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Published On: Fri, Oct 9th, 2020

Three months in solitary confinement, then deported

CAY HILL — Before the late Caulette Julien was locked up in the isolation cell of the Mental Health Foundation, another woman was in this cell. 29-year old F.L. was released on April 6th this year after three months in solitary confinement and taken to the airport to be deported.

Things got out of hand at Princess Juliana International Airport. The woman panicked. According to witnesses, she had been taken to the airport from the Mental Health Foundation (MHF) in Cay Hill by police officer Winston Amarello, the husband of Dr. Kitty Amarello-Pelswijk, the current interim director of the MHF. Inside the airport building, it became clear that F.L. would not board the plane voluntarily. After assistance was requested, it was decided that she would be taken to Suriname by air ambulance.

The married woman had come to St. Maarten from Dominica and was staying at an acquaintance’s house.  She became manic psychotic, started talking very fast, her mind was racing and she behaved irrationally. People around her didn’t know how to calm her down. They called the Mental Health Foundation. F.L. was taken to the facility in Cay Hill by a nurse accompanied by the police.

At the Mental Health Foundation, it turned out that F.L. had no relatives on the island to care for her. And she had no medical insurance. By order of Dr. Amarello-Pelswijk, and approval of the then interim-director Eileen Healy, the young woman was locked in the isolation cell and received an injection with antipsychotic drugs and other medication. This happened on January 7th. The patient remained in isolation from that day on.

In St. Maarten, a person can be detained against his or her will without a court order. The decision to place someone in solitary confinement is taken solely by Dr. Michael Mercuur, member of the Board of Directors of the Mental Health Foundation. Dr Kitty Amarello-Pelswijk requests the involuntary admission, stating that someone is a danger to others or himself. Dr. Mercuur, on behalf of the Minister, signs a Krankzinnigenverklaring (KZ), which means that the patient is considered insane and incapacitated.  It is striking that Dr. Mercuur is not a psychiatrist but a general practitioner. No second opinion from an independent psychiatrist is requested and, as far as is known, Dr. Mercuur has never refused to sign an application for Insanity. Dr. Mercuur signs the KZ-statement on behalf of the minister of VSA. After signing, the statement is forwarded to the Minister.

According to the Landsverordening tot regeling van het toezicht op krankzinningen (National Ordinance regulating the supervision of insane persons), the Minister of VSA is responsible for the involuntary treatment of patients. Article 15, section 2, requires the Minister to notify the Attorney General as soon as possible of the isolation and compulsory treatment of a patient. The attending physician should make daily notes of the medical treatment in a registry from the Ministry of VSA. A copy thereof must be submitted to the Court by the Attorney General within five weeks of the patient’s detention.

F.L. received injections of short-acting antipsychotics from Dr. Amarello-Pelswijk. If F.L. did not allow the injection, she was held by nurses. If more help was needed, the police would be called to restrain her. The medical staff noticed that the medication did not have the desired effect on the patient; F.L. continued to have manic psychotic episodes. Their advice to stop injections and to give a combination of two specific medicines was ignored by Amarello-Pelswijk. She reportedly continued to give F.L. the same injections.

According to insiders, after several weeks in isolation, the woman no longer had a healthy place on her body to inject her. Not sleeping for days during manic episodes left her completely exhausted. The medicine the patient herself asked for to be able to sleep was refused by her treating psychiatrist. The medical staff repeatedly entered into discussions with Dr. Amarello-Pelswijk, who maintained that F.L. did not cooperate, refused everything and that the treatment was therefore justified. According to her colleagues, the treatment should be aimed at getting F.L. stable to have her released from solitary confinement as soon as possible. Ultimately, Dr. Amarello-Pelswijk gave in and administered the woman the combination of two drugs recommended by her colleagues. Within a short period of time, the patient became stable.

A declaration of insanity allows a psychiatrist to treat the patient in the manner deemed necessary by the physician. Not only can medication be forcibly administered, this also applies to food and water or other liquids. The doctor may also decide to put the medication in the food or drinking water. However, in the case of compulsory medical care, the concepts of efficiency, subsidiarity and proportionality must always be met.

In the three month that the 29-year-old woman was in isolation, she had sporadic telephone contact with her husband, mother and a sister. Contact was limited, said an insider, because F.L.’s requests to call her family were regularly refused by the treating psychiatrist and nurses. She was also not allowed to receive visitors.

According to article 12 of the National Ordinance on the Supervision of the Insane, the Attorney General, the Inspector General or the Minister must pay an unannounced visit to the Mental Health Foundation at least once every three months to ensure that no one is unlawfully placed or detained there and that the patients are properly treated. Inspector General Earl Best was aware of F.L.’s situation but failed to intervene and prevent that she remained in isolation for longer than strictly necessary. That is nevertheless a requirement according to the law.

In February this year dr. Mercuur signed the application from dr. Amarello-Pelswijk to have the bipolar Caulette Julien declared insane. The two doctors are currently in dispute with each other about the autopsy of Julien. The 43-year-old woman from South Reward was found lifeless in the isolation cell of the MHF on August 25th. According to Dr. Amarello-Pelswijk, her patient died of natural causes. Dr. Mercuur also examined Julien’s body and concluded that there is evidence of an unnatural death.

Opinion piece: “Solitary confinement belongs in the Middle Ages” by Hilbert Haar

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