Erica Virtue, Senior Gleaner Writer

Already under the strain of too-meagre finances, the Intensive Care Units (ICU) of the island's hospitals must continue to bear the mounting costs to keep critically ill persons requiring specialised treatment alive.

The South East Regional Health Authority (SEHRA) which manages public hospitals in Kingston and St Andrew, said a 2005 estimate showed that the cost of keeping a patient in ICU was US$1,500 per day.

According to SEHRA, there are three patients who have been in ICU for the last two years at a free public-health facility.

"At present, we have three patients in an ICU extension who have been ventilated for over two years. They have full brain functions, but are unable to breathe," SEHRA told The Sunday Gleaner.

The regional authority noted that there are 18 beds in ICU at the University Hospital of the West Indies, seven adult beds at Kingston Public Hospital (KPH) and four paediatric beds at Bustamante Hospital For Children.

A two-bed high-dependency unit is also operated at the Victoria Jubilee Hospital, and a three-bed, chronic-care unit also at KPH.

According to SEHRA, last year, 390 patients were admitted to the seven ICU beds at the KPH.

"ICU is the most intensive medical and surgical care. Individuals can be in ICU for months and they rack up a senior bill, I can tell you," said one medical doctor who asked not to be named.

"ICU patients are very high-demand patients. You have to do everything. You have to get the patient incubated and ventilated. There is a fluid regime, antibiotics, urine output - you have to turn them every two hours, sometimes every hour.

"Then there is dressing. Sometimes dressing has to be changed regularly, and vitals (temperature, pulse, neuro-observation, respiratory rate) have to be monitored like clockwork. It's highly intensive, has to be checked rigorously, sometimes every five minutes or every 15 minutes," added the doctor.

Overseas patients

He charged that because of the no-user-fee policy, many persons were leaving overseas to come to Jamaican hospitals for treatment, while persons admitted to ICU in private facilities were transferring to public hospitals to avoid the cost.

The former government abolished the no-user-fee policy as part of its campaign promise in the 2007 general election, and Opposition Leader Andrew Holness recently said the party stands by that position.

However, discussions are under way on a policy which could tweak, if not eliminate, the no-user-fee system.

"To tell you the truth, it's very hard in Jamaica and the demand is great. It's more demanding because we only have a few beds. That means you must have a selection process.

And that also means that the person with the better prognosis gets to go. The truth is, sometimes you literally have to play God and that's why ethics is such a big part of the profession," said the doctor who supports the elimination of the no-user-fee policy.