Words Without Answers: The Prime Minister’s Non-Clarification on Healthcare — and the Liability Crisis Nobody Is Talking About

When the public learns that most of the doctors treating them may be operating without proper local certification, they deserve answers. What they received instead from Prime Minister Dr. Luc Mercelina was a vocabulary lesson.

Speaking on the matter of doctor qualifications, licensing, and permits in St. Maarten, the Prime Minister took to the airwaves to tell the public that the issue has been “complicated by political debate and misunderstanding.” He then proceeded to distinguish between three terms, qualified, credentialed, and licensed, as though the problem was simply that ordinary people did not understand the words involved.

With respect, Prime Minister: we understood the words. What we are still waiting for are the answers.

A Distinction Without a Resolution

Yes, there is a difference between a doctor being academically qualified, having their credentials recognized locally, and holding a valid license to practice in St. Maarten. That is not a revelation. That is a dictionary.

What the public needed to hear, and did not, was which of these three standards the majority of St. Maarten’s GPs are currently failing to meet, why that gap exists, how long it has existed, and what this government intends to do about it.

None of that was addressed. Instead, the Prime Minister cited Article 3 of the National Ordinance regulating the practice of medicine, which provides for exceptions in cases of shortage. In other words: the law has a loophole, and we have been using it. That is not a healthcare policy. That is an admission dressed up as a legal argument.

The Deeper Insult

What makes this particularly troubling is not just what was left unsaid, it is the implied message behind what was said. By framing the public’s concern as a product of “political rhetoric” and “misunderstanding,” the Prime Minister effectively told the people of St. Maarten that their alarm was the problem, not the situation that caused it. That is not leadership. That is deflection with a medical degree attached.

The public is not confused about terminology. The public is asking a simple and reasonable question: are the doctors treating us properly authorized to do so under the standards this country should uphold? That question has still not been answered directly.

This Is Not New, and That Makes It Worse

Parliament was told that this situation has persisted across multiple administrations and multiple ministers. The Prime Minister offered that fact almost as a comfort, as if longevity excuses negligence. It does not. If anything, the fact that this has been quietly accepted for years makes the absence of a concrete solution now even less forgivable.

Every administration that looked away owns a share of this. But this administration is the one being asked to fix it, and a radio interview explaining word definitions is not a fix.

Who Carries the Bill When Something Goes Wrong?

Here is the question that has gone entirely unasked in the public discourse, and it is the most consequential one of all: if a patient is harmed by a doctor operating under an Article 3 exception permit, who is legally responsible?

Under Dutch Caribbean civil law, medical liability falls on two grounds. The first is wanprestatie, a contractual failure to meet the standard of care implied in the doctor-patient relationship. The second is onrechtmatige daad under Article 6:162 BW, unlawful conduct, either by violating a legal duty or by falling below the standard of a reasonably competent professional. The Dutch legal standard is clear: a doctor must act as a redelijk bekwame en redelijk handelende vakgenoot, a reasonably competent and reasonably acting peer.

But here is where the Article 3 framework creates a legal minefield. If a doctor is practicing under an exception, meaning they do not hold the standard qualification, what exactly is their peer standard? A fully certified family physician? Or someone operating under an emergency exemption issued years ago as a stopgap? That ambiguity alone exposes patients to a liability gap that government has never publicly addressed.

In normal circumstances, the chain runs as follows: the doctor is personally liable, or the institution they work under bears responsibility, covered by professional liability insurance. In the Netherlands, the KNMG requires such insurance as a professional condition. In Belgium it is mandated by law. In St. Maarten? Silence. There is no public confirmation that professional liability insurance is a mandatory requirement for doctors practicing under Article 3 exception permits. If it is not required, a patient who is harmed may find themselves chasing an individual practitioner through civil proceedings on a small island, with no institutional backstop and no guarantee of meaningful compensation.

Did Government Put Any Safeguard in Place?

This brings us to the most damning question of all: when government began issuing Article 3 exception permits, apparently over multiple administrations, did anyone put a supervisory structure in place?

In healthcare systems that authorize practitioners under exception frameworks, best practice requires a designated supervising physician: someone who holds full certification and takes clinical and legal responsibility for those practicing beneath the exception umbrella. It is a safeguard that acknowledges the gap and places a qualified professional accountable for bridging it.

There is no public evidence that any such structure exists in St. Maarten. No supervising physician framework has been announced. No oversight mechanism has been described. No risk assessment has been published. Government issued the permits, the doctors practiced, and apparently no one asked what would happen if something went wrong.

There is also the question of state liability. When a government issues a permit authorizing someone to practice outside the normal standard, it does not simply walk away from responsibility. The state that created the exception may well bear partial liability, aansprakelijkheid van de overheid, if harm results from a practitioner it chose to authorize. That is a question for the courts, but it is also a question government should be answering proactively, not waiting to have answered for them.

What Was Actually Needed

A genuine clarification would have included the following: a clear statement of how many practitioners are currently operating under exceptional authorization rather than standard licensing; a timeline for bringing the regulatory framework up to standard; confirmation of whether professional liability insurance is mandatory for exception-permit holders; an explanation of what supervisory structure, if any, is in place; an honest assessment of whether patient safety has been compromised; and a commitment to transparency, including what documentation Parliament will actually receive and when.

None of that was offered.

The Standard We Should Demand

St. Maarten is a small island with a fragile healthcare system still recovering from the devastation of Hurricane Irma. The people who live here, who have no choice but to rely on the doctors available to them, deserve to know that those doctors meet not just the minimum legally defensible threshold, but the standard that any self-respecting healthcare system would demand.

Playing with words in a radio interview while the real questions go unanswered is not governance. And the people of St. Maarten deserve far better than noise from the highest office in the land.

If a patient is harmed tomorrow, by a doctor practicing under a permit the government issued, without insurance the government never required, under supervision the government never arranged, the question of who carries that bill will not be answered with a vocabulary lesson. It will be answered in court. Government should make sure it has better answers ready before that day comes.

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