PM Mercelina says doctor’s exemption was not new, points to 2022 approval, MPS seek more clarity

GREAT BAY--"𝘞𝘦 𝘩𝘢𝘷𝘦 𝘨𝘳𝘦𝘢𝘵 𝘥𝘰𝘤𝘵𝘰𝘳𝘴 𝘪𝘯 𝘵𝘩𝘪𝘴 𝘤𝘰𝘶𝘯𝘵𝘳𝘺 𝘸𝘩𝘰 𝘩𝘢𝘷𝘦 𝘣𝘦𝘦𝘯 𝘴𝘦𝘳𝘷𝘪𝘯𝘨 𝘶𝘴 𝘧𝘰𝘳 𝘺𝘦𝘢𝘳𝘴. 𝘛𝘩𝘪𝘴 𝘪𝘴 𝘳𝘦𝘢𝘭𝘭𝘺 𝘢𝘯 𝘪𝘯𝘵𝘦𝘳𝘱𝘳𝘦𝘵𝘢𝘵𝘪𝘰𝘯 𝘰𝘧 𝘵𝘩𝘦 𝘥𝘦𝘧𝘪𝘯𝘪𝘵𝘪𝘰𝘯 𝘰𝘧 𝘸𝘩𝘢𝘵 𝘪𝘴 𝘢 𝘎𝘗, 𝘸𝘩𝘢𝘵 𝘪𝘴 𝘢 𝘧𝘢𝘮𝘪𝘭𝘺 𝘥𝘰𝘤𝘵𝘰𝘳, 𝘢𝘯𝘥 𝘸𝘩𝘢𝘵 𝘪𝘴 𝘢 𝘮𝘦𝘥𝘪𝘤𝘢𝘭 𝘥𝘰𝘤𝘵𝘰𝘳.” With that, Prime Minister Dr. Luc Mercelina told Parliament on Wednesday that the matter involving a medical doctor’s exemption to practice in St. Maarten was not a new request, but the renewal of an exemption that had already been granted in 2022 under then Minister of Public Health, Social Development and Labor Omar Ottley.

Pushing back, several Members of Parliament continued to question the Prime Minister’s explanation of the medical titles and the doctor’s exemption, arguing that the matter had not been fully clarified.

The Prime Minister addressed the matter during the continuation of the public meeting concerning allegations about his involvement in affairs related to the Ministry of Public Health, Social Development and Labor. Several questions from Members of Parliament focused on whether Mercelina, while acting Minister of VSA, had acted properly in disagreeing with a negative advice related to the doctor’s exemption.

Mercelina said the distinction between a new request and a renewal is important. He told Parliament that the doctor was already working in St. Maarten and was not seeking permission to establish a brand-new practice. According to the Prime Minister, the request placed before him concerned the continuation of an exemption that had already existed.

“This is not a new candidate that comes to work in St. Maarten,” Mercelina explained. “They were asking me, as acting minister, to agree to extend a pre-existing exemption.”

According to Mercelina, the first exemption was granted on February 3, 2022, during the tenure of former Minister Ottley. He made clear that he was not criticizing Ottley’s decision. Instead, Mercelina said the earlier approval showed that the use of an exemption in this case was not without precedent.

He told Parliament that the advice brought to him as acting Minister of VSA was a negative advice, meaning it recommended denying the renewal of the exemption. Mercelina said he signed “niet akkoord,” indicating that he did not agree with the recommendation to deny the renewal.

The Prime Minister stressed, however, that signing “niet akkoord” did not mean all paperwork had been finalized or that the doctor had automatically received final permission to work. He said the doctor still had not received a final response from the ministry on her request.

Mercelina also sought to clarify what he described as confusion over the terms medical doctor, general practitioner, house doctor and family physician. The issue became a point of debate after MP Ottley argued that there is a difference between a medical doctor and a general practitioner, stating that a medical doctor is someone who has completed medical school, while becoming a GP requires additional specific training.

Mercelina disagreed with the way the distinction was being presented. Speaking as a medical professional, he said that after completing medical school and becoming a physician, a doctor may function as a general practitioner depending on the rules of the country in which that person is trained or practicing.

He said this should not be confused with a family physician or family doctor, which he described as a further specialization. According to Mercelina, family medicine involves additional training focused on areas such as preventive healthcare, children’s healthcare and elderly healthcare.

The Prime Minister said different countries apply different systems and standards. He explained that in the Netherlands, a physician cannot simply leave university and establish as a house doctor without further specialization in family medicine. However, he said countries such as Colombia and Venezuela have different pathways, where doctors may be able to function as general practitioners under their national systems.

Mercelina told Parliament that St. Maarten must be careful not to confuse the public by applying one country’s medical structure as though it automatically applies everywhere else.

He also referred to advice from the Health Council, saying there was an underlying document indicating that there was no objection to the doctor working in a family practice setting, provided that she worked under supervision. He described that advice as an important part of the context that informed his disagreement with the negative recommendation.

The Prime Minister said the doctor had substantial local experience and had worked at the St. Maarten Medical Center in several departments, including surgery, orthopedic surgery, internal medicine, urology and oncology. He said this experience should have been strongly considered when assessing whether the exemption should be renewed.

Mercelina explained that his disagreement with the negative advice was not based simply on personal familiarity with the doctor. He said that when he referred to knowing the doctor, he meant that he knew her in a professional capacity from her work at the hospital, not through a personal relationship.

He said he was familiar with her professionalism, knowledge, skills and credentials through that professional setting.

The Prime Minister also linked the issue to St. Maarten’s wider shortage of medical professionals. He said there is a pressing demand for qualified medical professionals in family practice, especially as the population grows, as existing family doctors age, and as some family doctors retire.

According to Mercelina, St. Maarten must be realistic about its ability to attract and retain specialized medical professionals. He said that if the country focuses only on doctors with family medicine specialization, it may not have enough doctors available to serve the public.

Mercelina said the law provides a way to grant exemptions in appropriate cases, and that this mechanism can help maintain continuity of care for the population. He referred to Article 3 of the national ordinance regulating the practice of medicine as the legal avenue for deviation from the standard requirements.

He also noted that former Minister Ottley had made use of that same provision when the earlier exemption was granted in 2022. The Prime Minister said his position was that the doctor did not formally qualify as a family physician under the national ordinance, but that her local experience, track record and the need for medical professionals in St. Maarten had to be considered. He said this was the basis for his disagreement with the advice to deny the renewal.

Mercelina also pushed back against the suggestion that the matter should be reduced to politics. He told Parliament that the discussion should be understood within the reality of St. Maarten’s healthcare needs and the difficulty of securing enough qualified medical professionals to serve the community.

He said the issue is not whether standards should be ignored, but whether the country should use the legal mechanisms available to it when there is justification to do so and when continuity of care is at stake.

The Prime Minister maintained that his decision to sign “niet akkoord” was based on the doctor’s previous exemption, the fact that the matter involved a renewal rather than a new request, the Health Council’s position, the doctor’s professional experience, the legal possibility for exemptions, and the need to ensure access to medical care in St. Maarten.

Mercelina said the matter should be reviewed on the basis of the facts, the legal framework and the country’s healthcare reality, rather than political interpretation.

MP Omar Ottley challenged Mercelina’s reliance on the 2022 exemption, saying the document he signed at the time referred to the doctor practicing as a medical doctor in the capacity of a house officer at St. Maarten Medical Center, under the supervision of other doctors. Ottley said the extension request submitted on December 30, 2021, also referred to the doctor continuing as a house officer from February 28, 2022, to February 27, 2023. He asked the Prime Minister to clarify what exactly was extended, since, according to Ottley, the 2022 approval did not authorize the doctor to practice independently.

MP Darryl York also asked for clarity on the terminology. He asked the Prime Minister to explain what a house officer is, whether a house officer is the same as a GP, and what the proper term is for the family physicians known to the public. York said the debate appeared to be going in circles over definitions and asked for the Prime Minister’s official explanation.

York also asked Mercelina to clarify the exact license or credential the doctor had to function in St. Maarten, noting that one advice referred to a house officer while another appeared to discuss another role. He also asked the Prime Minister to clarify the “adequate reason” he said he had to deviate from the negative advice.

Mercelina also pointed to what he described as a growing shortage of doctors in St. Maarten’s first-line healthcare sector. He said several experienced medical professionals have left or reduced their active roles over the years due to age, including doctors such as Dr. Left, Dr. Swanson, Dr. Van Der Waal, Dr. James and Dr. Spencer.

He said St. Maarten has an aging group of general practitioners and not enough younger doctors entering the system to guarantee continuity of care for the population. According to Mercelina, this is a serious concern for the community, especially because attracting healthcare professionals to St. Maarten is not always easy.

He said doctors who consider relocating must also think about their families, the local school system, the cost and adjustment of moving to a new country, and whether they are prepared to build their lives in St. Maarten. For that reason, he said, government must be realistic about the challenge of securing enough doctors to serve the public.

Mercelina also corrected information he had given during a previous meeting. He said he had initially stated that four out of 19 doctors did not have family medicine certification, but later clarified that the correct figure is nine out of 21 doctors who have specialized family medicine certification.

He stressed that this does not mean the other doctors are not qualified to work as general practitioners in first-line care. He said St. Maarten has capable doctors who have served the country for many years, and that part of the current debate comes down to how the terms general practitioner, family doctor and medical doctor are interpreted.

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