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She was white, from Ireland, and over 65.
But in 2023, the board of the University Hospital of the West Indies (UHWI) felt Dorothy Hosein was the right choice to transform the beleaguered teaching hospital.
Despite her experience having done similarly for other troubled teaching health institutions in the U.K., her race, age and nationality became the focus at one of the UHWI board meetings. Board members discussed how to present and defend the appointment of an older, white Irish woman over a Jamaican candidate.
So, was the board appropriately considering political and cultural sensitivities or were the discussions merely a distraction from the effort to transform UHWI?
Board minutes and interviews by 18° North suggest that while directors focused on how the appointment would be perceived publicly, the greater obstacle to reform were key figures within and around the state-funded hospital.
Hosein had no ties to Jamaica but still emerged the best of 47 candidates that had applied to the advertised job. Two internal candidates “fell below the requirements,” according to a batch of minutes from the 2023 board meetings submitted to the Parliament’s Public Accounts Committee (PAC) in June 2026.
The Sept. 20, 2023 minutes show UHWI was seeking a proven, strategic leader with turnaround experience, one who could learn the culture and command respect. Wayne Chai Chong, who served as board chairman between December 2022 to December 2023, told 18° North he initially thought any experienced manager could do the job but soon realized a teaching hospital requires specialized skill.
Six candidates were shortlisted from Australia, the U.S., Trinidad and Tobago and the U.K. with only one Jamaican among them. Then-Interim CEO Fitzgerald Mitchell was added to the pool because he was already acting in the role but came last or second-to-last in the interviews, according to Chai Chong.
By round robin —where votes were submitted by email rather than at a meeting —the minutes show a majority of the board decided to proceed with Hosein. Chai Chong told 18° North she had a “tremendous resume.” Of note, her resume shows she had experience leading teaching hospitals.
Hosein subsequently visited the island and met with staff, members of the management team, some board directors and Health Minister Dr. Christopher Tufton.
Upon Hosein having visited, member Dr. Ronald Robinson, a former senator and junior minister under the Bruce Golding administration, questioned at the Sept. 20, 2023 meeting whether “a white woman from Ireland in her sixties” could immerse herself in Jamaican culture. Lisa Soares Lewis of Great People Solutions, the firm that led the search, defended the choice, pointing to Hosein’s actions and passion. She also cited former Jamaica Public Service CEO Kelly Tomblin, another white foreign executive, as proof that Jamaicans were receptive to outsiders who delivered results.
While Robinson praised the search process, he wondered how the decision would play out publicly and politically, pondering “if there was no Jamaican or black man or woman who could have gotten the job and was the Board prepared to offer them the same salary as the overseas candidate.” According to the minutes, the prescribed government basic salary for the CEO was $12.96 million (US$83,618) per year, and the board was seeking another $10-$12 million (US$64,520 - US$77,424) annually from the private sector to bolster the CEO Designate’s pay.
Prof. Horace Fletcher cautioned that making decisions based on anticipated political fallout risked favoring political people. Robinson objected and said that wasn’t the point he was making but countered that, whether the board liked it or not, “there were political ramifications.” Chai Chong maintained the process had been "fair and without bias," noting that neither the health minister nor the permanent secretary had cautioned against Hosein's selection. Board member Donovan Betancourt recommended a public relations team to explain the appointment.
Color and race continue to play a role in Jamaican society
Recruiter Dr. Leahcim Semaj, who has worked for both the public and private sectors, says the board’s deliberation was, “not an unreasonable discussion” because the preference is to find someone who is not only qualified but also a cultural fit who’ll command respect from the organization.
“Those kinds of discussions take place, but you don’t necessarily put that in writing,” Semaj said.
University of the West Indies Professor Emerita Carolyn Cooper says race remains a sensitive issue in Jamaica despite the national motto, “Out of Many, One People.” She pointed to the racist taunts directed at white Opposition Leader Mark Golding as evidence that race continues to shape public discourse and says if a white woman was hired for the top job at UHWI, “Some people would see her as an inappropriate hire in a predominantly black society.”
But Hosein doesn’t see it that way and said after being told by 18° North about the board discussion on her personal characteristics, “My race and gender were irrelevant, I believe,” and added that she has led healthcare organizations in the UK with up to 56 different nationalities and has also been married to a Trinidadian for 40 years.
If anything, she said in an earlier phone interview, staff she met viewed her foreignness as a plus because they wanted change from an independent person with “no connection to anything.”
Comments about age
Jamaica’s Charter of Fundamental Rights and Freedoms (Constitutional Amendment) Act, 2011 guarantees every person the right to freedom from discrimination on the grounds of being male or female, or on the basis of race, place of origin, social class, color, religion or political opinions. However, on the UHWI board discussions about Hosein, constitutional law expert Dr. Lloyd Barnett cautioned that “a complaint on constitutional breach is based on action that affects the person, not discussion about problems that may arise.”
Hosein’s age also came under scrutiny at the Sept. 20 and Oct. 3, 2023 board meetings.
Senior Director, Clinical Services (SDCS) Dr. Carl Bruce argued that a transformational leader should not be retired and questioned whether there had been an age range set for the CEO role. He noted that before the board was asked to ratify Hosein’s appointment, members should have seen due diligence documents, including a psychometric test, police report and medical report, “especially for an elderly person.” Unlike countries like the United States and Canada, there appears to be no explicit prohibition in the law against age discrimination in Jamaica.
Soares Lewis responded that the position was a fixed-term contract, which allowed for flexibility, “even with age,” and confirmed that due diligence was the employer’s responsibility. Chai Chong chimed in that Hosein’s visit was part of that process and that it was customary for the contract to be awarded subject to the psychometric test and the medical. The board then agreed they would require a police report and psychometric test, though the minutes didn’t specifically mention requiring a medical.
BBC reported in 2021 that Hosein had to leave her job as CEO of the East of England Ambulance Service NHS Trust (EEAST) because of ill health, including a severe bout of COVID. But, in her interview with 18° North, Hosein described herself as very fit and not even taking one pill. The BBC article quoted the EEAST chairwoman as saying that under Hosein’s leadership, “The trust moved from being the worst-performing ambulance trust in England to one that regularly met and even outperformed national standards.”
From the UHWI board minutes back in 2023, Prof. John Lindo reassured colleagues that “he did not see the candidate being hampered by her age based on his interaction with her” and described her as “a very solid candidate” with a fresh pair of eyes who could “bring the transformation to reality.”
Prof. Minerva Thame called her “a very confident woman” with much to offer, and Roger Anderson remarked that she was “energetic and full of passion.”
Hosein was selected but walked away anyway
Ultimately, the board selected Hosein despite her race, nationality and age, but it was Hosein who walked away.
She told 18° North that while most board members and staff warmed to her and seemed to want change, she sensed resistance from key influential figures.
She recounted how when she visited UHWI, then-Interim CEO Fitzgerald Mitchell refused to show her around despite being assigned to do so; Bruce, the SDCS, declined to meet with her and, she was told, said he would not report to her; and Health Minister Tufton was “not welcoming” and appeared to favor Mitchell.
The minutes of Oct. 3, 2023 record that Hosein turned down the offer “as she did not believe that she could make the necessary changes required for the transformation of the Hospital, due to the hostile environment in which she perceived she would be engulfed.” Hosein told 18° North the decisive moment came when the board later informed her it couldn’t make the governance and power structure changes she believed were essential for any CEO to succeed.
Mitchell eventually became CEO. Chai Chong says it was the decision by Tufton to reinstate Mitchell as acting CEO in December 2023 after his board had voted to replace him with another senior director at UHWI during the ongoing CEO search that prompted his resignation as chairman and the dissolution of his board. Tufton has since dismissed the claim, saying, “Ministers don’t appoint CEOs” and said there was no evidence that the board had taken such a decision in the first place for him to have then overturned it.
Mitchell is now on accrued leave amid a fraud squad investigation following a damning Auditor General’s report in January 2026 into procurement breaches and management and governance failures at UHWI dating back to 2019. He has declined to comment on the report or appear before the PAC probing the allegations.
A review committee established in response to the report later identified some of the same governance and power structure problems Hosein said had convinced her she could not succeed as CEO.
Among its recommendations was eliminating the anomaly, as stated in the 1948 UHWI Act, that makes the Chair of the Hospital Medical Committee — a position held by Bruce as SDCS — an ex-officio member of the board, but not the CEO. It also recommended hiring international transformational expertise in hospital administration for at least a year to provide fulltime board support to institute change.
“We do not have, in my humble personal opinion, the level of expertise available here in Jamaica in relation to teaching hospitals,” review committee chairman Howard Mitchell said in May. “The choice of that expert is critical.”
UHWI has since put out an international tender for a consulting firm with such expertise and a deadline of August 24, 2026.
As the institution faces continued criticism over poor patient care, lack of resources and failures of management and governance, the question is: will this next attempt to enlist international expertise also involve talk about race, age and nationality, or will the board’s sole focus be on removing whatever hurdles exist in order to fix the hospital?
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Editing help from ChatGPT.
Exchange rate used was J$154.99:US$1, the average sell rate on the Bank of Jamaica’s website for 2023.
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