Published On: Mon, Jun 11th, 2018

Update: ‘Red card for Adventist hospital after serious mistakes’

WILLEMSTAD - The decision of the Court of First Instance in the case of the Adventist Hospital against the Public Health Inspectorate is worrying. Never before has a health care institution imposed a penalty on Curaçao, which is then also enforced in court.

The verdict also surprisingly says something about the Inspection itself. Which initially took no action after alarming messages. The Inspectorate learned from its mistakes. Now it is the Adventist Hospital that has some learning to do.

Who says that the serious shortcomings in the Adventist Department of Internal Medicine - as now confirmed by the Court - are not adequately countered by the administration?

Dr Nagy Bakir

Dr Nagy Bakir

The attitude of the board of the hospital in this issue, led by Mrs Cenaida Pannevlek, gives little hope. She supported and still supports her own doctor, Nagy Bakir. While an audit report in January 2016 and a follow-up audit in October of that year give enough reasons for not doing so.

Perhaps that support was surmounted by the fact that the Inspectorate played along at that time. The two audit reports mentioned had, for unclear reasons, not led to action by the then Inspector Joe Alcalá (acting) and Gersji Rodriquez Pereira.

The latter even disregarded a complaint about Dr Bakir's sexual transgressive behavior in 2013, while the relevant internist, for a similar complaint, was dismissed in 2003 by the Medical Disciplinary Court in the Netherlands. It should not be surprising: Pareira and Bakir were good friends of each other. Action towards Advent and Bakir ultimately follows only after the arrival of a new boss at the Inspection, Dr. Jan Huurman, in 2017.

The latter did not have any other options when a patient of Dr. Bakir dies due to jaundice at the beginning of December of that year. A sad incident that was discovered in the Sehos Hospital, where the patient was admitted urgently after a discharge from the Adventist Hospital and after a missed diagnosis by the relevant internist Bakir. She eventually died in a hospital in the Netherlands due to liver failure. The conclusion of the missed diagnosis is later endorsed by Dr. Bakir himself.

During the treatment of the lawsuit, it appeared that Bakir had already been dismissed by the Sehos. There were questions about the clinical

Cenaida Panneflek

Cenaida Panneflek

relevance of his hospital intake policy, his substantive functioning, lack of insight into illness, and Bakir proved stubborn, uncorrectable.

In addition, sexual advances to students and doctor-assistants had been reported during outpatient activities. The entry of Dr. Bakir was therefore denied by the Sehos for an indefinite period as of October 2013. Bakir is still not admitted to the Sehos.

The intake indications of Dr. Bakir are spacious in the Advent Hospital, reports the Inspectorate. More spacious than what is customary within the profession. In plain English: Bakir tended to take in patients very quickly, while there was no medical need for this. Good for the hospital's cash register. At least that can be concluded when Advent itself says that not admitting patients by Bakir will lead Advent to consider firing personnel due to its financial situation.

The audit reports also show that the hospital earns a lot of money by admitting patients unnecessarily. Bakir appears to be a master in the intake of mainly non-acute patients with dysregulated blood sugar and high blood pressure. This form of care can be called GP care.

Doubtful intakes, according to the inspection. In any case, it is questionable whether the patients of Dr. Bakir in accordance with the medical professional standard are eligible for admission to a hospital for treatment. In most cases, it was possible to suffice with outpatient care or had to be referred back to the general practitioner.

Advent does not agree with this. Bakir treats approximately 1,500 patients per month, 18,000 per year. Bakir admits about 400 patients, two percent of the total. No exaggerated percentage, according to the hospital. But a defense, focused on medical substantive grounds, is omitted.

The Inspectorate then produces a series of instructions, the latter of which even contains a penalty payment. The immediate cause is the fact that Bakir, in violation of previous indications, has nevertheless admitted a patient. Adventist Hospital does not adhere to the direction of the Inspection. What the hospital itself confirms in a letter from lawyer Braams.

In view of the above, the judge is of the opinion that the audits of 2016 and 2018 showed that the quality of the internist care offered by the institution was insufficient and that there was a patient of whom the death may have been caused by this poor internist care. And that the hospital indeed did not follow all instructions. That while those instructions have been imposed with a view to quality improvement and the provision of responsible care.

Under these circumstances, the judge thinks that the probability is small that the judge in the main proceeding will rule that the Inspectorate should not have proceeded to impose the 20,000 guilder penalty. Adventist Hospital loses the case.

In the legal case, Advent does not challenge the audit reports and the explanations given by the Inspectorate, in any case not sufficiently in accordance with the court. And the non-disputed conclusions in the inspection reports are not tender, as already indicated above.

In addition, Advent does not succeed in improving the first and last audit, during a period of two years, to improve care in such a way that it meets the relevant quality requirements. That is not possible either if the administration of the hospital does not deal seriously with complaints about its doctors and nursing staff. In business, you are out.

Time for a new board for the Adventist Hospital? The name of the hospital could not only be a heavenly but perhaps also an earthly prediction.

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