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Published On: Tue, Nov 17th, 2020

Mismanagement at MHF continues

CAY HILL — During a presentation in Parliament on Monday, November 17, 2020, Dr. Kitty Pelswijk described how psychiatric care in St. Maarten is rather uncertain. “One psychiatrist is currently at home and I am the only other psychiatrist. If I fall ill, St. Maarten is done.” Pelswijk stated.

This dramatic statement corroborates the information StMaartenNews.com has received over the past months. However, sources cite mismanagement as the reason for the uncertainty in the psychiatric care at the island’s only mental health institution. For instance, for the third time in three months, a patient has died, a tragic event that could have been prevented, according to these sources.

On November 12, a 58-year-old history teacher committed suicide. For five months the lady had been a patient of psychiatrist Dr. Kitty Pelswijk, interim director of the Mental Health Foundation, but reportedly had not seen her treating psychiatrist in person. A psychologist noted that the woman was in distress and that there where alarming signs. On November 10, Dr. Pelswijk is said to have issued a new prescription for medication without a consultation. Two days later the woman was found dead.

According to the Dutch Individual Health Care Professions Act (Wet BIG), medicines are only prescribed by a doctor and these actions fall under the heading of ‘acting with due care’. To minimize the risk to the patient, prescriptions and medication are only provided according to protocol. This protocol prescribes that there must be personal contact between doctor and patient: during a consultation, the doctor tries to arrive at a diagnosis based on the patient’s story, the clinical picture and professional knowledge. Because all antipsychotics have moderate to very serious side effects, a physical examination is often part of the medical assessment, and may include blood tests and an ECG. According to the BIG Act, the treating physician is personally responsible for prescribing and administering medication.

Dr. Kitty Pelswijk, trained in Suriname, is not BIG registered and fails to follow internationally respected medical specialist guidelines on her own initiative. At the beginning of August, Dr. Pelswijk put a bipolar patient in solitary confinement for an indefinite period. After three weeks in the small cell, 43-year-old Caulette Julien was found dead by an employee of the Mental Health Foundation. It has been established by the medical examiner that she died of unnatural causes.

Related article: An audit at Mental Health, but no death investigation

Seven weeks later another patient of dr. Pelswijk died due to a possible overdose of medication. The elderly lady collapsed after having been injected with antipsychotics several times that day at her home. She was taken to the St. Maarten Medical Center, where she was treated at the ICU for six days before she passed.

In January this year, Dr. Pelswijk put a 29-year-old woman in solitary confinement for three months. Reportedly, she injected her patient so many times that the young woman didn’t have a healthy spot left on her body to give her another shot. The medical team intervened and insisted on proper medical treatment.

In the same week in October when the elderly woman collapsed after receiving multiple injections, Dr. Pelswijk ordered a young female patient to be injected against her will. The police was called for assistance. On Saturday afternoon October 10th, 2020 about 2pm, the central dispatch directed several patrols to the Texaco Gas Station close to the Causeway where J.M. was sitting in her car with her boyfriend. She refused to cooperate with two nurses from the Mental Health Foundation who right then and there wanted to give her a combination of antipsychotics by injection.

According to the National Ordinance regulating the supervision of insane persons, applicable in St. Maarten since 2013, the Attorney General must be notified if a patient is neglected outside the institution or is not nursed in a suitable environment (article 11). This did not happen in the case of J.M. At the gas station the officers encountered the patient sitting in her car, forbid her to drive off and when she got out of her car, they tried to restrain her. During the struggle J.M. suffered a broken arm and bruises.

Is a doctor allowed to order compulsive medication on the street? “Of course not,” says Mr. Cor Merx, the victim’s lawyer. “A patient has the right to refuse medication. In a modern law-abiding society, you cannot simply restrain a person and forcibly inject him or her with medication. And certainly not on the street, without a doctor nearby.” If someone poses an immediate danger to his environment, the police must arrest this person and transfer the suspect to the police station, the lawyer explains. “The legal position of the patient must be protected.”

According to Article 13 of the National Ordinance, forced treatment can only take place with the consent of the Minister of VSA or on the basis of a judicial authorization (Article 13). Compulsive treatment is only possible after admission to an institution. “Every application of a means of coercion to a patient in an insane asylum is recorded daily in a register, arranged according to a model to be determined by the Minister. This register is submitted to the Attorney General and the Minister, in addition to the Inspector General,” reads Article 10 of the LV. None of these provisions have been complied with by the Mental Health Foundation, which has been headed by Dr. Kitty Pelswijk since October 1.

Related article: Mental Health Law not being applied

For J.M. it didn’t stop at the gas station incident. After her broken arm was treated in hospital, she was forcibly injected with high doses of antipsychotic and anti-anxiety medication at home with the help of the police, she says. She has not seen any authorization from a judge or the minister of VSA to do so.

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Related articles:
Eileen Healy: “Not enough money for mental health care and lack of legislation”
Worrisome trend in mental health issues
Mental health patient dies due to possible overdose of medication
Mental Health Law not being applied
Distinction between natural and unnatural death remains unclear
Three months in solitary confinement, then deported
Solitary confinement belongs in the Middle Ages
MHF explains hiring process non-BIG Medical Professionals
Video images of Caulette Julien still not released
‘Black stock’ of antipsychotic drugs at MHF
Too many drugs: polypharmacy alarming trend at Mental Health Foundation
Medical liability issue gets attention from government
Psychiatric patient dead in solitary confinement
MHF response to article StMaartenNews.com September 22, 2020
Medical recognition divisive issue at Mental Health Foundation
Interim Director responds to publication about MHF turmoil
Mental Health Foundation in turmoil
Announcement New Interim Director Oct 1 2020

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