Court decides on Tuesday on hospital’s supervision

POSTED: 10/10/12 12:12 PM

GREAT BAY – Next week Tuesday at 2 p.m. the Court in First Instance will rule on an administrative appeal by the St. Maarten Medical Center against a decision by the Healthcare Inspectorate to place the hospital under stricter supervision. The hospital has asked the court to suspend the inspectorate’s decision, while the inspectorate maintains that it has not started to enforce its recommendations.

The row between the hospital and the inspectorate finds its roots in events that began in November of last year when the inspectorate announced that it wanted to talk with several people at the SMMC with a delegation from IGZ, the Dutch healthcare inspectorate.

Attorney Maarten Le Poole detailed the events from November of last year until September 8 of this year, when the Inspectorate announced it has placed the hospital for the period of one year under higher supervision.

“The confrontation between the SMMC and the inspectorate about the quality of care in our hospital has kicked up a lot of dust. SMMC finds this confrontation and its consequences embarrassing and regrets it. She refuses however to be overrun by a runaway inspectorate.”

The attorney said that the measure is unlawful because based on St. Maarten law it is not surrounded by any guarantee, it is not limited by any framework and cannot be reviewed based on legislation or policy.

The disadvantage the hospital has suffered is incalculable, mr. Le Poole pointed out. “First the Minister created unrest with negative statements about the hospital and afterwards the inspectorate did – possibly not completely coincidental – the same. The public got the impression that the SMMC is a completely drifting, highly dangerous institution. That is disastrous for healthcare in St. Maarten, for the future hospital’s future and it also affects the staff. There is also the threat of unrest in St. Maarten’s small financial market on which the SMMC depends for its expansion. Ironically that expansion is essential for the improvement of the care.”

Le Poole furthermore attacked the negative report the inspectorate wrote about the hospital, saying that it based on “the incorrect assessment of facts and circumstances.” The hospital has indicated to the Inspectorate what these inaccuracies are, but a reaction from the inspectorate shows that parties disagree about several issues.

“Enough is enough,” mr. Le Poole concluded. “The inspectorate has to be called back and return to the barracks. The inspection report has been written based on a negative attitude towards management and the supervisory board; it contains inaccuracies, does not tally with the vision of other experts and forms a much too shaky basis for a measure like higher supervision.”

The attorney said that the hospital’s provisional action plan is sufficiently solid to continue on the road towards the feasible action plan the inspectorate demanded in its letter of September 8. The inspectorate’s authoritarian attitude leads to almost daily summonses, appeals and deadlines. “They make that the hospital is more occupied with the inspectorate than with the provision of care. This way the picture the inspectorate attempts to paint threatens to become a reality.”

Lastly, the SMMC-attorney pointed to the reasons for the inspectorate’s attitude: “Behind the inspectorate’s actions the SMMC suspects the minister’s hand or that of politics, and the existence of improper motives that are not linked to healthcare. “Think about dumping the member of the board (director George Scot – ed.) and members of the supervisory council in the garbage and creating more influence by politics at the hospital. The term détournement de pouvoir (abuse of power – ed.) comes to mind.”

The attorney for the inspectorate, mr. Jairo Bloem, outlined his client’s authority and said that the term higher supervision may come across as confusing. “It could create the impression that management gets a subordinate position relative to the Inspectorate, but that is not the case at all.”

mr. Bloem quoted from the September 8 letter wherein the Inspectorate announced the contested measure: “This means that the board of directors must present a feasible action plan to the inspectorate 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.”

The attorney told the court that the inspectorate has not yet started to enforce its recommendations and that the hospital’s legal position is not affected by more frequent supervision. He further noted that the inspectorate hardly got any cooperation from the board of directors and the supervisory council. “They perceived the Inspectorate’s intervention as a threat,” mr. Bloem said.

The most critical argument against the hospital remains: “The inspectorate is of the opinion that currently the SMMC does not meet basic quality and patient safety requirements.”

Reacting to the hospital’s argument that the public controversy has caused damages, mr. Bloem stated: “It seems that the SMMC for reasons of self-interest wants to cover up the findings (of the Inspectorate – ed.). It is hard to see how the public interest of healthcare will benefit from silence. It is up to the board of directors to act decisively, to motivate the staff, to improve the quality of care and to be transparent about the care it provides. When that happens the inspectorate will be able to publish that the quality requirements are met.”

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