Replacing BIG - HCPR is for St. Maarten’s Reality

GREAT BAY--Prime Minister Luc Mercelina on Wednesday said he hopes to see the draft National Ordinance establishing the Healthcare Professionals Registry (HCPR) create a faster, clearer, legally anchored system for registering qualified medical professionals in St. Maarten. Speaking as a surgeon who has worked on the island since 1999, Mercelina argued that reliance on the Dutch-based Individual Healthcare Professions Act (BIG Act) has left St. Maarten constrained by rules built for a different healthcare environment, limiting flexibility to bring in skilled specialists who can meet the island’s needs.

He said the problem is not only recruitment, but fit, warning that BIG often delivers highly specialized doctors trained for systems with broad academic backup and advanced technology, while St. Maarten requires adaptable generalists who can handle everything from emergency trauma to routine surgical cases, often without immediate access to large referral centers. Mercelina said the HCPR ordinance is meant to help the country attract and register professionals who are better matched to the realities of small-island healthcare as the draft advances through stakeholder review, advisory scrutiny, and eventual parliamentary approval.

The BIG Act is a Dutch-centric system that has restricted St. Maarten’s flexibility to bring in qualified professionals from outside the Dutch education and registration pipeline. He said the HCPR is designed to create local legislation that better matches the country’s healthcare reality, especially as the country works toward staffing needs connected to his second major healthcare priority, a new hospital.

“This has been my baby since 1999”

The Prime Minister told Parliament that since arriving in St. Maarten in 1999 and working as a specialist surgeon, he has repeatedly encountered the limitations of the BIG framework. He gave an example from his own professional experience: under BIG-based rules, a specialist from Colombia could be deemed not qualified to come to St. Maarten to operate, even though the country pays significant sums for patients to receive surgery abroad in Colombia by doctors performing those same procedures. He said that inability to bring a specialist in to carry out multiple surgeries locally, including to save costs, has been a persistent and frustrating reality throughout his career.

Mercelina said that working through these constraints over the years convinced him that significant legislative change was necessary to better regulate and admit healthcare professionals who can strengthen local services. When asked whether the new ordinance is intended as a replacement for BIG, he said his “biggest dream” is that one day this legislation can replace BIG, and he answered that question in the affirmative.

The core principle of the HCPR legislation is that all professionals working in St. Maarten must meet clear standards for continuous professional development and ongoing education, supported by competency and skills assessments. It also safeguards the public by protecting against unqualified or outdated practice. In terms of international and regional relevance, the framework allows for recognition of approved foreign medical registers through the national accreditation body, and it includes an admission program for foreign-trained professionals to assess their knowledge and skills, and confirm they are familiar with the local healthcare context in which they will work.

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BIG seen as a poor fit for St. Maarten’s needs

Mercelina said the Netherlands can regulate its own medical professionals through BIG because it has its own education institutions and does not, in his view, face the same necessity to recruit medical professionals outside its borders. He argued that St. Maarten, although part of the Kingdom and operating under the BIG framework, does not have sufficient inflow of medical professionals to meet local needs, and that the country has already proven that qualified professionals from other countries can deliver high-quality care.

He cited the example of three urologists from Venezuela currently working on the island, and stated that it took a long time to convince the system of their qualifications, but that they have made strong contributions to healthcare delivery in St. Maarten. He presented this as evidence that other countries can provide capable professionals who can serve the population effectively.

Mercelina further explained that one of St. Maarten’s biggest challenges is not only recruiting doctors, but recruiting the right kind of doctors for a small island system. He contrasted the experience of many BIG-registered doctors trained in environments with extensive technology and super-specialization, with the demands placed on physicians in St. Maarten, where medical professionals often must function as broad generalists and respond to a wide range of emergencies and surgeries.

He said that on St. Maarten a doctor may face stab wounds, gunshot wounds, traffic accident trauma, and routine surgical cases, sometimes without the ability to immediately consult large academic centers at night. He described the reality of practicing medicine on an island as requiring professionals who can adapt, “pull up their socks” when more is demanded, and manage high-stakes situations without a university academic backup close at hand. He said the proposed HCPR framework is intended to help the country attract professionals who are better suited to that reality.

Drafting process, structure, and role of legislative expertise

Mercelina explained that government first worked on a draft concept and structure for how a national healthcare professional registry should be formalized. He said the next step required a legislator with the technical skill to translate those ideas into proper ordinance form. He identified Mrs. Aarti Baran as the legislative writer who took the working file and developed it into a draft national ordinance, including the supporting explanatory memorandum.

He stated that at the time she began working on the file, she was officially disconnected from the Council of Advice of St. Maarten. According to the Prime Minister, she worked as a legislative drafter for government, and he and others met with her multiple times to explain the intended direction and content. He said those sessions resulted in what he described as a strong draft ordinance and explanatory memorandum.

Mercelina also addressed a question on whether a public publication was issued to hire a legislative writer, and indicated that was not the route taken. He said the approach chosen was to develop the draft through existing and assigned legislative capacity, while keeping the process transparent and correct.

The Prime Minister emphasized that the draft ordinance still has a full legislative path ahead. He said stakeholders must first review and verify the draft, after which it will follow the normal process, including review by the Council of Advice, then onward through the required governmental steps, and ultimately to Parliament of St. Maarten for ratification.

He also said that while healthcare is not technically his ministry, he brought the file to the Minister responsible and offered the draft so it can be advanced through the proper channel for the benefit of the people of St. Maarten. He noted that when he left the hospital before becoming Prime Minister, colleagues urged him to “do something” for healthcare from the other side of public service, and he said he has not given up on making the registry a reality.

“Two dreams in healthcare”

Prime Minister Mercelina reiterated that establishing a national healthcare professionals registry is a long-standing goal he has carried for years, and he expressed hope that the draft will complete its legislative journey so St. Maarten can finally have its own registration framework anchored in national law. He said he has two dreams in healthcare: replacing BIG through local legislation, and achieving a new hospital for the country.

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