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SZV funds being drained; Bricks and Blocks will not improve the Quality of Care on St. Maarten.

PHILIPSBURG:--- In this article SMN News will go into details to highlight the current status on quality of Healthcare on St. Maarten and what the Minister of Public Health Emil Lee has done thus far to change the gloom and doom facing the people of St. Maarten.

NHI
Already the Dutch Government informed the government of St. Maarten that the National Health Insurance (NHI) which was placed on the back burner by several governments has to be implemented by December 31st, 2017 if not the country will have to face an instruction. The NHI which according to several stakeholders will not work for St. Maarten and definitely will cost the people of St. Maarten more money, said to be the only thing that will give almost everyone access to healthcare.
If and when implemented the Minister of Health Emil Lee intends for SZV to manage the NHI but that is like putting the “blind to lead the blind” since SZV is in total chaos and they have still not evolved from a creeping baby to a walking child, despite the millions spent on consultants over the past 5 years.
It has been proven in the past years that a health care financing system such as NHI, as perfect as it may look, is not sustainable in small scale economies and it becomes a burden for governments. It might work in countries with a strict tax system providing a steady income for government. Periodic premium increases and or economizing on the insured package will be unavoidable.
St. Maarten should start planning for alternatives financing systems and or for rigorous tax reform.

SZV and medical referrals.
Patients are given a hard time to get the medical referral they need while Louis Constant Hospital (LCF) claimed they were not paid for their services. Not to mention the CEO SZV Director Glen Carty knows nothing about medical referrals or Medicare and it is now rumored that the Minister of Health Emil Lee want to bring the retired director of AZV (Aruba) Anco Ringeling to take over from Glen Carty bear in mind this is a pensioner that is given another huge job while St. Maarten professionals sit on the sidelines. It is understood that the Council of Ministers already gave a negative on the hiring of Ringeling but the Minister of Health is hell bent on getting him to work at SZV even if as another well-paid consultant.
It is a known fact that SZV is spending millions on medical referrals, it also known that the medical insurance company is spending about $36M annually on referrals alone simply because many patients leave St. Maarten for medical investigations and treatment overseas and their stay frequently exceeds a month unnecessarily. During this period overseas, patients stay in hotels and they are collecting a daily allowance. Based on in debt research it shows that some patients go overseas at least three times per year just to hear the same thing over and over and absolutely no new insights result from these visits that improve the patient’s health.
What should be noted is that even though SZV has doctors working in house and they could request re-evaluation on patients that are leaving too often for medical care, SZV chose to approve the referrals instead of questioning some of the unnecessary referrals. This is mainly due to the lack of the necessary competencies and procedures in the medical department of SZV and political interference.
SMN News learned that several civil servants have been traveling to the Dominican Republic on SZV accounts and instead of seeking medical treatment they are busy building homes or involved in other activities in that country.
A particular employee of SZV has chosen to use her medical condition to travel to Curacao every school vacation and no questions are being asked. SZV even paid for this employee to stay at the Renaissance Hotel in Curacao during the mid-term break in October 2016 citing that the employee was there on a medical referral. Again in July this year when school vacation started the same employee managed to obtain a medical referral letter from a doctor on St. Maarten to travel for medical care. While SZV and its management are fully aware of the abuse of the medical referral process by this employee they have done absolutely nothing to put an end to the abuse. The said employee who has been abusing her benefits at the Social Insurance Bank chose to apply for the COO position, hopefully, management will ensure a healthy qualified candidate is placed in that position and not someone that has a health condition and is known for abusing SZV medical referral process.
As it stands now SZV has spent almost $30M on consultants that had to provide advices for the New General Hospital (NGH) and work on “SZV 3.0”. Besides that, a whopping $1M was paid as settlement to VAMED, yet there is still no NGH in sight.
It is clear that management of SZV has drained the ZV funds and has been dipping their hands in the other funds, mainly the AOV and AVBZ fund, from which money is transferred to the ZV funds to compensate for the high overhead caused by the New General Hospital Project and medical referrals abroad. The Minister and the CEO of SZV are trying to legalize this practice with the introduction of a “swing fund” for which there is no legal basis.
SZV has illegally spent money from the AOV fund on projects. This illegal activity was raised by the former Chairman of SZV Supervisory Board Dr. Michel Petit with Minister Lee. However no actions were taken.
Based on information SMN News received it shows that slowly but surely SZV will end up bankrupt if they continue spending at the same rate under the guidance of Minister of VSA Emil Lee and CEO Glen Carty.
Mr. Carty has been at the helm of SZV for the past three years, while also working full time at UTS. Besides the fact that he was supposed to be there no longer than a year at SZV, one may wonder how it is possible to manage two companies effectively at the same time and being paid full time at both. Due to the fact that he has no knowledge of health care and social insurances and the weak organization SZV is, this has resulted in millions being spent on consultants instead of hiring competent staff.

Agreement between Observatoire de la Sante and SZV
It should be noted that the French authorities are busy conducting an investigation into the alleged illegal activities conducted by Observatoire de la Sante (OBS) St. Martin that signed an agreement with SZV to handle medical referrals and payment to the Louis Constant Fleming Hospital (LCF). Based on documentations SMN News received it showed that SZV has been paying OBS for the past 10 months through an offshore account to evade taxes while the LCF didn’t receive any payment leading to the refusal of SZV patients.
Besides that OBS is an association that was created to foster better cooperation in public health and health care and conducts public health research between the French side and all other overseas countries and islands including Dutch St. Maarten.
Board members of the OBS include the Acting Secretary General and head of the Department of Public Health VSA Fenna Arnell and the Minister of VSA from Dutch St. Maarten, the Medical Director of LCF Louis Jeffry, the Director of OBS Arnauld BENET, Yawo Nyuiadzi, Fleur Hermanides and Monique Rakotomalala. OBS doesn’t have any permit from the French authorities nor the authority to act as a “Medicare broker”. The fact that SZV signed an agreement with OBS paying OBS an annual service fee of circa $250K on top of the costs, clearly illustrates a lack of due diligence being conducted by SZV, the incompetence in medical referrals and the misappropriation of funds.
The French authorities are continuing their investigation and looking at possible financial fraud.

Tripartite
The tripartite, a platform consisting of the Ministry VSA, SZV, and the SMMC was initialized in March 26th, 2015 with the goal to develop a business case for the NGH. It soon became clear that SZV “hijacked” the tripartite and the Ministry who should be in the leading role became a “follower”. All activities related to this platform have been financed by SZV. KPMG became the biggest earner. The result so far of this derailed platform, a bidding procedure that ended in court and with a settlement with VAMED. The judge basically condemned the bidding procedure and indirectly concluded that the CEO of SZV and the Minister VSA have committed fraud. The business case is unacceptable for the CFT because it only discusses financial aspects and lacks the part how the quality and continuity of care will be guaranteed in the NGH. The financial analysis is based on assumptions without local data (financial and health) being available.
It is time the Tripartite is dissolved and the Ministry is reinforced and assumes its responsibility as a regulator, instead of tagging along with parties (SZV and SMMC).

Improving Healthcare at SMMC.
While it’s been a year Minister of Health Emil Lee is championing the construction of the New General Hospital and the Minister is trying effortlessly to secure funding from the Dutch Government or SZV and APS, it is clear that Minister Lee has not placed any focus on finding ways to improve healthcare on St. Maarten which would limit medical referrals abroad.
A larger hospital building with state of the art equipment will certainly not limit medical referrals if St. Maarten and SMMC does not place focus on finding fully qualified specialists that are willing to work at the medical institution while providing quality medical services to the people of St. Maarten.
One of the things the Minister has to focus on is to increase the fee’s for SMMC, the same money that is spent by SZV to send patients for 3 or more weeks overseas, can be used to increase SMMC fees in order for SMMC to attract and keep the much-needed specialists locally. The Minister of Health should make it a priority to have the necessary laws and policies in place that would allow the much-needed increase. Being part of the Netherlands Antilles is no longer an excuse since St. Maarten obtained its country status some seven years ago.
The Minister announced at several press briefings that he was working on legislation such as the BIG and he also paid some Euros 14,000.00 to Everard Van Kemenade to conduct a baseline study of the health care chain in order to improve the status of St. Maarten Medical Center (SMMC) and Public Health. Thus far the Minister has not presented any law to the Council of Ministers or Parliament for approval. Suddenly the Minister has lost his hype on improving healthcare and these laws seemingly do not matter. Van Kemenade submitted three reports to Minister Emil Lee, after meeting with SMMC, Public Health, and the Inspectorate. While Minister Lee boasts of integrity and transparency he has refused to make the full contents of these reports available to SMN News and the general public. Besides hiding the reports which clearly outline the current situation at the entities especially at SMMC and where suggestions were made for improvements. Even though Euros 14,000.00 were spent on these reports the Minister has done absolutely nothing to put in place the necessary legislation which will ensure that due diligence is done when granting MB’s to doctors that want to work on St. Maarten. If the Minister had quality health care in mind he would have ensured that management of SMMC gets their acts together when recruiting specialists to work at the island’s only medical institution.
The slogan of the SMMC “We Care” doesn’t seem to be applicable when it comes to making necessary improvements in quality and safety of care due to a lack of visionary leadership, poor communication and a weak board of directors and supervisory board.
This situation has amongst others resulted in at least 7 specialists abandoning the SMMC in the past 10 months and more to follow, while the SMMC has lots of difficulties recruiting new competent specialists.
It has been decided that this same organization and management will be in charge of the NGH.

Ministry VSA
Besides, that the Minister would have ensured that the Department of Public Health is up to speed with knowledgeable personnel that would conduct the necessary background checks on doctors who apply to work on St. Maarten.
Public Health over the years has not been working close enough with the Inspectorate of Education who are requested to vet diplomas submitted by candidate doctors. Another loop hole in the system which must be fixed is at the Inspectorate of Education which is tasked with checking to see if the diplomas submitted by candidate doctors are authentic. However, the Inspectorate of Education does not have the required knowledge and tools in place to see if specialists who applied to work on St. Maarten meet the requirements as laid down by Dutch laws. However, this task is left up to Public Health who often does not do due diligence when vetting specialists. Public Health went as far as advising to issue MB’s to none Dutch or English speaking specialists to work at SMMC, certainly, this created confusion among the staff at SMMC. They have failed to ensure that specialists who want to work on St. Maarten has the required education and practical skills as stipulated by Dutch laws.

SMN News asked Minister Lee what he did to improve the quality of healthcare on St. Maarten and which legislation he implemented during his time in office to ensure that SMMC attracts the right types of specialists. Minister Lee simply said he is doing everything possible only focusing on the NHI and the NGH and not the legislation and suggestions made in the Van Kemenade reports.
What is evident so far is that the Minister of Public Health is refusing to follow the advices given to him by longtime healthcare professionals, the situation became so frustrating that at least two of those healthcare professionals that held key positions chose to leave St. Maarten because the Minister of Health simply refuses to follow the principle of the law. One being the former Chairman of SZV Supervisory Board Dr. Michel Petit who openly spoke out against the ills of the Minister of Health. It has also been learned that the Chairman of the Council of Health Dr. Theo Jolles who worked on St. Maarten for 35-years has chosen to step down and leave St. Maarten. It appears that the Minister of Health has chosen to go against most of the pieces of advices the Council of Health provided to him especially when it comes to allowing specialists that were recruited by SMMC to work on St. Maarten.
The Minister doesn’t even support his own Inspectorate in trying to get the SMMC to provide quality and safe care. The SMMC is publicly strongly supported by the Minister which has led to an attitude of the SMMC against the Inspectorate resulting in many court cases which SMMC ultimately lost. The Minister went as far as to issue an MB against the Inspectorate basically paralyzing the Inspectorate in the execution of its legal tasks. A few days after issuing the MB the Minister had to withdraw the MB after being taken to court by the Inspectorate.
Under Minister Lee, the Ministry VSA has become more and more like a “ship adrift” not being given the attention it requires. Poor communication, many vacancies left unfilled, lack of necessary tools and deficient infrastructure have led to overloaded, demotivated staff and departments not being able to execute their tasks properly. The Minister has focused only on his “NGH” and NHI.

Mental Health and MHF
With the support of the Pan American Health Organization, a mental health survey was conducted on Sint Maarten resulting in the WHO-AIMS report in 2013. On September 30th 2013 a three day addiction and psychiatry conference “Transforming Care” was held at the Westin to initialize the follow up on the WHO AIMS report and the objective to draft a National plan on Mental Health for Sint Maarten. This National plan was finalized in August 2014.
At present we can conclude that not much progress has been made with the execution of the National plan. The revision of national mental health legislation in accordance with international human rights and expansion with much more community-based outreach, both priority strategic areas have not happened.
The Mental Health Foundation is for quite some time without a director in a crisis and being run by a management team, leading to much dissatisfaction and frustration amongst staff. The chairman of the board of MHF has been appointed a medical director at the SMMC but kept his position as chairman at MHF, leading to a dysfunctioning board.

Collective Prevention Services (CPS)
This department of the ministry is responsible for public health education, public health surveillance, vector (rodents, insects) control and youth health care. The lack of an epidemiologist for some years now and the recent departure of both the youth health care specialist and the head of the department have caused a tremendous gap and public health tasks not being executed optimally.
Home care, Nursing care, Rehabilitation care
These forms of care are provided by the White Yellow Cross Foundation and are for a great deal up to par. This institution is managed professionally by a director, management team and supervisory board. Expansion with a small new division providing terminal (hospice) care will be realized early 2018. Quality of care is a continuous focus.

GP care.
GP’s are supposed to be the gate keepers of the health care system. This means that they have to be competent, skilled and possess good social skills. Nowadays this is a specialty of 3 years.

GP care is mainly provided by the doctor’s office in Sint Maarten. House visits are more an exception than rule. There’s is no availability outside office hours. Communication with specialists is poor. Feedback from specialists visited by patients is not structured.
Many GP’s are 55+ years old. This might cause shortage problems in the near future.

It has become clear that this Minister nor his cabinet have the required knowledge and experience to run the Ministry nor guide our health care system in the right direction. The focus remains very limited while the Ministry is falling apart.
Meanwhile, SZV remains a very weak organization allegedly involved in illegal activities and the SMMC is not able to provide quality care in basic areas and faces many problems but aims to get JCI accredited.