 patients are currently being classified as social cases across the public hospitals. This number does not include those at Bellevue Hospital, the island’s primary mental healthcare facility, which reported some 400 long-term social cases earlier this year.

Cornwall Regional Hospital (CRH) has the largest number, with 65, the health ministry said, followed by Savanna-la-Mar General Hospital with 26; Spanish Town Hospital with 21; May Pen Hospital with 19; and Kingston Public Hospital with 18.

Significant burden

In some instances, social cases account for as much as 15 per cent of hospital bed spaces at some facilities, he said, emphasising the significant burden this places on the health system.

“Persons who have been discharged but either have nowhere else to go, or they have been abandoned by their loved ones, require the hospital to feed them, house them, at the expense of persons waiting for a bed,” he said. “Hospitals are designed primarily to provide acute medical care and are not intended to serve as long-term residential facilities for persons who no longer require hospital-based treatment.

“We really have to look now at legislation and policy to strengthen the mechanisms to ensure that there is an alternative,” he said. “Because the hospital is certainly not the place to house these persons.”

According to Suzette Camille Buchanan, CEO of Bellevue Hospital, feeding the people, some of whom have lived at the hospital for decades, costs as much as $20 million per month for food, and at least $11 million per month for diagnostic tests and other healthcare needs. All of this is on a budget of just over $3 billion per annum.

“Just imagine, we have 500 bed spaces, but 400 are social cases – they only leave here when they die,” she told the newspaper. “These people are stable and have been discharged, but what a pandemonium it would create if I were to send out 400 of these patients onto the public. How would the public manage with them in addition to the ones already on the road?”

The situation has been even more worrisome following the passage of Hurricane Melissa, which has left some patients, particularly the elderly, homeless, and their loved ones without suitable houses or the financial means to care for them.

According to the health minister, some patients are suitable for placement in infirmaries. However, those facilities are also overcrowded.

“We have gone as far as, in some instances, working with the local government to build out additional spaces ... . At Spanish Town Hospital, we are actually paying to maintain persons in those facilities, which, again, is not really our mandate,” he charged.

“So the appeal is really to relatives in the case of those who have somewhere to go: take your loved ones.”

The problem has prompted moves to expand infirmary capacity. In July, Montego Bay Mayor Richard Vernon said plans were nearing completion for an expansion of the St James Infirmary to accommodate more than 50 social cases from CRH, with the health ministry expected to finance construction and initially fund operations.

Tufton said relatives of social cases will be assisted through community health aides and by training through an unpaid caregivers initiative. A long-term solution, however, requires legislative and policy changes, he stressed.

However, Tufton said the growing problem cannot continue to be managed by hospitals absorbing the cost of housing and caring for people who no longer require acute medical treatment.

“Every occupied bed represents a potential delay for another patient who may be waiting in Accident and Emergency, requiring surgery, or needing admission for urgent medical attention.”

corey.robinson@gleanerjm.com