WILLEMSTAD – The Court of First Instance of Curaçao has ruled that a doctor's assistant employed by the General Practitioners' Emergency Post (Huisartsenpost, HAP) was lawfully dismissed with immediate effect after failing to follow established medical triage procedures during an emergency telephone call involving a patient who died later that night.
In a recent ruling, the court concluded that the employee's failure to properly assess the urgency of the patient's condition, despite previous warnings and additional training, constituted sufficient grounds for immediate dismissal.
The General Practitioners' Emergency Post (Huisartsenpost, HAP)
The assistant had challenged her dismissal and demanded XCG 10,500 in unpaid wages, along with other employment-related payments. However, the court rejected most of her claims and ordered her to pay XCG 1,500 in legal costs.
The judgment raises important questions about patient safety, the responsibilities of medical assistants, and the strict procedures that must be followed when patients contact emergency healthcare services.
Emergency Call Followed by Patient's Death
According to the court documents, the incident occurred shortly after midnight on August 29, 2025.
At approximately 12:35 a.m., a patient or the patient's family contacted HAP seeking medical assistance.
The call was answered by the doctor's assistant, who was responsible for telephone triage, a process used to assess the seriousness of a patient's medical condition and determine how urgently medical attention is required.
During the conversation, the assistant spoke with the patient and family members. After the connection was interrupted, the patient contacted HAP again and spoke with the same assistant.
At the end of the conversation, the assistant advised the patient to come to the emergency post as soon as possible.
However, the situation subsequently deteriorated.
A family member called HAP again and spoke with another assistant, who discovered that no report of the earlier conversation had been entered into the patient information system.
Without the necessary documentation, the colleague lacked important information about the patient's condition and arranged for the original assistant to call the family back.
When the assistant contacted the family again, she was informed that the patient had lost consciousness and that the family had already called an ambulance.
The patient died in the hospital later that night.
The court ruling does not establish that the assistant's actions caused the patient's death. Its findings concern her failure to follow required triage procedures and the resulting danger to patient safety.
HAP Launches Internal Investigation
Following the incident, the foundation operating HAP initiated an internal investigation into the assistant's handling of the emergency calls.
The investigation focused on whether she had correctly assessed the patient's medical condition and followed the established guidelines for telephone triage.
According to HAP, the assistant failed to properly determine the urgency of the situation and did not arrange for an ambulance to be dispatched.
The employer also maintained that she had failed to follow the Dutch General Practitioners' Triage Guide, known as the NHG Triagewijzer.
This guide provides structured questions and procedures to help medical personnel identify potentially life-threatening situations and determine the appropriate level of medical assistance.
HAP argued that strict compliance with these procedures is essential because incorrect assessments can place patients at serious risk.
The foundation also alleged that the assistant behaved unprofessionally during the approximately nine-minute telephone conversation.
Following the investigation, HAP dismissed the assistant with immediate effect on August 31, 2025. The dismissal was formally confirmed in writing on September 2.
Previous Warnings and Additional Training
The court established that the assistant had previously received written warnings concerning her professional performance.
She began working at HAP on June 1, 2024, under a six-month employment contract that was subsequently extended twice.
Her final contract was scheduled to expire on November 30, 2025.
During her employment, she received written warnings on October 7, 2024, and May 16, 2025.
The warnings concerned failures to document important patient information, incorrect handling of medical triage, and inappropriate workplace behavior.
HAP also provided additional training to improve her ability to apply the triage guidelines correctly.
According to the employer, the assistant had repeatedly been informed of the importance of following the established procedures, documenting patient information, and maintaining professional conduct.
Despite those warnings and training opportunities, the court found that she again failed to apply the required procedures during the August 29 emergency call.
Assistant Claims She Followed Doctor's Instructions
During the legal proceedings, the assistant disputed the justification for her dismissal.
She argued that she had been overwhelmed by information provided by the patient and family members during the telephone conversation.
She also stated that the patient had visited a medical specialist earlier that day and had already received treatment.
According to the assistant, a doctor overheard the conversation and instructed her to tell the patient to come directly to HAP.
She maintained that she had simply followed that instruction.
However, the court found insufficient evidence to support this explanation.
The judgment noted that the assistant had not documented receiving such an instruction, although the applicable procedures required relevant medical instructions to be recorded.
Furthermore, a statement provided by the doctor concerned contradicted her account.
The court therefore rejected her argument that she had been justified in departing from the established triage guidelines.
Court: Patient Safety Was Seriously Endangered
In its assessment, the court emphasized that dismissal with immediate effect is an exceptional measure that should be used only when an employer has a sufficiently urgent reason.
However, the judge concluded that the circumstances justified HAP's decision.
The court determined that the assistant had again failed to follow the required triage guidelines despite earlier warnings.
As a result, she was unable to properly assess the urgency of the patient's medical condition.
The judge concluded that her actions had seriously endangered patient safety and demonstrated a significant failure to perform her professional responsibilities.
The court also considered the assistant's continued insistence that she had handled the call correctly, despite not applying the prescribed procedures.
According to the judgment, this position contributed to the employer's loss of confidence that she would act differently in a similar situation in the future.
The court concluded that HAP could not reasonably be expected to continue the employment relationship.
Consequently, the immediate dismissal of August 31, 2025, was declared legally valid.
Assistant Loses Claim for XCG 10,500
Following her dismissal, the assistant challenged the termination and sought compensation.
She requested XCG 10,500 in unpaid wages covering September through November 2025, arguing that her employment contract should have remained valid until its scheduled expiration date.
She also requested severance compensation, payment for unused vacation days, statutory increases, and interest.
Because the court upheld the immediate dismissal, it rejected her claim for the three months of unpaid wages.
The judge also ruled that she was not entitled to statutory severance compensation, known as cessantia, because the employment relationship had ended as a result of her own conduct.
However, the court determined that HAP remained responsible for paying any accrued but unused vacation days up to August 31, 2025, if those amounts had not already been paid.
The foundation was ordered to settle any outstanding vacation entitlement, including applicable statutory increases and interest.
The assistant was also ordered to pay XCG 1,500 toward the foundation's legal costs, with additional procedural costs potentially applicable.
The court additionally granted HAP's conditional request to terminate the employment relationship should the immediate dismissal subsequently be overturned on appeal.
Ruling Highlights Importance of Emergency Triage Procedures
The case demonstrates the importance of following established medical procedures when handling emergency calls.
Medical assistants working as triage officers are responsible for gathering essential information, recognizing warning signs, documenting conversations, and determining whether immediate medical intervention is necessary.
The court emphasized that these responsibilities are particularly important because incorrect assessments can have serious consequences for patient safety.
The judgment does not determine the medical cause of the patient's death or establish that different actions by the assistant would have prevented the fatal outcome.
Instead, it focuses on whether the assistant complied with her professional obligations and whether HAP was legally justified in terminating her employment.
The court concluded that the repeated failure to follow mandatory triage procedures, despite previous warnings and training, provided sufficient grounds for immediate dismissal.