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Overview of Diagnostic Imaging Services Post 2017 Hurricanes

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#Providenciales, February 7, 2019 – Turks and Caicos – Similar to other major service providers across the country, InterHealth Canada – Turks and Caicos Islands Hospital received significant damages during the hurricanes in September 2017.  These included latent damages to the electrical circuitry of medical equipment that only became apparent over time.  The total cost of repairing the damages to the hospital’s infrastructure and medical equipment is estimated to be USD$16 million.

The majority of the equipment in the hospital is highly sophisticated and extremely sensitive.  The environment of CT, MRI and Mammography machines require tight control over temperature and humidity.  An independent review of the Diagnostic Imaging infrastructure at Cheshire Hall Medical Centre was conducted by XRCT Limited, a physics consulting company based in Ontario.

The report stated: “In the wake of the storms, the lack of air conditioning lead to ambient air temperature and humidity conditions within the facility that were outside of the manufacturer requirements.  This created a severely hazardous environment for electronic components.  In addition, the restoration of power to the island created multiple daily power outages, surges and brownouts.  All of these conditions, when combined have led to premature component failure, significant increase in downtime and potentially shortened the expected lifecycle of the diagnostic imaging equipment.”

 

INTERIM CORRECTIVE MEASURES

Biomedical Engineers employed at the facility assisted by overseas specialists worked assiduously to resolve any emerging technical issues.  To date, all diagnostic imaging machines are fully operational.  The intermittent downtime experienced in previous months with CT and Mammography machines were minimal.  The MRI machine was operational, but with limitations on the type of radiological scans that could be performed at the time.

“Despite the high temperatures and lack of humidity control present in the facility, the records show the hospital continued to make every effort to operate the equipment under these extreme conditions in the interest of providing vital and medically necessary patient care,” stated XRCT Consultants in an official report.  These efforts sought to ensure the continuity of high-quality care and to minimize the number of patients who require treatment abroad.  Patients were categorized based on clinical priority and the equipment up-times were maximized by increasing the volume of radiological scans performed per day.

 

THE MAINTENANCE PROCESS

CT, MRI and Mammography machines generate significant heat while in use and at rest.  Therefore, operating temperatures within these areas are closely monitored, checked and reviewed regularly to ensure temperature and humidity is within the guidelines established by the manufacturer.  Any changes in these precise specifications can create the risk of overheating and damage to internal components.  Monitoring the relative humidity of MRI rooms is also crucial to avoid the risk of moisture damage to very delicate electronic components such as electronic expansion boards, cables, and connectors.

XRCT Limited also performed an extensive review of the service records for the Diagnostic Imaging department and stated: “Over the months/years preceding the storms in 2017, the service history for all the equipment was excellent.  In fact, with the exception of a few random downtime events and planned maintenance, the uptime of all clinical systems was quite good, in excess of 99%.”  Based on these expert findings, the technical issues experienced over previous months were evidently not attributed to inefficiencies in the maintenance or management processes established by InterHealth Canada, but were connected to acts of nature, beyond human control.

 

THE COMMUNICATION PROCESS

InterHealth Canada has continued to abide by the terms of the Project Agreement and meet the extensive reporting and service standards detailed in the contract.  As partners in health care, InterHealth Canada is contractually mandated to submit monthly reports to the Turks and Caicos Islands Government (TCIG) related to over 48 clinical key performance indicators, including Diagnostic Imaging services.  These key performance indicators seek to demonstrate how effectively the management company is achieving pre-established targets. InterHealth Canada fully supports and complies with these accountability mechanisms.

The TCI Government via the Contract Management Unit has been kept informed, at all times, where services have required expansion or, where challenges such as the 2017 hurricanes have caused damage to equipment, resulting in some delays to services.  Representatives of TCI Government’s Contract Management Unit and Fortis TCI also conducted a physical inspection of the UPS and surge protectors in the Diagnostic Imaging Department.

    

THE LIFE CYCLE PROGRAM

Managing the lifecycle of medical equipment from planning to purchase, installation, operation all the way through decommissioning and disposal helps medical institutions improve operational efficiency, enhance quality and reduce service-related cost.

The purchase of capital equipment is covered under a life-cycle program, which is a reserve fund established under the contract between TCI Government and InterHealth Canada for equipment replacement.  The decision to purchase equipment involves several key considerations.  These include: Equipment Specifications and Suitability, Procurement and Logistics, Available Financial Resources, Prospects for Maintenance, Repair and Life expectancy.

InterHealth Canada has filed a short term and long-term recovery plan with TCI Government and are actively considering replacement possibilities for key modalities in diagnostic imaging. Negotiations are also underway with the insurance companies relative to the damages ensued.

 

Release: InterHealth Canada

 

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Facts According to the Turks & Caicos Premier About His Constitutional Amendments    

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What Premier Charles Washington Misick says the proposed constitutional reforms are—and are not.

 

FACT 1: The proposed amendments are not intended to extend the life of Parliament.

According to Premier Misick, his Government did not request longer parliamentary terms and has not sought constitutional changes to keep itself in office beyond the existing electoral cycle.

FACT 2: Cabinet expansion is about governing capacity, not political power.

The Premier says the proposed increase in the number of ministers reflects the growing responsibilities of Government and is intended to improve administration rather than create political advantage.

FACT 3: The Government wants greater local responsibility.

Misick says the constitutional proposals are designed to strengthen the Turks and Caicos Islands’ ability to govern its own affairs while maintaining its constitutional relationship with the United Kingdom.

FACT 4: The Constitution should not become a political weapon.

The Premier argues constitutional reform should be approached as a national issue that outlives individual governments and political parties.

Include his strongest quote on this point.

FACT 5: The Commission process involved consultation.

According to the Premier, the constitutional proposals emerged through discussions with the Constitutional Review Commission and engagement with stakeholders before being presented to the United Kingdom.

Insert his supporting quote.

FACT 6: Government is seeking better governance, not fewer checks and balances.

The Premier maintains the reforms are intended to improve decision-making, accountability and the effectiveness of Government.

Insert his supporting quote.

FACT 7: The Premier says some proposals now being criticized were previously supported.

Misick contends that several constitutional recommendations now under attack had earlier received support across the political spectrum.

Insert the relevant quotation.

FACT 8: The goal is a modern Constitution.

The Premier says the reforms are intended to modernize the Turks and Caicos Islands’ governance framework to better reflect today’s realities and future development.

Insert his closing quotation.

Editor’s Note

This Fact Report summarizes Premier Charles Washington Misick’s explanation of the proposed constitutional amendments as presented in the House of Assembly on July 31, 2026. It reflects the Premier’s stated positions and is intended to help readers understand the Government’s rationale. Responses from the Opposition and other stakeholders will be presented separately.

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“The Contract is The Problem, Not The Hospitals”

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Premier says people deserve the full story as he lays out the cost of the InterHealth Canada concession and Government’s plan to reclaim public control

By Deandrea Hamilton | Editor

Turks and Caicos, August 4, 2026 – PROVIDENCIALES, Turks and Caicos Islands — Saying the public deserved to hear the whole story, Premier Charles Washington Misick laid bare the InterHealth Canada debacle, revealing that more than $827 million has been paid by the people of the Turks and Caicos Islands under the hospital concession while insisting, “the contract is the problem, not the hospitals.”

Delivering what he described as “a full and frank account” to the House of Assembly on July 31, the Premier said the people “deserve honesty. They deserve to understand how we arrived at this moment, what it has cost them, and what this Government is doing about it.” He acknowledged that the opening of modern hospitals in Providenciales and Grand Turk marked “a genuine step forward for healthcare,” but argued that the agreement supporting them was fundamentally flawed.

“The hospitals themselves are an asset. The contract under which they are operated has become an unsustainable burden.”

Turning to the origins of the agreement, Misick relied heavily on the findings of the Commission of Inquiry led by Sir Robin Auld, saying the public must understand why the dispute has become so costly.

“There was no competitive tender. The construction contract was awarded to a company linked to the same ultimate beneficial owner as InterHealth Canada itself — creating, in the Commission’s own words, a closed commercial loop in which public money flowed from the government to one entity and back to the same private interest through another. The Commission found this constituted an unacceptable conflict of interest.”

He continued:

“Those findings had consequences that extended far beyond this project. They contributed directly to the suspension of our Constitution and the imposition of direct rule from London in 2009.”

The Premier said he was not revisiting the history to assign blame but because “the House and the public must understand the nature of the problem we inherited — and why the structural flaws embedded in this agreement from the very beginning have proven so difficult and so costly to resolve.”

Misick also outlined what he described as the staggering financial burden now carried by taxpayers.

“Between 2016 and 2025, this Territory spent $827.8 million on public healthcare. Today, healthcare consumes more than 32 percent of all government expenditure and 8.1 percent of our GDP.”

He argued the concession’s payment model is largely responsible for those costs.

“The operator was reimbursed for its actual costs, plus a fixed margin… That is not a sustainable model for any healthcare system. And it is a central reason why the cost of this arrangement has grown to the levels we are now confronting.”

Looking ahead, the Premier said the Government’s focus is not only on resolving the current concession but also on preventing small island states from facing similar legal and financial burdens in the future.

“We will engage the United Kingdom Government… We will work through CARICOM and the Commonwealth to advocate for reform of international arbitration — to introduce procedural flexibility, development-sensitive interpretation, and affordability safeguards that protect small states from the disproportionate burden that the current system imposes.”

He closed by reaffirming his Government’s objective:

“This Government will resolve the concession. It will reclaim the hospitals. And it will build a healthcare system worthy of the trust that our people place in it.”

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Premier Lays Out Cost of Hospital Dispute

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Misick details legal losses, mounting healthcare costs and Government’s plan to move beyond the InterHealth concession

 

By Deandrea Hamilton | Editor

Speaking during the House of Assembly on Friday, July 31, Premier Washington Misick delivered what he described as a “full and frank account” of the Government’s long-running dispute with InterHealth Canada, revealing that litigation surrounding the hospital concession has already cost the Turks and Caicos Islands approximately $39.7 million and confirming that another arbitration remains before the tribunal.

“The people deserve honesty,” Misick told the House. “They deserve to understand how we arrived at this moment and what it has cost them and what this Government is doing about it.”

The Premier said he intends to table a detailed paper outlining the history of the hospital agreement, the financial figures and the legal decisions that have shaped the dispute.

“I think we owe it to the public to be transparent at all times,” he said. “At the end of the day, they are the ones who are paying for these things.”

Misick stressed that the hospitals themselves have transformed healthcare in the Turks and Caicos Islands, but argued the concession agreement underpinning them has proven financially and legally unsustainable.

“The hospitals themselves are an asset. The contract on which they operate has become unsustainable.”

Tracing the agreement back to 2008, the Premier said findings by the Commission of Inquiry highlighted the absence of a competitive tender process and identified conflicts of interest that, he argued, contributed to the structural weaknesses of the contract.

“I do not rehearse this history to apportion blame across party lines,” Misick said. “I raise it because the House and the public must understand the nature of the problem we inherited and why the structural flaws embedded in this agreement from the very beginning have proven so difficult and so costly to resolve.”

He explained that the concession created separate responsibilities for infrastructure management and clinical services, making accountability difficult to enforce, while the payment model reimbursed costs plus a guaranteed profit.

“This is not a sustainable model for any healthcare system,” he said.

The Premier also disclosed the scale of healthcare spending, stating that public healthcare cost the country $828 million between 2016 and 2025, representing 32 percent of Government expenditure and 8.1 percent of national GDP.

He then outlined the cost of the first international arbitration, saying Government was ordered to pay $18.5 million in principal and interest, $8.2 million toward the company’s legal costs, in addition to arbitration expenses and the Government’s own legal fees.

“The total cost of the territory from the first arbitration alone was approximately $39.7 million,” Misick said. “I want this House to sit with that figure for a moment. Eight percent of our annual budget consumed—not by schools, not by roads, not by housing—but by the cost of resolving a dispute with a private contractor.”

Turning to the second arbitration, the Premier said the tribunal ruled that Government must pay $9.3 million in outstanding invoices, while the substantive arbitration over maintenance, performance and Government’s counterclaims continues.

“In plain terms, the contract requires the Government to pay first and dispute later,” Misick said. He added that the ruling “does not mean the arbitration is over” and “does not mean that the Government’s position on performance has been found without merit.”

Despite the legal setbacks, the Premier maintained that Government remains committed to bringing the concession to an orderly conclusion.

“Over the coming months, we will resolve the concession. We will reclaim the hospitals and build a healthier system worthy of the trust that people place in it,” he said.

While Misick did not elaborate on what “resolving the concession” will involve, he said the objective is to replace what he described as an unsustainable arrangement with a healthcare system that is “publicly accountable, financially sound and built on a foundation that will last.”

Editor’s Note: This report is based on Premier Washington Misick’s statement to the House of Assembly on Friday, July 31, 2026. The Government has indicated that a supporting paper detailing the history, financial figures and legal decisions surrounding the hospital concession will be tabled in the House of Assembly.

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