State secretary laments Statia patients’ deaths

Dutch State Secre­tary of Public Health, Welfare and Sport Maarten van Rooijen deeply regrets the recent death of two patients in St. Eustatius, and an­nounced a general investigation into the state of healthcare in the Carib­bean Netherlands. And there will be a pilot for St. Eustatius and Saba to have automatic referrals for certain medical specialists.

“I find it awful that two patients came to die in such a short period of time. This must have had an im­mense impact on the close-knit Sta­tia community,” stated Van Rooijen on Thursday in response to written questions submitted by Members of the Second Chamber of the Dutch Parliament Jorien Wuite and Wieke Paulusma, both of the Democratic Party D66.

The two Members of Parliament (MPs) sought clarity following me­dia reports about the level of health­care in St. Eustatius, the death of two patients and the medical refer­ral system, which in the case of the two patients in St. Eustatius, was un­able to prevent their deaths.

“With regard to the first death case, I can imagine that residents wonder whether the doctors of St. Eustatius Health Care Foundation (SEHCF) and the insurance office of the Ministry of Public Health, Wel­fare and Sport VWS handled the situation adequately,” stated Van Rooijen.

According to the state sec­retary, the assumptions in the media that medical mistakes were made cannot be con­firmed as yet, as the cases are still under investigation. “In conformity with procedures of the Inspection Healthcare and Youth IGJ, SEHCF has initiated a calamity investiga­tion.”

However, the concerns ex­pressed in the media reports are sufficient reason for the state secretary to have con­sultations with the involved healthcare institutions to dis­cuss the events and to make sure that healthcare in St. Eustatius is improved, Van Rooijen stated.

As for a general qualifica­tion of the level of healthcare, including medical referrals, provided in St. Eustatius and the rest of the Caribbean Netherlands, the state secre­tary said he found accessibil­ity and quality “sufficient to good.”

Aside from MPs Wuite and Paulusma, two other MPs, Roelien Kamminga and Jac­queline van den Hil, both of the liberal democratic VVD party, had sought clarity via written questions about healthcare and medical refer­rals in St. Eustatius.

In replying to the questions by Kamminga and Van den Hil, Van Rooijen acknowl­edged that there was room for improvement. “There are backlogs in a number of areas and not everywhere the level of healthcare is the same as in the Netherlands. At the same time, the discussions sur­rounding the medical refer­rals with regard to the recent deaths in St. Eustatius make clear that improvements are necessary in the execution of the referral process,” he stated.

The state secretary an­nounced a general investiga­tion into the state of health­care in the Caribbean Neth­erlands, whereby the results that have been accomplished since 2010 will be looked into. There will be special atten­tion for the manner in which healthcare functions, the improvements desired and requirements to approach a Dutch level of supply and quality, he said.

In his reply to a question by MPs Wuite and Paulusma, Van Rooijen explained that the health insurance office ZVK of Care and Youth Ca­ribbean Netherlands ZJCN handles between 6,000 and 8,000 medical referrals an­nually. Also, during the CO­VID-19 period, medical re­ferrals continued, he added. In 2020, 40 complaints were filed against ZVK/ZJCN. There are bottlenecks that need to be solved, the state secretary admitted. In the past year, several steps were taken to improve the regular medical referrals. In October 2021, the medical special­ists of SEHCF in St. Eusta­tius and the ZJCN made an agreement about the quality of referrals. For 2022, priority is being given to the medical referral process.

The state secretary further announced that possibilities to permit medical referrals without a process “for certain specialties” would be looked into. He did not state which specialist care, but said there would be a pilot for St. Eusta­tius and Saba.

The state secretary ex­plained the protocols and procedures for medical refer­rals in his extensive reply to the written questions. A re­ferral request is filed at ZJCN in case a doctor in Bonaire, St. Eustatius or Saba concludes that a patient requires specialist insured care which is not available on-island. The doctor indicates the level of urgency.

The medical advisors (doc­tors) at ZJCN assess and decide, for regular medical referrals, whether the referral request complies with the re­quirements of the Caribbean Netherlands health insurance law. The doctor receives a re­ply with substantiation in case the referral is denied.

When the referral case is ap­proved, the staff of ZJCN fur­ther handle the medical refer­ral and plan the appointment and the associated logistics of the flight, accommodation, transport, polymerase chain reaction (PCR) test and daily allowance. They also main­tain contact with the insured person.

With regard to medical evacuations, ZJCN has made agreements with National Helicopters (Medevac) for St. Eustatius and Saba, and the Air Ambulance in Bonaire. Both services are available 24/7. In the case of the Mede­vac in St. Eustatius and Saba, permission is asked before­hand, but if this proves not possible, permission can also be granted afterwards.

The Daily Herald.

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