Published On: Sun, Oct 18th, 2020

Health / Legal Matters / News | By The Publisher

Mental Health Law not being applied

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conclusions Mental Health Care law review

PHILIPSBURG – In the supervision of mental health care in St. Maarten, the Minister of Public Health, Social Development and Labor (VSA), the Health Inspectorate and the Public Prosecution Office do not comply with the existing law. This collective failure has left the Mental Health Foundation’s health personnel at the mercy of the institution’s management and board. The quality of the care provided is worrying: at least two patients have fallen victim to negligence.

Developing story: Another mental health patient dies….

Related article: Psychiatric patient dead in solitary confinement

On August 25 this year, a 43-year-old bipolar patient was found dead in the isolation cell of the Mental Health Foundation. At the beginning of the year, a 29-year-old woman diagnosed with a manic psychosis was locked up in that same isolation cell for three months. It was only after the involvement of the medical team that this woman, who is a nurse by profession and who herself asked in vain for certain medicines, received the correct medication from the treating psychiatrist and was then stable within a short time. Although she posed no danger to herself or her environment, during the lockdown in St. Maarten, she was flown to Suriname at the expense of the St. Maarten taxpayers in an air ambulance jet. This air transportation cost more than thirty thousand dollars.

In June, before the late Caulette Julien was locked up in solitary confinement, health care workers were already ringing the alarm bell with the chairman of the Mental Health Foundation, Dr. Felix Holiday. In their letter, the medical staff indicated that they no longer have confidence in the interim director Eileen Healy and the management team. “For a long period, the former and currently interim director of the MHF created a culture of fear amongst employees, systematically and continuously mistreating and abusing power towards selective employees, who want to remain anonymous due to fear of severe repercussion and incomplete transition to our new union ABVO,” says the letter to Dr. Holiday. The employees emphasize that Interim director Eileen Healy made it clear that she has the last say in all decisions. “Furthermore, we are experiencing the mistreatment from the intended director, Dr. Kitty Pelswijk. Also, Mrs. Carina Ellis, human resources manager, willfully adds unrest to the work environment by encouraging the ill-treatment of the majority of the staff.”

Related article: Mental Health Foundation in turmoil

The employees criticize ‘the unworkable situation’ and ‘a lack of quality of health care’. “Ms. Healy is systematically excluding certain experienced and highly educated healthcare workers from participating in the process of decision-making on medical content affecting clients’ care,” they wrote. The transition to a new electronic client file also had a negative impact. “Medical information, including diagnosis and use of medication, were no longer available, which gives immediate and severe risks for the safety of giving care to clients.”

Research by StMaartenNews.com has shown that MHF has a black stock of medicines that all employees of the institution can access. There is no complete and reliable record of diagnoses of patients and the drugs they receive. There is also uncertainty about the current number of patients with MHF. Since the transition to the new electronic client file, in March of this year, records of patients who have died or have left the island are active again in the system, which means that the active patient database is larger than the actual number of people who currently need care.

Related article: ‘Black stock’ of antipsychotic drugs at MHF

MHF lacks checks and balances; patients are assigned to one of the psychiatrists and are dependent on that psychiatrist for their treatment. There is rarely consultation with other experts. No second opinion is sought from an independent psychiatrist before the signing of a Declaration of Insanity (Krankzinnigverklaring or KZ-verklaring) by Dr. Michael Mercuur, a general practitioner. As far as is known, every request for a KZ-verklaring in the past seven years has been approved, after which compulsory treatment followed for an indefinite period, at the discretion of the treating psychiatrist. It has been established that Caulette Julien died in isolation due to unnatural causes. No autopsy took place. The body of the victim was released and buried with no known cause of death.

According to the Landsverordening tot regeling van het toezicht op krankzinnigen (National Ordinance on the Supervision of the Insane), which has been in force on St. Maarten since 2013, the Minister of VSA is responsible for the general supervision of the Mental Health Foundation, as well as the supervision of the management and board of the institution, and the admission and nursing of patients. The minister must also supervise the financial management, in particular the nursing fees.

“He who nurses an insane person is obliged to report this to the minister within 48 hours after the start of the nursing,” the law states. And: “The Minister shall immediately notify the Attorney General and the Inspector General of a report as referred to in the first paragraph.” In practice, this obligation is not being adhered to. In the case of 29-year-old nurse F.L., who was locked up for three months, employees say there is not even a report of her January admission and no letter of discharge from April when she was taken to the airport to be deported.

Caulette Julien died after three weeks in solitary confinement while her attending physician was quarantined at home due to alleged Covid infection. Julien was not visited by a psychiatrist or other doctor for days. By law, the Inspector General of the Inspectorate of VSA is obliged to immediately notify the Attorney General of the Public Prosecution Service in the event of neglect. By law, Dr. Earl Best should have made unannounced visits to the Cay Hill facility to make sure that “no one is being unlawfully placed or detained there and that patients are properly treated.”

Seven weeks after the death of Caulette Julien, the Public Prosecution Office is still awaiting a report from the Inspector General on the circumstances of her death. When asked, Dr. Earl Best indicates that the investigation is still ongoing. The Inspector-General has asked the MHF medical staff for a report. In turn, the medical staff demands an answer and explanation from the Inspector General.

Related article: “Solitary confinement belongs in the Middle Ages”

On Wednesday, September 23, during the weekly press briefing, Minister Richard Panneflek denied being responsible for the appointment of psychiatrists at MHF. “One has to understand that a foundation has its own board, and the responsibility of its functioning is by the board, not by the minister. The minister does not appoint within foundations,” Panneflek said. According to the National Ordinance Regulating the Supervision of the Insane, the Minister is not only responsible for the doctors and medical treatment of patients but is primarily responsible for the entire course of affairs within the Mental Health Foundation. Minister Panneflek has not yet responded to questions from StMaartennews.com about mental health care on St. Maarten.

According to Article 19, the judge decides on the compulsory admission of a patient to the Mental Health Foundation after submission of proof of insanity by the Attorney General, who must obtain that proof from the Minister. “Requesting the judge for an authorization (rechterlijke machtiging), I don’t think we do that at all,” says Chief Public Prosecutor Mirjam Mol. She is surprised by the existence of the National Ordinance. “It contains quite a few obligations for the Public Prosecution Office, and I must say in all honesty that they are not being met. We are not actively involved in this. But we have to be. So we are going to take that up. We are going to organize this together with the Courthouse, the Mental Health Foundation, the Probation Service and the Police. As we do have the legislation, we have to start applying it in a structured way and in coordination with each other.”

It is now up to minister Richard Panneflek of VSA to issue an ultimatum to the management of the Mental Health Foundation. If the foundation does not properly comply with the regulations and conditions of the National Ordinance within a period to be determined by the Minister, the Minister is obliged by law to withdraw the license of the MHF and to close the institution.

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