St. Maarten Medical Center placed under supervision


~ 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.