Bermuda Hospitals Board: First public meeting

Notes from Thursday evening's public meeting, organised by the Bermuda Hospitals Board (BHB), about the location of the new hospital.

The room was packed. Every available seat was taken, and people were standing in the aisles too. I estimated that about 250 people were present. Most (perhaps 80%) were white. Are Bermuda’s blacks less concerned about building on the Botanical Gardens? I had thought that this was one issue that would unite the races.

The panel included: Anthony Richardson, Board Chairman of the BHB; Vernetta Symonds, deputy CEO of the BHB; George Melling, facilities director for the BHB; Dr. Daniel Stovell, director of diagnostic imaging for the BHB; Joe Rekab, costing consultant for BTY Group; Raymond Moldenhauer, architect for Cannon Designs; Ronald McIntyre, architect for Cannon Designs; and Colin Campbell, architect for OBM Group. The consortium selected to build the new hospital comprises BTY Group (costing consultants), Cannon Designs (healthcare architects), OBM Ltd (local architects) and PriceWaterhouseCoopers (consultants). PWC were the only company who did not have a representative on the panel.

UBP MPs present in the audience included Wayne Furbert, Michael Dunkley, John Barritt, Patricia Gordon-Pamplin and Louise Jackson. I didn’t see any PLP MPs.

The atmosphere was rambunctious, with the crowd frequently laughing at, heckling or jeering the speakers, and applauding members of the audience who spoke eloquently in the Gardens’ defence. It was clear that the audience contained few supporters of the plan to build in the Gardens, a point driven home when Louise Jackson asked how many people present opposed the current plan and almost everyone in the room raised their hands and cheered.

I got the impression that the BHB was trying to deflect blame away from themselves, by implying that the Government had tied their hands. Anthony Richardson said that the Arboretum had been the BHB’s preferred site, but that the Government had told them that this was not an option. He also said that the Government’s stipulation that the project should cost no more than $500 million had forced them to choose the Botanical Gardens over the existing hospital site.

Vernetta Symonds said that a new hospital was required because the maintenance costs of the current building comprise a disproportionate amount of the BHB’s budget, the quality of care is impacted by the working environment, the equipment is outdated and it’s difficult to find people willing to work with that kind of technology in that kind of environment. Critical failures are becoming more likely, she said, and the BHB is currently struggling to maintain the current site so that it does not impact patient care or staff safety. She pointed out that the ceilings in the current building, which are 13 feet high, are much lower than those in modern hospitals, typically 20 to 22 feet. This creates difficulties when trying to accommodate modern equipment. Dr. Daniel Stovell said that these problems were the reason that it took four months to install the new X-ray imaging room, when it should have taken just one. “We fight with this every day,” he said.

George Melling described how the $500 million cost of building on the Botanical Gardens broke down. 30% represented the cost to build such a facility in Canada; 21% comprised the additional cost of doing business in Bermuda; 9% was project costs (management, fees, etc); 19% was for furnishings and equipment; 14% was for escalation; and the remaining 7% was for site development (preparing the site, installing fencing, building a new incinerator, etc). Joe Rekab said that $15 million (not including staff costs) had been allocated to demolish the existing hospital and return it to parkland. He said that $5 million had been allocated to move the Ministry of the Environment buildings currently within the footprint of the new site.

From the audience, Bruce Barritt asked why the BHB had decided that 10 acres of land was required for the new building. Why not build up? George Melling replied that there were operational efficiencies to be gained by keeping certain functions on the same floor. Raymond Moldenhauer stressed that these are important since the ongoing running costs of the hospital will be much greater than the construction costs.

Louise Jackson asked why we couldn’t redevelop the existing site when many other hospitals, such as the children’s hospital in Philadelphia, have successfully pursued this option. Ronald McIntyre pointed out that the hospital in Philadelphia had contingency plans to evacuate patients to nearby hospitals in the event of a problem during construction that threatened patient care. He pointed out that, in contrast, KEMH is the only hospital in Bermuda, and in an emergency there would be nowhere else for the patients to go. George Melling noted that no plans were available for some of the old buildings on the existing site, increasing the risk that a pipe or cable would be accidentally severed during work.

That didn’t impress one lady. “You’re saying, ‘Yes we can do it on the same site but…’. Take away the ‘but’ and just do it!” she said.

Patricia Gordon-Pamplin suggested that the $500 million price cap was a red herring, and was putting the cart before the horse. She criticised Government ministers for saying that the project was a fait accompli, and making comparisons with the cost overruns on the Berkeley project. I thought that such overt politicisation of the discussion was unnecessary, but most of the rest of the audience seemed to like it.

One man pointed out that Bacardi had recently given the hospital $600,000 for one room and told the BHB to think more creatively about financing options. Anthony Richardson said that research had been done to estimate how much money could be raised from the community, including international business, and the total figure was only $25 million. Bob Steinhoff said that he had been approached by the hospital for money some time ago, and that he and some friends had set some aside. However he asked how the BHB expected to raise any substantial amount of money from the community while their plan was to build in the Botanical Gardens.

Peter Nash noted that the public was being asked to sacrifice 10 acres of parkland now in exchange for the promise of 14 acres in the years to come. He said he didn’t believe that promise would be honoured. He pointed out that when the Government administration offices were moved to the site of the old police station 30 years ago, the police station was moved into a condemned building with the promise that a new one would be built. We’re still waiting for that today, he said.

Steve Conway said that although the old hospital land would currently remain under the ownership of the BHB and be classified as ‘institutional’, the Premier had written to the National Trust suggesting that legislative changes might be possible to guarantee that the old site would be turned into parkland.

All through the meeting, the members of the panel seemed to suggest the only options were to build in the Botanical Gardens or redevelop the existing site. Several people seemed to feel this was a false dichotomy, however, and asked for information to be provided on the other locations that the BHB considered too.

Although there was insufficient time for every member of the audience to have their say, everyone was given a card on which they were encouraged to write any questions they had. The BHB promised to post responses to all questions on their website. Anthony Richardson said that given the high turnout at tonight’s meeting, the location of the meetings on Friday and Saturday might be reconsidered too. Keep an ear open for any changes if you’re planning to attend either of them.

» UPDATE - According to this morning's radio news, Friday evening's meeting has also been moved to the Bermuda College. Saturday morning's meeting is still scheduled to be at KEMH.

» UPDATE - The BHB has confirmed that Saturday's meeting will be held at the Bermuda College too.

Comments

[Gerry C on 22.09.06 at 21:14]

But back to hospitals...

BHB 2005 - ....”Building a new acute care hospital was a vital part of this vision and three concept were presented at three different sites”

Not true. One concept was presented for three different locations. Furthermore, the research undertaken by BHB uses an after-the-fact analytic model. Interviewees were not invited to discuss any kind of open vision for the new facilities, but were rather asked to comment on what was given to them. I think this is called ‘loading the dice’ or ‘distorting the normal distribution’. To present an option as a fait accompli is not an act of consultation but rather one of rubber stamping and agenda-setting.

At the moment, there’s a great danger that people will be distracted from this, or railroaded into a decision, (already made), or simply bemused by what all the fuss is about.

On page 3 of their presentation they say 3 major objectives are: ‘All critical services provided in Bermuda’; creating ‘Community Network of services, Centred on ‘Campuses of Care’; and ; Digital Technology to overcome Location/Isolation Issues.’

These ‘Campuses of Care’ are to be sited at Port Royal, The Wellness Institute and Southside St Davids – the point being to create a ‘Decentralised Health Delivery Service centred on these Campuses of Care, A Centre for Psychiatric Care and an Acute Care Hospital.

This is essentially still a wheel and spokes model of health care infrastructure. What it is emphatically not is a distributed, decentralised one. If it was that, it would be a network.

Apart from wondering who’s handling the BHB’s PR, this is a so nearly-but-not-quite job I could cry. Also whilst I see and agree with the sensibility of much of the plan, the jargon reeks of shallow thinking. I’m not downgrading the integrity and care that’s gone into this decision-making, just its vision and imagination, and perhaps some cynicism about how some of this might play through. For instance, the whole Digital Technology thing disappears, and to work, it has to lie right at the centre of the project. Stuff may exist about it, but one line on even a pdf presentation does not bode well. This isn’t something to be tacked on as a ‘simply must have shopping list thing’, but a chance to fundamentally re-think the whole process and function of both the acute care unit and the satellites, ( staying with the model offered). Given how the island’s handled its IT and telecoms infrastructure so far, I would certainly have worries about how its integration into the overall plan is to be achieved.

I also worry the project is not being presented in any sense as the decentralised system as envisaged. I don’t see how the concept is being carried though to reality, or how, in any sense a distributed open system of health provision is achieved by this. It’s merely a replication of what is, updated for the 1980’s.

We really have to consider in what sense is any health issue ‘critical’ here. What a medic thinks that is, is fair enough, within their professional sphere and we rely on that for their intervention in our individual crises. But what may be critical to the Bermudian population as a whole may ask a whole different view of health services in the terms of their import and impact. I don’t know the answer to that question, but more worringly, I’m not sure that anyone else does either.

If the scale of the project is so overwhelming that whatever choices are made Bermuda loses something, then I think there is something wrong with the scale of the project. I’d argue that BHB and the Government should actually look to the remit they set themselves, and this time set out to achieve it. There is no reason why most ‘acute’ services could not be distributed out to the regional sites. And I can think of many good reasons for doing so. I can see the argument for core services in central Hamilton, just because of proximal population density, but beyond that…I can see the argument for those same services throughout the island. But can you see that if the approach I’m suggesting is taken up then perhaps the land the present hospital is on might pay for the whole project, (and more).

A lot more thought is required from the health professionals to re-engineer the whole process of health care delivery in Bermuda, before anyone starts spending 500,000,000 on anything bigger than a bedpan. Talk to some health services which are already using this model, or moving towards it. I think you need to get some quality IT /comms specialists who really understand the potential of the technology to change the face of health care in on the design process now. As a first line design principle the largest site should be no more than say 5 acres. Come up with a new or fully realised brief, put it out for competition, get some good architects in on it, competitive tender the building, and create a buzz that means something to people. Shoot any ‘consultant’ (of the non-medical variety) that comes with 200 miles.

And don’t get me started on the complete lack of any discussion about energy systems, costs and zero-carbon technologies

[Phil on 22.09.06 at 21:40]

V

I understand what you're saying, but why should environmentalism be a white cause?

Turtle

Does anyone know why the Government ruled out the Arboretum?

They were concerned about accessibility, particularly given the other public buildings in the area (e.g. National Stadium).

[V on 22.09.06 at 21:41]

"I understand what you're saying, but why should environmentalism be a white cause?"

It isn't, Phil. Listen to the overwhelmingly negative feedback to the Botanical Gardens proposal from Black Bermudians on the talk radio shows. And, as I said at the outset, some of the loudest voices raised against the plan in the print media have included Stuart Hayward, Heather Wood, Dr. Eva Hodgson and DJ LT (who I assume is black but I stand to be corrected). But the activist organisations that were out in force at last night's meeting have historically had predominantly white memberships (most of the faces I recognised are veterans of God only knows how many environmental battles). The overwhelming majority of people, Phil -- both black and white, both here and abroad -- do not protest, they don't phone up talk shows, they don't write newspaper columns or Letters to the Editor. But they do have opinions and act on them when they feel they can -- usually on election day.

[Phil on 22.09.06 at 21:42]

V

But the activist organisations that were out in force at last night's meeting have historically had predominantly white memberships

Why?

[Gerry C on 22.09.06 at 21:46]

Limey > perhaps its because, like everything else in our society, black people experience 'environmentalism' as something that is done to them, acted upon without their wishes, by other people for their own reasons which do not include them, for purposes upon which they are never consulted, to ends which are not their concern.... stuff like that.

as other posts have pointed out, most of the 'activist' organisations represented last night are for historical perceived as, and are in the main, white.

Maybe rather than seeing this 'phenonemon' of black non-involvement as a lack of interest in environmental issues, but more an un-willingness to get involved in organisations that are perceived as white might be closer to the truth.

Again, this one needs to be turned on its head. Black people may not be turning up, not because they don't hug trees, want to save a garden or watch a cloud for hours, but they find most white institutions, at the very least, totally bloody boring..... As V points out black people are using forums they feel comfortable with.

some things in life are just simple, Why why ?

[Martin on 22.09.06 at 21:54]

Gerry and V...

I understand what you have said, but are we really saying that because something is perceived as "white"...(we) will remain silent?

It seems kind off strange to get to polling day to express one's disappointment at what happened two yrs ago.

[stuart J Hayward on 22.09.06 at 23:37]

Limey writes:

Most (perhaps 80%) were white. Are Bermuda’s blacks less concerned about building on the Botanical Gardens? I had thought that this was one issue that would unite the races.

Variety of reasons: Environmental/open space issues are generally populated more by whites than blacks. Both the BG and the College are in Paget = translates into easier journey for Paget residents. Those black who were going out may have been more attracted to Col Burch's mtg on housing. Some media have portrayed the battle as between environmentalists (largely white) and govt/BHB (largely black) -- could be a factor. Could also be cultural differences affecting meeting attendance in the 6-8pm evening...

I wouldn't read too much into it. I have been accosted by blacks as well as whites (though not as many, to be sure) who want the gardens saved for their kids.

[stuart J Hayward on 22.09.06 at 23:51]

Gerry C writes:
Furthermore, the Gardens are a public commons, green lung and hugely important environmental space on the island. In traditional economics, these are all 'intangibles' and therefore discounted. But what price do you put on them ? In the new environmental 'total-economics', these three issues alone would give pause for thought, both in terms of what their loss would mean to the island, and their long term benefits to the population as a whole.

Exquisitely well stated! Cash-centered economics has taught us all to undervalue social and environmental factors. When open space gives way to buildings or asphalt or cars (think traffic jams) human health and well-being is negatively affected.

[stuart J Hayward on 23.09.06 at 00:08]

Sandgrownan writes:
Regardless of its history, with the AG show etc, using that history as a basis for not protecting a space that is used by ALL secotrs of the community because its a white cause IS retarded. I'm stunned that this, of all issues, has become a black/white issue. Maybe i shouldn't be...

You are too quick to convert a "strawman" into something of substance. I don't think anyone is suggesting that the history is a valid reason for not protecting the space. Rather, that the history can explain the racial makeup of the audience at Thursday nights BHB meeting. Just because blacks didn't crowd the meeting does not mean that blacks aren't concerned.

Your being stunned is itself stunning. Remember, it was Limey who initiated the racial question in his opening post.

[Rossini on 23.09.06 at 06:53]

What an interesting series this one is. Let me provoke a little this morning....just where were all those attendees at the meeting when the people of Devonshire pleaded for "no-more". National Stadium, CedarBridge, Tyne's Bay incinerator, Cable & Wireless Dish and the Dump...all in Devonshire. I remember Dame Lois in the 1980s pleading in vain on behalf of her constituents about the government's policy of "dumping it in Devonshire". One caller to the talk show yesterday said "This government doesn't care because this is in Paget". The irony of it all was not wasted on me.Sorry guys, the evil twin in me says "its your turn now !!". I disagree with the plan to build the Hospital on Botanical Gardens but damn its hard not to say "F it !" in light of the hypocrisy that it has bred. The unveiled threat of Bob Steinoff that the Board better start looking for some new donors was simply shocking...so it wasn't about healthcare and the commuity all along.

[RedOnion on 23.09.06 at 07:02]

I guess if we get a little technical here, virtually all of us Bermudians are from Paget, most if not all of us were born in KEMH which of course is in .... Paget.

I am not quite getting what this obsession with blaming the residents of Paget for objecting on some parish loyalty grounds has to do with the rest of us who live or have lived in the other parishes.

[island dweller on 23.09.06 at 07:49]

To answer your question, is environmentalism a black concern too?

The answer is no.

White people went sailing class for the summer and skiing in the winter. They were taken into grandma's garden as children.

Black people went summer day camp for part of the summer and learn about crafts. During the winter, they went shopping with the family to New York. And their garden was ashphalt with weeds sticking out of it.

When you deny childern an understanding of their natural environment, you can be assured as adults they have less appreciation for it.

So, all this banter about destroying the botanical gardens is mute. You did not see the 60% of the community that could stop the hospital being built on open space.

See what happens when education is denied.

[Gerry C on 23.09.06 at 07:54]

Rossini, it's a great point yr making. Its not great shock to me that racism rears up in environmental politics as well, and your points about how this has happened in Bermuda don't surprise me either.

My evil twin too could have a healthy cackle at the irony of this present debacle. But evil twins are for xmas, not for life, eh ?

There's a danger here that these kinds of topsy-turvy politics, however compelling, both distract from real issues, and prevent everyone from seeing what their real commonalities are.

I suppose what I'm really saying, is that it's one thing to think this stuff, but it can't be allowed to continue to get in the way of building the common wealth of the community. On either 'side'.

[newbie on 23.09.06 at 08:00]

Yes, I'm a resident of Paget and no, that has nothing to do with my objection to the Government's insane plan to take away a chunk of what little green space we still have left on this increasingly overbuilt and overcrowded Island.

[Bill Cook on 23.09.06 at 08:43]

There are many objectors to the obscene plan to destroy the golf course at Fairmont Southampton by erecting townhouses on it, who live in Paget including myself who have been very vocal on talk radio etc.

As time goes on and this horrendous plan is again raised I think you will see strong objection to it by many not just the residents of Southampton.

Many Bermudians need to be educated as to the effect of the loss of green space and their health etc.

You will note that while some put trees and plants on their property as I did on my small lot others cut down trees and plants so that the view of their house from roadside is not obscured, unless its a protected cedar tree.

[sad on 23.09.06 at 08:50]

SAD, SAD, SAD, Why does this turn into a race issue. Yes, the Ag. Show used to be run by majority white, but it isnt anymore, EVERYBODY is involved now and that is how it should be and continue to get more balanced over the years its called progress!Lets not spoil that. Also lets look at the workers who have and are still working on all those collections and gardens in the Bot. Gardens, who are a well mixed bunch. How sad must they be to see all that work and planning ( not including the cost) go on the chopping block.
I was at the meeting last night, and pleased to see a better mix represented there, please dont make this a race issue. I have been an educator in Bermuda for 22 years and have been involved in many activities in the gardens including all races. Every school in Bermuda uses the gardens in its curriculums. Bermudians of all colours need to support this fight. The hospitals board are doing their best, but can only change these ideas with support from the community. Where are the government in this change of decision?????

[Adjustah on 23.09.06 at 09:28]

Well said, Sad.

We're far too busy it seems pointing figers at each other to deal with the actual problem. One would think that something like this would provide some common ground. Literally.

I'm beginning to wonder whether we deserve what we get.

[island dweller on 23.09.06 at 09:41]

Sad,

You have a point, but you have to look at what people treasure.

This is about what the community defines as important:

- Asphalt and weeds are an everyday thing for some, so having nice grass is not too big of a deal.

- Having a garden is an everyday thing for some, so losing species is a big deal.

What we are asking our community to do is support the idea that grass is important.

I know this is in basic terms.

The debate is either about loosing an open space or loosing trees.

This is not only about race, it is about education. If people know the value of the environment, they are less likely to destroy it.

[Rossini on 23.09.06 at 10:08]

The residents of Harlem Heights, Crawl, Friswell's Hill, Middletown, Rocklands Estate, Riviera Estate, Town Hill, Loyal Hill are saying "huh ? what do you mean no green space....what's the problem,,,welcome to my world !"

[Bill Cook on 23.09.06 at 10:41]

Not much green space on Bostock Hill either and I lived there for app 15 yrs.

The point is that "The Island " needs as much green open space as possible as its not a matter so much about the aesthetics of ones own property as the quality of air and the assistance of rainfall etc.

Manhattan island is app same size as Bermuda 12 by 2 v/s 21 by 1

If Manhattan lost Central Park and Van Courtland plus all the trees it may be in deep trouble considering its density of big skyscrapers.

It is interesting what happened when London started concreting over its little front gardens for parking space for cars.

Ther is a study on the dire consequences of that move.

[thereyougo on 23.09.06 at 11:02]

LB,

I was not thinking of the dump as a site for the hospital but as a new park which will be available in the centre of the island. I am wondering if the acreage will put back into the parks system what the hospital takes out. I am wondering if a new park in the centre of Pembroke plus the destruction of the BG might be seen by the PLP as a timely move of community garden from Paget (seen as white) to Pembroke (seen as black)?

[Raptor on 23.09.06 at 11:38]

Bill Cook writes: “Manhattan island is app same size as Bermuda 12 by 2 v/s 21 by 1,” and asks what would happen "if Manhattan lost Central Park.”

I was curious, so I checked out the size of the Park:

How big is Central Park?
843 acres or 6% of Manhattan's total acreage, including:
150 acres in 7 waterbodies
250 acres of lawns
136 acres of woodlands

6% of Manhattan’s total acreage! How’s Bermuda doing on that scale for parkland?

Golf courses do not count. Also, I worry about the pesticides and herbicides used on golf courses. So I’m just wondering about parkland in Bermuda.

Obviously, there are parks at the beaches, but that is a different kind of environment, as many trees and plants cannot grow in saltwater spray. Also these parks lend themselves to fairly limited uses, such as swimming and picnicking, than, say, Central Park, which is more analogous to our Botanical Gardens.

Central Park is a beautiful place. It is actually one of the main flyways in the United States for birds. Who would have thought?! It is the site of many concerts during the summer. And it is an incredible gathering place for everyone under the sun. People picnic, they go to the small restaurants, they buy food from vendors, they rollerblade, jog, walk, fly kites. Also, it is a site for art exhibits, such as Christo’s “Gates.” There are parks like this in so many major cities, and they are the core of those cultures. If anything, I believe the use of the Botanical Gardens could be further enhanced to attract even more Bermudians year round. Where's the vision?

[newbie on 23.09.06 at 12:18]

Sad,

I have just left this morning's meeting with BHB at the College and can report that, yes, a certain Ms. Eva Hodgson, brought race into the discussion.

[vitruvius on 23.09.06 at 13:01]

I think we need to tease out how perceptions of how our environment can be very flexible and changeable and how the crude notion that densely built environments inevitably lead to depravations, crime and social decay.
In the local context we have St George Town to show how an urban density can provide for remarkable townscape and architecture and also demonstrate a sustainable model for development. Perhaps now suffocating under the supervision of the “Heritage” types, this UNESCO World heritage site still should be examined for clues how to find a sustainable development model suited to the land mass of this island.
Also consider the perception green open space always must mean well-being and social harmony. On a few occasions here the Botanical Gardens value has been equated to that of Central Park as a “green lung” for urban communities. We should remind ourselves though that Central Park not so long ago was a notoriously dangerous space – inhabited by a feral criminal element preying on those who entered.
The character of this space, and the rest of New York, has changed incredibly over the last 10-15 years and this, to my knowledge, has happened without any significant material change to the built environment. (With the exception of course of the WTC)
Why is this so?

[Turtle on 23.09.06 at 15:30]

My main concern is the survival of the Botanical Gardens as a botanical gardens so that we will always have the opportunity for study and research into the variety of plants that grow in Bermuda. This is far more than just being a "green space" or a "park" or a "green lung", although I can understand those perspectives.

The proposed siting of the new hospital places it squarely in the centre of the Garden's botanical collections and greenhouses. I'd like to see a detailed plan as to how the Government plans to ensure that the programme, and the plants survive. If trees are to be transplanted, which ones, and where? If trees will be lost, which ones, and are they replaceable? If gardens such as the sensory garden and the butterfly garden are to be relocated, where? Where will the greenhouses go? What about the Department of Environmental Protection?

If there are alternatives in other locations what are they?

If the answer is that they will be accommodated in other parts of the Gardens I want to see exactly how this will be done so that the needs of the Botanical Gardens, the Ag Show, the groups using the grounds, the Premier's residence, Masterworks and the park-like purposes of the Gardens can be balanced and met.

Although I would like to see the old hospital grounds and adjacent acreage kept undeveloped I think that is an unreasonable demand. The new hospital will need room to grow in the future and that land will help to maintain the hospital's "sustainability" for a long time.

thereyougo has an interesting perspective: Coming through on the redevelopment of Pembroke Dump as a recreational area would go a long way toward providing inhabitants of the central parishes with room to stretch their bodies and minds and would also compensate for the loss of parts of the BG. Connecting all the central park-type areas (BG, Arboretum, Pembroke Marsh, etc.) with bicycle trails and foot paths would be even more outstanding.

[sad on 23.09.06 at 17:03]

Yes Turtle, I agree, if they really intend to use the gardens, why there in that specific spot??
It couldnt be in a worse place as alot of the plants in those collections will be unable to be transplanted to the Arbo, (or wherever), why not move the ring infront of Camden (as it wouldnt spoil the P's view too much!!) and do something along that side???
The place they plan to put the hospital is right in the middle of everything and would basically make it, Camden gardens and the hospital grounds!

[Black Bermudian on 24.09.06 at 12:33]

I also thought it was interesting that whites clearly outnumbered blacks in that meeting, and I don't quite get their outrage over it. In general white Bermudians seem to be the first to support increasing our population for international business, building more high end condos and giving full rights to sell Bermuda property to foreigners. Over the last ten years we've seen so much land get developed and overdeveloped to accommodate more people, and this same crowd has sat by and said nothing. So the protectionist stance here seems unusual to me.

I don't know the history of racism when it comes to the Gardens, but I would say that historically most blacks only visited there for the Ag Show. I would therefore imagine that they would be fine with the new hospital as long as the ag show was retained. Other than the Dog Show, Premier's Tea Party and the recently opened art gallery, I have no idea what else happens there.

Of course those attending the meeting might mostly be residents from that area and/or people who actually use the park year round. That part of Bermuda is relatively wealthy, and we can certainly tie historical wealth and parish to race in this country. My assumption then is that there would be a strong correlation between use of the BG and race. Blacks, who visit the park once a year, probably don't see this as an environmental issue.

Perhaps I would see this as a real environmental issue if this was an untouched open space like Spittal Pond or Ferry Reach, but this is a man-managed park that is rather boring to be perfectly honest. Further, when completed the overall land space is actually supposed to be less that currently consumed by KEMH. I'd fight for Spittal Pond, but not the BG.

We could use a better national park, museum, music and arts centre with a strong emphasis on celebrating Bermudians and maintaining open space. There is enough land for all of this and still retain a huge amount of open space. The only change I'd make is to not have the hospital smack in the middle of the park. Have it in a corner somewhere and have the national centre be the jewel in the crown.

As it is, the BG can go for all I care, but I hope they do something more than just put a hospital on it.

[Lisa on 24.09.06 at 13:25]

Phil - You deserve a lot of credit for your detailed notes of the meeting. I am impressed!!

Everyone I have spoken to no mattter what their skin tone or political persuasion wants to save the Botanical Gardens. Some of them however, especially those who work at the hospital are against a same site rebuild primarily because they want a new hospital built as quickly as possible, without it costing the earth and they don't want to work through the noise of jack hammers (and other such annoying disturbance) for several years. They are also concerned about how much this disturbance may affect the patients.

It is very difficult for these workers (and there are LOTS of them!) to accept a same site rebuild despite the fact the disadvantages to this option are only short term whereas building on the Botanical Gardens is a long term disadvantage. I don't blame them for this - I don't have to work there! How many of us would be content to think that far into the future and put up with our current daily lives being severely affected? I think anyone who is passionately backing a same site rebuild needs to understand that for a lot of Bermudians - this is going to mean a living hell for quite some time and we need to understand this.

Rebuilding on the existing site is possible but it is not going to be easy. I think that the hard working folks at the hospital believe that people who want an existing site rebuild - don't understand and aren't sympathetic towards the problems that this option will entail.

It is sad that this issue is being misinterpreted by so many people. For some it's a racial issue, for others it is about putting the value of health care side by side with the value of open space but what I think it should boil down to is that all Bermudians benefit from having the Botanical gardens either indirectly or directly and it is something that should be preserved for future generations. We are not sacrificing a hospital for this. We are talking about a few years of sacrifice (financial and other inconveniences) for the sake of saving something, which makes our island what it is. This is where the debate should be focussed - not on race or politics.

There is also the possibilty that the hospital could be built elsewhere but most people don't like the Arboretum suggestion either and I have yet to hear suggestions of any realistically alternative sites - Pembroke Marsh would cost far more than a same site rebuild since the marsh is 600ft deep!)

Equally overcrowded areas such as Singapore and Hong Kong have not built on their Botanical Gardens. I think destroying such a huge part of this island's heritage for any reason would make Bermuda one of the most stupid nations on the planet.

The Botanical Gardens is a lot more than a park! It is part of our identity! The only other leaders I can think of who destroyed such a significant part of their nation's heritage is the Government of China.

So while I do understand the costs... I still want to SAVE THE GARDENS!! :-)

[Gerry C on 24.09.06 at 14:41]

Lisa, I agree entirely with you where the focus of the debate should be I think and I anyone would recognise the value of both the hospital and the BG.

Like many other people, your two main issues seem to be thosed caused by the two major option put forward so far - the disruption caused by a rebuild on the same site, and the open land of the BG being lost by the current proposal. Like you I recognise that finding a site of the size required for the proposed development seems to be a bit pie in the sky.

I dont know whether you read my above post or my opinion piece in the MON for a decentralised health service using a distributed network model.

As I explain in both, this approach would not only save the BG, but free up space at the present hospital site. I'd also like to point out that by moving out most acute care services to the primary care sites on the island, and only keeping a much smaller acute and emergency admissions unit (plus all management, clinical and non medical support services), not only do you make relatively huge central Bermuda land savings, but the proposed model would create far less chaos and disruption.

Furthermore these by definition are spread across the island, and if phased correctly in their development could keep any building disruption to a minimum. If the transitions from the present site to the new enhanced primary care centres I'm talking about were also managed properly, it would mean far less disruption for the teams of medical staff and all management / ancillary workers. If you have a look as well at BHB's plans for the whole service it might help you see what I saying might just make a lot of sense..for all kinds of reasons, but it would certainly address your concerns.

BB - I think you've got a really interesting suggestion about actually developing the BG to make it more of a park. I'd be interested to hear your ideas of what you might mean by that.

[Lisa on 24.09.06 at 15:59]

Gerry - I have seen the entire BHB PDF presentation which lays out plans for continuing care units on Morgans Point and at Southside... and I did read your post above (not the bit in the MON though - I will search for it online). Have you asked the BHB to investigate the feasability of your specific proposal. If so, what did they did say?

[Gerry C on 24.09.06 at 16:35]

Not yet. I only picked up on this recently and the idea's taken quite a lot of research, thought and boring the pants of people to see whether it may be feasible or not. The piece on MON was an opener on that as well. I'm kind of hoping that Bermudians might pick it up as an option that should be explored.

I know they're not on the ground in Bermuda, but the health professionals here in the UK I've discussed the idea with all think it's a goer as an architecture for clinical practice on the island, and agree with my main points about costs, development, health impacts and good medical practice. The main problem they all see are getting the health professionals to really think through how the different health processes and types of medicine should be grouped to meet the island's needs, since this would be key to how to decentralise effectively. They also said that in essence, its no different from the change of emphasis in clinical care that's being developed in the UK.
The main other point made was the criticality of the telecoms and information systems support which I'd already assumed.

I suppose really I was waiting to see if people want to pick up the idea and run with it. It just seemed to me that the way the present proposal was offered as the only logical option, just didn't deal with the problems it creates, and I think if people are opposed to the development in BG, there's got to be another way. That's what I'm offering. The basic ideas of this alternative aren't difficult to grasp, and not that different what whole BHB plan is about. The thing that gets me is that the Board seem to be 2/3 of the way there, so its not as if they're entirely new to the central idea. I just think they've come up with the answer to a problem that hasn't been defined clearly, and whilst paying a nod to new ways of operating the health service, haven't really thought through the implications of their own ideas. And in doing so, have ended up offering Bermudians a limited set of 'alternatives'.

So, to answer your question, no I haven't yet and so they haven't said anything.

[Full Fullish on 24.09.06 at 18:42]

Gerry C,
Just ready your MON peice. I completely agree with you on this. Having almost all facilities in the same place creates a single point of failure, should something happen to the new building that would impact it's operation, moving to a decentralised, or redundant model will only provide a greater coverage in terms of hospital care and optimised medicine for the population.

[Lisa on 24.09.06 at 22:43]

Gerry,

Please visit the Government blog (for Sustainable Development) and submit your suggestion, in detail. I have been told that this is one of the best places for our messages to get accross to the Cabinet.

Cheers
L.

[stuart J Hayward on 25.09.06 at 08:24]

Lisa writes:

Phil - You deserve a lot of credit for your detailed notes of the meeting. I am impressed!!

I agree. I would not be able to make such a detailed report without a tape recorder. Well done, Phil. And thanks.

[Bill Cook on 25.09.06 at 09:07]

There have been some very useful comments that are worthy of further study.

One of the weaknesses in my opinion, for even greater support for preservation of the BG, is that we never really created a more inviting atmosphere for its expanded use by the general public.

As Raptor pointed out Central Park is very much used and designed to be, even ice skating in winter, but it has a great deal of open space.

I used it a lot during my 27 yrs of staying in the St Moritz hotel on CPS as my base, visiting while on business in NY.

We must face the fact that with only a small population of some 65,000 app. we cannot sustain enough specialists to treat all our needs and will always need to go off island for many procedures.

The idea of decentralising where practicable by placing patients elsewhere, would seem to make sense, as would building much higher.

There is quite a lot of space at the Wellness location and other places to build where those who do not need to be at KEH could be moved to.

It is not an easy problem to solve and hopefully reason will return before any final decisions are made.

[Onion on 25.09.06 at 12:49]

Limey, you ask, "where were all the black people at the meetings?" Fair enough.

Equally however, I ask the question:

Where were all the white people when it was proposed that Tucker's Town be conveyed out of the hands of the Talbots and the other Devil's Hole families?

Where were all the white people when a similar thing happened to the residents of St. Davids to make way for the airport and US base and now further low cost housing?

Where were all the white people when the people of Devonshire complained about an incinerator being built in their back yard?

Where were all the white people complaining when it was proposed that the Pembroke Dump be put in it's location just north of TCD?

Where were all the white people complaining for the plight of the 1000s of residents in the area who have had to live for decades with the smell of rotting garbage and toxic chemicals being absorbed into the soil? Where were all the so-called "environmentalists"??

Where were all the white people complaining when further to this it was proposed that it be named after one of our greatest civil rights leaders, Dr. E.F. Gordon? A dump!!

Where were all the white people at the latest forum in the wake of the shooting of a BLACK innocent victim on Ord Road?

Where were all the white people on the demonstrations with respect to Anchorage in St. Georges?

Where were all the white people during the Perimeter Road meetings when it was proposed the Prospect site would be the location for more low cost housing?" (this to go along with the already existing low-cost housing , and two stadium sized fields.)

So now you have these town hall meetings and email petitions to maintain the status quo for Loughlands in Paget and the Botanical Gardens and you don't see black people en masse and you say, "oh how curious, where are all the black people? Do they not care for their environment?"

You have the gall to ask such a question?

I just wonder to myself. If it was proposed that Somerset cricket Club or Western Stars sports facility was to be demolished and the hospital was to be put in any of these locations I wonder if the complexion of these town hall meetings would still have such a fair hue.

Most black people who have an opinion on this probably are against the hospital being built in the gardens. They probably fear for the congestion that will result at the site near Loughlands. But you know what? North Shore Rd is pretty congested too. So is Parson's Road. So is Happy Valley. So is Middle Town. So is Till's Hill.

It is quite apparent that our environmentalism in this country does not go beyond NIMBYism (not in my back yard), and it is disinenuous to ignore the fact that race has always and continues to divide us when it comes property and housing.

[SmokingGun on 25.09.06 at 13:05]

Can't disagree with you Onion. But we do need to start somewhere. Maybe we should all take a good look at ourselves and say enough is enough. Sometimes you can fix the past by making change today and ensuring the future is done correctly. Together.

[Bill Cook on 25.09.06 at 13:19]

Smoke,
Public places should be just that.
Otherwise we are sawing the branch of the tree we are all sitting on, it seems to me.

[Liam Brady on 25.09.06 at 13:36]

Thereyougo,

I can tell you it is not. The plans to convert Pembroke Marh/Dump into a national park has been in the works for years. I remember studying it in highschool (hahah which was only 6/7 years ago). I think it has just been slow in fruition due to the nature of the land mass that is being dealt with. But there has been a plan for the dump. I don't know if you can find it anywhere. Best to ask Waste Management Section of W&E.

[texpat on 25.09.06 at 14:30]

Good Grief, Charlie Brown!!!

As an expat I am not qualified to address Bermuda's history, either political or racial. Neither of these topics should even be considered when the focus is medical services. But, I see that this thread is really going down a rabbit trail.

Bermuda (the people) should be looking at the $500 million price tag, and what it will provide in the way of medical services. Questions such as: "Do we need a cardiac cath lab? How many operating rooms? Open air MRI?", need to be made, and answered. Does $500 million buy enough of the right services, is certainly more important than where it will be built.

Site selection is of little importance when the ambulance is taking your loved one to the emergency room. The new hospital should be centrally located, as are all the proposed sites.

However, regarding the Botanic Gardens site. Getting 14 acres for 10 acres sounds like a good deal. Will it be of equal quality, will it been replanted, sodded and manicured? Where are these costs? Will whatever trees that were removed from the 10 acres, be planted on the returned site? These are the questions which need to be answered now.

From the images I saw on my television, some of these questions were asked, and ably avoided by those who should already have those answers. This brings up a bigger question, how involved is the Bermuda Hospital Board in the planning process for this project?

Thank you for the opportunity to offer my two cents.

texpat

[Lost in Flatts on 25.09.06 at 15:11]

I couldn't agree more. I think the question that should be asked is, do we need a $500m single hospital building and is every piece of that completely necessary? If the powers that be do indeed agree with this, and surely they'd have a better idea than the public, then it doesn't seem like there is another option. The arboretum was ruled out by the government (and doesn't really have much more support than the BG) and doing it on the current site is not cost efficient nor practical. So I don't understand what government were supposed to do?

[SmokingGun on 25.09.06 at 15:29]

texpat - you are absolutely correct. What exactly will the $500 million beget the hospital and Bermuda as a whole? It may be safe to say that building on the Botanical Gardens is the "cheapest" route but I would imagine nobody would say $500 million is exactly chicken feed.

With the numbers and percentages that have been bandied about I would like for our representatives to ask the real and pragmatic questions. What will that very considerable amount of money actually produce. In real terms and real time. It all comes down to how many beds?

Is $500 million too much or too little for what Bermuda truly needs at this time. Is there a better way. Should the government put a hiatus on this whole project and get a fresh team to look at the big picture? I think they should. Will it happen? I doubt it. Too many vested interests at stake. But heck, all Bermudians have a vested interest in making sure this is done right.

I'm a firm believer in "Measure twice and cut once".

[Gerry C on 25.09.06 at 16:19]

I'd agree with much of the last 3 posts. We don't even know if £500,000,000 is the price tag or not, never mind what exactly Bermudians will be getting for this spend. The 500 mill figure was merely the cap that the PLP gov put on the project.

How that relates to actual spend and investment on Bermudian health services isn't information that is publicly available. How the proposal relates to any health needs analysis is not available. What infrastructure this money will buy hasnt been made clear. Pretty pastels of proposed new sites do not a plan make.

I think my own opinion about this present proposal should be clear by now, and I know that many Bermudians are vehemently opposed to this development. So far, most of that opposition has come from emotional concerns about the BG and so on. Entirely laudable This is to miss the point entirely of what's going on here.

Having watched the 'stakeholders' muddle their way through similar developments in the NHS, I'm not a great believer in conspiracy/corruption theories, but I am a total convert to 'if people can f**k up they will, and if they can do it together, they'll make one almighty …. of it. I’m sure both are full of well-intentioned people trying their utmost to come up with something that will work for the island. But the road to hell…. Etc.

Only the lawyers and the accountants make real money out of this….. managed chaos.

Whilst BHB and the government have spent time and (presumably) a lot of effort to gather a rationale for the proposal offered, very little of the relevant information is in the public sphere. So how in any sense are the pubic supposed to make any kind of informed choice as to whether or not they are actually going to get the health services they need ?

Remember, the present exercise is one of consultation only, and after the fact at that. Although the development plans on the BHB ‘s site deal with the actual build and in general terms what Bermudians get for their dollar, I think they need both the detailed plans for service provision and for the infrastructure that will be necessary to support that. I believe that BHB have and are doing their best at this level, but what they're offering is a long way from what's really required.

Whilst clinical decisions are (perhaps) best left in the hands of the professionals, I think all Bermudians have a right to know exactly what they're going to get in terms of health service provision over the next 5-10 yrs as a result of the relatively enormous sum of money.

SG > the only point I'd make to your post, is that in today's medicine, the numbers of beds are in many senses the least of yr issues. It's more useful to think about from the angle of the range of services and facilities a health service can offer for a given cost. I’m going for a CT scan next week – I don’t think they’ll use a slumberland divan…..

[Student on 25.09.06 at 16:38]

A serious question, although I recognize it might sound naive. How many acres is the Loughland's site in Paget? Politics aside, could there be space enough to build the new hospital there (it seems as if *something* will be there, so traffic flows are unavoidable)? And then the "affordable" housing could be built at the old hospital site? Just curious to hear some thoughts...

[SmokingGun on 25.09.06 at 16:53]

GC - Too funny. I hope whatever you end up on is comfortable.

The reason I use beds is to bring it down to what I've been told is how hospitals look at the cost of developing a facility. For instance if there is a general average cost per foot for cost then using a budgeted number will give you the amount of beds one will get. Obviously other things come into consideration but it simplifies the way of determining the bang for the buck. This is used in building hotel rooms for instance. I'm certainly not an authority on the subject but have had a few discussions with some friends in the US who are.

It's all about the math. Do the budgeted amounts get us what we really need.

[Bill Cook on 25.09.06 at 18:52]

Student,

The area in Loughlands was too small for a hospital as was less than half the required area.

I once examined it for a retirement home for active seniors who could have moved out of their homes to reside there in a very pleasant environment.

It would have been great for that purpose we felt.

[SmokingGun on 25.09.06 at 18:59]

And it still would be Bill.

If they insist on 96 condos I would much rather see elderly retirees in that area for the simple reason there would be far less cars, bikes and comings and goings. Much more suitable especially as the hospital is only around the corner.

Maybe you should dust off the proposal.

[Bill Cook on 25.09.06 at 19:19]

Smoke,
We looked at South Capers on White Sands Rd and Huntley Towers too.

We have an ever increasing need for a retirement area for seniors, also for those who could sell their homes and live along side others, play tennis have a nice restuarant, theatre etc and a few buses for transport.

Less active seniors need more care and another facility could cater to them, thus easing the stress on the hospital.

It is important to decentralise when it can be done, without any health risk as others have suggested.

It just makes sense to me.
People are at first reluctant about being next to such places but they need not be.

Of course now I am becoming older and have to look at San Diego or Arizona who have fantastic facilities for active seniors while we are still in the Bronze Age !!

[SmokingGun on 25.09.06 at 19:53]

Bill,

What you say makes a great deal of sense. By creating facilities that cater to like-kind groups of people one can get huge benefits and create better value. Bermuda is really just a big resort much like Disney World, it's about time we started treating it as one and create the infrastructures and facilities accordingly.

Just to keep things on track, the hospital board for instance should be extremely open as to exactly how far they have come with their plans. Have they really done their homework or did they get rail-roaded by self interest groups, or individuals, in government or with government connections.

[SANDGROWNAN on 26.09.06 at 08:19]

I was speaking to some physicians who commented that the argument that you couldn't rebuild the current hospital becasue of the noise, dust, etc., was totally bogus.

Every single hospital you ever visit is undergoing some sort of construction, mainly because they don't have the luxury of fresh open space on which to build. If it can be done elsewhere, it can certainly be done here.