The hospital has lost lengthy legal proceedings about the uninsured patients from the governments of the Netherlands Antilles and Curaçao.

The governments are not obligated to write a “blank check”, as it were, for the costs Sehos had to incur for uninsured persons that cannot be recovered, according to judge Van Schendel yesterday. In a case that Sint Elisabeth Hospital already filed on April 21, 2008 - more than two years ago -, the hospital wanted the governments of the Netherlands Antilles and Curaçao to be ordered to pay the medical treatment of legal and illegal uninsured patients that fail to pay; a cost item that amounts to some hundreds of thousands in individual cases and millions combined. Sehos can and may not evade its duty of due care, but cannot recover the costs. This has impoverished Sehos, according to the hospital’s lawyers, whereas the two governments have been enriched. However, it was alleged “undisputedly” that the rates take into account the item doubtful debtors. “These certainly also include the uninsured parties referred to by Sehos.” It is then up to Sehos to make a statement of a responsible estimate of the costs to be incurred by it for these uninsured patients during negotiations on the rates. “The mere circumstance that Sehos did not succeed in letting its expenses concur with its income does not mean in any way that the governments have failed towards it”, the court holds.

According to the judge, all this does not change the obligation of the governments, of course, to see to a system that also makes realistic provisions for the costs of uninsured patients. But that the governments of the Netherlands Antilles and Curaçao have taken this to heart appears from the provision for the item doubtful debtors, but also from the phenomenon of the “favor grants” and the financial contributions Sehos receives every now and then to cover the deficits and to incur the necessary expenses it cannot pay for itself. According to the judge, it boils down to it that in new negotiations a solution has to be found, so that also the costs of uninsured persons are covered adequately.

Source: national newspaper "Antilliaans Dagblad" dated 8 June 2010

Judgment comes as a bombshell for Sehos

The judgment about the uninsured patients came as a bombshell for Sint Elisabeth Hospital.

This according to Javier Hernandez of the Board of Directors. “There is major frustration at the hospital. We have been waiting for so long. I myself was not so optimistic as the judge already told parties once before to sit down together. In essence, he says the same in his judgment now: to arrive at a solution by negotiating on the rates.” But the problem is that there have been negotiations for five years, Hernandez continues. The problem of the duty of due care is in fact an economic issue.

Yesterday, this newspaper reported that Sehos has lost the legal proceedings against the governments of the Netherlands Antilles and of Curaçao about who has to absorb the financial costs for the uninsured. The court order is presently first discussed internally and with the Supervisory Board, inter alia the possibility of appeal.

Twenty million guilders lost

In the meantime, a different approach has been used for several months with regard to medical care. Someone who is not insured and requests medical assistance is first sent to a general practitioner. Only if there is question of a life-threatening situation will Sehos provide care, according to Hernandez, who indicates again that the financial situation is delicate.

On account of medical care provided to uninsured patients, Sehos lost over 20 million guilders in the period between 1995 and 2008. The judgment states that it was not disputed that the rates also take into account the item doubtful debtors. “Yes”, the Director says, “in the rate increase of 13.1 percent we propose. If Sehos would have received it as per January 1, 2009, that year Sehos would break even. However, it became 10.8 percent in mid-2009.”

Sehos will respect the judge’s decision, but Hernandez warns at the same time that Curaçao becomes Mother Teresa of Calcutta. Recently, there was another Colombian requiring necessary medical assistance as a “tourist” and got it, but could not pay. “So the problem has not been solved yet,” the member of the Supervisory Board concludes.

Source: national newspaper "Antilliaans Dagblad" dated 9 June 2010

Aike Krips and Michiel Gorsira acted on behalf the State of The Netherlands Antilles which was confronted with a claim of Sint Elisabeth Hospital (“Sehos”), the largest hospital in Curacao.

Sehos claimed compensation from The State of The Netherlands Antilles in connection with the costs incurred by Sehos due to several urgent medical treatments of uninsured (legal as well illegal) patients. Sehos based its claim on undue enrichment by the State which is – in the opinion of Sehos – obliged to bear such costs.

On behalf of the State, Michiel Gorsira and Aike Krips successfully contended such statement, thereby pointing out that in the procedure for drawing up/determining the medical tariffs such questionable debtors/poor credit risks were already taken into account. The medical tariffs have been thoroughly discussed and negotiated by and between Sehos and the State (or, mostly The Island Territory of Curacao). Insofar as the medical tariffs (jointly determined by and between the State/Island Territory of Curacao and Sehos) appear to be insufficient to cover the costs relating to such urgent medical treatments of uninsured patients, the State Ordinances and Island Decrees in respect of medical tariffs already provide for an adequate mechanism/procedure to adjust such tariffs accordingly.

The Curacao Court of First Instance acknowledged and agreed on our contention, thereby denying Sehos its claim without further review of all the other defenses raised by the State.