Court of First Instance Maintains Role of Inspectorate Against SMMC --- More Demands Placed on SMMC --- Medical Institution Faces $500 fine per day for Non Compliance.

Inspector General Dr. Earl Best told reporters that he is hoping that the Director of the St. Maarten Medical Center would comply with the intensified supervision and that the institution will not continue going to court. One of the demands placed on SMMC is for the institution to appoint a replacement (interim) medical director that would replace Dr. George Scot when he is not on St. Maarten. The St. Maarten Medical Center has to also make sure all its data, files, and other information is stored in one location at the SMMC and is accessible to the person that is appointed as the interim director. This person should also be given equal powers when it comes to decision making.

The inspectorate investigated seven cases of death beginning April 2010 and of the seven cases they concluded that at least three of the patients could have received more adequate care from SMMC. Dr. Best described in his findings that sub-optimal care was provided and the families of these patients can now decide what type of action they would take against the St. Maarten Medical Center. As for the case of Ms. Olivacci, Dr. Best said that the investigation on that case is not yet complete and that was not part of the seven cases that were investigated.

Below is the statement made by the Inspector General Dr. Earl Best and his team made on Tuesday afternoon after receiving the decision of the courts.

Inspectorate wins court case: Intensified Supervision on the SMMC is maintained. Inspectorate imposes Demands against SMMC, under penalty of forfeiture of fines in case of non-compliance by SMMC.

The Court of First Instance declared SMMC not admissible on October 16^th, 2012, in its claims against the Inspectorate of Health (“the Inspectorate”) to suspend the imposed measures by the Inspectorate of (i) intensified supervision on SMMC and (ii) the demand for SMMC to provide the Inspectorate with an action plan with concrete measures to remedy various cardinal deficiencies within SMMC. The Court thereby followed the prinicpal defense of the Inspectorate: its announed measures of intensified supervision is not a decision that can be appealed by the SMMC.

The Inspectorate is very pleased with this 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.

After the Inspectorate conducted extensive investigations in the SMMC over a period of 9 months, it rendered a draft report on its findings on August 24^th, 2012 to SMMC, with the request to the SMMC to comment on its findings. These findings were highly critical in numerous areas that concern basic care that must be rendered by SMMC and can be within reason expected by the St. Maarten Community. The Inspectorate is bound to ensure that the St. Maarten Public can enjoy proper basic medical services by SMMC as per internationally accepted standards.

Instead of providing the Inspectorate with the requested feedback on its –preliminary- findings, SMMC requested the Inspectorate for one week extension on nota bene the final day of the deadline given. This request for 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- extension and rendered its final report. The Inspectorate thereby announced on September 8^th, 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.

The continued failure by the SMMC to not adhere to the legal demands by the Inspectorate to take actions that will remedy the current deficiencies in rendering basic care within the hospital has regretfully resulted in a decision by the Inspectorate to impose various Demands against SMMC, under the penalty of forfeiture of significant fines in case of non-compliance within set deadlines. These Demands by the Inspectorate, that can be appealed by SMMC, were made on Friday, October 12^th, 2012. The Demands are to :

1. Procure that on or before October 26^th, 2012, there will be an approved Rules of Regulation for the Board of Directors of SMMC as per article 5 of the Articles of Incorporation of SMMC and article 16 of the national ordinance on Health Care Institutions;
2. on or before October 26^th, 2012 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 for Members of the Board of Directors within the SMMC. This to be issued mandate is aimed 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;
3. that the Board of Directors is adequately represented in absence of one board member on St. Maarten. Consequently the quality of care and safety in the hospital is warranted (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);
4. That on or before October 26^th, 2012 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 .(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);
5. send an overview to the Inspectorate detailing all the dates whereon the present sole member of the Board of Directors of SMMC intends to not be physically present on 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. (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);
6. procure that on or before October 26^th, 2012 all medical administrative data, medical data, files and computer files required for an adequate representation and care are placed on one (1) location within SMMC; (national ordinance on Health Care Institutions art 18);
7. realizes that on or before December 8^th, 2012 the Board of Directors of SMMC is expanded with one member who will take on the portfolio  “Medical Technical matters”  and as such guaranteeing the continuity of the management; (Articles of Incorporation SMMC art.5; national ordinance on Health Care Institutions art.8, 9, 16);
8. to fill out the vacant Personnel Formation places within SMMC on or before December  8^th, 2012 2 for  the basic specialist medical care of: surgery, internal medicine, Ob-Gyn, pediatrics, anaestiology and radiology  (national ordinance on Health Care Institutions art. 9, 18);
9. on or before December 8^th, 2012 show  that the Board of Directors is actively negotiating with the medical staff pertaining to an Admittance Contract for  the Medical Specialists that will result in a mutually accepted Admittance Contract on or before January 1, 2013; (Articles of Incorporation SMMC art. 12; national ordinance on Health Care Institutions art.16, 18, 19);
10. provide a suitable action plan on or before December 8^th, 2012 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 theater (national ordinance on Health Care Institutions art. 8, 9, 10, 20);
11. on or before December 8^th, 2012 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 patience needs must be addressed more urgently, introduction of protocols for to most common diseases and finally made working agreements with stakeholders (national ordinance on Health Care Institutions art. 8, 9, 10, 20, 21);
12. on or before December 8^th, 2012 deliver an updated disaster plan and a plan to promote “disaster awareness” and establish annual drills for the staff of SMMC (Vastgesteld Rampenplan Sint Maarten 4 Maart 2002 AB 2002 no. 8; national ordinance on Health Care Institutions art. 8, 9, 10, 20, 21);
13. ensure that on or before December 8^th 2012 all committees in charge of safeguarding and managing the quality of care are staffed with at least three (3) persons and that these committees report quarterly to the Board of Directors of SMMC on various matters (national ordinance on Health Care Institutions art. 17).

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 understands that it is (i) subject to the external supervision by the Inspectorate and (ii) must abide to 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.

The Inspectorate in closing 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.  

Click here to view the decision rendered by the Court of First Instance in SMMC vs. the Inspectorate of Health.