Family Seeks Revocation of Medical License of St. Maarten Psychiatrist Kitty Pelswijk; Locked Patient in Solitary Confinement for 3 Weeks, Patient Died

May 31, 2022

PHILIPSBURG, St. Maarten--On behalf of the mother and sister of the late Caulette Julien (43), the Medical Disciplinary Board if St. Maarten has been requested to remove psychiatrist Dr. Kitty Pelswijk from her authority to practice medicine. The court-regulated board acknowledged receipt of the complaint on May 16.

Dr. Pelswijk was in charge of the medical treatment of bipolar patient Julien who died of unnatural causes on August 25, 2020, in the Mental Health Foundation (MHF) isolation cell in Cay Hill. Julien had been in isolation for three weeks when she was found on the floor with a head wound and appeared to be non-responsive. Based on video footage of the incident, then-Inspector General Dr. Earl Best would later conclude that security and nurses reacted late and incorrectly applied cardio-pulmonary resuscitation (CPR).

Dr. Pelswijk failed to report her patient’s death to the Public Health Inspectorate, which she was obliged to do based on the Inspectorate’s 2018 directive for reporting potential calamities. She also failed to warn medical examiner Dr. Michael Mercuur, and, in violation of the regulations, Pelswijk herself signed the death certificate.

After death, the so-called A and B certificates must be signed. These are official documents that are required by law to be allowed to bury or cremate someone. On the A-statement, someone is officially declared dead. The B-statement then indicates the cause of death.

The attending physician is not authorized to complete the forms. This was the task of 2002 court-appointed medical examiner Dr. Michael Mercuur, up until his retirement last year.

Dr. Mercuur was no stranger to Dr. Pelswijk, as he was the doctor who would sign the document a psychiatrist needs to be able to place a patient in isolation for more than 24 hours, the so-called verklaring van krankzinnigheid (KZ), or declaration of insanity. This document is also required for medication under duress.

Julien had bipolar disorder, which caused her to experience manic episodes, and at times needed professional help to stay in control of her life. She was an MHF outpatient for many years. At the beginning of August 2020, Julien herself noticed that she was not doing very well and she was voluntarily admitted to the Mental Health Foundation clinic in Cay Hill. Instead of in one of the two multi-patient rooms in the clinic, she ended up in the isolation cell.

During the next three weeks, Julien was only once allowed to talk briefly with her sister through the bars of her cell door, said attorney Geert Hatzmann, who assists Julien’s family and drafted a 69-point complaint on their behalf.

Their complaint to the Medical Disciplinary Board, which falls under the Joint Court of Justice of Aruba, Curaçao and St. Maarten, and of Bonaire, St. Eustatius and Saba, is handled by a judge and two doctors who together form the Medical Disciplinary Board. If this board declares the complaint of the mother and sister of the deceased admissible, five accusations against Dr. Pelswijk will be assessed.

The main reproach to Dr. Pelswijk is that she placed her patient in an isolation cell for an excessively long time and hardly looked after her during the three weeks of isolation.

“As a result, Caulette must have felt lonely, miserable and desperate in her last weeks of life, and ultimately died in a degrading way,” said Hatzmann.

In general, it can be said that a psychiatrist is entitled to place a patient in an isolation cell at any time, even if the patient, as in Julien’s case, has voluntarily reported to the clinic for treatment, the lawyer said. “However, placement in an isolation cell is a very drastic means of coercion. In some countries it is prohibited. For those countries where this measure is applied, this should be done with great caution.

“Holding a patient in an isolation cell is only permitted as a temporary emergency solution if there is an acute danger and there is no less-drastic alternative available at that time.”

Julien was neither aggressive nor suicidal, according to witness statements. At most, she was difficult and rather tiring for herself and her environment when she experienced an episode, the lawyer concluded after talking to the family.

“But Caulette was not locked up in the isolation cell for a day, or two, but for three weeks,” Hatzmann said. “This measure taken by Dr. Pelswijk was never intended as time out for the doctor to come up with a treatment plan. In fact, Dr. Pelswijk failed to see for herself how Caulette was doing each day, and the psychiatrist went into COVID quarantine, after which she left the supervision and care of Caulette entirely to the guards and nurses.”

The lawyer said that the question that remains is: how long would Julien have been in the isolation cell if she had not died?

“It is certain that Dr. Pelswijk has already dared to lock up a Surinamese patient in the isolation cell of MHF in Cay Hill for three months continuously. With regard to that case, fellow psychiatrist Dr. Hendrik Nijdam testified that Dr. Pelswijk ignored repeated advice from colleagues for months and put the patient in a hopeless situation where there was a risk that she would die from physical exhaustion or malignant catatonia,” he said.

“All in all, it can be concluded that in both the case of the Surinamese patient and that of Caulette there was no actual medical treatment.”

Dr. Pelswijk is secondarily accused of having failed to take and keep daily notes of the coercive measures she applied to Julien, including the confinement in isolation, in accordance with Article 10 of the national ordinance regulating the supervision of insane people. Dr. Pelswijk also failed to make a daily report of Julien’s condition in accordance with Article 21(1) of this national ordinance.

It was Dr. Pelswijk’s responsibility as interim director of MHF to ensure that the isolation cell was safe. According to the report of the Public Health Inspectorate, which investigated after Julien’s death was in the news, the isolation cell was not in good condition. The walls had strips of concrete embedded in them. The audio from the video surveillance system did not function, the patient might not have been heard from outside the cell when she fell.

“It is striking that Dr. Pelswijk concluded that this was a natural death,” said attorney Hatzmann, noting that “there are strong indications that Dr. Pelswijk had a bad conscience and wanted to cover up the incident.”

For the complainants, it is unacceptable that their beloved daughter and sister died under such heart-breaking and degrading circumstances, the lawyer said, “What makes it all the worse and more worrying for the future is that Caulette’s case has apparently not been a one-off faux pas with horrific consequences, but that Dr. Pelswijk is a repeat offender who systematically flouts the rights of very vulnerable patients. She does not seem to care at all about their wellbeing.”

Hatzmann stated that “Dr. Pelswijk is a great danger to her (future) patients and therefore already unsuitable for her profession.” For that reason, the Medical Disciplinary Board is requested not to settle for any other sanction than to remove Dr. Pelswijk’s medical license.”

Source: Jacqueline Hooftman, “Complaint against psychiatrist filed with Medical Disciplinary Committee,” The Daily Herald, May 30, 2022, URL: https://www.thedailyherald.sx/islands/complaint-against-psychiatrist-filed-with-medical-disciplinary-committee