PHILIPSBURG--Almost two weeks week after the Court of First Instance ordered Minister of Public Health, Social Development and Labor VSA Omar Ottley to issue decrees for new mental health facility Psycare and two psychiatrists, the minister has not yet signed these Ministerial Decrees. The May 3 Court verdict states that the doctors were to be allowed to work on St. Maarten effective immediately.
When asked during the Council of Minister’s press briefing on Wednesday if he would reissue decrees for psychiatrists Dr. Ilse Kelbrick-Fürstenburg and Dr. Hendrik Nijdam, who both worked for Mental Health Foundation (MHF) in Cay Hill, Minister Ottley said: “We are in discussions with the cabinet and the department on how to move forward. I have been, from the beginning, well, I have been instructed at the end to stay out.”
Minister Ottley did not say who instructed him “to stay out”.
On Wednesday Ottley further stated that he does not consider the two May 3 verdicts a loss. “I just think that we need to find a way to work together – which was always my goal, that MHF and these persons find a way to work together.”
The Ministry of VSA is discussing “the best ways and conditions” to move forward, Minister Ottley said. “If they [Dr. Kelbrick and Dr. Nijdam – Ed.] are to be established, they would still have to work together [with MHF] because MHF is the only place that offers in-care.”
MHF informed the minister in a letter dated December 10, 2020, that Dr. Nijdam had resigned, and that he no longer provided services for MHF as of January 19, 2021. The management of MHF requested the minister to annul the Ministerial Order that was issued facilitating the working agreement with Dr. Nijdam. This Order, signed on March 16, 2020, by the then VSA Minister Pamela Gordon-Carty, required that Dr. Nijdam, as an employee of MHF, only offered his services as a psychiatrist through the clinic in Cay Hill.
On August 19, 2019, Gordon-Carty had issued a similar order for Dr. Kelbrick, a South African physician by birth who has Dutch nationality and has multiple specialisations as a psychiatrist with 17 years of service. Unlike Dr. Nijdam, she was not an employee of MHF, but had a freelance contract for 20 hours a week. Due to the high demand for psychiatric care Dr. Kelbrick structurally worked many more hours per week.
On November 18, 2020, the psychiatrist requested the new minister of VSA, Richard Panneflek, to amend the Order issued, in the sense that she would no longer be restricted to offer services exclusively via MHF. The next day, November 19, 2020, MHF ended its working relationship with Dr. Kelbrick.
In a letter dated December 3, 2020, MHF informed the minister that the cooperation with Dr. Kelbrick was dissolved on November 19. MHF requested the minister to annul the decree that allowed Dr. Kelbrick to work.
VSA Minister Panneflek did not respond to Dr. Kelbrick’s request to allow her to offer her services as an independent doctor on St. Maarten. The minister’s refusal to take a decision was challenged by Dr. Kelbrick by means of interlocutory proceedings. On April 1, 2021, the judge instructed Panneflek to issue an order within four weeks. But before this term ended, Panneflek resigned as Minister of VSA and his United People’s Party colleague Omar Ottley succeeded him on April 20, 2021.
On April 29, 2021, new VSA Minister Ottley explained in a four-page Ministerial Decree that “the minister finds that the established mental health facility [MHF] would be disproportionally burdened if another facility would provide the mental health services which are the easiest to execute and the most profitable from a financial perspective”, referring to consultations and ambulant home care, with crises interventions at home.
Minister Ottley concluded that “There is no established need for another mental health facility. Additionally, the ways in which the applicant intends to meet their perceived need for another mental health facility threatens the sustainability and affordability of locally available mental health care, while not improving the accessibility nor quality of mental health services. The request is therefore denied.”
With this rejection, Minister Ottley followed the advice of the Council for Public Health, according to the judge’s ruling on Psycare, on May 3, 2022. The Court considered that the Council’s opinion is “incomplete and, as such, not sufficiently substantiated” to serve as grounds for rejection of the application of Psycare.
The Council had argued, among other things, that MHF has the national quota of four psychiatrists, which is factually incorrect. There are currently two psychiatrists working at MHF: Dr. Kitty Pelswijk and Dr. Ricardo Teixeira.
At the request of the minister, MHF shared its view, stating that the opening of Psycare in Cay Hill, diagonally opposite the St. Maarten Medical Center, will cause confusion among patients because of the proximity to MHF’s clinic on Leopard Road.
MHF also argued that the arrival of Psycare will lead to an increase in the cost of healthcare, partly in view of the overlap of the care offered with that of existing healthcare institutions. This creates a “disproportionally burden”, according to MHF, which fears financial problems due to “unfair competition” from Psycare.
The judge concluded that the minister did not provide any evidence for the expected deterioration of MHF’s financial position. The minister did not sufficiently justify why Psycare would not be a welcome addition to the existing care, the judge ruled.