St. Maarten Hospital adds two specialists

POSTED: 05/17/13

GREAT BAY – The St. Maarten Medical center SMMC had added General Surgeon Dr. Robert W.J. Muller and pediatrician Dr. Martijn E.C. Tilanus to its staff of specialists.

Dr. Muller, who has 25 years of experience in his field, started working at the hospital last Monday. Dr. Tilanus will begin on June 1.

“The employment of these specialists is an important initiative in providing quality care to the general public,” the SMMC stated in a press release. “The new general surgeon and pediatrician will be working together with General Surgeon Dr. Holiday and Pediatrician Dr. Offringa respectively. St. Maarten Medical Center looks forward to a good working relationship with the specialists and hopes to employ more specialists to serve the community of St. Maarten and its neighboring islands.”

Next week Saturday SMMC-representatives will be at the Flinx Recruitment Expo Dutch Caribbean (Fred) at the World Trade Center in Rotterdam to attract more specialists and medical professionals to work in St. Maarten.

Bron: Today Newspaper St. Maarten

De Weever congratulates SMMC on new specialists

Monday, May 20, 2013 CAY HILL – Health Minister Cornelius de Weever commended St. Maarten Medical Center (SMMC) Sunday on its recent hiring of an additional peadiatrician and general surgeon.

TDH 20-5-2013 Specialists

Bron: The Daily Herald St. Maarten

Nurses Association focuses on improving health care on St. Maarten

TUESDAY, 07 MAY 2013

~ International Nurses Week opens ~

CAY HILL–Improving health care and closing the healthcare gap are among the things on which the St. Maarten Nurses Association will focus this year, Association President Candida McRae said at the opening of International Nurses week at St. Maarten Medical Center (SMMC) on Monday.

The opening ceremony featured the hoisting the St. Maarten Nurses Association Flag outside the SMMC building and the cutting of a huge celebration cake presented by SMMC management.

Prime Minister Sarah Wescot-Williams and Health Minister Cornelius de Weever were among the dignitaries who attended the ceremony. Nurses also took part in the annual Torch Walk from Raoul Illidge Sports Complex to Taloula Mango’s on Boardwalk Boulevard (the Great Bay beach promenade) on Monday evening in celebration of the week, which runs May 6-13.

McRae said during the opening ceremony that nurses found themselves in the unique position of being able to influence the way people think, feel and act, and as a result nurses should feel encouraged to join a professional body targeted toward enhancing their profession and allowing their voices to heard as they continued to work with government and others to strengthen the health system and create the conditions necessary to maximise their contribution.

“For this nurse’s week and throughout this year we will be focused on closing the gap and improving healthcare by taking a closer look at the Millennium Development Goals and how they can help to improve health care on our little piece of the world.”

International Nurses Week is being observed under the theme: “Closing the Gap: the Millennium Development Goals: 8, 7, 6, 5, 4, 3, 2, 1.” McRae said this slogan was intended to be a countdown to 2015, with an emphasis on the health-related goals.

The adoption of the Millennium Declaration by the UN General Assembly in 2000 resulted in the creation of the Millennium Development Goal (MDG) framework, which has been used to galvanise development efforts, set global and national priorities, and focus attention, action and resources.

Eight MDGs with a range of targets and indicators were developed and agreed. Taken together, these provide an holistic framework for sustainable poverty reduction and development. Three goals – numbers 4, 5 and 6 – are specifically related to health and their achievement is closely linked to the other goals, including those focused on poverty, hunger, gender equality and women’s empowerment.

“When we take an in-depth look at the MDGs, we might be prone to ask ourselves what they have to do with St. Maarten. Well, though we may not face some of these problems on a large scale, we too can improve our health care as it refers to the MDGs 4, 5 and 6 and adapt the MDGs to suit our situation.

“We can improve maternal health and thus reduce child mortality and we are all aware of the fight to combat HIV/AIDS. We too here in St. Maarten have families in our community that are struggling with poverty, and to this fact we cannot turn a blind eye,” said McRae.

“The ICN is encouraging nurses to engage in advocacy and lobbying. We must be involved in the development of any programme introduced to improve health services, as it is nurses who have the practical knowledge of how health service delivery can be designed, coordinated and effectively implemented.”

She said national nurses associations (NNAs) also were being encouraged to assume an important role in informing, advising, encouraging and supporting nurses in their work. NNAs are being encouraged to continue to work with governments and others to strengthen health systems and create the conditions necessary to maximise nurses’ contributions.

“The St. Maarten Nurses Association since its inception has been working together with the government of St. Maarten to create, enhance and improve the communication channels, which will help to improve health services on our island for the good of our population,” she said, thanking all the nurses in St. Maarten for their hard work and dedication.

Prime Minister Sarah Wescot-Williams commended nurses for being committed to their calling and for the improvement of health care.

SMMC’s new General Director Yvonne van Ameijden said she was happy to note that patient care at SMMC had been in order when she arrived, giving her time to focus on other things.

Patient Care Manager Tony Pantophlet said the fact that nurses were present must mean something for patients. He said patients might not remember their doses of medication or the injections they had been given, but they would remember the warmth, smile and nurse’s touch given.

A number of other activities are planned this week for International Nurses Week, including lectures and social functions.

Statia and Saba present clear-cut ideas to save health care cost

FRIDAY, 19 APRIL 2013

THE HAGUE–Cease referrals of patients to Guadeloupe, send more patients to Bonaire and other hospitals in the region, fly medical specialists over to St. Eustatius and Saba, and expand the cooperation between the Amsterdam hospitals and St. Maarten Medical Center (SMMC).

These are some of the concrete proposals representatives of St. Eustatius and Saba have put forward in talks with the Dutch Ministry of Public Health, Wellbeing and Sports VWS. The meeting, which is taking place in St. Maarten, started on Thursday and will continue today, Friday, with the various health care institutions.

The Executive Councils of St. Eustatius and Saba have outlined their wishes and suggestions, which should lead to substantial savings in health care cost, in a lengthy joint letter that was sent to Dutch Minister of VWS Edith Schippers on Thursday. At least US $1 million per year could be saved by organising health care and referrals more cost-effectively.

Schippers wants to reorganise the health insurance package and exclude a number of treatments such as dental hygiene and physical therapy per July 1, 2013, in an effort to reduce the increased health care cost in the Caribbean Netherlands.

It was agreed during the last Caribbean Netherlands week in The Hague that the Minister would reconsider her original plans if an alternative plan could be realised. This plan had to reduce health care cost by $2 million without actually harming the quality and extent of health care on the islands. The governments of St. Eustatius and Saba went to work right away and started talks with health care providers.

One of the most direct suggestions in the letter of the two island governments that The Daily Herald has obtained is to terminate the contract to refer patients to Guadeloupe in 2013 or at least to stop reserving structural cost for apartments and personnel.

According to St. Eustatius and Saba, the cooperation with Guadeloupe to treat patients from the islands has not led to the “desired results and is now a structural burden,” considering the limited use and the relatively high patient cost.

Patients are positive about the quality of care offered in Colombia, but the long and unnecessary waiting times at the hospitals there lead to needless travel and lodging cost. Colombia doctors also tend to perform additional tests that are unrelated to the original reason for referral, which St. Eustatius and Saba called a “total makeover attitude.”

Flying in medical specialists to St. Eustatius and Saba is much more cost-effective and less time-consuming for the patients. A visiting medical specialist will cost about $1,500 per day, whereas the cost of sending 10 patients to hospitals in the region is between $3,500 and 5,000. The visiting medical specialists could be flown in from Bonaire’s Mariadal Hospital, which has a cooperation agreement with the VUmc and AMC hospitals in Amsterdam.

More patients could be sent to Bonaire, as this would cut down the number of referrals to Colombia. There is sufficient operation capacity at Mariadal Hospital. “The safety and quality of care is also safeguarded there and the money would be spent within The Netherlands,” stated the Statia and Saba Executive Councils in their letter. A proper connection by air between the Windward Islands and Bonaire is imperative.

St. Maarten and St. Martin are also an option to reduce cost. “We remain of the opinion that basic and acute care can best be delivered by SMMC. For this reason, we consider it desirable to resume the cooperation between the Bonaire hospital and SMMC and to extend the twinning between Amsterdam and SMMC.”

The Executive Councils further pointed out that a medical test, scan or ultrasound is less expensive in French St. Martin than in Guadeloupe. Referrals to Puerto Rico also should be considered seriously.

Making use of so-called E-health, communicating via video conferencing or the Internet, could further save travelling cost, as it offers prospects to communicate with doctors at the hospitals in Bonaire, St. Maarten, Colombia and The Netherlands about diagnostic results.

Savings are also possible at the Health Insurance Bureau ZKV where, according to St. Eustatius and Saba, “unnecessary management and administrative cost” is incurred because of bureaucracy, excessive personnel and too many intermediates, and bad planning resulting in unnecessary travel and lodging expenses.

Representing St. Eustatius at the mini-conference in St. Maarten on Thursday and Friday with the Ministry of VWS and health care institutions are Commissioner Koos Sneek and Island Secretary Jan Helmond.

Saba’s Commissioner Bruce Zagers is accompanied by Saba Health Care Director Dr. Joke Blauboer and Saba Health Care Foundation Chairman Sydney Sorton. Commissioner Zagers said in a press release on Thursday that it was “imperative” to find a solution to reduce cost while maintaining the quality of health care on the islands.

Minister De Weever: local institution willing to finance St. Maarten Medical Center expansion project

TUESDAY, 16 APRIL 2013

PHILIPSBURG–Health Minister Cornelius de Weever said he has been in discussions with “one of our local institutions” that is willing to finance the entire St. Maarten Medical Center (SMMC) expansion project.

“They don’t even have to float a bond,” De Weever said during Monday’s plenary session of parliament on the draft 2013 budget.

The minister did not name the local institution in question. Alluding to a question that had been asked during the meeting of the Central Committee of Parliament last week about the cutting of SMMC’s subsidy, the minister said SMMC had “never really used it last year.”

He said too that the medical centre never made use of the services of the Central Bank, even though he had “introduced” them to bank officials to work on a bond issue. “They [SMMC - Ed] chose to go with another company. That is beyond my control, that was the board’s decision. I believe that we should continue the communications and try to resolve these issues.”

SMMC had been exploring several options for its expansion.

Minister De Weever assures St. Maarten Medical Center issue has his full attention

MONDAY, 15 APRIL 2013

PHILIPSBURG–Health Minister Cornelius de Weever said on Sunday that the serious governance issues at the St. Maarten Medical Centre (SMMC), which resulted in the end of the specialist care cooperation with two Amsterdam hospitals has his “full attention.”

De Weever’s comments were in reaction to the statements made by Minister of Home Affairs and Kingdom Relations Ronald Plasterk on the issue in a letter to the Second Chamber of the Dutch Parliament, which was published by The Daily Herald on Saturday. The letter, also sent on behalf of Minister of Public Health, Well-being and Sports Edith Schippers, was a response to the agreements that the four Parliaments in the Kingdom made during their meetings in The Hague in March this year.

De Weever said in a press release on Sunday evening that “Great efforts have been and are still continuously being made by both my Ministry and the Inspectorate of Health to address these issues. These efforts have resulted in the placement by the Health Inspectorate of SMMC under intensified supervision and the subsequent issuance of 14 orders by the Health Inspectorate to SMMC, to address amongst others several governance matters, or else pay significant fines.”

De Weever said one of these measures was the much discussed measure to either terminate the contract with former Board Chairman Dr. George Scot, or terminate the contract with his consultancy firm ANG Consulting N.V. “Although SMMC is still opposing all the imposed measures through litigation, it has meanwhile complied with some of them. There has consequently been some improvement. There is, however, still much work to do and I can only hope that with the appointment of a new interim director of SMMC recently the era of constant opposition and litigation by SMMC will be replaced with the much needed collaboration, dialogue and decisive actions, so that our combined efforts can promptly resolve the existing issues.”

The minister said the cooperation with AMC and VUmc is important for both

St. Maarten and our sister islands Saba and St. Eustatius. Conditions must be set for the prompt realization thereof.

Governance issues at St. Maarten Medical Center ended specialist cooperation

SATURDAY, 13 APRIL 2013

THE HAGUE–Serious governance issues at St. Maarten Medical Center (SMMC) have ended the specialist care cooperation with two Amsterdam hospitals, Minister of Home Affairs and Kingdom Relations Ronald Plasterk confirmed on Thursday.

He stated this in a letter to the Second Chamber of the Dutch Parliament. The letter, also sent on behalf of Minister of Public Health, Wellbeing and Sports Edith Schippers, was a response to the agreements that the four Parliaments in the Kingdom had made during their meetings in The Hague in March this year.

Plasterk explained that the assistance offered by the Dutch Ministry of Public Health, Wellbeing and Sports VWS to expand medical specialist care from Bonaire to St. Maarten through the cooperation with VUmc and AMC from Amsterdam had ended due to “serious governance problems at SMMC.”

For a while medical specialists from the two Amsterdam hospitals worked both in Bonaire and in St. Maarten last year. This brought much needed additional specialist care to the islands.

Minister Plasterk provided no further details on what had caused these serious governance problems. VWS has also offered policy support to Curaçao several times. The hospital is not functioning up to par there either.

The Minister stated that his colleague Schippers applauded the wish of the four Parliaments in the Kingdom to seek closer cooperation in the area of health care in an effort to improve health care within the Kingdom.

Cooperation between the countries can be stimulated through policy of the various governments. But further development in this area depends on the local situation per hospital and per country. “The influence of the policy is limited because of the space of the various health care systems and the private health institutions.”

The countries have little say on policy decisions and the concentration of medical specialist care at the local hospitals, as these are private institutions. The hospitals in charge of specialist care and a possible cooperation with each other are imbedded in the health care insurance systems of the various countries. “These systems are currently undergoing major changes in Curaçao and St. Maarten.”

Plasterk and Schippers concluded that for the cooperation in the health care sector to be successful the countries must first have their own internal health care policies in order before any mutual agreements can be made.

Making agreements where it comes to health care can be useful, but countries should not set their expectations too high for the health care summit that Aruba wants to organise later this year, stated the Ministers. VWS is prepared to help with policy making, but will not make funds available for health care institutions in the countries. “This remains a responsibility of the individual countries.”

Where it comes to medical referrals abroad, Plasterk and Schippers were of the opinion that the countries first have to get their policy, including legislation, in order if the countries want to make cooperation in this area and a possible reduction of the cost of sending patients abroad a success.

Cooperation in the area of organ transplantation and matching, an idea originally brought forward by St. Maarten’s President of Parliament Rodolphe Samuel, is only possible if the entire health care system is readied to collect and match organs. “This involves a complete system of donor organisation with accompanying medical teams and legislation. The question is whether the limited scale of the islands is suitable for this.”

St. Maarten Medical Center gets new general director

THURSDAY, 04 APRIL 2013

CAY HILL–Three months after the departure of Dr. George Scot, St. Maarten Medical Center (SMMC) has a new General Director as of April 1.

SMMC’s Supervisory Council announced on Wednesday, that it has appointed Yvonne van Ameijden as the Chairperson of the Board of Directors and Interim Financial Director. The Chairperson of the Board and the General Director of SMMC are considered the same position.

Van Ameijden holds a masters degree in Strategic Business Administration. She has a vast experience in top management positions in various health care organisations including a nurse care and home care organisation with over 1,200 employees, and being the operations manager for the laboratories and pharmacy division of the university hospital of Utrecht in The Netherlands as well as holding a position as interim manager at ADC in Curaçao from 2002 to 2003, it was stated in a press release on Wednesday. She was scheduled to arrive in St. Maarten on Wednesday evening.

As interim manager she has assisted diverse organisations with the development of quality improvements, cost reductions and development and implementation of strategic policy measures, it was stated in the release.

“After executing an extensive interview process with several candidates we believe that Mrs. van Ameijden is a good fit for the interim position at the SMMC, and we are very pleased that she has accepted,” said Chairman of the Supervisor Council of SMMC Dr. Izzy Gerstenbluth.

The review of the organisational structure is one of the priorities of the St. Maarten Medical Center. Mid last year, SMMC had commissioned an independent agency to conduct an organisational scan of the hospital. Based on that the Supervisory Council has decided to fill the Board of Directors with two positions: a Financial Director and a Medical Director.

Currently the open recruitment process to fill said positions in the Board of Directors for the long term is ongoing. This is a separate process that is not connected to the interim position.

“St. Maarten Medical Center will continue, as usual, to work towards improving the level and quality of care for the benefit of all the residents of St. Maarten, Saba and St. Eustatius and surrounding islands. We look forward to doing so in collaboration with our stakeholders,” it was stated in the release.

St. Maarten Medical Center launches new website

TUESDAY, 19 MARCH 2013

CAY HILL–St. Maarten Medical Center (SMMC) unveiled its new Website on Monday, one day after the operational anniversary of the hospital.

The new Website – www.smmc.sx. – is designed to provide Internet users with up-to-date information about the hospital. Patients can be ‘prepped’ for their hospital experience by obtaining useful information and tips within the Patient Care web pages.

The Website provides visiting information for family and friends, and also serves as a channel for job seekers, who are interested in having a career at SMMC.

As the primary medical institution for St. Maarten and neighbouring territories, an informative and user-friendly Website is an important aspect of its communications. “We want our Website to serve as the primary source for information about our institution,” says SMMC Human Resource/Communications Manager Juliëtte Hassell.

“We are also pleased to be among the early group of users supporting the new domain name for St. Maarten .sx. Finding our Website will be easy for Internet users searching for our Website with the ‘short name’ SMMC.” The other web addresses (www.sxmmc.org and www.sintmaartenmedicalcenter.org) are also still open, so persons using those links will be directed to the new Website.

“We want our patient care experience to begin at your homes and on your mobiles with a comprehensive knowledge of our institution, and we are proud to do so by providing a simple and user-friendly experience on our Website. We invite you to visit our pages,” said Hassell.

The new Website will be on display at the Lions Health and Wellness fair on March 23; this is an opportunity for persons to navigate the Website and give feedback about their web experience.

As a continuation of International Women’s Day, Women’s Health will be a featured topic at the Health and Wellness fair, particularly hypertension during pregnancy. Hypertension is one of the most frequent ailments in St. Maarten. This is not only a challenge to St. Maarten; in fact, hypertension is this year’s theme for World Health Day on April 7.

SMMC has chosen to address this health topic by providing useful information and high blood pressure screenings at the fair. The community is invited to attend and visit the SMMC booth.

Statia, Saba look at direct patients’ flight to Bonaire

THURSDAY, 14 MARCH 2013

THE HAGUE–As St. Maarten seems to have little enthusiasm for upgrading St. Maarten Medical Center (SMMC) to provide St. Eustatius and Saba with specialist health care, the islands have taken it upon themselves to explore options for a direct flight to Bonaire so patients can be treated at Mariadal Hospital in Kralendijk.

Statia Commissioner Koos Sneek announced on Wednesday evening that the islands, together with the Dutch Ministry of Public Health, Wellbeing and Sports VWS, are looking for a direct flight from St. Eustatius to Bonaire so they can transport 20-24 patients from St. Eustatius and Saba to the hospital in Bonaire.

The level of specialist care at SMMC is not what it should be, also because cooperation with Amsterdam hospitals VU Medical Centre and AMC didn’t work out. “A number of specialists that were working there under the agreement with the VU and AMC have left disappointed,” said Sneek at a dialogue gathering with people from the islands in The Hague, organised by the Consultative Body for Dutch Caribbean persons in The Netherlands OCaN.

“It is our wish and also that of The Hague to concentrate more on St. Maarten, whereby The Netherlands is willing to assist the SMMC and to support moves to increase specialist care, as this would reduce the need for referrals to Colombia and Guadeloupe,” he said.

However, he added, “Up to now there seems to be little enthusiasm on the part of St. Maarten.” He noted that the care currently offered at Mariadal Hospital was better, because Dutch specialists work there and the range of specialist care has expanded.

Investment in upgrading SMMC has not materialised. This investment is important for St. Eustatius and Saba for the referral of their patients for specialist care. “Our people want to stay closer to home for medical care, even though health care in Colombia is top of the line,” said Sneek.

According to Sneek, investment in SMMC would benefit the people of St. Maarten as well as the people from St. Eustatius and Saba. The medical referrals, some 24 persons on a daily basis, contribute to St. Maarten’s economy. Patients use Windward Islands Airways International Winair, busses, taxis and rental cars, they eat in restaurants and if necessary they spend the night in a hotel.

“It is clear that good relations are beneficial both for St. Maarten and for our islands,” said Sneek.

In the event of a medical emergency St. Eustatius and Saba have an emergency helicopter on standby. This helicopter has been stationed in St. Eustatius since last year. “As SMMC is the first destination for our medical emergencies, some improvement in the relations between our islands is desirable, not only where it comes to SMMC, but also regarding services at Princess Juliana International Airport, which leave a lot to be desired.”

The Commissioner reported that the Bonaire, St. Eustatius and Saba delegations had had a “very good meeting” with Dutch Minister of Public Health, Wellbeing and Sports Edith Schippers on Wednesday. “It was better than we and she had expected.”

Parties discussed ways to reduce the cost of sending patients abroad to hospitals in Guadeloupe and Colombia, which amounted to US $85 million in 2012. “World-class, quality healthcare is provided there, but at a very high cost,” said Sneek.

Because of the increased cost of health care on the islands and the need to slash the health care budget in The Netherlands, Minister Schippers announced late December last year that she would take dental work and physical therapy out of the health care package on the islands.

The islands presented a counterproposal on Wednesday. “We too see that money is wasted, but we think there are other ways to save cost without taking dental care and physical therapy out of the package. With our proposal The Netherlands saves money and we keep the package, which is a win-win situation for everyone,” said Sneek.

Interparlementair Koninkrijksoverleg wil aan tafel met alle partijen gezondheidszorg

DONDERDAG, 07 MAART 2013

ORANJESTAD/DEN HAAG — Bij samenwerking in de gezondheidszorg zijn zoveel partijen betrokken dat het beter is om een grote Koninkrijksconferentie over het complexe onderwerp te houden, inclusief de deelname van Curaçao. Dit voorstel van het Arubaanse onafhankelijke Statenlid Mervin Ras, voorzitter van de commissie gezondheidszorg, kreeg woensdag de steun van alle delegaties tijdens het Interparlementair Koninkrijksoverleg (IPKO).

Ras constateert dat de samenwerking met Nederlandse instellingen en met de Pan American Health Organization eigenlijk beter verloopt dan de samenwerking tussen de overheden van Aruba, Curaçao, St. Maarten en Nederland. Als voorbeeld noemde ze de oude afspraak tussen Curaçao en Aruba om zich op één terrein te specialiseren, hetzij oncologie of cardiologie, zodat patiënten onderling uitgewisseld konden worden. De plannen voor een cardiologisch centrum in San Nicolas sneuvelden echter door politieke onenigheid en Curaçao wil inmiddels beide expertises aanbieden in het nieuwe ziekenhuis. Het Arubaanse onafhankelijke Statenlid Booshi Wever – die voorheen als minister van Volksgezondheid het cardiologisch centrum wilde realiseren – merkte op dat de apparatuur voor het cardiologisch centrum inmiddels ligt weg te roesten.

Ras stelde daarom voor om een grote conferentie te houden, waar niet alleen overheden, maar ook particuliere zorginstellingen en verzekeraars over samenwerking praten. Eerste Kamerlid Ruard Ganzevoort (Groen Links) noemde ook patiëntenorganisaties als een belangrijke partner. “Het zou goed zijn als onze regeringen bij elkaar komen, want het terrein gezondheidszorg is erg breed. De Gezondheidsraad zou dit kunnen voorbereiden”, zei Ras, die expliciet ook Curaçao uitnodigde om mee te doen. De Curaçaose delegatie maakte immers geen deel uit van de werkgroep gezondheidszorg, omdat de Statenleden tijdens het vorige IPKO besloten dat gezondheidszorg een autonome aangelegenheid is en de opbouw van Curaçao bovendien veel tijd vergde. Statenlid Humprey Davelaar verzekerde de andere delegaties echter dat Curaçao weer volop deelneemt en vroeg ook aandacht voor samenwerking in de bijscholing van huisartsen en een onderzoek naar fouten in de gezondheidszorg.

Ras zei vooraf aan de werkgroep overigens al met een voorstel te komen die was afgestemd met haar Curaçaose collega’s. Op Aruba bereidde ze bovendien ook een stuk voor in de vaste Statencommissie die over zorg gaat. Met inbreng van alle belanghebbenden uit de zorgsector en feedback van de minister van Volksgezondheid, was de conclusie opnieuw getrokken dat op de eilanden verschillende specialismen zouden moeten komen die vervolgens uitgewisseld kunnen worden.

Tweede Kamerlid Madeleine van Toorenburg (CDA) stelde tot slot voor om een kwartiermaker te benoemen, die de Koninkrijksconferentie over gezondheid voorbereidt. Ze noemde de naam van partijgenoot en voormalig Tweede Kamerlid Bas Jan van Bochove, terwijl de Arubaanse delegatievoorzitter Rene Herdé juist Mervin Ras als een geschikte kandidaat zag. De wens voor het houden van een gezondheidsconferentie zal onderdeel uitmaken van de IPKO-besluitenlijst.

Uitbreiding St. Maarten

St. Maarten vroeg nog specifiek om hulp voor het uitbreiden van het St. Maarten Medical Center. “Strategisch en geografisch is St. Maarten de beste locatie voor patiënten van Saba en St. Eustatius, maar om een uitbreiding te realiseren hebben we financiering nodig. Ik kijk beleefd naar de delegatie van Nederland om ons hiermee te helpen,’’ aldus onafhankelijk Statenlid Lloyd Richardson, die een bedrag van 30 miljoen gulden noemde. Eerste Kamerlid Marijke Linthorst (PvdA) vroeg of St. Maarten ook niet zelf actie kan ondernemen door inkomsten uit medisch toerisme te gebruiken voor de financiering van de gewone medische zorg. Richardson zei dat dit weliswaar het streven is, maar dat hier zoveel partijen bij betrokken zijn dat het lange tijd kan duren. Ook benadrukte hij dat St. Maarten niet direct om geld vraagt, maar om een bemiddeling bij het afsluiten van een voordelige lening.

Presentation for medical tourism on St. Maarten by American Clinic B.V.

POSTED: 03/7/13

St. Maarten – Today, the American Clinic B.V is expected to make a presentation to the Council of Ministers on its plans for medical tourism on St. Maarten.

During the launch of its governing program, the government indicated that it was fully committed to the realization of medical tourism on St. Maarten which is expected to make the country, “the wellness center of the Caribbean.”
Critics of the initiative have indicated that more effort should be placed on developing St. Maarten lone healthcare facility, the St. Maarten Medical Centre.

Prime Minister Sarah Wescot-Williams confirmed the meeting yesterday, adding that it is customary for the Council of Ministers to meet with third parties on Thursdays, along with its regularly scheduled Tuesday meetings.

One of the initiators of the American Clinic here that is expected to expose the island to medical tourism, Dr. Samuel Hess was featured in the American media article, as he along with other doctors contributed to the discourse on alternatives to Obama Care such as medical tourism. A Memorandum of Understanding has already been signed with the American Clinic under the previous administration. Yet there are other health professionals knocking on the island’s doors to set up shop. The island offers a therapeutic, private and on occasion, less costly environment.

A Florida-based orthopedist Hess is part of a group that’s working to open a full-service hospital here. Hess was quoted as saying that, he’s grown “tired of the legal and bureaucratic headaches of practicing medicine in the U.S. I still love what I do, but the issues I have to deal with that have nothing to do with patient care take a lot of wind out of my sails. We have to assign more and more of our staff to address insurance concerns and approvals. We order tests we don’t need to cover ourselves legally,” he said.

St. Maarten boasts natural hub assets, such as location and accessibility and this will be maximally exploited to attract regional travelers, the government says.

“These assets also make our island a preferred destination for off-shore educational and medical facilities, attracting a new type of tourism. Diversification and serving up market type tourism (medical, VIP clients, niche markets, ecological and marine tourism) may possibly be a policy recommendation for reinventing the economy as promoted by economic diplomacy in the region,” the government program stated.

Hess would also like the freedom to offer treatments that aren’t legal yet in the U.S. Medical tourism offers doctors and patients a way around the FDA’s often slow-moving approval process.

Under its project description that was presented some two years ago, the American Clinic establishes the intention to open temporary offices “to commence the treatment of island residents covered under the SZV and /or private insurance.” The clinic also is to establish relationships with the University of St. Martin and the American University of the Caribbean in Cupecoy.

Apart from its meeting with the American Clinic, the Council of Ministers will also meet today with Mavis Albertina, the coordinator of the Dutch Caribbean celebration activities for the coronation of King Willem. St. Maarten’s participating in the historical event at the end of April, will be discussed.

St. Maarten delegation seeks support for soft loan to SMMC in The Hague

THURSDAY, 07 MARCH 2013

THE HAGUE–The St. Maarten delegation has asked The Netherlands for support to realise a soft loan of NAf. 30 million to expand and upgrade St. Maarten Medical Center (SMMC) during a meeting of the Inter-Parliamentary Consultation of the Kingdom IPOK on Wednesday.

Member of St. Maarten’s Parliament Lloyd Richardson (NA), who brought up the issue, said the soft loan was needed to finance a structural expansion of SMMC, which would enable the hospital to increase its services in the areas of neurology, orthopaedics, cardiology and urology.

“We kindly look to you to support this. We ask your cooperation and understanding,” said Richardson, who explained that the expansion and upgrading would not only benefit the people of St. Maarten, but also the residents of St. Eustatius and Saba. “The idea is to offer health care as close to home as possible. However you look at it, St. Maarten is the best place for specialist care for St. Eustatius and Saba,” he said.

Member of the First Chamber of the Dutch Parliament Marijke Linthorst of the Labour Party PvdA said it was important to maintain the lucrative services of health care at the hospital. One of the ways to make SMMC profitable is through medical tourism, she said.

According to Linthorst, it was “unacceptable” that government should support a hospital that loses money while private clinics make money by offering lucrative medical services. “What is your government doing to make sure that the lucrative medical treatments flow back into the hospital?” she asked. “It is not right to ask The Netherlands for help with a loan while your government doesn’t do what it should,” she said.

Richardson responded that St. Maarten wasn’t asking for money, but merely for support by the Dutch to negotiate a low interest loan. He said that the St. Maarten Government was looking into the aspect of private clinics, but added that the SMMC project was urgent and the clock was ticking.

Member of the Second Chamber Ronald van Raak of the Socialist Party (SP) said there was no way he would support a soft loan for SMMC. “My colleagues and I looked at each other when St. Maarten came with that request and we all had the same thought: we will not support that,” he told The Daily Herald after the meeting.

Other aspects discussed at Wednesday’s meeting on health care in the Dutch Caribbean included dividing specialist care between Curaçao and Aruba. The two countries want to specialise in the same medical area which is oncology, whereas the initial idea was that Aruba would specialise in oncology and Curaçao in cardiology. Member of Aruba’s Parliament Mervin Ras (AVP) explained that Curaçao was now focusing on oncology and radiology.

Independent Member of Aruba’s Parliament Booshi Wever pointed out that Aruba already had the equipment to offer specialist cardiology care, but the equipment was rusting at the closed Cardiology Centre in San Nicolas. He said Aruba should stop focusing at oncology and concentrate on cardiology – the market was too small for two neighbouring countries to have the same specialisation and this would not benefit the patients.

The Parliamentary delegations agreed to urge their governments to facilitate organising a health care conference in Aruba later this year to discuss this and other health care-related issues on the local and Kingdom levels. Governments, hospitals, health care insurance providers and patient organisations would be invited.

Member of the Second Chamber of the Democratic Party D66 Wassila Hachchi said cooperation in health care was also important in the interest of the people of the Dutch public entities Bonaire, St. Eustatius and Saba.

Member of the Second Chamber Pierre Heijnen of the Labour Party PvdA remarked that it was essential to prepare well for this conference. “The success of a conference depends on a solid preparation. You have to be able to take concrete decisions,” he said. The delegations agreed to assign a quartermaster for the conference.

Former director St. Maarten Medical Center Scot: Constitutional change was main reason SMMC expansion not achieved

FRIDAY, 22 FEBRUARY 2013

~ Says: ‘It’s time for me to go’ ~

PHILIPSBURG–The uncertainty that accompanied the constitutional changes St. Maarten had been pursuing was the main factor responsible for the much-needed expansion of St. Maarten Medical Center (SMMC) not being realised when the hospital was ready for this step four years ago.

This was the view expressed by former SMMC Director and Board Chairman Dr. George Scot, who said SMMC had had everything ready for the expansion in 2009, but authorities had been focussing on the constitutional changes.
Scot said during his farewell reception at Great Bay Beach Hotel on Thursday evening that he believed the “next step” for the expansion was the one thing missing at SMMC.

The fact that SMMC has not expanded its facilities has had a very negative impact on many things and that certain things had not happened because of this, he said. Scot said he had “wondered” and had many discussions as to the reasons SMMC was not able to achieve its expansion.

“We were ready at SMMC for the expansion in 2009. Everything was finalised for that next step; the last part of that process was that the property was transferred to SMMC. We had the hospital, we had a lot of money on our account, … we had zero debt – zero, we had our contractors in place, we had the plans.

“Everything was ready to go, but I think one of the problems, the main problem in this, was the constitutional change,” Scot told the guests, who included Governor Eugene Holiday, ministers, other dignitaries and a cross section of the community in the health care, business and other sectors (see related story).

“That change brought with it uncertainty and if a financial institution like a bank or similar to that doesn’t like something then it is uncertainty. We thought we had a good plan, they [the bank – Ed.] told us it’s a good plan, but [there was – Ed.] uncertainty and for that uncertainty they wanted a guarantee and a guarantee they wanted from the government.”
Scot said that in 2009 St. Maarten was on the verge of 10/10/10 and the Central and Island Governments “were all busy with the restructuring process. They were not involved, convinced that this was the right time for SMMC to take the next step. They were busy with other things,” he said.

Scot said the expansion was important. “It’s now 2013, 10/10/10 has passed and I think it’s important that all stakeholders start to understand the potential of a healthy SMMC – healthy as an organisation, healthy financially and the potential to become a very, very good hospital in quality care, not only financial. And that step needs to be taken and I wish everyone, especially SMMC itself, good luck in achieving its next goal.”

Scot opened his speech by saying the farewell reception had been “very strange” for him, because it had felt like a funeral. However, he said he was happy with the presence of everyone at the reception, because he felt it was “time for me to go.”
He said a hospital was a very difficult institution to manage. He said too that a lot of emotion was involved in a medical institution, because people were born and died there at the same moment, with the same staff, who have to cope with all these different emotions on a daily basis.

Scot was high in praises for the SMMC staff, saying they were SMMC’s most important assets. “The fact that we achieved all of this in a few years’ time is all because of the dedication and the motivation and professionalism of the staff of SMMC. And that’s my keynote for this speech.”

“It is very important that everyone recognises and understands the importance of staff of SMMC during the good times, but for sure during the bad times.”

Scot said he had worked at the hospital with “a lot of satisfaction.” “Of course we had a lot of stressful times, but it didn’t feel stressful at times, because we always knew that we would get out of it in a positive way.”
He thanked SMMC for the reception and said he had been very impressed with everything that had been done. “I feel honoured and privileged about the fact that after a period of 10 years people can still say such nice things about you. That feels good too.”

Scot had a turbulent last few months at SMMC before leaving at the end of December.

St. Maarten Medical Center Council calls ‘timing’ of minister De Weever’s request ‘remarkable’

MONDAY, 18 FEBRUARY 2013

~ Will not ‘reconsider positions’ ~

CAY HILL–The St. Maarten Medical Center (SMMC) Supervisory Council will not “reconsider their positions” as requested by Health Minister Cornelius de Weever in a letter dated January 26.

De Weever has not responded to questions from The Daily Herald on Friday about his next step in this matter. He had asked the Supervisory Council, which has taken over the responsibilities of former General Director Dr. George Scot and two members of which reside off-island, to reconsider their positions. The minister had said that this bordered on mismanagement and negligence, and was unfortunate.

In a letter responding to the minister, a copy of which was sent to this newspaper along with a press release on Sunday, the Supervisory Council said “none” of its members believed there was any reason to reconsider their position, as each member had been and continuously was performing his/her duties in accordance with the articles of association of SMMC and any and all laws that apply to it.

The council said too that SMMC and its staff continuously were making all efforts to ensure that SMMC provided the best health care to its patients.

“We as a supervisory council are doing our utmost to ensure that this is done in the best possible manner and we hope that the Minister of Public Health will appreciate this and assist in this endeavour. You can always count on our cooperation,” the members said in their letter dated February 6, which was copied to the Council of Ministers and the Inspectorate of Public Health.

The SMMC Council said the timing of De Weever’s request was “remarkable” and it disagreed with the minister’s statements about mismanagement at SMMC. It said it had taken notice with “great regret” of De Weever’s letter request that “all” members of the SMMC Supervisory Council reconsider their position.

“Firstly, we feel that the timing of your request is remarkable, to say the least. As you have been fully informed by us, there is currently no managing director active at SMMC. Consequently, in accordance with the articles of association of SMMC, the Supervisory Council currently represents and is responsible for SMMC,” the Council said
“You state that it is imperative that the quality of health care provided at SMMC is safeguarded – it is unclear how your request exactly fits into this picture.

“Secondly, we do not agree with the incorrect statements made in your letter about the functioning of the Supervisory Council. Since you fail to substantiate any of the strong accusations made in your letter, we are not in a position to respond to this other than by stating that we disagree with the statements made. Please identify the matters which, in your opinion, constitute mismanagement and how the Supervisory Council in your opinion should have acted to avoid this,” the Council said.

“Thirdly, in your letter you mention that the largest investors have questioned the validity of the composition of the Supervisory Council hampering the further development of the SMMC. Please clarify to which investors you refer and how this would have hampered the further development of the SMMC in order for us to address this matter further,” the Council said.

In its release the Council said a number of statements had been made publicly again by De Weever recently regarding SMMC. “We regret this development. The Prime Minister Mrs. Sarah Wescot-Williams fairly recently requested all parties to refrain from publicly addressing any issues and St. Maarten Medical Center has chosen to honour this request.”
The Council said it agreed with the Prime Minister that holding public discussions was not conducive to further improving the care SMMC was are giving to its patients. The Council said SMMC’s dedicated personnel, patients who are residents of St. Maarten, Saba, St. Eustatius, the surrounding islands and the tourists it served had suffered enough of the “unfounded and negative public media display in recent months from the Minister of Health Care and certain members of Parliament.”

“The Minister of Health Care has now chosen to publicly discuss his request to the Supervisory Council of the SMMC to reconsider our position and has publicly referred to our response while taking this again totally out of context.”

The Council said it believed it was correct to forward to the media its official response given to the minister and said it would refrain from further comments, honouring the Prime Minister’s request.
“St. Maarten Medical Center will continue as usual to improve the care and services to all our patients who are in need of treatment, for their wellbeing and for the benefit of their families,” the Council said. “We look forward to doing so in collaboration with the Government of St. Maarten and the Inspectorate of Health.”

St. Maarten Public Health Minister De Weever outlines health care approach 2013 in governing program

POSTED: 01/18/13

St. Maarten – For 2013 it’s all about promoting jobs and protecting people, Dr. Cornelius de Weever said at Wednesday’s launch of the governing program.

With responsibility for the Ministry of Public Health, Social Development and Labour (VSA), de Weever has a budget of 59 million guilders and a staff of 139 civil servants with which to execute his many plans. While he remains a part of the National Alliance/Democratic Party/Independent-3 coalition, the minister assured that St. Maarten will continue along the course towards becoming the “wellness centre of the Caribbean.” But with some of his plans heading into 2016, and 2014 being an election year, only time will tell whether the Working for the People governing programme will run its course.

“The challenge is for us to be smarter and use our limited resources in an efficient manner,” the minister said.
He described his ministry as “the hardest working” ministry within the government apparatus to cheers of approval from the modest audience that was in attendance at the launch.
Strengthen government’s social agenda, renew or modify policies, reduce bureaucracy, strengthen supervision and adherence to legislation, national, regional and international cooperation and partnerships.

Labour
“As we acknowledge the first positive outcomes of employability programs, we recognize the global trend of high youth unemployment and therefore embrace the labour vision to ensure that the people of St. Maarten are fairly employed and that they apply themselves on the job,” the minister said.
This year he projects a proactive approach to job placement, effective registration and more use of the labour management information system (LMIS) to justify every decision that will be made.
Decisions such as the revision of the foreign employment legislation, short term contracts, the dismissal law and employment agencies will premised on data, Minister de Weever emphasized.

Health and Social Security
In the area of health and social security, the minister spoke of accelerating the quality of life, through a 4 year program. Improvements are to be phased out and extend to 2016.
His final destination?
“A supportive social security and health system that is based on clarity and good governance,” as well as “a system that gives the customer a central place.”
That vision the minister said makes provision for medical tourism and “ultimately ensures that St. Maarten becomes the wellness centre of the Caribbean where our population can experience an improved quality of life,” the minister stated.
He wants to do so through improvements in the basic health and social security infrastructure, additional regulations, more supervision, increased health promotion activities and data collection on the needs of the population.
In the area of public health, he plans to establish a water authority and push for policy reforms in quality of care, prevention and health education.
In the meantime, in the area of social development, he spoke only of increases.
“Increase pension benefits, even adding a second layer in our pension system, adjusting financial aid and more partnerships.”

He used a cartoon to illustrate his ministry’s course towards a wholistic individual and nation.

Achievements
In his address, the minister not only spoke of his vision for the ministry but spent a great deal of time on achievements to date. It read like a resume for VSA.
“With performance in mind, I believe an 82 percent accomplishment should be acknowledged and respected for the work team VSA has achieved,” he stated.
He did not say whether the 82 percent accomplishment was based on an internal or external evaluation but indicated he was still awaiting the official rating.
He cited initiatives such as HIV/ Aids and RED Campaign, Integrated Neighbourhood Development Programme, the Community Help Desks, SEI: Employability through Training project and the facelift of the Labour Office on the Pondfill as achievements over the last two years.

The establishment of the SZV and the policy units for labour, public health and social development in 2011 were also highlighted.

For 2012, the minister said that investments into customer service training and technology had also yielded good results.

He spoke of an improved turnaround time, the appointment system and translation services at Labour Affairs, the labour market information system, the E-SZV, the health management information system and various policies and forms that are now on the government website to indicate that VSA is moving in the right direction.
He reiterated that the completion of the draft legislation for Social Security and Health Reform, the AOV increase, the National Health Insurance (NHI), dismissal procedures and financial aid draft national decrees all “deserve recognition.”
“The people’s ministry,” the minister said had out numerous positions on critical issues such as short term contracts, environmental health, temporary employment agencies and accelerating the quality of life.

Evidence Based Policy Making
The minister said that the availability of statistics is important in order to make responsible decisions.
“Many VSA agencies such as the Labour Affairs, Inspectorate and Collective Preventative Services produce many facts and figures that provide careful insight to analyze trends and needs for required changes.
In summary we have managed to introduce the performance management, prepare and conduct various research studies leading to informed decision making, establish the appeals committee for social services, establish the community help desk, improving customer service at the labour and social affairs, improve ambulance services and recruit the right people for critical positions.”

St. Maarten Medical Center
A brief paragraph in the section Improved Wellness and Health Care of the governing programme referred to the St. Maarten Medical Center.

“As part of its investments in public infrastructure, government will increase the level of expenditures in the infrastructure of public health and health care systems. In concrete terms, government will continue to ensure that the St. Maarten Medical Centre meets the needs of a growing and changing St. Maarten demography as well as expands its services to accommodate more medical specialties and support services. In addition, government intends to pursue the development of medical tourism on St. Maarten. Simultaneously, government will also strengthen its control and supervisory capacity in this area by placing emphasis on an effective Inspectorate of Public Health.”
Though, Minister de Weever made no direct reference to the SMMC during his remarks, several sections of the audience remarked that his greatest accomplishment to date may have been getting rid of the hospital’s director.

Director Scot’s contract at St. Maarten Medical Centre will end on December 31

FRIDAY, 07 DECEMBER 2012

CAY HILL–The Supervisory Council of the St. Maarten Medical Center (SMMC) has decided to end the contract of embattled General Director of SMMC Dr. George Scot as hospital Director as of December 31.

The council said in a press release on Thursday that this decision was taken “in the best interest of the SMMC, its patients, staff and personnel as well as of Scot.”

The council said SMMC has as an important goal to strengthen the organizational structure of “our institution, so that we could better cope with the changing environment and demands placed on it”, while positioning itself to be able to meet those ever- increasing demands in a most human and equitable manner, while aiming for the highest possible standard of quality of care.

“Therefore we have contracted an independent agency earlier this year with ample experience in health care institutions to make an organizational scan of the top structure of the SMMC in order to advise us as to the most ideal make-up of the top managerial structure in the SMMC,” the council said.

“This independent agency has taken the future plans, the scale of the island, the context in which we have to perform our services as well as the scarce availability of specific capacities into account. The organizational scan is currently in its final stages and on basis of the outcome and the discussions that will ensue, the Supervisory Council will make the necessary decisions regarding the ideal constellation of the Board of Directors as well as the necessary supporting Management Team,” it was stated in the release.

“In addition and in view of the ever-increasing responsibilities and workload of the Board of Directors, the plans for the future of SMMC and the expressed wishes of Dr. Scot to be able to spend more time with his family in The Netherlands, earlier this year Dr. Scot and the Supervisory Council have jointly agreed that the current contract with AnG Consultancy NV and the appointment of Dr. Scot as managing director would not be renewed as is. Based among others on the outcome of the organizational scan, further decisions on this matter would be taken.”

“However, the situation has changed. Due to external factors beyond our control, a negative and highly stressful atmosphere has been created that has affected the doctors and staff of SMMC and their patients on a daily basis. The personal accusations and unfounded allegations from outside SMMC towards Dr. Scot moreover led to an untenable work situation.

“Therefore, in the best interest of the SMMC, its patients, staff and personnel as well as that of the person Dr. Scot, the Supervisory Council decided to end the appointment of Dr. Scot as Director by December 31, 2012. This decision was reached in agreement with Dr. Scot. This was not an easy decision for either party. We are currently engaged in finding an interim director. An interim position will allow us to manage the transition to the structure we will decide on, based on the evaluation, advice and debate following the organizational scan, while securing the continuity within our Board of Directors.

“We are also looking to strengthen the Board of Directors with an interim medical director.

The job descriptions for both positions have been presented to the Minister of Health.

“Dr. Scot will provide full collaboration towards ensuring a smooth handoff to the new interim director,” it was stated in the release.

“The SMMC will continue as always to work towards improving the level and quality of care for the benefit of all residents of St. Maarten, Saba and St. Eustatius and looks forward to doing so, working together with Government and the Inspectorate,” it concluded.

St. Maarten Medical Centre challenges Inspectorate’s call for director Scot to resign

THURSDAY, 06 DECEMBER 2012

PHILIPSBURG–St. Maarten Medical Centre (SMMC) is challenging the Inspectorate of Public Health’s latest ‘demand’ for the hospital’s general director Dr. George Scot to either resign as President of SMMC’s Board of Directors or terminate the contract between his company, AnG Consultancy, and SMMC.

The inspectorate learnt of this latest legal action on Tuesday, Inspector General Dr. Earl Best said on Wednesday. The action was filed in November.

Best said while the Inspectorate has not instituted any fines on SMMC as these had been thrown out in the last court case, the inspectorate is continuing its inspections weekly at SMMC.

The inspections are intended to ensure that the situation at SMMC is improving in the best interest of health care. “We are visiting them and expecting them to comply with certain things,” Best said.

“We haven’t seen much structural progress as yet for improvement. They are doing things in an ad-hoc manner. There is nothing structural. This means there is a lack of guidance to achieve the improvements and to make the improvements,” Best said adding that the SMMC Director had been in The Netherlands for two weeks again recently. Scot travels once monthly on a business class ticket to and from The Netherlands, he said.

Best had called for the termination of Scot’s contract after he said there had been continued failure by SMMC to adhere to the Inspectorate’s previous “legal demands” and after uncovering what Best said had been “severe conflict of interest” involving Scot.
Best had said while the hospital was still under intensified supervision, the Inspectorate discovered the existence of a contract signed on September 17, 2008, between AnG Consulting N.V. and SMMC, for supplying services to the hospital such as the daily board of directors/Chief Executive Officer (CEO) for the hospital during the next five years.

Best had said AnG Consulting N.V. was established at the home address of Dr. Scot who appears to also be one of the owners of AnG Consulting N.V. and in any case the CEO of this company. The contract was signed by Scot on behalf of AnG consulting N.V. with SMMC as the other contracting party, represented by the Chairman of the Supervisory Board of SMMC at that time.

Meanwhile, the Chamber of Commerce on St. Maarten has indicated that the service provider AnG Consulting N.V. is not registered in the Registry with the Chamber of Commerce on St. Maarten. AnG Consultancy (not Consulting) is registered in St. Maarten.

Best said Scot is not only the CEO of AnG Consulting N.V., but for all intent and purposes appears to also have a financial stake in this company.

Effective April 25, 2008, Dr. Scot has also been appointed as the only member of the Board of Directors of SMMC and functions as the Director of SMMC. Dr. Scot in reality thus holds two different positions related to SMMC. On the one hand he is the Director of SMMC and on the other hand he is the CEO of the “independent” service provider AnG Consulting N.V., a company wherein again he appears to also have a financial interest, Best had said.

Minister De Weever says St. Maarten Medical Center request for documentation ‘inadmissible’

WEDNESDAY, 21 NOVEMBER 2012

PHILIPSBURG–”Inadmissible” was the word used by Health Minister Cornelius de Weever to describe a request from St. Maarten Medical Center (SMMC) Foundation via its attorney HBN Law to provide a number of documents to the medical facility.

SMMC made the request in a letter dated September 30. In his response, dated November 16, De Weever said the SMMC Board of Directors represented SMMC in legal matters. He said it should be unambiguous at all times who was legally authorised to represent SMMC and that representation must be compliant with any relevant legislation.

“By letter of August, 21, 2012, the Supervisory Council of SMMC was requested to provide a number of documents to enable this office [Minister's cabinet, ed.] to ascertain the relationship between the sole member of the Board of Directors and a contract with AnG Consulting (/Consultancy) NV to provide services that should be provided by an individual who is a member of the Board of Directors,” De Weever said.

“The documents as requested have not been promptly delivered and are therefore still pending. With reference to aforementioned letter, the Minister has already expressed that a construction whereby a third party is used to provide services that an individual should be providing is not in compliance with the law,” he added.

“The same member of the Board of Directors has recently received an instruction from the Inspectorate to either nullify the aforementioned contract or resign as a member of the Board of Directors. The instruction from the Inspectorate is part of an ongoing investigation regarding SMMC, whereby it’s not unthinkable that the Inspectorate will continue to seek all and use all recourse at its disposal to ensure quality care.

“Notwithstanding the aforementioned, but more so in support of the forgone, the Minister also needs to initiate the necessary procedure (civil/legislative/criminal) to ensure that clarity and good governance is achieved in an as-short-as possible time.”

De Weever continued: “Any information should only be delivered to an individual (natuurlijke persoon) as per the Articles of Incorporation of SMMC and (indirectly) based on the ‘Landsverordening zorginstellingen’ (rechtspositieregeling).

“It is at present inevitable to conclude that due to the existence of the contract with AnG, any information requested by SMMC will automatically end up in the hands of a third party (AnG), a (legal) entity whose mere existence is questionable.
“The request as submitted is deemed inadmissible, as this third party (AnG) is de facto requesting information on behalf of SMMC and that a third party is not recognized as the legal representative of SMMC.”

The Minister said the request must be denied, based on Article 11, Section 1, subsections a, and b of the LOB,. He said the information requested endangered the unity of government by creating a rift between various entities and ministries should the request be honoured.

“The safety of the country will also be damaged, as patients will increasingly shy away from SMMC. This could possibly lead to the bankruptcy of the sole hospital in the country and have a damaging impact, as government will not be able guarantee quality health care,” he added.

He said too that “based on Article 11, Section 2, subsection a of the LOB, the requested documents will not be provided, as it has not been established that SMMC has any prevailing interest in obtaining the said documents.

“The Minister considers this request as a gleaming example of poor management, not to speak of mismanagement. It is a blatant attempt to diffuse the matter of mismanagement at SMMC by the Board of Directors and the lack of supervision by the Supervisory Council of SMMC.

“To entertain the request as submitted will inevitably lead to frivolous remarks and attempts to discredit the Ministry, the Minister or the Inspectorate of Public Health and/or to delay aforementioned parties in taking the necessary steps to prevent lives from being put in danger.

“Any delays for whatever reason are not warranted, considering that this will unavoidably lead to further economic or financial loss for SMMC, government and SZV and therefore the quality of care for the citizens of St. Maarten.Furthermore, it is being determined whether or not certain matters should be brought to the attention of the Prosecutor.

“Lastly, any or all of the requested documents, if indeed available, are or should be part of the file the Inspectorate of Public Health holds on SMMC. Considering that the Inspectorate of Public Health is carrying out its legally attributed inspection task to, amongst other things, guarantee quality health care, none of the requested documents can be provided to SMMC at this time.

“Any interest SMMC may believe it has cannot at this point outweigh or stand in the way of the Inspectorate of Public Health or the Minister doing what is necessary to save lives.”

The Minister said “remarkably” the request alluded to a peculiar reversal of roles, as if SMMC believed itself to be above the Inspectorate of Public Health and/or government, or at least equal partners to them.

In its request, SMMC requested that the Minister provide any instruction given to the Inspectorate of Public Health as it relates to instructions directly or indirectly to SMMC; the Memorandum of Understanding or agreement in whatever form between the government of St. Maarten and The American Clinic and/or Mr. S. Hess, D. Haight and T. Allen, and all landsbesluiten containing the decisions to appoint the current health inspectors, including the current Inspector General, among other requests.

HBN said that if one or more of these documents had not been issued, was missing and/or was incomplete, the Minister should indicate so in his response to its request.

HBN said SMMC had a right to and had pressing interest in receiving the documents in light of recent developments regarding the investigation by the Inspectorate and/or recent announcements regarding government’s intention to allow other health care institutions to provide medical care in St. Maarten.

St. Maarten Medical Center is happy with second court case verdict

MONDAY, 19 NOVEMBER 2012

~ Wants focus on improving health care ~

CAY HILL–St. Maarten Medical Centre (SMMC) says it is happy with the verdict in its most recent court case against the Health Inspectorate.

In a lengthy press release Sunday night SMMC noted that the Court of First Instance last week ruled in its favour in the second court case it had started against the Inspectorate.

“SMMC is very happy with the outcome and we hope that this verdict can help bring back the focus on improving quality health care in a realistic manner. In the first court case the judge had ruled that the case was not admissible because the letter send by the Inspectorate to the SMMC was not a formal decision (in Dutch: “beschikking”) but an informative letter that could not be appealed,” SMMC stated in its press release.

“SMMC first wants to stress that it recognizes the authority of the Inspectorate of Health Care. A good and healthy working relation with the Inspectorate stimulates the improvement of safe and quality health care, which is our goal. SMMC is not opposed to external supervision on its services.”

In this second court case, the release read, the Court of First Instance ruled against the 13 demands that the Inspectorate of Public Health imposed on SMMC on October 12, citing that the demands are insufficient substantially motivated and carelessly prepared.

“It is unacceptable and irresponsible that the Inspectorate being the highest supervisory authority in health care handled in that manner,” SMMC said.

“The judge ruled in favour of SMMC because he is of the opinion that: there is no final report as the inspector did not take the 23 pages of comments of SMMC into consideration; the Inspectorate did not give SMMC reasonable time to respond to the draft report and again not enough time to submit an action plan that should be fully supported by the Board of Directors, Supervisory Council and Specialists; the Inspectorate complained about the attitude of SMMC while there were no facts or findings in the report to substantiate this; the Inspectorate stated in the report that there were no high risk factors found that needed immediate action. This cannot support the stringent and heavy measures that the Inspectorate imposed on SMMC.”

The release continued: “The judge concluded that the imposed demands in the letter of October 12, does not have a legal basis, are unjustified, unnecessary or practically impossible to carry out in the given timeframe. The manner in which the Inspectorate handled towards SMMC defied all grounds of reasonableness and fairness. We started the court case because we felt that the Inspectorate interfered in the governance of SMMC in a way that has no direct relation to health care. The SMMC, however, does not oppose the external supervision of the Inspectorate on our services.”
“Imposing unreasonable demands and communicating and/or implying that SMMC is unsafe, while this is clearly not the case and again also not proven in the draft report, has had detrimental consequences on the trust of the community in the care given at SMMC.

Chairman of the Board of Directors, Dr. George Scot said: “If you talk about sub-optimal care you should be clear and give an explanation or definition what sub-optimal care entails. If you talk about 7 incidents whereby patients died, you should have the final reports of your investigations in your hand and not be “still working on them.
He continued: “If you perform unannounced inspections, ask questions, look into documents and even take pictures, you should explain what you came to inspect, submit a report of the findings of that visit as soon as possible with your recommendations how to improve the service. These changes in approach will lead to improvement of the care and in building a relationship based on trust.”

“This will then positively improve the trust of potential financiers in SMMC’s ability to responsibly carry the financial obligation of the investment related to the expansion and will increase the chance for the realization of the much needed expansion project. A project that is critical to improve the health care in the SMMC.”
SMMC said its staff deals with patients and visitors who on a daily basis question the safety of care at the hospital and question the staffs qualifications and ability. The hostile situation created has made it extremely difficult for our staff to stay motivated and focused on delivering quality care. We publically commend our staff and affiliated specialists for still doing so.

“In the ruling the judge highlighted that in the audit report the inspectorate literally stated that it has not noted any findings at SMMC of severe risk to health care. The judge stated that based on the law, the instruments of administrative enforcement, conditional penalties and imposing fines are reserved for severe cases of misconduct. This is categorically not the case at SMMC.”

“Amidst the negative campaign against SMMC, we maintained our focus on improving quality care. We have been and are working on improving the health care offered. We agree with certain points mentioned in the audit report and prior to receipt of the report have developed a plan of approach to further improve quality care aspects. We have shared our plan with the Inspectorate, however, it did not consider it. We have developed an action plan in line with the request of the Inspectorate and have worked on meeting the demands imposed on us in the letter of October 12, within our capabilities. All which have not been considered by the Inspectorate. The Judge has recognized our actions and considered this in his verdict.”

“The SMMC will continue to work on the action plan that was sent to the Inspectorate and will execute and implement the steps to improve the quality and patient safety in the SMMC. We will work with the Inspectorate when they come, announced or unannounced.

“Management and its entire staff are committed to improve the care in a realistic manner. A critical stance from our stakeholders to do the right things right and continue to work on improvement, be it from the Inspectorate, patient groups, insurance companies and alike are welcomed by the SMMC.

“It is, however, essential that there can be a dialogue between parties whereby parties are willing to listen to and consider the information given and that there is a basis of trust. Trust is something you have to earn, something that we also have to learn. If we have to be more transparent then we will work on that.”

SMMC said the Community should feel safe at SMMC being the only hospital in Dutch St. Maarten. “We truly hope that the verdict can help establish some form a normalcy,” stated the release which came from the Management Team, Board of Directors and Supervisory Council.

St. Maarten Medical Center reacts to court ruling “Let’s put the focus back on improving health care together”

POSTED: 11/19/12

St. Maarten – The Management Team, the Board of Directors, and the Supervisory Council of the St. Maarten Medical Center issued last night their reaction to Friday’s court ruling that suspended the measures the Inspectorate for Public health wanted to impose on the hospital. This is the unabridged text of the hospital’s reaction.

“The Court of First Instance has ruled in favor of St. Maarten Medical Center (SMMC) in this second court case we started against the Inspectorate. SMMC is very happy with the outcome and we hope that this verdict can help bring back the focus on improving quality health care in a realistic manner. In the first court case the judge had ruled that the case was not admissible because the letter send by the Inspectorate to the SMMC was not a formal decision (in Dutch: “beschikking”) but an informative letter that could not be appealed.

SMMC first wants to stress that it recognizes the authority of the Inspectorate of Health Care. A good and healthy working relation with the inspectorate stimulates the improvement of safe and quality health care, which is our goal. SMMC is not opposed external supervision on its services.

In this second court case the Court of First Instance ruled against the 13 demands that the Inspectorate of Public Health imposed on SMMC on October 12 citing that the demands are insufficient substantially motivated and carelessly prepared.

It is unacceptable and irresponsible that the inspectorate being the highest supervisory authority in health care handled in that manner.

The judge ruled in favor of SMMC because he is of the opinion that:

there is no final report as the inspector did not take the 23 pages of comments of SMMC in consideration;
the Inspectorate did not give SMMC reasonable time to respond to the draft report and again not enough time to submit an action plan that should be fully supported by the Board of Directors, Supervisory Council and Specialists;
the Inspectorate complained about the attitude of SMMC while there were no facts or findings in the report to substantiate this;
the Inspectorate stated in the report that there were no high risk factors found that needed immediate action. This cannot support the stringent and heavy measures that the Inspectorate imposed on SMMC.
The judge concluded that the imposed demands in the letter of October 12th don’t have a legal basis, are unjustified, unnecessary or practically impossible to carry out in the given timeframe.

The manner in which the Inspectorate handled towards SMMC defied all grounds of reasonableness and fairness. We started the court case because we felt that the Inspectorate interfered in the governance of SMMC in a way that has no direct relation to health care. The SMMC however does not oppose the external supervision of the Inspectorate on our services.

Imposing unreasonable demands and communicating and/or implying that SMMC is unsafe, while this is clearly not the case and again also not proven in the draft report, has had detrimental consequences on the trust of the community in the care given at SMMC.

Chairman of the Board of Directors, Dr. Scot: “If you talk about sub-optimal care you should be clear and give an explanation or definition what sub-optimal care entails. If you talk about 7 incidents whereby patients died, you should have the final reports of your investigations in your hand and not be “still working on them”. He continues: ”If you perform unannounced inspections, ask questions, look into documents and even take pictures, you should explain what you came to inspect, submit a report of the findings of that visit as soon as possible with your recommendations how to improve the service. These changes in approach will lead to improvement of the care and in building a relationship based on trust.”

This will then positively improve the trust of potential financiers in SMMC’s ability to responsibly carry the financial obligation of the investment related to the expansion and will increase the chance for the realization of the much needed expansion project. A project that is critical to improve the health care in the SMMC.

Daily our staff deals with patients and visitors who question the safety of care at the hospital and question the staffs qualifications and ability. The hostile situation created has made it extremely difficult for our staff to stay motivated and focused on delivering quality care. We publically commend our staff and affiliated specialists for still doing so.

In the ruling the judge highlighted that in the audit report the Inspectorate literally stated that it has not noted any findings at SMMC of severe risk to health care. The judge stated that based on the law, the instruments of administrative enforcement, conditional penalties and imposing fines are reserved for severe cases of misconduct. This is categorically not the case at SMMC.

Amidst the negative campaign against SMMC, we maintained our focus on improving quality care. We have been and are working on improving the health care offered. We agree with certain points mentioned in the audit report and prior to receipt of the report have developed a plan of approach to further improve quality care aspects. We have shared our plan with the Inspectorate, however it did not consider it. We have developed an action plan in line with the request of the Inspectorate and have worked on meeting the demands imposed on us in the letter of October 12 within our capabilities. All this has not been considered by the Inspectorate. The Judge has recognized our actions and considered this in his verdict.

The SMMC will continue to work on the action plan that was sent to the Inspectorate and will execute and implement the steps to improve the quality and patient safety in the SMMC. We will work with the Inspectorate when they come, announced or unannounced. Management and the entire staff are committed to improve the care in a realistic manner.

A critical stance from our stakeholders to do the right things right and continue to work on improvement, be it from the Inspectorate, patient groups, insurance companies and alike are welcomed by the SMMC. It is however essential that there can be a dialogue between parties whereby parties are willing to listen to and consider the information given and that there is a basis of trust. Trust is something you have to earn, something that we also have to earn. If we have to be more transparent then we will work on that.

The St. Maarten Medical Center is the only hospital on the Dutch side of St. Maarten. The community should feel safe at SMMC. We truly hope that the verdict can help establish some form a normalcy.”

St. Maarten Court says ‘no’ to fines in hospital-inspectorate case

SATURDAY, 17 NOVEMBER 2012

PHILIPSBURG–St. Maarten Medical Center (SMMC) has objected successfully to the conditions attached to the demands placed on it by the Inspectorate of Public Health. The Court of First Instance ruled Friday that the conditions the Inspectorate had placed on SMMC on October 12 had not been imposed with the proper care and were insufficiently motivated.

The Inspectorate had imposed 13 demands on SMMC geared towards improving medical care at the facility. Some of the demands were to be met by October 26, and others before December 8.

SMMC sent a letter on October 25, a day before the first deadline, stating it had already complied with some demands. SMMC also claimed that certain demands were without legal basis and that the demands were “overkill.”
However, the Inspectorate contended that SMMC had not complied and still had to do so.

Failure of SMMC to comply with the measures by the set deadline could result in the imposition of fines of up to US $500 per day per infringement, up to a maximum of $50,000 per infringement. The Inspectorate may also close certain units at SMMC.

SMMC’s lawyer Maarten Le Poole had argued that the imposition of fines would “disproportionately” damage the hospital. The fines would put the hospital in financial problems and would further damage the hospital’s reputation, jeopardising SMMC’s plans to extend the facility, it was stated.

Staff and patients would be turning their backs to the hospital, the lawyer said. He claimed that the “overkill” in measures imposed on it by the Inspectorate was threatening the hospital’s existence, “thus reaching the opposite of what the Inspectorate is claiming to pursue.”

In the meantime, SMMC had started working on an improvement action plan, which would be finalised in the near future, it was said.

Judge René van Veen said the Inspectorate’s decision to attach fines to its demands was unreasonable. “The Inspection should have set a reasonable timeframe for a reaction on its draft report” of the hospital audit, the Judge stated.
He said the Inspectorate should have allowed SMMC more time to respond and comment on the Inspectorate’s findings during the audit. In this respect, the Judge also found it of importance that the Inspectorate had not mentioned any “high-risk” findings in the audit report.

In this light, the Judge came to the conclusion that SMMC interest’s outweighed those of the Inspectorate where the imposition of fines was concerned.

The Judge said the question whether there actually was a legal basis for the issuance of fines by the Inspectorate would have to be answered in the court case on the merits.

Health Inspectorate says ruling ‘judicially flawed’

SATURDAY, 17 NOVEMBER 2012

PHILIPSBURG–”Judicially flawed” was the term used by Inspector General Dr. Earl Best to describe Friday’s ruling in St. Maarten Medical Centre’s (SMMC’s) appeal case against the demands the Inspectorate imposed on the hospital on October 12.

Best, who met with reporters along with attorney Jairo Bloem and Dr. Jan Haeck on Friday, November 16, said that while the Inspectorate respected this verdict, it lamented very much the grounds on which the judge assessed the case and believed the verdict was judicially flawed.

The Inspectorate imposed 13 measures on SMMC on October 12 to ensure that good basic quality of care is rendered in SMMC, the only hospital in St. Maarten, Best said.

“These measures were imposed after the Inspectorate established, following an extensive investigation, that the care rendered is presently sub-optimal/sub-standard. This was also the conclusion drawn by the Inspectorate of the now defunct Netherlands Antilles in its reports in the years 2007 and 2008,” Best told reporters.
“It is therefore not now that sub-standard care is being rendered in SMMC. That has been going on for several years. SMMC is or should be aware thereof and the Inspectorate regretfully established in its latest report that matters are not improving. On the contrary.

“It is well-known that in the course of especially the last years various incidents have occurred in SMMC, with often dramatic consequences. It can in practice not be established that the sub-standard basic care that is being rendered within SMMC is at the root of or forms the – main – cause of these incidents. On the other hand, it can also not be excluded that this sub-standard basic care has caused/influenced some of these incidents.
“It is therefore of cardinal importance that SMMC renders good basic care, as is required by law and as can and should be expected by the St. Maarten citizens. Instead of adjudging whether or not the measures imposed by the Inspectorate result in disproportional advantage to SMMC as per article 85 LAR, the Court of First Instance considered if the measures imposed by the Inspectorate are reasonable.

“This is an entirely different examination or review, and one that unavoidably puts the Court of First Instance in the seat of the Inspectorate, a position wherein it should not want to find itself, for the simple reason that the Court of First Instance is not equipped or capable to determine whether or not good basic quality of care is rendered and what does and/or does not constitute serious violations that inhibit good basic quality of care.
“It is not without reason that the legislator has granted a discretionary right to the Inspectorate to make assertions with regard to quality of care and has determined that measures imposed, in this case by the Inspectorate, can only be suspended in case they are disproportionally disadvantageous to a party.”

Best said the disputed verdict did not contain one consideration pertaining to possible disproportional disadvantage.
“The Court of First Instance in essence ruled that the Inspectorate did not give SMMC enough time to respond to the draft report made by the Inspectorate and that the Inspectorate did not give SMMC the opportunity, although the St. Maarten law does not require that, to be heard before deciding to impose the 13 measures. No consideration has been made pertaining to how this, even if assumed that it is correct, causes SMMC to suffer disproportional disadvantage as a result of the imposed measures,” he said.

“One of the most remarkable aspects of the disputed verdict is that the Court of First Instance doesn’t take a decision as to whether or not SMMC violated the law, as established by the Inspection. Without determining if the law has been violated by SMMC, the Court of First Instance, however, concludes that the reasons given by the Inspectorate to impose measures are not severe enough.

“The Inspectorate begs to differ and wonders what definition, if any, the Court of First Instance applied for the qualification of ‘severe violation’ in order to determine that the violations established by the Inspectorate (a subject that the Court of First Instance as it stated deliberately did not address in its verdict) are not severe enough to justify imposing measures.”

He said the Court of First Instance not only applied incorrect judicial criteria in its decision of November 16, but in deciding to within the limited scope of this injunction procedure as per the law, also evaluate whether or not the infringements established by the Inspectorate should or should not be considered serious, it violated the discretionary rights granted by the legislator to the Inspectorate.

“The Inspectorate is of the opinion that it is especially fit and suited with professionals in the medical field, with the capacity to determine, as designated by the legislator, whether or not good basic quality of care is being rendered. The quality of care and well-being of the St. Maarten citizens is what is at stake.

“The suspension by the Court of First Instance of the measures imposed by the Inspectorate in essence makes it impossible and in any case very challenging for the Inspectorate to fulfil its legal obligation to ensure that proper quality of care is rendered, at least expeditiously, and in general for the Inspectorate to exercise its legal authority.
“The Inspectorate fears that the various established infringements and the sub-standard care that is now being rendered with SMMC will continue. By law the decision of the Court of First Instance cannot be appealed.”

Best and attorney Bloem said the Inspectorate would be analysing its recourses to still be able to safeguard that basic quality of care is available in St. Maarten for all citizens.

Inspector General asks St. Maarten Medical Center director George Scot to resign or end his company’s contract with SMMC

THURSDAY, 15 NOVEMBER 2012

~ Inspectorate cites ‘severe’ conflict of interest ~

PHILIPSBURG–Inspector General Dr. Earl Best has given St. Maarten Medical Center (SMMC) General Director Dr. George Scot fourteen days to either resign as President of SMMC’s Board of Directors or terminate the contract between his company, AnG Consultancy, and SMMC.

Best imposed this latest “demand” after continued failure by SMMC to adhere to previous “legal demands” and after uncovering “severe conflict of interest” involving Scot.
AnG Consulting N.V.

Best said in a lengthy press release last night that while the hospital was still under intensified supervision, the Inspectorate had discovered the existence of a contract signed on September 17, 2008, between AnG Consulting N.V. and SMMC, for supplying services to the hospital, such as the daily board of directors/Chief Executive Officer (CEO) for the hospital during the next five years.

Best said AnG Consulting N.V. was established at the home address of Dr. Scot, who also appears to be one of the owners of AnG Consulting N.V. and in any case the CEO of this company. The contract was signed by Scot on behalf of AnG consulting N.V. with SMMC as the other contracting party, represented by the Chairman of SMMC’s Supervisory Board at that time.

Meanwhile, the Director of the Chamber of Commerce has indicated that the service provider AnG Consulting N.V. is not registered in its Registry. Research by the Inspectorate in Curaçao, Aruba, the BES islands and even in The Netherlands shows furthermore that AnG Consulting N.V. also is not registered in any of these other countries.

The Department of Tourism, Economy, Transportation and Telecommunication in St. Maarten moreover confirmed to the Inspectorate that no business licence had been issued to a company with the corporate name AnG Consulting N.V.
Best said Scot is not only the CEO of AnG Consulting N.V., but for all intent and purposes appears to also have a financial stake in this company that is registered at his home address in St. Maarten, and seems to have been incorporated by his wife A. Scot.

Conflict of interest

Dr. Scot also was appointed as the only member of the Board of Directors of SMMC effective April 25, 2008, and functions as the Director of SMMC. Dr. Scot, in reality, thus holds two different positions related to SMMC. On the one hand he is the Director of SMMC and on the other hand he is the CEO of the “independent” service provider AnG Consulting N.V., a company wherein again he appears to also have a financial interest, Best said in the release.
Article 15, paragraph 3 of the National Ordinance on Health Care Institutions clearly states that it is prohibited for members of the Board of Directors of a hospital to have a stake in any other company that does business with the hospital.

The reason behind this law is to prevent abuse in hospitals by persons holding key positions and/or who have decisive power. The quality of care can be seriously hampered if such abuse could materialise within hospitals as a consequence of a conflict of interest.

“Dr. G.A. Scot is wearing two different hats, one as the director of SMMC and the other as the CEO or representative of the independent service provider AnG Consulting N.V. This is clearly a violation of the law.

“This conflict of interest enables abuse by a person/company who is holding a key position within SMMC, with decisive powers. Consequently, financial interests can potentially prevail over conditions to enforce a responsible quality of care,” Best said in the release.

“The Inspectorate establishes that the service agreement between SMMC and AnG Consulting N.V., managed by Dr. G.A. Scot, allows ANG Consulting N.V. (read Dr. G.A. Scot) to also render services to SMMC from abroad; does not regulate how many hours ANG Consulting N.V. (read Dr. G.A. Scot) must render services to earn a fixed monthly fee; does not, at least not directly, contain any performance standards and/or norms; stipulates that the performance of ANG Consulting N.V. will be evaluated by SMMC and thus in principle by the Director of SMMC, namely Dr. G.A. Scot.

“The service agreement itself does in any case not contain any provision to deal with this obvious conflict of interest; grants ANG Consulting N.V. the right to a yearly bonus and in case of premature termination a fixed termination compensation, if ANG Consulting N.V. receives a positive evaluation for its performance.”

Health care standards

According to the Inspector General, under the terms of the service agreement this evaluation can be performed by the Director of SMMC: Article 5, paragraph 5 of the bylaws of SMMC state that the Board of Directors of SMMC comprises one or maximum two natural persons.

“The founding fathers of SMMC clearly intended for only natural persons of flesh and blood, and not companies, to be able to manage SMMC. The Inspectorate understands that the reason for this limitation is to at all times ensure clarity and transparency pertaining to the person who actually manages SMMC, the only hospital on St. Maarten.

“AnG Consulting N.V. can therefore as a company never substitute the natural person who must render the managerial services as per the bylaws of SMMC. The investigation conducted by the Inspectorate, however, shows that AnG Consulting N.V. is in essence functioning as the director/manager of SMMC. This constitutes yet another potential violation of the bylaws of SMMC,” Best said.

He noted that several requests from the Inspectorate for clarification on these matters from the Board of Directors had been rejected on Scot’s behalf by SMMC’s attorney.

“Dr. G.A. Scot has also regretfully refused to attend a meeting called by the Inspectorate to give reason and account, stating simply again that he does not acknowledge any authority of the Inspectorate to exercise external supervision on what he calls Governance Matters.

“Contrary to what SMMC wants to stubbornly believe, the Inspectorate is bound to ensure that St. Maarten citizens can enjoy proper basic medical services by SMMC, as per internationally accepted standards.

“Exercising supervision on the governance of SMMC is not only legally codified in the law, it is the only way to ensure good quality care for St. Maarten citizens, who do not have the powers vested unto the Inspectorate, and are as such not able to act against, for example, the established conflict of interest and other violations by SMMC of its own bylaws.
“Where the health care professionals in St. Maarten haven’t defined norms and/or standards, the Inspectorate moreover has the authority, not to say the legal obligation, to apply internationally accepted minimum medical standards, in consultation with the field. These internationally accepted norms and/or minimum standards have been applied by the Inspectorate to SMMC.

“An example hereof is how many professionals must work in the ER [Emergency Room] Department of SMMC to continuously (24/7) provide efficient and good quality care, considering the approximately 60,000 citizens residing on St. Maarten.”

Best observed that Scot – the only member of the board of directors – had been off-island approximately 50-60 per cent of the time on a monthly basis for the past two years and maybe even longer. The data given is from Dr. G.A. Scot’s stay in The Netherlands alone. The Inspectorate has no data of the director’s stay elsewhere, e.g. in the USA.

“Meanwhile very important matters that determine quality of care and patient safety, such as: (i) a necessary quality management system in the hospital, (ii) performance and production by the medical specialists, (iii) medical treatment protocols, (iv) conducting periodical meetings with the Medical Staff and (v) preventive maintenance, haven’t gotten the attention they require over the past years.

“The continued lack of proper governance for the past years has led to deficiencies in critical areas, impacting the services provided by the SMMC.

“The tremendous understaffing amongst medical specialists for the past years is causing an enormous strain on the performance of those specialists, nurses and other staff members who do their utmost to provide care that complies with internationally accepted standards. Given the conditions under which they have to work, they try to prevent that suboptimal care is given.”

Best said an enthusiastic majority of the nursing staff had done a good job in keeping the wards and other departments operational, applying proper nursing standards. The actual presence in SMMC and commitment of these persons stand out in dire contrast to Scot’s structural 50-60 per cent on average absenteeism.

“It is high time for SMMC to, instead of continuously fighting against the Supervision exercised by the Inspectorate, and to that extent having already initiated four court cases (two main and two injunction cases) and having its attorneys write countless letters, devote its scarce resources and energy to ensuring that demands of the Inspectorate, the body exercising supervision on behalf of St. Maarten citizens to enable good basic quality of medical care, are properly and timely met.

“The sooner SMMC can understand that it is (i) subject to the external supervision by the Inspectorate and (ii) must abide by the imposed demands to improve the level of care, the sooner the quality of care in St. Maarten can be brought to what St. Maarten citizens can and should within reason expect.”

Best said SMMC’s continued failure to adhere to the Inspectorate’s legal demands to take actions that would remedy the current deficiencies in rendering a basic quality of care within the hospital had regrettably resulted in a decision by the Inspectorate to impose another demand against SMMC, under the penalty of forfeiture of significant fines in case of non-compliance within set deadlines.

Best said SMMC maintained its position that the Inspectorate was not authorised to supervise the governance process in the SMMC. He said, however, that articles 15, 16, 17 and 30 of the National Ordinance on Health Care Institutions stipulated clear regulations for governance, management and quality monitoring in these institutions. Articles 23, 24 and 30 of the same Ordinance also state that the Inspectorate is the body authorised to enforce those regulations.
“Unlike in the old days when the Supervisory Board only supervised the financial status of the hospital, nowadays the Supervisory Boards are also responsible for the internal supervision of the quality of care provided by hospitals. It is the Supervisory Board’s responsibility to act when the Board of Directors dysfunctions in providing quality care,” said Best.
“In the rest of the world, e.g. in Holland, it is quite common nowadays for external supervisory bodies like the Inspectorates of Health to audit a hospital on health governance matters. Since 2010 the Dutch Association of Hospitals has developed a governance code for all its members to explain this new policy.

“SMMC, however, refuses to subject itself to this external supervision on governance matters by the Inspectorate.”
Best said the Inspectorate strives to ensure that an adequate level of medical care is rendered to the St. Maarten community.

St. Maarten Medical Center objecting to Inspectorate’s demands in court

TUESDAY, 06 NOVEMBER 2012

PHILIPSBURG–St. Maarten Medical Center (SMMC) objected to the demands placed on it by the Inspectorate of Public Health during a hearing in the Court of First Instance on Monday.

SMMC moved to the court to object the demands that the Inspectorate had placed on it on October 12. The judge is expected to give his ruling next Tuesday at 9:00am.

The Inspectorate had imposed thirteen “demands” on SMMC geared towards improving care at the medical facility. Some of the demands were to be met by October 26 and the others by December 8.

Inspector General Dr. Earl Best said that, up to yesterday, SMMC had only complied with one of those demands – providing a service telephone number to reach SMMC General Director and Board President Dr. George Scot, who, the Inspectorate said, is off island 50 per cent of the time.

Best told this newspaper after the court case that SMMC had sent a letter on October 25, a day before the first deadline, stating that it had already complied with some of the demands. SMMC is also arguing that some of the demands have no legal basis and that the demands were overkill.

The Inspectorate, however, contends that SMMC has not complied and still has to do so. The Inspectorate presented its position in court yesterday. Best told this newspaper that SMMC has been given an extension on one of its demands – to fill in vacancies of all medical specialists. This was initially due on December 8, but has been extended to March 8, 2013.
“All the other 12 demands are still pending. They said they had complied with some of them, but not in the opinion of the Inspectorate,” Best said. He added that most of the first set of demands had to do with the functioning of the Board of Directors (Scot) “and one of the principal reasons is that he is 50 per cent off island and there is no mandatory replacement for him. And we made that clear again in court and they still hadn’t complied with it.”

The Inspectorate responded to SMMC’s letter on November 2, indicating that the demands had not been complied with, and emphasizing that this still needed to be done. Best said the Inspectorate has the authority to come up with new demands. He said, however, that given the current court case, the Inspectorate will wait for the verdict before proceeding. Both the hospital and Inspectorate were well represented in court on Monday.

Demands

The demands instituted on SMMC that were due on October 26 were: SMMC needs to have an approved Rules of Regulation for the Board of Directors as per article 5 of the Articles of Incorporation of SMMC, and article 16 of the National Ordinance on Health Care Institutions.

It has to ensure that representation of Management of SMMC, in absence of members of the Board of Directors, is regulated by means of a formal appointment of a replacement representative with the requisite experience and expertise, in accordance with the profile demands that apply to Members of the Board of Directors within SMMC. This to-be-issued mandate is meant to be guaranteed as per article 5 of the Articles of Incorporation of SMMC, and articles 8, 9 and 16 of the National Ordinance on Health Care Institutions.

The Board of Directors is to be adequately represented in absence of one board member. At the moment General Director Dr. George Scot is the only member of the SMMC Board. He is off-island two weeks out of every month.

It has to ensure that the member of the Board of Directors who is representing SMMC is at all times accessible by means of a service telephone. The medical specialists and all service providers at SMMC must receive the telephone number of the service telephone. An overview is to be sent to the Inspectorate, detailing all the dates when Scot intends to not be physically present in St. Maarten for more than one day. This was complied with.

All medical administrative data, medical data, files and computer files required for an adequate representation and care are to be placed in one location within SMMC.

The impositions due on or before October 8 were: SMMC’s Board of Directors should be expanded with one member who will take on the portfolio “Medical Technical Matters,” guaranteeing the continuity of the management. SMMC should also fill out the vacant Personnel Formation places within SMMC on or before December 8 for the basic specialist medical care of Surgery, Internal Medicine, Obstetrics/Gynaecology, Paediatrics, Anaesthesiology and Radiology.

SMMC also has to show that the Board of Directors is actively negotiating with the medical staff pertaining to an Admittance Contract for Medical Specialists that will result in a mutually accepted Admittance Contract on or before January 1, 2013.

The hospital must also provide a suitable action plan in conformity with the conditions imposed by the Inspectorate as mentioned in the report with regards to findings pertaining to infection prevention in the surgery theatre.
It needs to provide an appropriate action plan pertaining to the emergency care department (ER); the supervision, improvement of expertise of the medical staff; file management and a proper notification system for acute issues; a methodology to determine which patient needs must be addressed more urgently; introduction of protocols for the most common diseases and, finally, make working agreements with stakeholders.

It needs to deliver an updated disaster plan and a plan to promote “disaster awareness” and establish annual drills for the staff of SMMC by December 8. It should also ensure that on or before December 8, all committees in charge of safeguarding and managing the quality of care are staffed with at least three persons and that these committees report quarterly to the Board of Directors of SMMC on various matters.

Best had told reporters at a recent press conference, after the Inspectorate had won its first court case brought on by SMMC, that failure of SMMC to comply with the measures by the deadline set could result in the imposition of fines of up to US $500 per day per infringement up to a maximum of US $50,000 per infringement. The Inspectorate can also close certain functional units at SMMC or even detain SMMC officials if this becomes necessary.

Best had said at the time that the Inspectorate sincerely hoped that SMMC this time around would devote its scarce resources and energy to ensuring that these demands were properly and timely met, instead of again resorting to litigation and continuing to resist the supervision exercised by the Inspectorate.

Inspectorate imposes 13 demands on St. Maarten Medical Center

WEDNESDAY, 17 OCTOBER 2012

~ $500 per day, per infringement, or detention if ignored ~

PHILIPSBURG–The Inspectorate of Public Health has imposed thirteen “demands” on St. Maarten Medical Center geared towards improving care at the medical facility.

Failure of SMMC to comply with the measures by the deadline set could result in the imposition of fines of up to US $500 per day per infringement up to a maximum of US $50,000 per infringement. The Inspectorate can also close certain functional units at SMMC or even detain SMMC officials if this becomes necessary.

The demands were served October 12, reporters were told at a press conference on Tuesday, hours after the court announced that the inspectorate had won its court case initiated by SMMC. Inspector General Dr. Earl Best, Acting Inspector Dr. Jan Haeck and Attorney Jairo Bloem updated reporters on the measures.

Best said SMMC has until October 26, to have an approved Rules of Regulation for the Board of Directors as per article 5 of the Articles of Incorporation of SMMC, and article 16 of the national ordinance on Health Care Institutions.
On or before October 26, SMMC has to ensure that representation of Management of SMMC in absence of members of the Board of Directors is regulated by means of a formal appointment of a replacement representative with the requisite experience and expertise, in accordance with the profile demands that apply to Members of the Board of Directors within the SMMC. This to-be-issued mandate is meant to guarantee as per article 5 of the Articles of Incorporation of SMMC, and articles 8, 9 and 16 of the national ordinance on Health Care Institutions, Best said.

The Board of Directors is to be adequately represented in absence of one board member. At the moment General Director Dr. George Scot is the only member of the SMMC Board. He is off-island two weeks out of every month.
On or before October 26, SMMC has to ensure that the member of the Board of Directors who is representing SMMC is at all times accessible by means of a service telephone. The medical specialists and all service providers at SMMC must receive the telephone number of the service telephone. An overview is to be sent to the Inspectorate detailing all the dates where Scot intends to not be physically present in St. Maarten for more than one day.

“This overview must warrant the physical presence of adequate representation by the Board of Directors in SMMC on St. Maarten,” Best said.

All medical administrative data, medical data, files and computer files required for an adequate representation and care are to be placed in one location within SMMC by October 26.

On or before December 8, SMMC’s Board of Directors should also be expanded with one member who will take on the portfolio “Medical Technical Matters” and as such guaranteeing the continuity of the management. SMMC should also fill out the vacant Personnel Formation places within SMMC on or before December 8, for the basic specialist medical care of: surgery, internal medicine, Obstetrics/Gynaecology, paediatrics, anaesthesiology and radiology.
By December 8, SMMC also has to show that the Board of Directors is actively negotiating with the medical staff pertaining to an Admittance Contract for Medical Specialists that will result in a mutually accepted Admittance Contract on or before January 1, 2013.

The hospital must also provide a suitable action plan on or before December 8, in conformity with the conditions imposed by the inspectorate as mentioned in the report with regards to findings pertaining to infection prevention in the surgery theatre.

SMMC also has until December 8, to provide an appropriate action plan pertaining to the emergency care department (ER); the supervision, improvement of expertise of the medical staff; file management and a proper notification system for acute issues; a methodology to determine which patient needs must be addressed more urgently; introduction of protocols for the most common diseases and finally make working agreements with stakeholders.

SMMC must also deliver an updated disaster plan and a plan to promote “disaster awareness” and establish annual drills for the staff of SMMC by December 8. It should also ensure that on or before December 8, all committees in charge of safeguarding and managing the quality of care are staffed with at least three persons and that these committees report quarterly to the Board of Directors of SMMC on various matters.

Best said the Inspectorate sincerely hopes that SMMC, this time around, will devote its scarce resources and energy to ensuring that these demands are properly and timely met, instead of again resorting to litigation and continuing to resist the supervision exercised by the Inspectorate.

The sooner SMMC can understand that it is subject to the external supervision by the Inspectorate and must abide by the imposed demands to improve the level of care, the sooner the quality of care on St. Maarten can be brought to what the St. Maarten citizens can and should within reason expect,” Best said.

Best said the Inspectorate remains “very much willing” to work together with SMMC to ensure that the adequate level of medical care is given to the St. Maarten Community.
He said the “continued failure” by the SMMC to not adhere to the Inspectorate’s legal demands to remedy current deficiencies in rendering basic care resulted in the imposition of demands, which he said can be appealed by SMMC.
Pleased with verdict

Best said the Inspectorate is “very pleased” with the decision of the Court of First Instance. “This decision safeguards the authority of the Inspectorate to effectively make use of its legal rights to take requisite measures to supervise and control all health institutions and health providers,” Best said.
The inspector general said the findings of the extensive investigations in the SMMC over a period of nine months were highly critical in numerous areas that concern basic care at SMMC. “The Inspectorate is bound to ensure that the St. Maarten public can enjoy proper basic medical services by SMMC as per internationally accepted standards.”
He said instead of providing the Inspectorate with the requested feedback on its preliminary findings, SMMC requested of the Inspectorate a one week extension on the final day of the deadline given. This request for an extension by SMMC was one of many during the investigation conducted by the Inspectorate.

“The need for prompt measures to remedy various deficiencies was, however, so acute that it did not warrant any further delay. The Inspectorate consequently rejected the request for further extensions and rendered its final report. The Inspectorate, thereby, announced on September 8, 2012 that it would be conducting more frequent investigations within SMMC and that SMMC was obliged to provide the Inspectorate with a detailed action plan outlining how SMMC would address the encountered deficiencies, within a specific timeframe.

“However, instead of providing the Inspectorate with the requested detailed action plan addressing the issues as outlined by the Inspectorate, SMMC gave the Inspectorate a copy of a report that was previously prepared for a potential collaboration agreement between the Foundation Mariadal in Bonaire and the SMMC.

“SMMC next immediately proceeded to initiate litigation against the Inspectorate to first suspend and later cancel the decision by the Inspectorate to conduct more frequent inspections within SMMC and to provide the Inspectorate with the requested detailed action plan.

“The Inspectorate laments very much that SMMC decided to use its scarce means that are – in principle – earmarked to provide good health care for the St. Maarten public to litigate against the Inspectorate, instead of simply complying with the reasonable demands of the Inspectorate by law.”

Judge dismisses St. Maarten Medical Center’s appeal against higher supervision

WEDNESDAY, 17 OCTOBER 2012

PHILIPSBURG–The Court of First Instance declared St. Maarten Medical Center’s (SMMC’s) case inadmissible Tuesday in its appeal launched against the Inspectorate of Public Health’s decision to put the hospital under higher supervision.

SMMC had filed a summary administrative proceeding, based on the Administrative Law Ordinance LAR, on September 27. The case was heard October 9.

The Public Health Inspectorate, represented in the injunction by Inspector General Earl Best, had placed SMMC under higher supervision based on the findings of its governance audit and thematic site inspections conducted on SMMC from the end of 2011 to the first half of 2012.

The measure went into effect as of September 8, and is also based on measures that need to be taken at SMMC concerning quality of care and patient safety, some in the short term and others within a year.
Via its attorney Maarten Le Poole, SMMC rejected the higher supervision and asked for clarity on the legal basis used for the measure. It asked for the lifting of higher supervision until the outcome of the court case on the merits, which is not to be heard until December 2012 or January 2013.

The inspectorate had given SMMC’s Board of Directors two weeks to present a feasible action plan “to address many of the critical issues found” in the report. The inspectorate also said it would be conducting announced and unannounced inspections at least three times per month at SMMC, following up on the action plan. Failure by SMMC to comply with the higher supervision may result in temporary closure of “specific functional units” or the issuance of fines.

According to SMMC, the inspectorate overstepped the boundaries of its authority. It further claimed it had submitted an action plan which addressed several “points of concern and improvements.”

SMMC’s delegation in court, which consisted of Director George Scot, Assistant Director Bonnie Dekker, Manager Patient Care Antonio Pantophlet and Human Resources/Communications Officer Juliëtte Hassell claimed the inspectorate’s findings were incorrect.

SMMC, represented in this case by Le Poole, qualified the higher supervision, which had caused “great damage,” as disproportionate, untimely, inaccurate and illegitimate.

Judge René van Veen agreed with the inspectorate that the decision to put SMMC under higher supervision had not been based on administrative law, which rendered it impossible for the hospital to raise objections and appeal the decision.
SMMC had claimed that the inspectorate was not authorised to submit it to higher supervision and had informed it on September 12 that it would not recognise the supervision and cooperate.

The court stated that the decision to impose higher supervision, the order to draft an action plan and the announced inspections did not have any binding legal consequences, nor had they altered SMMC’s rights, obligations, competences and legal status.

SMMC’s claim that higher supervision constituted “harsh coercion” was also rejected by the court. The Judge stated that in its letter of September 8, the inspectorate had merely pointed to the possibility that failure to comply with higher supervision “may result in fines or (temporary) closure of specific functional units.”
This led the court to the conclusion that the letter did not contain any legal consequences, and that SMMC’s appeal should be dismissed.

Rechter wijst juridische stappen St. Maarten Medical Center tegen Inspectie af

WOENSDAG, 17 OKTOBER 2012

PHILIPSBURG — Het Gerecht in Eerste Aanleg heeft gister de St. Maarten Medical Center (SMMC) niet-ontvankelijk verklaard in de zaak die is aangespannen tegen de Inspectie van Volksgezondheid, die het ziekenhuis onder hoger toezicht heeft gesteld. SMMC was op 27 september conform de LAR-wetgeving in beroep gegaan tegen de beslissing van de Inspectie van Volksgezondheid om het ziekenhuis onder hoger toezicht te stellen. De zaak kwam op 9 oktober voor.

De Inspectie, die in dezen werd vertegenwoordigd door Inspecteur van Volksgezondheid Earl Best, had het SMMC onder toezicht gesteld op basis van haar bevindingen aan de hand van haar onderzoek naar het beheer van de medische instelling en haar controle op werkplaatsen van de verschillende disciplines in het SMMC zoals uitgevoerd in de periode van eind 2011 tot het einde van de eerste helft van 2012.

De beslissing voor hoger toezicht werd van kracht op 8 september en is ook gebaseerd op maatregelen die genomen moeten worden in het SMMC om de kwaliteit van zorg en veiligheid van de patiënt op korte termijn of binnen een jaar te garanderen.

De advocaat van het SMMC, Maarten Le Poole, wees de instelling van hoger toezicht af en verzocht om duidelijkheid over de legale basis van de maatregel. Het ziekenhuis verzocht hoger toezicht op te heffen tot de uitspraak in de bodemprocedure die in december 2012 of januari 2013 verwacht kan worden.

De Inspectie had de Raad van Commissarissen van het SMMC twee weken de tijd gegeven om te komen met een uitvoerbaar plan van aanpak ter oplossing van de problemen die aangegeven werden in het rapport. De Inspectie maakte ook bekend dat zij minstens drie keer per maand controle zou uitoefenen in het SMMC na invoering van het actieplan. Indien het SMMC zich niet hield aan de regels van hoger toezicht zou dit de sluiting van specifieke functionele afdelingen of de oplegging van boetes tot gevolg hebben.

Volgens het SMMC had de Inspectie haar grenzen van bevoegdheden overtreden. Ook haalde het ziekenhuis aan dat een actieplan was ingediend en dat in dit document een aantal zorgwekkende onderwerpen en verbeteringen waren opgenomen.

Het SMMC werd tijdens de behandeling van de zaak vertegenwoordigd door directeur George Scot, assistent-directeur Bonnie Dekker, manager Patiëntenzorg Antonio Pantophlet en Juliette Hassel van Personeelszaken en Communicatie, die de bevindingen van de Inspectie niet correct achtten.

Advocaat Jairo Bloem trad op als raadsman van het SMMC. Hij kwam tot de conclusie dat hoger toezicht grote schade had berokkend, buiten proportie, inaccuraat en ongeldig was en op een verkeerd moment was ingevoerd.

Rechter René van Veen ging akkoord met de redenering van de Inspectie dat de beslissing om het SMMC onder hoger toezicht te stellen niet gebaseerd was op administratieve wetgeving met het gevolg dat het ziekenhuis onmogelijk bezwaar kon aantekenen en in beroep kon gaan tegen het besluit. Het ziekenhuis was van mening geweest dat de inspectie de bevoegdheid niet had haar onder hoger toezicht te plaatsen en had op 12 september te kennen gegeven dat zij de onder toezichtstelling niet zou erkennen en geen medewerking zou verlenen.

De rechter bracht naar voren dat de beslissing het SMMC onder hoger toezicht te stellen, de instructie met een actieplan te komen en de aankondiging van controle, geen bindende juridische resultaten hadden en geen verandering hadden aangebracht in de rechten, verplichtingen, bevoegdheden en legale status van het SMMC.

Het gerechtshof wees ook het standpunt, dat hoger toezicht een ernstige dwangmaatregel was, af. De rechter haalde aan dat in haar brief van 8 september, de Inspectie alleen had gewezen op de mogelijkheid dat het niet naleven van hoger toezicht tot de instelling van boetes kon leiden of dat specifieke functionele afdelingen (tijdelijk) zouden worden gesloten.

Dit leidde tot de beslissing van de rechter dat de brief geen juridische gevolgen met zich meebracht en dat het bezwaar van het SMMC als niet-ontvankelijk moest worden verklaard.

Zorg SMCC bij drie fatale incidenten beneden peil

WOENSDAG, 17 OKTOBER 2012

PHILIPSBURG — De Inspectie van de Volksgezondheid is tot de conclusie gekomen dat de kwaliteit van zorg te wensen overliet bij drie van de zeven sterfgevallen die onderzocht werden in het St. Maarten Medical Center (SMMCA) gedurende de afgelopen twee jaren.

Volgens Inspecteur van Volksgezondheid dr. Earl Best werden zeven gevallen met dodelijke afloop onderzocht, sinds hij in april 2010 in zijn positie werd benoemd. Hij haalde aan dat onderzoek in minstens drie zaken uitwees dat de patiëntenzorg te wensen overliet. Familieleden van de patiënten konden een kopie van het rapport opvragen, stelde Best. De drie zaken hebben zich gedurende het afgelopen anderhalf jaar voorgedaan.

Best beantwoordde vragen van The Daily Herald tijdens een persconferentie, die dinsdag werd gehouden. Aanwezig waren ook waarnemend inspecteur dr. Jan Haeck en advocaat Jairo Bloem.

Hij bracht naar voren dat deze zaken gerapporteerd waren of onder de aandacht van de Inspectie waren gebracht door de media. Hij verklaarde ook dat de Inspectie nog steeds in afwachting was van een rapport over onderzoeken, die ondernomen waren voor St. Maarten een autonoom land werd binnen het Koninkrijk en de instelling van een eigen Inspectie

St. Maarten government to gather valuable data at upcoming Cancer Conference

TUESDAY, 16 OCTOBER 2012

PHILIPSBURG–Government hopes to gather valuable data during the Cancer Conference at Sonesta Great Bay Beach Hotel, scheduled for Friday and Saturday, October 26 and 27.

Local and regional speakers will focus on four types of cancer: breast, cervical, colon and prostate. Government is covering the cost of the conference to the tune of a little over NAf. 45,000.

Health Minister Cornelius de Weever said at a press conference on Monday that over the past year and a half several organizations had been trying to address the issue of cancer in their own way. The conference is a way of synchronizing everyone’s efforts. He said this would hopefully synchronise the way to move forward when it comes to cancer in general.
In response to questions about available cancer statistics, Section Head General Public Health Maria Henry said figures are available at several institutions and organisations such as at St. Maarten Medical Center (SMMC), Social and Health Insurance SZV and at family practitioners.

De Weever said the main question to be answered at the conference is how to collectively structure local cancer services and registry. He said figures are available from several sources, but these are not synchronized and government is starting the process of collecting this information. It is important for government to establish the number of cancer patients on the island to be able to build on this, he added. Government is also looking at its Health Management Information System, which will also provide these data.

Shelly Alphonso of the Positive Foundation said the foundation was “extremely excited” about the conference and the information to be gathered from intended speakers. She said the foundation would be inviting the population to get involved. “We are grateful that government has seen the need to bring us together to be able to give this matter the attention that it needs,” she said. “And we definitely applaud all the organizations that are involved.”

St. Maarten Cancer Foundation Public Relations Officer (PRO) Graciella Zimmerman said cancer is a disease that touches everyone. She said government’s initiative in organizing the conference shows the seriousness of the disease.
The conference is being held under the theme “Cancer and aging, collectively improving our local cancer care and responsibility,” and is being jointly organised by the Health Ministry’s Collective Prevention Services (CPS) and a number of Non-Governmental Organizations (NGOs).

The line-up of regional speakers include Dr. Wassenaar from Aruba; Dr. Igor Gomes and Dr. Carmen Coronel from Curaçao; Dr. Jennifer Alexander from Jamaica and Professor Hassel from Barbados. Local speakers are Dr. Virginia Asin; Nurse Jasmine Cijntje; Hose Booi; Dr. Romney; Lydia Vanterpool and Graciella Zimmerman.

The conference will focus on sharing information on specific cancers with the objective of developing a strategic plan of approach in registering, managing and monitoring cancers; increasing awareness; and new treatments/techniques.
The stakeholders involved in this activity are: Cancer Foundation, Positive Foundation, The Lions, Kelaha Projects, St. Maarten Medical Center, Windward Islands Medical Association, St. Maarten Medical Association, St. Maarten Laboratory Services, SZV Social Insurance Bank, Pharmacies, Insurance Companies, and individuals. The Department of Communications is also providing support.

St. Maarten Medical Center requests court to take higher supervision off table

WEDNESDAY, 10 OCTOBER 2012

PHILIPSBURG–The Inspectorate for Public Health has gone on a “rampage” and has painted an “ominous” and incorrect picture of sub-standard healthcare at St. Maarten Medical Center (SMMC). Attorney-at-law Maarten Le Poole said this Tuesday during the injunction filed by SMMC against the higher supervision imposed by the Inspectorate.

The Public Health Inspectorate, represented in the injunction by Inspector General Earl Best, had placed SMMC under higher supervision based on the findings of its governance audit, thematic site inspections conducted on SMMC from the end of 2011 to the first half of 2012.

The measure went into effect as of September 8, and is also based on the measures that need to be taken at SMMC concerning quality of care and patient safety, some on short-term and others within a year.

Via its attorney SMMC rejected the higher supervision and asked for clarity on the legal basis used for the measure. It asked for the lifting of higher supervision until the outcome of the court case on the merits, which is not to be heard until December 2012 or January 2013.

Minister of Public Health, Social Development and Labour Cornelius de Weever was in the audience during the hearing of the injunction.

The inspectorate had given SMMC’s Board of Directors two weeks to present a feasible action plan “to address many of the critical issues found” in the report. The inspectorate also said it would be conducting announced and unannounced inspections at least three times per month at SMMC, following up on the action plan. Failure by SMMC to comply with the higher supervision may result in temporary closure of “specific functional units.” or the issuance of fines.
According to SMMC, the inspectorate had overstepped the boundaries of its authority. It further claimed that within the framework of possible cooperation with Fundashon Mariadal in Bonaire, it had submitted an action plan which addressed several “points of concern and improvements.”

SMMC’s delegation in court, consisting of Director George Scot, Assistant Director Bonnie Dekker, Manager Patient Care Antonio Pantophlet and Human Resources/ Communications Officer Juliëtte Hassell claimed the inspectorate’s findings were incorrect.

“The medical specialists underlined that the quality of patient care is up to standard and they do not agree with the assumption that the quality of patient care is being hampered,” attorney Le Poole stated on SMMC’s behalf.
SMMC stated that the inspection report has been founded on a “negative attitude” towards the Board of Directors and Supervisory Board, and is not in compliance with the vision of other experts and would, therefore, be a much too unsteady basis for higher supervision.

SMMC qualified this measure, which had caused “great damage,” as disproportionate, untimely, inaccurate and illegitimate.

Higher supervision does not mean that SMMC’s management has become subordinate to the inspectorate, said the inspectorate’s lawyer Jairo Bloem.

Bloem said the audit had included quality care, internal governance, first aid, reports of calamities, as well as inspections of equipment, medication and localities. Documents were studied and operations attended, while conversations were held with hospital staff, as well as the Board of Directors and Supervisory Board.

The inspectorate mentioned various deficiencies such as the lack of logs concerning the maintenance of medical equipment, lack of communication between management, unmotivated staff and high work pressure. It said the Board of Directors should act diligently in motivating staff, optimising care and in providing transparency on the quality of provided care in order to have the higher supervision lifted.

The inspectorate contested claims that it had overstepped the boundaries of its authority and had submitted SMMC to standards applicable to large hospitals in The Netherlands. Judge René van Veen will give his decision on Tuesday, October 16.

St. Maarten parliament meeting with minister De Weever about SMMC goes on despite his request to postpone it

TUESDAY, 09 OCTOBER 2012

~ MPs question minister about health-care issues ~

PHILIPSBURG–A meeting of the Central Committee of Parliament on the health situation at St. Maarten Medical Center (SMMC) and its impact on social and labour policies continued on Monday despite a request by Health Minister Cornelius de Weever for a postponement or for Members of Parliament (MPs) to submit their questions in writing.
De Weever made the request due to “the sensitivity” of today’s court case between SMMC and the Inspectorate of Public Health. SMMC had filed an administrative appeal against the Inspectorate as well as an administrative injunction case requesting the Court to suspend the higher supervision decision by the inspectorate pending the outcome of the administrative appeal.

The minister said it would “not be in our best interest” to “discuss the details, policies, impact or strategies” before the case was heard. “The lawyers will present their case and I am sure that this is the beginning of inevitable change that will come to SMMC and health care in general,” he said.

However, several MPs objected to the minister’s request and indicated that Monday’s meeting had been duly called and should proceed as planned. Several MPs said that while they understood that the minister would be unable to answer certain questions in light of the court case, there were other issues that could be addressed.

When the meeting was initially scheduled, the minister had written Parliament Chairman Rodolphe Samuel requesting that the meeting be postponed until after the court hearing. However, Samuel denied this request in a written response to the minister dated October 4 – a move that drew commendations from some MPs who said such a decision could not be made unilaterally.

Some MPs from the opposition benches also raised concerns about what they considered the lengthy time period some ministers were taking to respond to their questions.

Monday’s meeting proceeded with MPs quizzing the minister about a range of issues regarding the Medical Center and labour issues.

The 68 questions posed by United People’s (UP) party MP Jules James drew sharp reactions from some MPs in the governing coalition, one of whom classified 99 per cent of James’ questions as “irrelevant.”

James’ list of questions included requests for the minister to explain what was causing the delay in the hospital expansion; when the minister had become aware of this expansion; and to provide Parliament with copies of all correspondence between SMMC and the health ministry, including with attorneys.

The minister was also asked whether a request had been made for members of SMMC’s Supervisory Council to resign and if so, what had prompted this request, on what basis it had been made and whether the minister was in a position to make such a request.

James also wanted details on the current capacity of the hospital and whether the minister believed a larger hospital was needed because of the population growth in St. Maarten. He also asked the minister to indicate whether he had learnt about SMMC’s expansion before or after his “scouting trip” to South Africa with other MPs. He also asked if the expansion was a priority for the minister and if this was the case, what De Weever had done to expedite this expansion. Other questions posed by James related to how much subsidy government was giving SMMC and whether De Weever was playing “politics” with SMMC.

James also asked the minister to indicate how he rated SMMC, what were some of the specialists that he would like to see working there; how many Registered Nurses were in service and whether this was sufficient. It was also asked whether the filling of Great Salt Pond for a drag-racing facility was more important at this time than the expansion of SMMC.
James said UP would be calling more ministers to Parliament and asking them “a barrage of questions,” because, according to him, ministers were not answering questions from MPs in a timely manner.

Irrelevant

Democratic Party (DP) Member of Parliament Roy Marlin reacted strongly to James’ line of questioning. Alluding to the saying, “One crazy man can ask more questions than 10 wise men,” Marlin said most of the questions asked were irrelevant. He said the issue at SMMC warranted all 15 MPs’ coming together to help the minister bring about positive changes at the hospital – that improvements were needed at SMMC and this is what focus should be placed on. He said the minister was being questioned about issues while he had no authority at the medical facility. He said the situation at SMMC was such that SMMC General Director and Board of Directors President Dr. George Scot could tell Parliament that he didn’t have to meet with them, “forcing” the calling of a parliamentary inquiry. “We wasted about 45 minutes of the people’s time, asking questions that are irrelevant,” the MP contended. He said MPs should be putting their “brains” together to talk about how to “force” changes at SMMC.

He said there were issues at SMMC that needed to be addressed. While most hospitals have separate female and male wards, this is not the case at SMMC. The SMMC Director spends half of his time abroad and half at SMMC, Marlin said. He asked whether everyone should “sit back” and allow this situation continue.
UP MP Gracita Arrindell said MPs were being paid to perform their duties and it was their prerogative to ask as many questions as they chose. She asked De Weever to give an update on the national health-care policy, to say how long the approval process took for employment permits and to list the medical credentials for health care workers, among other matters.

On the issue of receiving answers, she recommended that a system be put in place to track questions sent to government and remind ministers of their responsibilities to respond in a timely manner.

Independent MP Romain Laville said De Weever did not have the power to tell SMMC what to do and the focus of the meeting should have been what Parliament could do to help the minister prevent a health crisis in the country. He said too that the situation at SMMC was similar to that of utilities company GEBE, in which people were afraid to speak about the issues. “We cannot address the health issue in St. Maarten in the rightful way, because some of us don’t go to the SMMC for treatment so we don’t know what other people in St. Maarten are going through.”

Laville also urged some of his fellow MPs not to be used. He said some MPs had been given papers with questions to “trap” the minister and some of them did not even understand what they were asking.

UP MP Johan “Janchi” Leonard later said that they had been given questions to ask by the people. Laville said it was “petty nonsense” to mention the race track in the context of the hospital expansion.

Bridge to nowhere

Independent MP Frans Richardson said UP leader Theo Heyliger should have used some of the US $150 million that was being hidden for the “bridge to nowhere” for the hospital expansion. He said there were millions of passengers coming to St. Maarten by cruise and air and “at least the previous coalition partner should have come and said we would put the bridge aside” and invested in health. They “could have made a nice injection to SMMC with the same funds from the creation of a bridge to nowhere. Is a bridge more important that the investment in a hospital? Does a bridge give more return than the health of the people of this island?” Frans Richardson asked. The independent MP urged De Weever to present his vision for health care. This vision, he added, should take into account residents and the many visitors to the island.

Serious issues

UP MP Dr. Ruth Douglass said SMMC had been facing some “serious issues” that must be dealt with. She said as a medical practitioner it was “alarming” for her to listen to what was being said about health care. She asked what was government’s health-care standard for St. Maarten and how SMMC rated against it. She also enquired what powers the current inspectorate had over the management of SMMC and how this power was exercised. She also asked how many complaints were received by the inspectorate; how the recent higher supervision would affect SMMC’s planned expansion; and what were the specifics of higher supervision, among other questions.

UP MP Silvia Meyers asked the minister to provide the inspectorate’s report on the hospital. She also asked how many inspections had been conducted on SMMC; what were the results and when was the first time SMMC had been inspected. She also asked some labour-related questions.

Also speaking at the meeting were National Alliance (NA) MPs George Pantophlet, Hyacinth Richardson and Dr. Lloyd Richardson, independent MP Patrick Illidge and earlier in the meeting Democratic Party (DP) MP Leroy de Weever. The meeting which began at 10:00am was adjourned around 2:00pm, when another meeting with Education Minister Silveria Jacobs was scheduled. De Weever is to appear before Parliament for the continuation of the meeting within a week.

Nederland wil helpen bij St. Maarten Medical Center

05 OKTOBER 2012

PHILIPSBURG – Volgens de voorzitter van het Parlement, Rodolphe Samuel, is Nederland geïnteresseerd om deel uit te maken van de ontwikkeling van het SMMC.

AD 05.10.12

Hospitaal en Inspectie op zoek naar oplossing op St. Maarten

ZATERDAG, 29 SEPTEMBER 2012

PHILIPSBURG — Het St. Maarten Medical Center (SMMC) en de Inspectie van Volksgezondheid hebben een ontmoeting gehad in een poging om uit de huidige impasse te geraken nadat twee weken geleden het ziekenhuis onder hoger toezicht is gesteld.

De Inspectie van Volksgezondheid heeft de SMMC onder hoger toezicht gesteld aan de hand van haar bevindingen tijdens de inspectie uitgevoerd binnen het SMMC eind vorig jaar en gedurende de eerste helft van 2012. De maatregel is op 8 september van kracht geworden en is ook gebaseerd op de maatregelen die genomen moeten worden bij de SMMC voor wat betreft de kwaliteit van zorg en de veiligheid van patiënten op korte termijn of in andere gevallen binnen een jaar.

SMMC heeft zich later door middel van haar advocaat verzet tegen hoger toezicht en om duidelijkheid over de juridische basis van deze maatregel verzocht.

De Inspectie heeft de Raad van Commissarissen van het SMMC twee weken de tijd gegeven om een uitvoerbaar actieplan te komen. In het plan moet een oplossing voor de meerderheid van de spoedeisende onderwerpen worden ondergebracht. De Inspectie heeft ook vermeld dat zij minstens drie keer per maand zonder afspraak het SMMC zal bezoeken. Indien het SMMC zich niet houdt aan het hoger toezicht kan men overgaan tot tijdelijke sluiting van bepaalde functionele afdelingen.

St. Maarten hospital, inspectorate meet to iron out issues

TUESDAY, 25 SEPTEMBER 2012

CAY HILL–St. Maarten Medical Center (SMMC) and the Inspectorate of Public Health met on Monday afternoon to iron out issues related to the higher supervision placed on the hospital a little over two weeks ago.

The details of the meeting could not be ascertained. The Daily Herald understands that parties did not completely agree on the agenda before the meeting, but the meeting went ahead anyway and an agenda was supposed to have been made at the meeting.

The Inspectorate for Public Health had placed SMMC under higher supervision based on the findings of its governance audit thematic site inspections conducted on SMMC from the end of 2011 to the first half of 2012. The measure went into effect as of September 8, and is also based on the measures that need to be taken at SMMC with regard to quality of care and patient safety, some on short-term and others within a year.

SMMC via its attorney later rejected the higher supervision and asked for clarity on the legal basis used for this measure.
The Inspectorate had given SMMC’s Board of Directors two weeks to present a feasible action plan “to address many of the critical issues found” in the report. The Inspectorate also said it would be conducting announced and unannounced inspections at least three times per month at SMMC following up on the action plan. Failure by SMMC to comply with the higher supervision may result in temporary closure of “specific functional units.”

SMMC’s attorney Maarten le Poole of HBN Law said last week he was confident that the deadline would not be used to implement all kinds of measures at SMMC, especially given the fact that parties were working on meeting this week.

St. Maarten Medical Center to file administrative appeal against Health Inspectorate

TUESDAY, 18 SEPTEMBER 2012

~ Says hospital already submitted plan of action ~

PHILIPSBURG–St. Maarten Medical Center (SMMC) will be filing an administrative appeal to annul the decision of the Inspectorate of Public Health to place SMMC under “higher supervision.”
SMMC’s attorney Maarten le Poole of HBN law said on Monday that there seems to be no legal basis for higher supervision to be placed on the hospital and for the imposition of measures as a result of the supervision.
Le Poole said he found it disturbing that in all its communication on the SMMC issue, the Inspectorate had been silent about the plan of action SMMC had submitted to it a day before the higher supervision had been imposed. The Inspectorate had instructed SMMC’s board of directors to present a feasible action plan within two weeks to address many of the critical issues found in its governance audit and thematic site inspections at SMMC. The Inspectorate said it would also be conducting announced and unannounced inspections at least three times a month following up on the action plan.

Le Poole: “SMMC had already submitted a plan of action concerning many points addressed in the Inspectorate report. The Inspectorate has been completely silent on this. SMMC had submitted the report on September 7 and the letter of higher supervision was issued on September 8 and the press release on the subject issued on September 10.”
“There was no mention that on September 7 SMMC had already, on its own account because the hospital felt it necessary, presented a broad overview of the status of affairs at SMMC combined with a plan on certain issues. It is striking that the Inspectorate pretends that this plan does not exist and does not even mention it.”
Le Poole said he knew the Inspectorate had received the plan, because he had seen correspondence in which the Inspectorate confirmed receiving it.

He said the hospital wanted the Inspectorate to provide clarification on the law used to institute higher supervision, as SMMC is of the view that there is no legal basis. Inspector General Earl Best has said that the Inspectorate has the authority to act if health care is in jeopardy (see related story).
Best has been asked to publicly retract his statement that SMMC is under higher supervision. Le Poole said too that while SMMC had responded to Best’s correspondence, Best has not responded to SMMC’s latest correspondence sent last week Friday.

In that letter, HBN informed the Inspectorate on behalf of its clients of its plans to file an administrative appeal. The Inspectorate was also asked if it was willing to suspend its current actions pending the outcome of the administrative appeal. Le Poole said this question “remains unanswered. We can therefore only conclude that the Inspectorate refuses to communicate with us.”
Best had responded to HBN’s first correspondence.

Best maintains that SMMC higher supervision stands

TUESDAY, 18 SEPTEMBER 2012

~ Says: Most hospitals would be eager to comply~

PHILIPSBURG–Inspector General Earl Best has maintained that the higher supervision placed on St. Maarten Medical Center (SMMC) stands and is hoping the hospital would adhere to the content of the supervision or measures will have to be taken.

However, SMMC’s attorney Maarten le Poole of HBN Law on Monday maintained that there is no legal basis for higher supervision to be placed on SMMC and said the hospital would be filing an administrative appeal against the Inspectorate to retract its order (see related story).

Best told The Daily Herald on Monday that most hospitals finding themselves in a situation as SMMC would be eager to work together with the Inspectorate to rectify things, but not SMMC. The Inspectorate said the hospital’s rejection of the supervision was “more or less expected, seeing the way they behaved in the whole inspection process.”

Best said the Inspectorate will have to meet with SMMC and determine a way forward. “We will have to meet with them first. Wanting to comply is the most simple and normal thing to do. Instead of fighting with the Inspectorate, you try to sit and resolve the situation. That is what all hospitals would love to do, but not here in St. Maarten,” Best said. “If they [SMMC ed.] want to fight with us, we have several measures we can take. We can fine them and if they don’t abide in the end we can say we will close [some functional units ed.]. That’s an option, or the minister can take a decision to come up with a decree.”

He said SMMC has been placed under “Verscherpt toezicht,” Dutch for “higher supervision.” Asked what was the legal basis for this action, he said the Inspectorate “does not need a legal basis” for this action, as “the Inspectorate is authorized” to take such a decision if it determines that health care is in jeopardy.

He said failure by SMMC to adhere to the conditions of its supervision would result in the imposition of measures. This could include fines and the closure of certain functional units. Two units that would face closure are the Emergency Room and the Surgical Ward. He said the Inspectorate is an independently functioning body and it is incumbent on the Health Ministry to determine what measures would be put in place to guarantee continuity of care in these areas, if this measure were to be taken.

Best said he had responded to SMMC’s letter rejecting the higher supervision last Friday. In his letter he maintained that the supervision stands and he urged SMMC to comply.
Asked for his views on the summons he was given by SMMC via its attorney that the Inspectorate should refrain from making further public statements while the issues with SMMC have not been clarified, and without first consulting SMMC, and from performing further acts which suggest that its office lets itself be used as a political tool, Best said this was SMMC’s opinion.

“We are the Inspectorate. We are independent. That’s their opinion.” He said if the Inspectorate has to call on government in this case, it would do so.

St. Maarten Hospital will not adhere to higher supervision

THURSDAY, 13 SEPTEMBER 2012

~ Gives Best two days to retract statement ~

CAY HILL–St. Maarten Medical Center (SMMC) says it will not cooperate with the higher supervision order placed on it by the Inspectorate for Public Health because there is no proper legal justification for the inspectorate’s decision.
In a letter to Inspector General Earl Best on Wednesday, HBN Law, the attorneys representing the hospital, also gave the inspectorate two days within which to publicly rectify its earlier public statement indicating that SMMC had been put under “higher supervision.”

In its letter HBN law also “summoned” the inspectorate “to refrain from making further public statements” while the issues with SMMC have not been clarified and without first consulting SMMC; and to avoid performing further acts, “which suggest that its office lets itself be used as a political tool.”

“Since it is abundantly clear that the phenomenon of higher supervision does not even exist in this context, since the connotation of the term higher supervision is, as you should have known, extremely ominous and leads to widespread misconceptions and to a lack of confidence and motivation both internally and externally, and since the use of this term is therefore highly irresponsible, you are also summoned to, within two days as of the date of this letter, publicly rectify your earlier public statement(s) indicating that SMMC has been put under higher supervision,” the law firm wrote.

HBN Law said SMMC had asked it to react to the inspectorate’s letter dated September 8, in which the Inspectorate had given notice to SMMC of its decision to put SMMC under higher supervision as of September 8, 2012, for a period of one year and “whereby you threatened to impose fines on SMMC, or take other coercive measures in case of noncompliance.”
“The first striking element of your letter is that it fails to refer to any ordinance, regulation or enforcement framework on which the abovementioned decision and its implications can be and have been based. This is all the more striking since your office was able and willing to provide a list of (supposedly) applicable ordinances and other documents to members of the local media,” the letter stated.

“This list, if correct at all, is neither specific as to the legal basis for the measure of ‘higher supervision’ and for the implications of this measure, nor as to the legal basis for the imposing of fines and/or for the closing of functional units. Our review of the ordinances, which have the most relevance in this matter, has neither revealed any basis for the measure of higher or intensified supervision of a medical institution like SMMC or for the implications of such measures.”
The letter continued: “The above leads to the preliminary conclusion drawn by SMMC that the decision mentioned in your letter of September 8, 2012 is either contrary to written law or in conflict with general legal principles, the latter, for instance, because the decision has not been substantiated properly and was taken in violation of the requirement of due care (in Dutch: zorgvuldigheidsbeginsel).This violation includes, but is not limited to the genesis of the decision, such as the unprofessional way in which the draft report HBN Law since 1938 containing many factual errors was circulated, the lack of hearing both sides in that regard and the unreasonable refusal of the request by SMMC for a short extension of the term for providing a reaction to the draft report.”

“Unless and until you have provided SMMC with a proper legal justification and, if the latter exists at all, with a proper substantiation of your decision, SMMC will not recognise same as being valid and will not cooperate with same.
“Please be advised in this regard that SMMC does not share your opinion that your decision cannot be appealed under the Ordinance on Administrative Justice LAR. SMMC is of the opinion that your decision is without any doubt subject to appeal and in fact intends to file such appeal within the shortest possible term. SMMC will also consider requesting the court to suspend your decision pending the handling of the appeal case.

“Furthermore, SMMC strongly takes exception to the fact that you have divulged your ill-considered decision to the local media behind its back, thereby creating yet another wave of unnecessary unrest in the community regarding the functioning of the hospital; and also to the fact that the provision by [SMMC General Director and Board President Dr. George, ed.] Scot of his own assessment dated August 2012 and sent on September 7, including an improvement plan to the Inspectorate, has deliberately been ignored by your office in the report as well as in the press release of September 10, 2012, whereby the erroneous impression was created that SMMC is not committed to pursuing improvements.”
HBN Law says if the Inspectorate disregards its summons this will lead to appropriate legal measures being taken by SMMC and to holding country St. Maarten liable for all damages resulting from “your actions or omissions.”

“SMMC is in the process of preparing a comprehensive reaction to both the draft and the final version of the audit report,” it was stated in the letter.

De Weever vows to guarantee quality care at medical center

THURSDAY, 13 SEPTEMBER 2012

PHILIPSBURG–Health Minister Cornelius de Weever says if functional units at St. Maarten Medical Center (SMMC) have to be closed by the Inspectorate of Public Health if the hospital fails to comply with the higher supervision placed on it, “then that’s what will have to be done.”

The minister was responding to questions by this newspaper as to what measures had been or would be put in place for the continuity of care if certain departments at SMMC were to be closed.

The minister said that if the Inspectorate “deems it necessary” to close functional units “for the safety and quality of patient care then that’s what they have to do. If different arrangements need to be made … then that’s what we have to do, but we have to ensure a quality level of health care that doesn’t drop. We cannot allow this to continue.”

On Wednesday, the Minister stuck to his position that as long as he holds his current function he will do what is necessary to guarantee quality care at SMMC. He also told reporters at the Council of Ministers press briefing on Wednesday that the Inspectorate of Public Health was an independently functioning body that was not obligated to inform him of every decision it made.

He was alluding to a press release he had issued on Sunday regarding the SMMC issue. The Inspectorate had placed SMMC under higher supervision on Saturday.

De Weever said the Inspectorate was free to issue “sanctions” against SMMC if it considered it necessary. “They are free to do so. They do not necessarily have to communicate with me about that, because they act on their own,” he said. “If I have to interfere in everything that the Inspectorate does, I’ll be doing their job. That’s the reason for the Inspectorate being independent.”

On the issue of corporate governance, De Weever said he had expressed his belief from the inception of his “amicable meetings” with SMMC that the Corporate Governance Council should be involved to some degree, “because we are a country as of 10/10/10 and their involvement, I believe, is essential as well.”

The minister said that whether the Corporate Governance Council or Corporate Governance Code was used, “I believe that would be doing things the right way.”
He said the Corporate Governance Council had been asked in a letter dated May 7 about its role and involvement with the medical centre and articles of incorporation. A response was received on September 11. He also spoke about letters dated July 19 and July 21.

He said, “Those who believe it [SMMC, ed.] is a private foundation and that in their opinion they can even have their lawyers make statements to me, it is okay. I have responsibility as Minister of Public Health to make sure the safety of the people of St. Maarten and if I can’t do my job …

“While I sit on this chair this will not happen. This will not happen as long as I am sitting in this chair and I need to make this extremely clear to everyone. That’s my job and that’s what I have to do and I will not apologise for doing my job. If I have to end up in court then so be it.”

Responding to statements questioning why he had not been called to Parliament, the minister said he had been called to Parliament.

He said he never had requested that the Supervisory Council members resign, but rather had requested in a letter dated August 31 that they “reconsider their positions,” which he said was different from requesting that they resign.
“You can interpret it or misinterpret it. I did what I felt was the best choice. If I ask you to reconsider you can reconsider or not. I think it warranted them to reconsider, because of the process and the way it was done,” he said.

St. Maarten Medical Center placed under supervision

TUESDAY, 11 SEPTEMBER 2012

~ Hospital has to present feasible plan in two weeks ~

CAY HILL–The Inspectorate for Public Health has placed St. Maarten Medical Center (SMMC) under higher supervision based on the findings of the inspectorate’s governance audit thematic site inspections conducted on SMMC from the end of 2011 through the first half of 2012.

The higher supervision, which took effect on September 8, also is based on the measures that need to be taken at SMMC with regard to quality of care and patient safety, some in the short term and others within a year.

The Inspectorate has given SMMC’s Board of Directors two weeks to present a feasible action plan “to address many of the critical issues found” in the report. The Inspectorate will also be conducting announced and unannounced inspections at least three times per month at SMMC, following up on the action plan.

Failure by SMMC to comply with the higher supervision may result in temporary closure of “specific functional units,” a press release issued via the Department of Communications DComm stated on Monday.

Quality of care, internal supervision (governance), surgical operations, the Emergency Department and the handling of accidents and incidents were audited through inspection visits and conversations with staff members, the board of directors and the Supervisory Council. For the audits on governance and surgical operations, support was provided by the Dutch Inspectorate for Healthcare IGZ.

The Inspectorate said it was aware of the fact that St. Maarten is a small island with only one hospital, the SMMC. “Demanding of this hospital that it complies with all requirements as stipulated for hospitals in the Western world would be unrealistic and not feasible, but one must expect the SMMC to comply with basic quality and patient-safety standards and healthcare ordinances and regulations,” it was stated in the release.

“The audit and inspections leave much to be desired. A common and important finding is the lack of proper communication in different areas and at different levels, resulting in severe delay in the development of a basic quality and safety system and a high risk for the patient.

“This situation is worsened by the fact that the Board of Directors is frequently (50 per cent of the time) off-island and replaced by a staff member without mandated authority and an incomplete Supervisory Council that cannot exercise its supervisory role adequately.”

Also included in this report are some investigative results of incidents that occurred in 2010, 2011 and 2012, because they provide insight into the way the SMMC is organised – on the one hand about the communication amongst professionals and between professionals and the board of directors, and on the other hand about how transparent management is to external supervision.

When publishing a report, the Inspectorate said it had taken into account the norms as prescribed by legislation such as the Openness in Government Law (“Landsverordening Openbaarheid van Bestuur”).

This means that wherever possible, personal information will not be mentioned in this report – for example, patient names – and staff members of SMMC will be referred to as much as possible by their function.

Due to less than optimal cooperation from the Board of Directors, it wasn’t until July 12, 2012, that the Inspectorate could speak with the director. The provided information has been processed in this report. The findings of the audit were compiled in a draft report which was delivered to the SMMC board of directors on August 24 for comment prior to publication. SMMC’s board is headed by Dr. George Scot. He is also General Director.

The Inspectorate said the deadline to deliver any comment to the Inspectorate was September 7. However, the board indicated in a September 7 letter to the Inspectorate that it couldn’t comply with the deadline due to several internal delays, and requested an extension until September 17. The Inspectorate said it had denied this request and indicated that possible comments would be dealt with when discussing the action plan to be drafted.

“Based on the findings and measures that need to be taken with regard to quality of care and patient safety, some on short term and others within a year, the Inspectorate has put the SMMC under higher supervision as of September 8, 2012.
“This means that the board of directors must present a feasible action plan within two weeks to address many of the critical issues found and that the Inspectorate will be conducting announced and unannounced inspections at least three times a month following up on the action plan. Failure to comply may result in (temporary) closure of specific functional units,” it was stated in the release.

The Inspectorate said it had used the following ordinances and regulations for this audit and measures to be taken: Landsverordening Zorginstellingen (PB 2007 no. 19); Landsverordening Corporate Governance (PB 2009 no. 74); Landsverordening Inspectie Volksgezondheid (PB 2003 no. 8); Landsverordening Beperking Vestiging Medische Beroepsbeoefenaren (PB 2005 no. 69); Landsverordening Uitoefening Geneeskunst (PB 1958 no. 174); BW boek 7 afdeling 5 Overeenkomst Inzake Geneeskundige Behandeling; Statuten SMMC 25 April 2008; Basis Reglementen Raad van Toezicht – SMMC 26 September 2011; Gedragcode Raad van Toezicht SMMC June 2011; and Model Toelatingsovereenkomst SMMC 2010 versie 6.0.

St. Maarten minister De Weever says actions SMMC must be within country’s legal framework

MONDAY, 10 SEPTEMBER 2012

PHILIPSBURG–Health Minister Cornelius de Weever said on Sunday that any actions he or government takes in relation to St. Maarten Medical Center (SMMC) “must be within the legal framework of our country and will not and shall not exclude the introduction of new legislation or amending existing laws or the amendment of existing licences.”
De Weever said in a press statement issued on Sunday that legislative processes took time, considering the necessary consultations and checks and balances. “However, in the event no other options are left, I shall proceed and expedite matters in the general interest of St. Maarten and my duty of care.”

The minister’s statement comes on the heels of a strongly-worded letter he was sent from the attorneys representing SMMC General Director Dr. George Scot and SMMC’s Supervisory Council in which the minister was told that the Council would not resign as had been requested. In the letter the minister also was requested to stop interfering in the affairs of SMMC and to stop slandering the institution.

In his release De Weever said that as Minister charged with public health, it was his duty to see to it that all care institutions in St. Maarten not only adhered to the laws governing the health care sector, but also to ensure that the provisions of those laws were not only enforced, but could be enforced justly.

“Patients, nurses, specialists, staff, management and board members of care institutions must know their responsibilities and should have been provided with the means to effectively perform their duties or seek their rights,” it was stated in the release.

“No one care institute in the world is perfect. However, that doesn’t mean that together we cannot strive for perfection. It is not uncommon that at times members of boards develop tunnel vision that no longer allows them to see their faults even when presented with sound arguments thereto.

“Boards at times may have established practices that are either inconsistent with the rules governing their institutions or that are interpretable/questionable. Both situations are undesirable with regard to the provision of care. Rules must be clear, logical and adhered to. Non-adherence to, misinterpretation or circumvention of laws, bylaws or own code of conduct is not conducive to any board, especially if such relates to our country’s largest care institution.

“The laws of our nation charge the Minister of Public Health with the issuance of various care-related licences, the amendment or revocation of previously issued ones. Furthermore, the Minister of Public Health can initiate and, together with his colleague ministers, pass resolutions (laws) that may have far reaching consequences.
“Subsequently or independently, government may together with the Parliament of St. Maarten pass new ordinances or amend existing ones to ensure that the minister charged with public health can effectively and proactively ensure the wellbeing of the citizens of St. Maarten and visitors alike.

“The extent to which the present laws allow government to intervene is far-reaching and doesn’t exclude intervening on the highest levels of any care institution. The situation at the SMMC is a very delicate matter and must be handled with the most care and as professionally as possible.

“The Public Health Department (research/policy), the Inspectorate of Public Health (inspection/issuance of fines/set instructions) play a crucial role in the public health management field and in my capacity as Minister, I cannot simply ignore those two key departments when addressing matters as presently is the case.

“As stated earlier, no institution is perfect, it is therefore necessary to continuously consult relevant stakeholders and professionals in the health care sector to strengthen and improve the governing structures of health care providers so they may improve their provision of care.

“Rest assured that I will do all that is necessary within my capacity to ensure that St. Maarten has a medical centre that is of the highest standards and that can meet the needs of the specialists, nurses, staff and most importantly the patients of the SMMC.”

St. Maarten hospital tells minister to stop interfering, stop public slander

FRIDAY, 07 SEPTEMBER 2012

~ Says no legal basis for Supervisory Council to resign ~

CAY HILL–Public Health Minister Cornelius de Weever was told on Thursday to stop interfering in the affairs of St. Maarten Medical Center (SMMC) immediately and to stop “slandering” the institution.

In a strongly-worded letter to the minister, attorneys representing the hospital and its Supervisory Council added that there was no legal basis for the minister to request that members of the Supervisory Council resign. The attorneys asked the minister to state the legal basis for his request that the members step down.

The minister had requested in a letter dated August 30 that the members of the hospital’s Supervisory Council resign.
However, on behalf of the hospital, attorneys C. J. Koster and R. Zwanikken stated in a September 6 letter to the minister that SMMC was a private foundation.

“The Minister of Public Health, Social Development and Labour only has very limited power to interfere within the corporate structure of SMMC. Based on the articles of incorporation, the minister only needs to be consulted regarding the appointment, suspension or dismissal of members of the board,” the attorneys stated.

“With regard to the appointment of members of the Supervisory Council, the minister only has the possibility to choose out of one of the two binding nominations presented by the Supervisory Council (Article 9 (2a)). If the minister does not make a choice in two months after receiving notice, then the Supervisory Council shall choose one of the two nominees.
“The request you made cannot be based on the articles of incorporation of SMMC. For clients it is unclear on what rule of law, statute or law you have based [your, ed.] requests. Please be therefore advised that the Supervisory Council will not comply with these requests, as a legal basis for same is or at least seems to be lacking.”

The attorneys said that if the minister believed there was a legal basis for his request, he should elaborate on it in a letter to the law firm BZSE Attorneys at Law and Tax Lawyers.

“In that case you are kindly requested to explicitly refer to the applicable articles in the law or to the applicable provisions in the articles of incorporation of SMMC.

“Please be also advised that clients are not pleased at all that you have decided to go to the press with negative statements about SMMC, allegedly based on a report of the Inspectorate, a report that my clients had not received yet. Clients consider this a violation of article 2c, e and f of the [transparency in government ordinance, ed.] Landsverordening Openbaarheid Bestuur IOB.

“Your statements have created unrest and have unnecessarily decreased confidence in the largest care-giving institution of the Dutch Windward Islands for residents of St. Maarten, Saba and Statia. The fact that these statements came from the Minister of Health cannot be deemed other than very irresponsible.

“Finally and last, but not least, please be advised that SMMC is of the opinion that political interference with its organisation and its daily operation is undesirable and inappropriate, especially in case the interference lacks any legal basis. Moreover, your interference and the interference of the Health Committee of Parliament have a detrimental effect on SMMC, its donors, its employees, its patients and the public opinion of the people of St. Maarten.
“SMMC requests you – and insofar as necessary summons you – to immediately cease this interference and public slandering of SMMC,” concluded the attorneys in their letter, which was copied to Parliament’s Permanent Committee for Public Health and to the media.

De Weever had sent three letters to SMMC: one dated August 21 requesting information and documents from the Supervisory Council, one dated August 31 asking the Council members to resign and one dated September 1 requesting that the Supervisory Council not enter into any agreements that might negatively affect the relationship between SMMC and government.

St. Maarten parlementarians afford SMMC-director Scot another chance to meet with them

THURSDAY, 06 SEPTEMBER 2012

~ Or they will request parliamentary inquiry ~

PHILIPSBURG–Parliament’s Permanent Committee for Public Health has given St. Maarten Medical Center (SMMC) General Director Dr. George Scot another chance to meet with them on September 13 or they will request a parliamentary inquiry into its concerns at the medical institution.

Scot, who also holds the position of President of SMMC’s Board, did not show up for a meeting called by the Committee on Monday. Scot sent a letter to the committee, requesting, among other things, that an impartial person chair that particular meeting, said Committee chairman Leroy de Weever.

De Weever (Democratic Party) said this request was not possible as Parliament’s committees have a certain structure. “I don’t know how he can expect that. We have a system and that is how it is. He [Scot ed.] also wanted specific elaborations on things,” said de Weever.

In his letter Scot had also referred to the structure of SMMC in relation to whom the MPs had invited to the closed-door meeting, which de Weever said, was “semantics” on the part of Scot.

De Weever said the Committee had sent a letter to Scot inviting him to another meeting on September 13. The Committee will also send Scot another letter this week enquiring whether he planned to show up to the meeting on September 13. The Committee plans to meet separately with Scot and the Supervisory Council on this date. “We have given Scot a new date and if that does not happen then as Parliament we will request a parliamentary inquiry and I don’t think they want to go that way,” said De Weever adding that any “recklessness” or “shady stuff” occurring at SMMC will be revealed in such an inquiry.

Members of Parliament serving on the Permanent Committee for Public Health along with other interested MPs still met among themselves on Monday and discussed the letter sent by Scot among other things.

De Weever called for the urgent meeting in August to discuss the level of care and constant “rumours” about the quality of care being delivered by SMMC. His concerns and those of other MPs stemmed from the recent passing of Ruth Olivacce, the sister of United People’s (UP) party Fraction Leader MP Silvia Meyers-Olivacce, at SMMC as well as other concerns about the institution.

MPs met with the Association of Medical Specialists and MPs on Tuesday (see related story) regarding their concerns at SMMC.

THURSDAY, 06 SEPTEMBER 2012

PHILIPSBURG–Members of Parliament (MPs) serving on the Permanent Committee for Public Health will be recommending that St. Maarten Medical Center (SMMC) be managed by a three-member board, instead of one person as is currently the case.

The current President of SMMC’s Board is Dr. George Scot, who is also SMMC’s General Director. This was one of the suggestions that came out of a meeting among MPs and members of the Association of Medical Specialists on Tuesday.
“It is a must that the managing board of the hospital is expanded,” said Committee Chairman Leroy de Weever. “Right now it’s only one person.”

The initial suggestion was for the board to be expanded to two persons, but De Weever said stalemates can be encountered if decisions are to be made by only two persons. This can be eliminated with a three-person board. He said one of the board members can have a financial background, one a medical background and the other a managerial background.

De Weever said the meeting attended by medical specialists, surgeon Dr. Felix Holiday, pediatrician Pieter Offringa and Internist Theo Jolles, had been a professional and cordial one. Obstetrician/Gynecologist Randall Friday could not attend due to a medical emergency. A total of 11 MPs, including those of the Committee attended the meeting.
Another recommendation to be made to Health Minister Cornelius de Weever, is for the Medical Council to be activated. De Weever said the establishment of such a body is already on paper, but does not exist in practice. The council would function as an independent body and review the applications of medical specialists and other persons who want to work in the medical field here.

De Weever said he will also be notifying the specialists of any decisions the Committee will be taking in the future, since these will ultimately affect them. “We want to be in harmony with them. Our recommendation is that physicians should also have a little more say in the management aspect of the facility and my proposal is that a physician be appointed to the supervisory board of the hospital.”

De Weever said MPs made it clear that the meeting had been called to discuss concerns at the institution and that no one had any personal vendetta against anyone.

“We want to make it clear that there is no vendetta against anyone and no one is gunning for anyone. We wanted to assure them that we are going about this enquiry not just because of bad press, but we had pointed questions such as whether physicians had problems with the constant absence of the General Director [Dr. George Scot, ed.] and not having someone to go to if issues come up in his absence.

“There is a report from [Inspector General Earl ed.] Best and we wanted to see what SMMC is doing about it and we wanted to talk about the expansion and the reluctance of Scot to provide information to the people who are financing the expansion,” said De Weever. The Committee has also requested a copy of the report from Best.

De Weever said Social and Health Insurance SZV is one of the financiers of SMMC’s expansion, yet information is not forthcoming from Scot to SZV. “He does not want to provide creditors with information and this is hampering the execution of the expansion for the hospital. A building is a building, but what’s important is the staffing. You can have the most beautiful building in the world, but if you’re not doing enough for the staff, quality will be compromised and we wanted to know how we can help,” he said.

Minister De Weever requests St. Maarten Medical Center board to make positions available

~ But procedure unclear ~

MONDAY, 03 SEPTEMBER 2012

CAY HILL–Reports over the weekend indicated that Minister of Public Health Cornelius de Weever has asked the members of the St. Maarten Medical Center Foundation (SMMC) Supervisory Board to make their position available to government.

Such a request requires some clarification considering that the SMMC board is a private one and the articles of incorporation of the foundation affords government the opportunity to appoint only a single member.
This issue was debated before between government and the SMMC in a court of law during the Chairmanship of Glen Carty. Government at the time lost that court case with the judge ruling that government could not appoint the members to the board to run the hospital.

The Daily Herald understands the minister informed the Supervisory Board of his wishes during an emergency meeting he had called on Saturday evening. The meeting had been preceded by a separate Supervisory Board meeting earlier in the day at which Reuben Essed announced to the rest of the board that he would not take up his new position as a board member. Essed had only been appointed days before.

The minister has not made a public statement and could not be reached for comment on Sunday, but will have to explain on what grounds he took the decision to make such a request of the board.

Additionally, in a letter to the Corporate Governance Council (CGC) last week, De Weever indicated that the SMMC foundation recently appointed new members to its Supervisory Board “following the procedures as set forth in the articles of incorporation,” which is an apparent acknowledgement that all procedures were followed.
Article nine empowers the SMMC to make a binding nomination of the candidate they wish to have appointed. This “binding nomination” means that the minister would have to accept such nomination as long as the procedures, as per the articles of incorporation, were followed.

The same Article nine provides the minister with the possibility to appoint a candidate if the Supervisory Board of the SMMC failed to do so within a specified time, and this would require vetting by the CGC. The minister asked the CGC to render advice concerning the appointment of supervisory board members before he takes a final decision. The CGC has not responded to the minister’s request thus far.

As such, if the minister has requested the board members to make their positions available he has done so prior to receiving the advice from the CGC, which he requested. This would put the CGC in a position that it has lamented on previous occasions, to render advice on something that a minister has already affected by virtue of ministerial action.
SMMC announced last Wednesday that two new Supervisory Board members, Reuben Essed and Robert Jan James, have been appointed as of August 25, 2012.

According to the SMMC, the Supervisory Board members have decided to view the coming six months as a transition phase during which the positions within the Supervisory Board are divided as follows: Izzy Gerstenbluth Interim Chairman (medical) since March 2011; Reuben Essed Interim Vice Chairman (legal) since August 2012; Sixto Peters Member (financial) since October 2008; Edwin Benjamin Member (business/managerial expertise) since March 2012; Robert Jan James Member (expertise on re-organisation processes and management) since August 2012.
After the six month transition phase the members will decide on the definite constellation within the Supervisory Council.

Parliamentarians to meet SMMC, specialists this week

MONDAY, 03 SEPTEMBER 2012

PHILIPSBURG–Members of Parliament (MPs) serving on the Permanent Committee for Public Health will meet with the Supervisory Board of St. Maarten Medical Centre (SMMC) in a closed door session today, Monday starting at 2:00pm in Parliament House.

This meeting comes following a call for an urgent session issued by Democratic Party (DP) Member of Parliament Leroy de Weever about the level of care and constant “rumours” about type of care delivered by SMMC in August.
His concerns and that of other MPs stemmed from the recent passing of Ruth Olivacce, the sister of United Peoples’ (UP) party Fraction Leader MP Silvia Meyers-Olivacce, at SMMC.

A second meeting about the SMMC issue will be held with the Association of Medical Specialists and MPs on Tuesday starting at 4:00pm in Parliament House.

The two meetings were originally slated for last week but was postponed on request of the invited parties.
Ahead of the two sessions, the specialists association and SMMC General Director Dr. George Scot met on Friday about hospital matters and other pressing issues.

St. Maarten Medical Center lashes back, will ‘fight false accusations’

THURSDAY, 23 AUGUST 2012

~Calls De Weever’s statement ‘disturbing’ ~

CAY HILL–St. Maarten Medical Center (SMMC) on Wednesday responded to the numerous statements made about it in recent days, calling statements specifically made by Health Minister Cornelius de Weever “very disturbing” and says they “create unnecessary panic and unrest.”

In its lengthy statement, SMMC also said its staff, board of directors, Supervisory Council and management team are “standing together to fight whatever false accusations are made about SMMC.
“We underline that our focus remains to provide safe, quality hospital care for the residents and visitors of St. Maarten and the surrounding islands. We will keep on working on improving the hospital care including the realization of the much-needed expansion,” SMMC said in its statement.

Referring to the media reports on SMMC as “damaging public campaign” which “holds unfounded and incorrect statements,” the hospital said the timing of the campaign is not a coincidence.

“We first and foremost wish to state that we are highly sensitive to the private and personal nature of the treatments that our patients undergo at SMMC. The handling of patient information is confidential, private and regulated by laws. We hold this confidentiality high and have utmost respect for the patients, their loved ones and for our staff as well when dealing with this information. This inherently brings along that we cannot and will not comment to public statements regarding treatment of individual patients. However, the SMMC is in its full right to defend itself and needs to provide correct information by addressing at this moment the following issues,” it was stated in a press release.

Expansion
On the issue of its expansion, SMMC said when it started 21 years ago there were about 23,000 people living on the island. It is estimated that there are now around 56,000 persons on the Dutch side of St. Maarten. So, the population more than doubled. It should be clear that the expansion of our hospital is not a luxury, but an urgent necessity, it was stated.

SMMC said following its “financial collapse” in 2003 and its rebound in 2006 it successfully balanced its financial status. “Since then we have been improving the quality of care and patient safety and we have been providing more and better services each year. We have been renovating some parts of the present building, but it has now become too small and inadequate. In 2007 we had a plan ready to build a new wing on the hospital grounds. This new wing will host a new and improved emergency room department, modern operating theatre, a larger intensive care unit and new medium care unit.

“The goal of this expansion is to improve the quality of hospital and specialist care on St. Maarten and to be able to attract more doctors, specialists and nurses.” On June 28, 2007 the government of St. Maarten agreed that the hospital and specialist care should be improved and approved a construction subsidy of over NAf. 1 million per year during five years, from the start of the construction. It is a construction subsidy, not an operational subsidy and is only provided when the construction starts, not before. This is the first and only subsidy that the government has ever pledged to give SMMC. Up to this present moment the SMMC is not receiving any subsidy from the government, it was stated in the release.

Since September 2011 SMMC is working on attracting parties to participate in the bond issue to finance the expansion of the hospital. Six parties already committed. “These parties are well-established local and regional pension funds, banks and insurance companies, SMMC said. The deadline that we set for the bond issue was August 15, 2012 and we were waiting for the last party to commit.

“On August 14, 2012, the SMMC had a meeting with the [Health ed.] Minister [Cornelius de Weever ed.] and the concerned party about the financing of the hospital building. The next day the minister went public with statements about a draft report of the Inspectorate of Health Care. The allegations ventilated, damage the reputation of staff and surely put the SMMC in a bad spotlight with the investors. It is hard to believe that the timing of these allegations and the mentioned deadline is a coincidence.”

Inspectorate of Health draft report
SMMC said Inspector General Dr. Earl Best refuted publically and in correspondence to SMMC that there is a draft inspection report, since he is still working on it. According to the Inspectorate of Health Care, the findings of its draft report need to be made known to the SMMC first. “The SMMC did not receive any draft report till this day and the Inspector General has confirmed in the media that he did not send the draft report to the SMMC. On July 12, SMMC had a meeting with the Inspectorate and the Inspector General stated that there are no urgent matters that he needs to address immediately with the SMMC.

“The minister said that he is in possession of the draft audit report. He has provided information to the press on the content of this report, while the Inspector General says that the audit report is not completed as yet.
“The statements of the minister are very disturbing. They cause great concerns and create unnecessary panic and unrest under our patients, the community, and show disrespect to the hospital staff. We expect an ethical and humane approach from our minister who in the end is responsible for the health of our population. We regret the unfair way in which the SMMC is being handled.

“In view of the contradictions in the statements of the Minister and his General Inspector, the SMMC is seriously considering to request independent and renowned experts in the field of hospital inspection to conduct an independent investigation at the SMMC.”

Misuse of funds
SMMC said last year the President of the Health Committee of Parliament started a public campaign against the SMMC. The SMMC was accused of misusing funds and our General Director of having too many “caps.” Since 2006 the SMMC has approved financial statements that are yearly audited by an external accountancy firm. This on request of the Supervisory Council to ensure and confirm that the finances are correctly used and administered, it was stated in the release. Not once were these statements questioned. Based on the negative publicity and wrongful allegations, the General Director in December 2011 requested the present Minister of Health for an independent audit by Stichting Overheidsaccountants Bureau (SOAB) to conduct an investigation in this area.

“The minister, however, till this day did not reply to this request. We assumed that it was not an issue for the minister anymore. Last week the Minister and the President of the Health Committee again publically stated their questions regarding alleged misuse of funds. We question why at this crucial stage in completing the financing of the expansion these questions are posed again.”

SMMC said on Wednesday, August 22, at the request of the WIHCUA, the Minister of Health Care addressed the staff of SMMC. “He apologized to the staff, stating that he stands by his words, but it was not his intention to attack the care given in SMMC. Different staff members remarked that his public statements created considerable unrest among patients and the general public and asked him what he is going to do to turn this around. Unfortunately this question was not answered by the minister.

De Weever to public: Don’t be afraid to file complaints

THURSDAY, 23 AUGUST 2012

~ Says some are intimidated ~

PHILIPSBURG–Health Minister Cornelius de Weever on Monday, said patients should not be afraid to file complaints to the Inspectorate of Health about issues at St. Maarten Medical Center (SMMC).

The minister told reporters at Wednesday’s Council of Minister’s press briefing that some persons are “intimidated” and fearful of filing complaints.

“People must not be afraid to report it. It is their duty…,” he stressed. “People must have the right as a civilian to make their remarks and their complaints to the inspectorate. We must not be afraid because some people are intimidated and some are afraid because they say if anything happens to me I have to go back to that same SMMC so I do not want to,” de Weever said.

“And I don’t think we should live in that type of fear and if we will address this, let us address it the right way, let us go through the inspectorate and whatever corrections need to be made, it will be made because that is what the inspectorate is for.”

De Weever said people are not used to having an Inspectorate based in St. Maarten. Prior to the dismantling of the Netherlands Antilles on October 10, 2010, the health Inspectorate was based in Curaçao. The inspectorate would announce when they are coming to St. Maarten to conduct their inspections, they would come and get their inspections done; then they would leave the island.

He said the inspectorate in those days were ultimately responsible to Curaçao not St. Maarten. “But now since 10/10/10 we’ve had our own inspectorate. They are on the job and they are doing what they have to do. We are a small community and these things live their own lives, but they have to do their job the right way,” de Weever said.

The minister said conducting an inspection is a tedious and lengthy process as the person filing a complaint has to give his or her statement and persons involved in the chain of care also have to give their statement. The report will then have to go back to SMMC for their rebuttal before being finalised.

The minister said persons usually approach him with complaints, and while he takes note of them and says he will inform the inspector, he always urges these persons to pursue the matter “because they or their family members had been affected by it.

“We should encourage people to complain because if we don’t then we will stay the same place.”
De Weever also mentioned at the meeting that the SMMC expansion is not the solution to everything. “We have been expanding our government building that isn’t the solution either. We have to address the issues structurally. Deal with the root and deal with it one by one, that’s the only way we will move forward,” he said.

St. Maarten nurses outraged over Minister de Weever’s remarks about SMMC

TUESDAY, 21 AUGUST 2012

CAY HILL–St. Maarten Medical Center (SMMC) nurses have expressed outrage over statements made by Health Minister Cornelius de Weever last week.

“We expected much more from this particular Minister. But not everything you see is gold. Not every sheep is without wolf’s clothing. We are not only ashamed of our Minister, who we hold up highly, but we are also deeply disappointed that he too can stoop so low,” the nurses said in a joint statement emailed to The Daily Herald on Monday.

“You have a beef with Dr. [George ed.] Scot [SMMC General Director ed]. Then deal with Dr. Scot. Have you thought of the consequences of your wording on the radio and in the papers?

“You put fear in the minds of our people. People in the hospital are now dropping their words ‘I hope you all don’t kill me too.’ Thank you Honourable Minister de Weever,” the nurses wrote.

“Is it your intention for the people to take the hospital to Court? A professional and careful thinking Minister, would and should never stoop so low to the media. You can say at the SMMC there are serious matters that need to be dealt with and government is giving their full attention. Are you crying down the care with such a statement and are you putting fear in the people?” they asked.

In a statement issued on Friday, de Weever said he had been informed of two more patients who passed away in the SMMC while or after receiving surgical treatment. He said seven cases had been reported by patients, family members or medical professionals and investigated by the Inspectorate of Health Care. “However, the SMMC has not reported accidents and incidents with mortal consequences and/or a higher rate of complications to the Inspectorate which is mandatory. The Council of Ministers received a briefing by the Inspectorate of Health Care which indicated that a lot needs to be corrected in a short time to drastically improve the quality of care in this institution.”

The minister also said while the Inspectorate of Health Care is in the final stage of its official report on the SMMC, “based on the past events and the preliminary findings, I am strongly of the opinion that there leaves much to be desired. Supervision by the Supervisory Council of the SMMC and daily management by the Board of Directors seem to have fallen short of their full responsibilities. It’s unacceptable to allow the healthcare provided by our only hospital to decline. The current situation at SMMC has my full attention and will be dealt with accordingly,” he said.

In their statement the nurses said the minister did not take into account that he “has put himself in the same arena with those who are on the blogs with their negative and destructive remarks. He has breached patient’s confidentiality and privacy.”

They added: “Nice Job: Sell this to our tourist industry. Mr. De Weever, for most of our nurses affectionately called Connie. You have shamed us in the worst way. Of all the good praises from you to us on several occasions, which should we believe, who should we believe? We don’t know you anymore. This hurts. Again, if you have a beef with Dr. Scot go through the right channel to deal with this. Don’t pull down the whole care of the SMMC. Based on the population growth it may seem that more deaths are occurring. Don’t forget that every operation procedure has its risk.

“We have never dropped our arms in providing care to our patients then, not now and even not after your destructive comments. As the Minister of Health you should not be judgmental. We will serve all people of St. Maarten, even those who think like you. Minister what is your beef?”

Union chastises minister for statement on hospital

TUESDAY, 21 AUGUST 2012

~Urgent workers’ meeting called for 1:00pm today~

CAY HILL–The Windward Islands Medical Workers Union Association is furious about the statement made last week by Health Minister Cornelius de Weever about St. Maarten Medical Center (SMMC).

And, the Union’s Public Relations Officer Greg Arrindell Monday invited all hospital workers to assemble at SMMC at 1:00pm today for an “urgent” and “important” meeting to discuss the matter and to “look at further action.”
Speaking with PJD2 on Monday, Arrindell said statements made by the minister have “traumatised” the staff, whom he said are standing in the cold “without any explanation.” He said workers should not miss this meeting as “their future and life depend on it.”

In a separate statement issued earlier in the day, the board of the union was critical of the minister’s statement. “If there is a personal vendetta going on between the Minister of Health Care and the SMMC Director, please deal with that person to person and do not generalise with the Medical Center.”

“When a minister can go and put confidential information in the news media, [it ed.] makes us wonder about the level of integrity this minister has for the people of St. Maarten and in particular the staff of his Medical Center.”

The union said SMMC staff had been working to keep St. Maarten Medical Center functioning, maintaining quality care. “We have been recruiting and attracting young people of St. Maarten, studying abroad, to come back home and work for their island’s hospital. This particular statement by our honourable Minister Cornelius De Weever will surely have an impact on the decision-making of our youth returning home to work for this institution,” the union said.
“When our honourable minister can go out and cry down the care of the only hospital on Dutch St. Maarten with this type of information, then it leaves us with no other alternative than to wonder what is the capability or secret agenda of our Honourable Minister of Health.”

“Where was our present Minister Doctor Cornelius De Weever from since 1993? SMMC has been upgrading its personnel, whereby SMMC also played an important role in upgrading the White and Yellow Cross, Ambulance, Sector Health Care, and to date SMMC will produce twenty registered nurses in June 2013, and they are hailing from SMMC, Ambulance Department, White and Yellow Cross and Statia,” the union said.

The union referred to a letter from Inspector General Earl Best to SMMC General Director Dr. George Scot which reads: “As far as I know, the draft report isn’t even ready and indeed hasn’t been sent to you yet. On specific request of the minister of Health, I have given a brief verbal preliminary overview to the COM (Council of Ministers ed.) last Tuesday on our hard findings.

“During this COM meeting I specifically mentioned that once the draft report is ready it has to be reviewed by the SMMC first before compiling the final report to be released. I am not responsible for whatever story is made up in the media and I regret this as much as you do. By next week you will receive the draft report,” it was stated in the letter from Best to Scot.

The situation at St. Maarten Medical Center ‘leaves much to be desired,’ says Health Minister

~ Confirms seven cases being investigated, two more patients passed away on Thursday ~

SATURDAY, 18 AUGUST 2012

PHILIPSBURG–Health Minister Cornelius de Weever says the situation at St. Maarten Medical Centre (SMMC) leaves much to be desired and it has his full attention.

In a statement on Friday de Weever said he was informed yesterday of two more patients who passed away at the SMMC while, or after, receiving surgical treatment.

“Seven cases have been reported by patients, family members or medical professionals and investigated by the Inspectorate of Health Care.

“However, the SMMC has not reported accidents and incidents with mortal consequences and/or a higher rate of complications to the Inspectorate which is mandatory. The Council of Ministers received a briefing by the Inspectorate of Health Care who indicated that a lot needs to be corrected in a short time to drastically improve the quality of care in this institution.

“The Inspectorate of Health Care is in the final stage of its official report on the SMMC, but based on the past events and the preliminary findings, I am strongly of the opinion that there leaves much to be desired,” de Weever said Friday.
He continued: “Supervision by the Supervisory Council of the SMMC and daily management by the Board of Directors seem to have fallen short of their full responsibilities. It’s unacceptable to allow the healthcare provided by our only hospital to decline. The current situation at SMMC has my full attention and will be dealt with accordingly.”

Meanwhile Inspector General Earl Best confirmed on Friday that his report will be finalised by mid September. The report, he said, is based on inspections conducted dating back to last year. He said the draft report has to be sent to SMMC for them to respond before the report is finalised.

SMMC Human Relations/Communications Manager Juliëtte Hassell said SMMC is still to receive the report.

SMMC says it regrets death of dialysis patient Ruth Olivacce

SATURDAY, 18 AUGUST 2012

~ Incident reported to Health Inspectorate ~

PHILIPSBURG–St. Maarten Medical Centre (SMMC) says it regrets the passing of dialysis patient Ruth Olivacce, who died at the hospital on Thursday after undergoing a medical procedure there.

SMMC Human Relations/Communications Manager Juliëtte Hassell said SMMC has since reported the incident to the Inspectorate and the hospital will await the outcome of the Inspectorate’s investigation.

Olivacce is the sister of United People’s (UP) party parliamentary group leader Member of Parliament (MP) Silvia Meyers-Olivacce.

“We regret that the dialysis patient died and I speak on behalf of management, staff and the specialists especially the staff and specialists who had been directly involved in treatment and we wish the family and their loved ones much strength,” she said.

“We followed the procedures that we had to and immediately informed the inspector.” She said all reports will be forwarded to the inspectorate to enable them to conduct their review. “We followed the procedures to ensure that this case is handled as correctly as possible. We want to ensure that it is dealt with as soon as possible. We regret that it happened at the hospital. The staff is affected by her loss and we really want to ensure that the correct procedures are followed.”

Hassell declined to go into the specifics of what occurred saying that the Inspectorate has to be allowed to conduct its inquiry. However, she said that the patient was a dialysis patient in need of certain treatment at SMMC. She said doctors from The Netherlands who treated Olivacce explained what occurred in their report to the inspectorate. “We will await their reaction.”

The patient underwent treatment on Wednesday and Thursday. Hassell said as with any procedure there is always a risk. “It is an important procedure like any procedure and in this case the dialysis patient did a specific procedure. There is always a risk especially if you’re talking about the arteries there is a risk as with any procedure.”

St. Maarten health minister wants meeting about care at hospital

SATURDAY, 18 AUGUST 2012

PHILIPSBURG–An urgent meeting of the Permanent Committee of Parliament on Health is necessary to address the level of care and constant “rumours” about the type of care being delivered by St. Maarten Medical Centre (SMMC), Democratic Party (DP) Member of Parliament Leroy de Weever said on Friday.

De Weever said he would request the meeting as soon as possible and called on all fellow MPs to attend.
Speaking at Friday’s Central Committee meeting of Parliament, De Weever said the request will also call for hospital officials including representative of the surgeons and Minister of Health Cornelius de Weever to be present to answer questions.

His concerns and that of other MPs stemmed from the recent passing of Ruth Olivacce, the sister of United Peoples’ (UP) party Fraction Leader MP Silvia Meyers-Olivacce, at SMMC.

National Alliance (NA) MP Louie Laveist, also offering condolences, said he was stunned by the passing and circumstances under which this took place. He called for an enquiry and the “need for things to run effectively.”
MP Dr. Lloyd Richardson (NA) recalled working with Ruth Olivacce in the Junior Chamber Jaycees in the 1970s and 1980s. He also expressed condolences to the family of the late cyclist Gassy Richardson, cyclist from Simpson Bay. He and fellow party member MP Hyacinth Richardson wished the family strength.

Several other MPs also offered their condolences to the two families.

St. Maarten minister says SZV has right to due diligence for SMMC investment

THURSDAY, 16 AUGUST 2012

PHILIPSBURG – Social and Health Care Insurance SZV has a right to due diligence for its investment in the St. Maarten Medical Center (SMMC) expansion says minister Cornelius de Weever.

Herald 16.08.12

St. Maarten Ministers focus on National Health Insurance and medical centre expansion

FRIDAY 3 AUGUST 2012, PHILIPSBURG – The status of the National Health Insurance proposal and the expansion of the St.Maarten Medical Centre (SMMC) are two issues expected to come in today’s Council of Ministers weekly meeting. Prime Minister Sarah Wescot-Williams confirmed that the board of the SMMC was “pretty close towards finalizing a financial package for the expansion.”

Three weeks ago the board and management of SMMC held a meeting with government to update them on the progress of expansion.

In July 2010, the Ministry of Public Health granted SMMC a license to pursue the first phase of its expansion project.  The overall expansion is expected to lead to a reduction in the country’s health care expenditures, as services and treatment that is currently unavailable would be made available locally. The expansion in services would include among other areas, cardiology, urology and neurology.

The National Health Insurance (NHI) on the other hand should have been in place since January 1. Delays in the draft law and handling in parliament has stymied the process. A report compiled by HBN Law firm in May outlined the implications of the new system.

“It will result in all residents and income tax subjects being obliged to take out the basic NHI insurance with SZV.  A guarantee fund will be established in order to cover the medical assistance required by uninsured persons. Care providers will only be able to appeal on this fund once they are able to prove that they have done everything within their power to recover the expenses made on the uninsured person and/or his warrantor.

The main difference between the current system and the NHI is that the NHI will contain one basic insurance and that insurers are obliged to accept all those who fall under its scope. It will, therefore no longer be possible to refuse a resident if he is not employed or a non-resident if he pays income taxes over his/her income. The NHI will be paid by the insured persons (with an income-dependent premium), an employers’ contribution and an annual government contribution for specific groups of insured persons.

The new tariff for the National Health Insurance is focused on containing healthcare costs. This also applies to the health system in general. In the latter case government will place more focus on preventative care. There are also plans to conduct a new health care study and create a new health information system that will monitor things like mortality and morbidity rates.”

Dutch specialists to operate on SMMC dialysis patients

WEDNESDAY 1 AUGUST 2012, CAY HILL –Nine dialysis patients at St. Maarten Medical Center (SMMC) will soon get relief.

DH SMMC dialyse 1-8-2012

SMMC without a St. Maarten based surgeon

SATURDAY, 23 JUNE 2012

~ Temporary arrangement put in place ~

CAY HILL–The recent sudden departure of a general surgeon from St. Maarten Medical Center (SMMC) has forced the hospital to obtain the services of two surgeons from Curaçao on a temporary basis to bridge the gap.
Reliable reports reaching The Daily Herald said a general surgeon had left his job at SMMC and the country abruptly about a week ago because of some internal problems at SMMC and in doing so had left the country’s main medical institution in a bit of a quandary.

SMMC officials are tight-lipped about the situation, but have confirmed that “an internal matter” in connection with one of its general surgeons “is under review.”

In a statement in response to queries by this newspaper on Friday, SMMC Human Resources and Communications Manager Juliëtte Hassell stressed that “ensuring quality health care is the main priority of St. Maarten Medical Center” and explained that “with one surgeon absent” the hospital had “immediately started the process to have a substitute surgeon in place.”

Hassell continued: “We are pleased to confirm that two very experienced surgeons affiliated with the St. Elisabeth Hospital in Curaçao have made themselves available to service St. Maarten Medical Center. The first surgeon, Dr. van Leeuwen, is currently here and will be succeeded by Dr. Nellensteijn next week.”

Referring to what she said was “an internal matter in connection with one of our general surgeons” that was “under review,” she said that review was being done in line with the systems and procedures that were in place to allow for “a responsible and objective evaluation.”

She said that out of respect for “confidentiality towards all parties involved,” SMMC did not wish to “comment with further details at this stage.”

SMMC-chairman George Scot expresses sorrow, calls for patient transport policy on St. Maarten

TUESDAY, 08 MAY 2012

CAY HILL–St. Maarten Medical Center (SMMC) Board of Directors Chairman Dr. George Scot has expressed sorrow over the tragic medivac accident that claimed the lives of four people over the weekend.

Scot explained that the patient, a cruise ship passenger, had been admitted to the ICU last week Thursday with a serious cardiac condition. One of the rotating cardiologists from Holland, who provides cardiological care at SMMC two weeks per month, was present at that moment to attend to the patient.

“On Friday the patient’s condition worsened. At that time there was a medical indication for the patient to be referred to a specialised cardiological centre. In order to have the patient evacuated, the patient’s insurance company needs to give approval for transport by air ambulance to the receiving hospital, in this case located in Martinique,” Scot explained.

“After the medical indication has been confirmed by specialists and it has been established that the required medical care can be provided by that institute, the receiving hospital will accept the patient. Friday afternoon we received clearance from all parties concerned and the patient left SMMC on Friday evening with a special medical team of the hospital in Martinique by ambulance to Princess Juliana International Airport.”

Scot said SMMC had not been informed that the air ambulance at Princess Juliana Airport had technical difficulties or that the patient had been transported from Princess Juliana International Airport to Grand Case Airport.

“If the patient’s condition exceeds the treatment options at SMMC, it is to the medical judgment of the treating physician to refer a patient to a different hospital in order to receive proper care. The responsibility of the SMMC and the specialists at SMMC is to provide the necessary medical information timely to the insurance company of the patient and to arrange the ambulance to the airport,” Scot said.

“The insurance company of the patient is responsible for arranging the transport to the receiving hospital. In most cases the insurance companies have their own contract with the air ambulance services and hospitals in the region.”

Scot said it was important that a full investigation be carried out on how the tragic accident could have occurred. Even without the results of that investigation, he continued, “it would be wise that a policy is made for air transportation of patients of both the Dutch and French side and those strict guidelines for air ambulance services are agreed upon. The size of the population of St. Maarten/St. Martin together, and that of Saba and St. Eustatius plus the limited medical services to these islands, justifies such a policy.

“Staff, specialists and management of SMMC truly regret the tragic accident and we wish the family members, colleagues and friends of the deceased much strength in dealing with their unexpected tragic loss.”

Public Health Ministry St. Maarten concerned about doctors availability at night

THURSDAY, 26 APRIL 2012

~ Gives recommendations to improve services ~

PHILIPSBURG–Create a General Practitioner’s (GP) post in St. Maarten Medical Centre that will be managed and operated by GPs, and cancel the arrangement between GPs and St. Maarten Medical Center (SMMC) to see patients in the emergency department at night and on weekends, was one of several recommendations presented to Public Health VSA Minister Cornelius de Weever by Health Inspector Earl Best.

The Health Inspectorate is “very surprised” by the agreement between GPs and SMMC concerning GP care during the night and weekends in the emergency room, Dr. Best said.

This means that almost none of the general practitioners are available at night or on weekends, and that the emergency room does “figurative work” and most of the time has a long waiting line. “This affects the quality of care provided negatively.”

Most GPs can be consulted by telephone during office hours; however, home visits to less ambulant patients and emergency visits are not provided by many GPs, said Best, adding this is an explanation for the fact that many GPs do not possess “a doctor’s bag anymore.”

The recommendation, which has to be addressed by the VSA Minister, physician organisations, SMMC and health insurers, stems from a quality and service survey carried out by the ministry.

The 20 doctors who operate as GPs had to fill out a questionnaire dealing with the subject of the survey. All of the clinics, except one GP who refused to cooperate, were visited by the inspectorate, explained Best in his presentation in A.C. Wathey Legislative Hall on Wednesday morning.

The inspectorate also recommended the development of a registration system for general practitioners and establishment of requirements for necessary training and GP skills; as well, a sound professional communication between GPs, pharmacists and medical specialists and improvement in the quality of the patient files.

Improved quality of care by developing evidence-based diagnostic and treatment protocols/guidelines for common medical conditions and the urgent introduction of an electronic health record (EHR) were outlined as very necessary.

GPs will have to ensure the practice (clinic) is easily accessible for the disabled and proper technical maintenance of equipment, Bess pointed out from the findings.

The most important part of the survey, according to the inspector, was to examine whether the GPs complied with the conditions for qualitatively responsible care, given the fact that no substantive guidelines on the medical content exist on St. Maarten.

GPs have two organisations, Windward Islands Medical Association (WIMA) and St. Maarten Medical Association (SMA) that provide peer-to-peer contacts and to organise common and continuous training.

“Yet it is striking that in St. Maarten professional communication about the individual patient and the organisation of care is a major problem; and not just between the GPs and the medical specialists but also between GPs and pharmacists,” Best said. “Of course both parties have responsibilities in improving this issue. Except for inter-professional contacts within WIMA and SMA, the peer-to-peer contacts within the GP group needs improvement.”

The quality of patients’ files is “often very poor.” This differs considerably from the GPs using an electronic patient record (EPR) and those who do not.

“St. Maarten has no accreditation for GPs. Vocational training is not mandatory. During the interviews it was often unclear how GPs maintained their skills,” Best said.

Minister De Weever said the report establishes a baseline for the ministry to work with and build on to improve the health services to the community.

Bonaire, St. Maarten hospitals sign cooperation letter of intent

THURSDAY, 19 APRIL 2012

PHILIPSBURG–Dutch Minister of Health Edith Schippers was present on Wednesday for the signing of a letter of intent between St. Maarten Medical Center and Fundashon Mariadal, the hospital of Bonaire, for cooperation on specialty care.

This cooperation agreement will regulate, among other things, the provision of specialists by the two university hospitals in The Netherlands, VUMC and AMC, to SMMC to service the patients of St. Maarten, Saba and Statia. The signing of this agreement was hailed as an important step in further developing continued quality care.

Fundashon Mariadal General Manager Giovanni Frans lauded the fact that the countries of the Dutch Kingdom would be working together to improve quality of care. He said a final agreement would be worked out over the next three months.

He dubbed the signing as a “historic moment” after the dismantling of the Netherlands Antilles that creates a new structure to provide hospital care on the islands. He said cooperation was important considering the small size of the islands.

Minister Schippers was present, but did not make any comment during the signing. St. Maarten’s Minister of Public Health Cornelius De Weever also was present.

Inspectorate to meet with St. Maarten Medical Center today on complaints

TUESDAY, 06 MARCH 2012

CAY HILL–The Inspectorate of Health will meet with St. Maarten Medical Center (SMMC) today, Tuesday, regarding complaints about the care provided to the patient of a gunshot wound over the weekend.

The Inspectorate contacted SMMC on Monday for the meeting. In a statement issued on Monday, following queries by this newspaper on Sunday about the incident, SMMC said a full account of the incident was not given.

“SMMC regrets to learn via the media that a patient or a friend on behalf of the patient indicated not to be content with the care given at SMMC. It is our objective to give safe, quality health care and that patients are satisfied with the received care.

“In respecting the patient’s privacy, we can merely state that the article unfortunately does not give a full account of the medical treatment given, stated incorrect facts, and didn’t indicate that upon the patient’s return visit to SMMC, he was advised by the specialist to be admitted and he opted not to do this.

“We have contacted the patient and set up a meeting to personally discuss the events involving his treatment with him and his dissatisfaction,” the hospital said in the statement.

“If a patient is of the opinion that improper medical care has been given, the patient can file a complaint with the Complaint Committee that is set up by the White and Yellow Cross and SMMC. The Complaint Committee is an independent body with third party members and members of both the White and Yellow Cross and SMMC.

“The patient can also choose to file a complaint with the Inspectorate of Health Care. The inspectorate is an independent department of government, which can investigate the complaint. The inspectorate, with the permission of the patient, will have full access to the patient’s medical files, and can decide whether the given medical treatment was correct or not.

“Upon request of the inspectorate of Health Care, we are more than willing to have the provided treatment and advice given by our medical staff to said patient, reviewed for correctness.

“We also recognise that as long as there are uninsured persons, the payment of the treatment will be an additional stress factor, whether they are treated at SMMC or any other hospital. If a person needs urgent medical care, SMMC will provide this care and make payment arrangements with the person or his/her caretaker. Nevertheless, provided limited situations, a person can choose not to follow the doctor’s advice.

“If dissatisfied patients choose the media to complain about the services they received at the SMMC, the SMMC cannot and will not reply in public to the details of the complaint, because for us the privacy of every patient prevails above giving our account of the incident,” the hospital said.

“We strive to provide safe, quality health care and have put systems and committees in place to learn from unsatisfied situations and to minimize that these situations happen again in the future. As such we urge and welcome patients to inform us directly about their experiences or contact the Inspectorate of Heath Care. In this way their concern can be directly addressed.”

On Sunday, a friend of the patient in question accused SMMC of negligence and of “robbing” the victim by presenting him with a high bill and not properly tending to his wound.

The friend, who spoke to this newspaper on condition of anonymity, said his friend was accosted by a gun-toting robber while waiting on a bus at the last bus stop on Back Street. The robber fired two shots, one of which hit the man in his leg, penetrating his bone. Although the victim put up a fight, the robber went off with the man’s gold chain, the friend said. The victim was taken to SMMC for treatment, but the friend said the treatment was not up to par as the man’s wound was still bleeding after being placed in a cast. The man was later taken for medical attention to French St. Martin, where, according to his friend, he was properly tended to for a fraction of what SMMC charged him. While the man received a bill of over US $1,200 at SMMC, he was charged over 240 euros (not 75 euros as inadvertently stated in an article in Monday’s issue).

Minister De Weever wants waiting time at SMMC ER to be shorter

Expansion of medical specialists at St. Maarten Medical Center (SMMC)

TUESDAY, 31 JANUARY 2012

THE HAGUE/PHILIPSBURG–The number of specialists at St. Maarten Medical Center (SMMC) will be expanded by three or four in 2012, Dutch Minister of Public Health Edith Schippers informed the Second Chamber on Monday.

Dutch and St. Maarten authorities are looking to add a nephrologist, neurologist, orthopaedist and urologist, who also would provide service for residents of St. Eustatius and Saba. The Dutch Ministry of Public Health, Wellbeing and Sports VWS is involved because of its responsibility for residents of the latter two islands as they are part of the Netherlands. Schippers said she wanted to treat St. Eustatius and Saba patients as close to home as possible.

The expansion by three to four specialists at SMMC depends on the approval of the St. Maarten Government, Schippers told Parliament’s Permanent Committee for Kingdom Relations. Members of Parliament (MPs) asked the Minister to secure more cooperation between hospitals within the Kingdom. This would reduce the number of referrals of patients in Bonaire, St. Eustatius and Saba to hospitals abroad in Colombia and Guadeloupe.
Treating patients closer to home is not only more cost-effective, but also better for the patients, who don’t have to travel too far to receive medical care, said MP Ineke van Gent of the green left party GroenLinks.

A team of Dutch medical specialists of Academic Medical Center (AMC) and Free University Medical Center VUMC in the Netherlands visited St. Maarten last week for talks with SMMC management and specialists. SMMC Human Resource/Communications Manager Juliëtte Hassell said the meeting had gone “very well.”
The team of Dutch medical specialists, who arrived in St. Maarten last week Tuesday and left over the weekend, included a neurologist, urologist, nephrologist and an orthopaedic specialist, among others.
Other MPs shared similar sentiments. “Sabans and Statians are best served with good specialist care in St. Maarten,” said Jeroen Recourt of the Labour Party PvdA.

“Facilities at SMMC should be made more use of,” said Kees van der Staaij of the reformed SGP party, who made a case for “practical solutions to practical problems.”

Schippers agreed. She said she was in favour of referring patients to SMMC where possible, but added that it would be unwise not to make use of the high level and cheap medical care in Colombia. “The quality of health care in Colombia is excellent. It is at European level, if not higher, and at one third of the cost,” she said.

The Minister said she foresaw an increase in the number of referrals to Colombia this year because of the declining level of health care at Curaçao’s St. Elisabeth Hospital Sehos. “Medical care in Curaçao is deteriorating at a rapid pace. Curaçao has to get things in order. They have to adjust the downwards spiral,” she said. She stressed that Curaçao was an autonomous country and that it was its responsibility to do so. She didn’t mention the level of care at the Guadeloupe hospital.

Schippers provided numbers of referrals abroad during Monday’s meeting. In 2011, there were some 7,000 in Bonaire, and 4,500 in St. Eustatius and Saba combined. The majority of patients in St. Eustatius and Saba were referred to St. Maarten and St. Martin.

Specialist care at Bonaire’s hospital has been expanded in seven areas, in cooperation with the AMC and VUMC hospitals from Amsterdam. The cost of health care for the three islands was 50 million euros in 2011, and 40 million euros has been made available for 2012.

The Minister said the cooperation with SMMC and St. Maarten was “intensive.” However, not all health care can be provided in St. Maarten and that is why it remains important to maintain an alternative, which is Colombia and Guadeloupe. She announced that she would be visiting the islands late March.

MP Ronald van Raak of the Socialist Party (SP) criticised the high monthly fee for permanent helicopter medical evacuation service from St. Maarten to St. Eustatius and Saba. “We pay US $16,000 per month, also when it doesn’t fly,” he said.

Schippers announced that this cost might go down in the future, as the Coast Guard had expressed interest in making use of the helicopter. She promised that this would be discussed with the Ministry of Defence before May 1. She explained that the helicopter service was in addition to medical evacuations via the regular Winair flights.

The high cost of medication in St. Eustatius also was raised during Monday’s meeting. Schippers said her policy was to reduce the cost of medication on all three islands and that this had been successful so far, with the exception of St. Eustatius. She explained that the pharmacies in St. Eustatius were independent facilities.

MP Van Raak said St. Eustatius “refused” to purchase cheaper medication via SMMC. MP Erica Lucassen of the Party for Freedom PVV questioned the high cost of medication in St. Eustatius and urged the Minister to look into the possibilities of making use of SMMC’s offer to deliver medication at a lower price.

In the meantime, Hassell said it was SMMC’s strategic objective to establish a relationship with a large hospital to help guarantee and maintain continued quality care. Alluding to the nephrologist, who will be based here, Hassell said there were a number patients suffering from kidney diseases in Saba, Statia and in particular St. Maarten, and the services of such a specialist would be a positive development for dialysis care.

A nephrologist visited SMMC last year for two weeks on invitation of Dr. Theo Jolles. There were a lot of positive reactions from the dialysis patients to the advice given by that specialist.
“The specialists from both Dutch hospitals had a chance to see for themselves the level of service that SMMC currently offers. They also had the opportunity to speak with the local specialists and exchange ideas how best to introduce new specialties or increase the level of specialities currently provided. In addition the discussions included training,” Hassell said about last week’s visit.

Raghosing bewaakt medische communicatie tussen BES en Sint Maarten

29 december 2011

KRALENDIJK/PHILIPSBURG – De Sintmaartense huisarts Radha Raghosing verzorgt vanaf 1 januari 2012 de communicatie tussen artsen en specialisten in Caribisch Nederland, Colombia en Guadeloupe. Ook zal zij de specialisten begeleiden bij medische uitzendingen vanuit het Sint Maarten Medical Center.

Het gaat om begeleiding, hulp en advies bij uitzendprocedures en bijstand en toezicht voor het doorsturen van de dossiers van de patiënten die worden uitgezonden.

Voordat Raghosing zich als huisarts vestigde, werkte zij onder meer acht jaar in het ziekenhuis op Sint Maarten. “Vanwege haar brede ervaring en grote kennis hebben wij haar gevraagd om te helpen de communicatie en verwijzingen tussen de artsen in de diverse landen verder te stroomlijnen”, aldus Rob Sardeman van het ministerie voor Volksgezondheid, Welzijn en Sport.

Formeel wordt deze (deeltijds) functie ondergebracht bij het zorgverzekeringskantoor ZVK op Bonaire.

St. Maarten minister De Weever says Government working with SMMC to secure growth financing

WEDNESDAY, 28 DECEMBER 2011

PHILIPSBURG–Government has been working with the St. Maarten Medical Center (SMMC) to help the institution secure financing for its much-needed and long-awaited expansion.

Health Minister Cornelius de Weever told television personality Oral Gibbes on his Tuesday evening television programme that government “has been there all along” assisting the hospital. He said he had met with SMMC Director Dr. George Scot and the board “numerous times” and that he was likely to meet with them again yesterday, Wednesday.

SMMC officials as well as the Windward Islands Health Care Union Association recently highlighted the need for government to support the hospital’s expansion, which has been in the pipeline for several years now. SMMC Manager Patient Care/Education Coordinator Tony Pantophlet and Human Resources/Communications Manager Juliëtte Hassell had told this newspaper recently that the lengthy delay in the “critical” expansion was stifling the country’s only medical centre from moving forward and adequately preparing for the island’s growing population.

De Weever said on the television programme that at one point during his discussions with SMMC officials, it had been mentioned that banks were unwilling to completely finance SMMC’s expansion to the tune of US $20 million without a “letter of guarantee” from government. He said Deputy Prime Minister Theo Heyliger had, at one point, arranged for him to meet with the Central Bank to discuss financing. The possibility of “floating a bond” for the medical centre had been discussed, at the time.

De Weever said if government had taken the bond, it would have been for a low interest rate, but this would have reduced government’s borrowing capacity. If SMMC had taken the bond, he said, the hospital would have to pay a “slightly higher” interest rate, but government would have maintained its borrowing capacity, “but it was something that was feasible.”

De Weever said: “Parties have been meeting. They have been going through their negotiations and we have also discussed the possibilities of SZV [Social and Health Insurance-Ed.] also investing in SMMC. SZV was one party that was interested. [A pension fund-Ed.] was also considering the possibility of it as well and then there was a balance of 2 or 3 million that government said we were willing to [finance-Ed.) and if not, there were other banks that were also willing to do it. Technically we have been there all along, assisting.”

In the meantime, Pantophlet and Hassell had told this newspaper in a recent interview that the hospital was “bursting out of the walls right now,” awaiting the expansion.

SMMC was designed 20 years ago to cater to a population of 24,000, almost half the current registered population of just over 51,000. This does not take into account the unregistered population as well as persons from French St. Martin, neighbouring islands and tourists, who use SMMC.

The two SMMC officials had said at the time that SMMC’s challenges included not having sufficient rooms and facilities to accommodate patients and additional specialists.

Pantophlet had said there were only three rooms in the Intensive Care Unit (ICU) and sometimes there were as many as eight ICU patients to be tended to. In cases like these, SMMC has to put the additional ICU patients in another ward and monitor them via telemetry devices. Telemetry is a technology that allows remote measurement and transparent conveyance of remote information. “There are some patients who are required to go on telemetries, but if you have three patients in the ICU and have two others coming in to go on a ventilator, then you have to go outside, but you have to monitor them still, so you can monitor them from the ICU, but we want to expand the ICU to six beds,” Pantophlet had said.

SMMC is also limited in the number of specialists it can attract because of the limited space.
Three years ago, a team of visiting specialists, who conducted a training course here, had emphasised the need for SMMC to be upgraded, Pantophlet said. The specialists were back here recently, and there has not been any progress with the expansion.

The hospital is also recording high staff turnover, due in part to the expansion not getting off the ground.

The urgent need for government support for the expansion was stressed to Members of Parliament during a recent meeting with SMMC.

New SMMC tariffs alone won’t cause SZV premiums to go up on St. Maarten

~ All factors to be looked at~

SATURDAY, 17 DECEMBER 2011

PHILIPSBURG–The tariffs set for new services at St. Maarten Medical Center (SMMC) alone won’t cause Social and Health Insurance SZV (former Social Insurance Bank) premiums to go up.

SZV Chief Operations Officer (COO) Reginald Willemsberg said, however, that there are several factors that have an impact on SZV. These factors, he said, will be discussed in an upcoming meeting with the Health Ministry and Health Minister Cornelius de Weever to determine how to mitigate their effects on SZV.
De Weever had announced last week that he had signed the ministerial decree setting new tariffs for the hospital on November 18. The new tariffs only cover new services being offered by SMMC such as cardiology, neurology and urology. It does not address SMMC’s long time call for a change in its existing tariffs to reflect actual cost of services.

Factors
Willemsberg said SZV was already accustomed to sending patients to St. Elizabeth Hospital SEHOS in Curaçao and the tariffs for new services at SMMC are in line with that of SEHOS. As a result SZV will not have any significant impact on SZV. “Because it’s for new services alone, this alone won’t be a detrimental factor if premiums have to go up or not,” said Willemsberg.

He said, however, that the cost of healthcare continues to increase, while SZV’s income remains the same.
He said the biggest factor affecting SZV is increases in health care cost such as hospitalisation and pharmaceuticals. “This is quite a big factor and it impacts SZV. If you look at the last few years inflation went up by 14 per cent or more while medical expenses increased by 29 per cent. So this is the biggest single factor.”

Additionally, since the dismantling of the Netherlands Antilles, SZV patients sent to Curaçao for medical treatment are no longer being billed according to SVB prices. They are being billed as private patients, which is more costly.

“Specialists who adhered to SVB tariffs in Curaçao don’t have to adhere to them anymore because SZV is now considered a foreign country. We don’t fall under the same jurisprudence as SVB patients in Curaçao and this automatically affects cost of patients as it is quite an increase.”

Another factor, he said is the hundreds persons more than 60 years who have signed up for medical insurance via SZV since the voluntary medical insurance law went into effect in January 2010. “A lot of people are now signing up for it,” Willemsberg said, adding that between 500 and 600 persons have so far signed up. “These are the things we need to talk to government about because government has a role to play,” said the COO.

In his announcement last week de Weever said in accordance to article 7 of the transitional ordinance, the minister has the mandate to designate the SMMC as the body which replaces SEHOS. This ultimately entails that the rates established for services provided at SEHOS can also be applied to the SMMC, it was stated in a press release from the Minister’s cabinet.

In July 2010, the SMMC was granted a licence by the Executive Council of the former island territory, to initiate the first phase of the expansion plans of the medical centre. In its expansion request, the medical centre indicated that the expansion would eventually lead to a reduction in the country’s health care expenditures, as services and treatment that are currently unavailable would be made available locally. The expansion in services would include, among other things: cardiology, urology and neurology.
“Consequently, the expansion has led to the need in establishing tariffs for this specialty. In accordance to the ordinance of health insurance, which outlines the regulations of the Social security insurance, fees for the provision of medical care are to be established by means of national decree,” de Weever said.
“That decree which was transferred to country St. Maarten, stipulates the fees for specialised hospital care, however, the fees were specified per hospital, in other words, fees applicable to medical care provided in e.g. SEHOS of Curaçao were not always in line with those of SMMC.

Additionally, the fees/tariffs were only established for care that was provided in the various hospitals. Consequently, it was not possible to automatically assume that those tariffs would be applicable to SMMC after 10/10/10.

Tariffs set for St. Maarten Medical Center, minister signs decree

MONDAY, 12 DECEMBER 2011

PHILIPSBURG–After lengthy lobbying, St. Maarten Medical Center (SMMC) can now operate with new tariffs.
Health Minister Cornelius de Weever signed the ministerial decree on November 18, setting new tariffs for the hospital.

A team comprising representatives of the Department of Public Health and the minister’s cabinet conducted a study to determine to what extent the provisions outlined in the ordinance regulating the transition to country status (overgangsverordening) could be used to adapt the tariffs for medical care provided at St. Elisabeth Hospital Sehos in Curaçao to SMMC. Based on the results of that study, De Weever signed the ministerial decree on SMMC tariffs.

“SMMC can continue to expand the services and hire the necessary staff to do so. I believe that this will reduce the cost and inconvenience of having to travel abroad for these other medical services that are not available in St. Maarten,” De Weever explained.

The study concluded that SMMC and Sehos were considered equivalent hospitals by means of national decree. Sehos used to be considered the national hospital of the former Netherlands Antilles.

In accordance with Article 7 of the transitional ordinance, the minister has the mandate to designate SMMC as the institution that replaces Sehos. This ultimately entails that the rates established for services provided in Sehos can also be applied to SMMC, it was stated in a press release issued by the minister’s cabinet.

SMMC was granted a licence by the Executive Council of the then island territory in July 2010 to initiate the first phase of its expansion plans. In its expansion request, SMMC indicated that the expansion eventually would lead to a reduction in the country’s health care expenditures, as services and treatments that are currently unavailable would be made available locally, stated the release. The expansion in services would include cardiology, urology and neurology.

“Consequently, the expansion has led to the need in establishing tariffs for this specialty. In accordance with the ordinance of health insurance, which outlines the regulations of the social security insurance, fees for the provision of medical care are to be established by means of national decree.

“That decree which was transferred to country St. Maarten stipulates the fees for specialised hospital care; however, the fees were specified per hospital, in other words, fees applicable to medical care provided in e.g. Sehos of Curaçao were not always in line with those of SMMC.

“Additionally, the fees/tariffs were only established for care that was provided in the various hospitals. Consequently, it was not possible to automatically assume that those tariffs would be applicable to SMMC after 10/10/10,” the release stated.