Final report Inspectorate of Public Health on governance audit and inspections of the SMMC

The Inspectorate for Public Health, Social Development and Labor (VSA) conducted a governance audit of the Sint Maarten Medical Center (SMMC) and thematic site inspections at the end of 2011 to the first half of 2012.


Quality of care, internal supervision (governance), the surgical operations, the emergency department and the handling of accidents and incidents were audited through inspection visits and conversations with staff members, the board of directors and the supervisory council. For the audits on governance and surgical operations support was provided by the Inspectorate for Healthcare from Holland (IGZ).

The Inspectorate is aware of the fact that Sint Maarten is a small island with only one hospital, the SMMC. Demanding of this hospital that it complies with all requirements as stipulated for hospitals in the western world would be unrealistic and not feasible, but one must expect the SMMC to comply with basic quality –and patient safety standards and health care ordinances and regulations.

The audit and inspections leave much to desire. A common and important finding is the lack of proper communication in different areas and at different levels resulting in severe delay in the development of a basic quality- and safety system and a high risk for the patient. This situation is worsened by the fact that the Board of Directors is frequently (50% of the time) off island and replaced by a staff member without mandated authority and an incomplete Supervisory Council that cannot exercise its supervisory role adequately.

Also included in this report are some investigative results of incidents that occurred in 2010, 2011 and 2012, because they provide insight in the way the SMMC is organized. On one hand about the communication amongst professionals, and amongst professionals and the board of directors, and on the other hand how transparent the management is towards external supervision.

When publishing a report the Inspectorate takes into account the norms as prescribed by legislation such as the "Landsverordening Openbaarheid van Bestuur". This means that wherever possible personal information will not be mentioned in this report e.g. patient name and staff members of the SMMC will be mentioned as much as possible by their function.

Due to the Board of Directors not being very cooperative, it wasn’t until July 12th 2012 the Inspectorate could speak with the director. The provided information has been processed in this report.

The Inspectorate uses the following ordinances and regulations for this audit and measures to be taken;

1. Landsverordening zorginstellingen (PB 2007 no. 19)

2. Landsverordening Corporate Governance (PB2009 no.74)

3. Landsverordening Inspectie volksgezondheid (PB 2003 no. 8)

4. Landsverordening Beperking vestiging medische beroepsbeoefenaren (PB 2005 no.69)

5. Landsverordening Uitoefening geneeskunst (PB 1958 no. 174)

6. BW boek 7 afdeling 5 Overeenkomst inzake geneeskundige behandeling

7. Statuten SMMC 25 April 2008

8. Basis Reglementen Raad van Toezicht – SMMC 26 September 2011

9. Gedragcode Raad van Toezicht SMMC Juni 2011

10. Model Toelatingsovereenkomst SMMC 2010 versie 6.0

The findings of this audit have been compiled in a draft report which was delivered on August 24th to the board of directors of the SMMC for comment prior to publication. The deadline to deliver any comment to the Inspectorate was September 7th. On September 7th the board indicated in a letter to the Inspectorate that they couldn’t comply with the deadline due to several internal delays and requested an extension till September 17th. The inspectorate denied this request and indicated that possible comments will be dealt with when discussing the action plan to be drafted.

Based on the findings and measures that need to be taken with regard to quality of care and patient safety, some on short term and others within a year, the Inspectorate has put the SMMC under higher supervision as of September 8th 2012.

This means that the board of directors must present a feasible action plan 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. Failure to comply may result in (temporary) closure of specific functional units.