Cost to treat crime cases eating away health budget – Jamaica Gleaner

It was 18 years ago but veteran medical practitioner Dr Delroy Fray will never forget the day a man was rushed to the Cornwall Regional Hospital in Montego Bay, St James, suffering from gunshot wounds all over his body, after a gun attack at a community playfield.
Fray, the consultant on duty, recalled counting eight points of entry, including one to the man’s head, but miraculously he was still alive.
The bullet to the forehead travelled under the skin and exited at the back of the head, missing his cranial vault, the CT scan revealed.
“God was on his side because even with eight gunshots, including one to the head, the man was still conscious and talking to me,” recounted Fray, now the clinical coordinator at the Western Regional Health Authority. Had the cranial vault been hit, he would have died.
He noted, “But that was an exceptional case. We never had to take him to the operating theatre, and he only spent one week in the hospital, so the cost of treating him was minimal, even at today’s standard.”
Crime and violence have been the chief source of injury in Jamaica over the past 40 years, costing the health sector $2.2 billion annually, then Health Minister Rudyard Spencer revealed in 2009.
Five years later, a study conducted by the Violence Prevention Alliance (VPA) revealed that the total cost of violence-related injuries was $8.6 billion. The direct medical cost due to interpersonal violence ($3.6 billion) accounted for approximately 22 per cent of Jamaica’s total health budget (excluding compensation). And the indirect costs of interpersonal violence due to productivity loss amounted to $5 billion.
The figures represent 25,000 cases of violence-related injuries and 500 cases of attempted suicides, managed by public hospitals over the reported period.
The data also showed that the direct medical cost associated with suicide and attempted suicide was $0.4 billion, and the cost of loss of productivity was $0.4 billion, resulting in a total direct and indirect medical cost of $0.8 billion.
By 2017, the World Bank estimated that crime was costing Jamaica five per cent of gross domestic product (GDP) per year, which translates to about $68 billion annually.
Minister of Health and Wellness Dr Christopher Tufton said trauma cases continue to be a dominant feature in public health response.
“The accident and emergency rooms are significantly tied up with victims of domestic violence and gang-related violence, but trauma related to lifestyle diseases (such as heart attack and strokes) are also a major concern,” Tufton told The Sunday Gleaner.
The VPA study also showed an average cost of $400,000 to treat a gunshot victim back then, while $190,000 could save the life of a victim of stab wounds and lacerations.
Driven by the guns-for-drugs trade and the multimillion-dollar lottery scam, St James, Hanover, Westmoreland and, to a lesser extent, Trelawny have combined to become the most murderous region in Jamaica over the past 10 years, in spite of the implementation of numerous enhanced security measures.
Since the start of the year, Hanover is the only western parish that has shown an increase in serious crimes, despite the spate of killings in St James recently.
Compared to the corresponding period last year, Westmoreland, St James and Trelawny experienced a decline in murders of 33.3 per cent, 21 per cent, and 57.9 per cent, respectively. Hanover increased by 72.2 per cent.
There were 105 reported incidents of shootings in Area One over the period from which 86 persons were injured and had to be treated at the hospital. This is 42 less than the number treated during the same period in 2022 but Dr Fray, who has more than 30 years’ experience in public health care and is responsible for service quality at the hospitals in western Jamaica, is demanding that more be done to stop the bloodshed.
Providing a conservative estimate of the cost to treat the wounded, Fray said that 15 to 20 per cent of the health budget is consumed by gunshot victims.
“This is a conservative estimate, but just imagine a patient with head, chest, abdomen, and limb injuries. We must make a strong plea to eliminate the incidents that lead to such injuries because other crucial services are being seriously impacted,” the clinical director said.
The insecurity caused by crime could have a detrimental effect on trade, business operations, and production costs, ultimately hindering growth, especially in key sectors such as tourism and business process outsourcing (BPO), stakeholders fear.
“Clearly lower crime rate and safer environment need to be in place,” said Anand Biradar, president of the Global Services Association of Jamaica, which represents players in the outsourcing sector.
Biradar, senior vice-president and head of the Caribbean and Latin America international outsourcing firm Hinduja Global Solutions, also noted that clients’ perception of increasing crime will lead to lower growth of the business.
There are also concerns about the travel advisories being published by the United States and Canada against travelling to Jamaica, but chairman of the Tourism Enhancement Fund, Godfrey Dyer, said he was not bothered by it.
“Crime is negative and the notices by the US and Canadian embassies do not help, but tourism is doing well and will continue to grow,” he said. “But we just have to implore the authorities to fight, do more, to keep crime under control.”
Dyer believes the police have been showing improvement in solving serious crimes, but businessman and social commentator Lloyd B Smith disagrees.
“I believe the police are failing where investigations are concerned,” Smith said bluntly. “It is the little things we need to address, we don’t need to reinvent the wheel, we just need to find a way to enhance what is in place already.”
Smith, who like Dyer is a former president of the Montego Bay Chamber of Commerce and Industry, said the failure of the Jamaica Constabulary Force’s much-touted zero-tolerance campaign has significantly contributed to the disorder and lawlessness that currently exists.
“You only have to go on the road to see the number of traffic violations and everything that is happening around you. And I still believe that the police are failing where intelligence gathering is concerned,” Smith said.
He shared that the cost of crime must be seen in two contexts.
“On one hand, there is the underground economy which includes lottery scamming and drug running, which contributes tremendously to the overall economy of Montego Bay and western Jamaica in general,” Smith explained.
“Then there is the exponential cost as it relates to the treatment of gunshot wounds and the overall effect that crime has on the economy.”
Smith said the bottom line of business operations is affected by the escalation of crime, which includes increased cost in security and being forced to restrict their opening hours.
“I believe that there are some basic things that can be done. For example, having sufficient CCTV cameras,” he said.
“I have been to other cities in the world and one of the key crime-fighting tools is that on every street corner, every stoplight there is a camera, which is used to deter criminal activities.”
He continued, “If the Government cannot find the money to build out such a programme and sustain it, then the private sector should contribute, because they are the ones who are set to benefit.”
• Wounds with vascular injury to limbs – $300,000
• Vascular injury with fracture of long bones – $600,000
• Abdominal injuries – $250,000
• Chest injuries with major lung, vascular or heart injury – $600,000
• Head and neck injuries – $200,000
• Brain injury – $4 million to $6 million
• Hospital stay (which varies from three to 21 days depending on the type of injury) – $8,000 per day.
• Medication during hospital stay – $10,000 to $50,000 per day.
• Additional special investigations such as CT scans or MRIs – $25,000 to $75,000 per investigation.
• Intensive Care Unit admission – $25,000 daily.
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