CAY HILL:— 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 the St. Maarten Medical Center (SMMC) on October 12th 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 time-frame.
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 publicly 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 12th 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 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.
Management Team, Board of Directors, Supervisory Council
St. Maarten Medical Center
