Inspectorate imposes 13 demands on St. Maarten Medical Center


~ $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."