Alcala: Inspectorate reform ready, but staff, legal support and stronger structure needed

GREAT BAY--The Inspectorate of Public Health, Social Development and Labor is operating with approximately 17 of its planned 27 staff members and remains without several key professionals, including an in-house legal expert, Interim Inspector General Dr. Joe Alcala has disclosed.

Alcala, who recently took up the interim position, said the staffing shortage affects an institution responsible for supervising a broad range of laws governing healthcare, pharmaceuticals, food safety, working conditions and social-development services.

The Inspectorate’s reform plan has been completed at the technical level and must now be submitted to the Minister of Public Health, Social Development and Labor for approval before implementation can proceed.

Speaking on the Government’s 𝘐𝘯𝘴𝘪𝘥𝘦 𝘎𝘰𝘷𝘦𝘳𝘯𝘮𝘦𝘯𝘵 program with Cedric Peterson, Alcala said the Inspectorate has a planned staffing capacity of 27 but currently has about 17 employees.

“We are still missing a lot of personnel, and we are missing some key personnel also,” he said.

Among the most significant vacancies is that of a legal expert. Alcala said an institution whose primary responsibility is supervising laws and regulations requires legal support to advise inspectors, interpret the applicable legislation and assist with cases that may eventually reach the courts.

The staffing imbalance is particularly evident within the health division.

According to Alcala, only three officials are formally assigned to health supervision: an inspector of pharmacy, a health inspector and the Inspector General. Alcala currently also performs the duties of chief health inspector because that position was not separately established.

He described the arrangement as undesirable, noting that it places both overall management and direct health-inspection responsibilities under the Inspector General.

The health division is responsible for supervising medical professionals and institutions, including doctors, dentists, pharmacists, midwives, hospitals, psychiatric facilities, ambulance services, pharmacies and pharmaceutical wholesalers. Other healthcare professions also fall partly within its area of responsibility.

“If you look at the law, the area is immense,” Alcala said. “But actually, there are only three persons that are formally working in health.”

The labor division, by comparison, has one chief inspector, two inspectors and four controllers. Food safety has one chief inspector, one inspector and three controllers.

Alcala said the differences in staffing, capacity and activity among the divisions must be addressed as part of the reform process.

Reform plan completed

The reform process began with an assessment of the Inspectorate’s current position and how it is viewed by institutions, professionals and other stakeholders.

It also included comparisons with inspectorates in Curaçao, Aruba and other jurisdictions, along with internal consultations involving the Inspectorate and the Ministry’s policy department.

Alcala said the process examined three central questions: what type of organisation St. Maarten needs, what leadership structure it should have and how the current Inspectorate can be transformed into that organisation.

That phase has now been completed.

“A choice has been made how we want to see the Inspectorate in the future,” Alcala said, adding that the proposal must be sent to the VSA Minister for approval before the next steps can be taken.

The proposed structure would place health, pharmaceuticals and food safety under one section, while labor and social development would form another.

It also proposes the appointment of an assistant inspector general who would support the Inspector General with the operational and administrative management of the organisation.

Alcala said this would allow the Inspector General to devote more time to the substance of health supervision and to areas that are currently not being addressed because of limited staffing, policy gaps or incomplete legislation.

He also noted that social-development supervision remains limited. At present, the Inspectorate’s legal authority in that area applies mainly to daycare centres.

Further policy, regulations and legislation would have to be developed before the Inspectorate could exercise broader supervisory powers in the social-development field.

Independence important in small community

Alcala said an independent supervisory body is especially important in a small community, where personal and professional relationships may discourage residents from filing complaints or reporting possible violations.

“The smaller the population of the island is, the bigger risk there is for non-compliance, in the sense that everything is very personal,” he said.

He added that close relationships may cause people to fear repercussions if they come forward, making an impartial institution capable of assessing complaints independently even more important.

The Inspectorate is part of the Ministry of VSA, but Alcala said its supervisory decisions must remain independent and impartial.

While the Inspectorate reports to the minister, it is authorised to decide where inspections are needed, how the law should be interpreted and what action should be taken when violations are identified.

Depending on the law involved and the nature of the violation, the Inspectorate can issue warnings, increase the frequency of inspections, require periodic reporting, issue directives or impose fines.

Some fines currently fall under criminal law and depend on the Prosecutor’s Office and the Ministry of Justice for further execution. Alcala said discussions have been underway to give the Inspectorate greater authority to issue certain fines directly.

Few public complaints

The Inspectorate conducts planned inspections, responds to complaints and may act on other information indicating a possible risk or violation.

Alcala acknowledged, however, that relatively few complaints are currently being submitted by the public.

He said this may be partly connected to the Inspectorate’s limited public visibility in recent years, including the absence of an Inspector General for an extended period.

Work is now underway on a website that will explain the Inspectorate’s responsibilities, identify the laws it supervises and provide clearer information on how residents can submit complaints.

Complaints may currently be submitted in writing, by email or in person at the Inspectorate’s office on W.G. Buncamper Road.

Once a complaint is received, officials determine whether it falls under legislation supervised by the Inspectorate and assess its possible impact on an individual or the wider public.

Alcala said the Inspectorate tries to act on all complaints. However, because of the staffing shortage in health, complaints against healthcare institutions may first be referred to the institution’s internal complaints committee, where one exists. The Inspectorate follows the process, evaluates the findings and may intervene afterward when necessary.

He also said complaints are treated confidentially. Findings are not released publicly, but the complainant is informed of the outcome. In some cases, the findings may assist a complainant who decides to pursue a civil matter.

Greater focus on guidance and transparency

Alcala said the Inspectorate must improve its public education and provide more guidance to the sectors it supervises.

He said inspectors should not be viewed only as enforcement officers waiting to issue penalties. Instead, they should work with institutions and businesses to explain why laws exist, what standards are expected and how compliance can be achieved.

“The idea is for the inspector to help you get where we all want to get, a better service for the whole population,” he said.

Building that relationship, Alcala added, will require time, sufficient personnel and greater transparency about what the Inspectorate is doing and why.

He also intends for the Inspectorate to produce quarterly divisional reports and a consolidated annual report outlining its plans, work completed, results and continuing challenges.

Alcala said no consolidated report was produced for the previous year because he had not yet taken office and the available information was difficult to compile. The intention going forward is to publish an annual account of the Inspectorate’s activities.

In healthcare, Alcala said one of his priorities will be moving discussions beyond individual incidents towards measurable outcomes and the effect that healthcare services have on the population.

He said talks have begun with St. Maarten Medical Center and should be formalised before similar discussions are held with other institutions.

Alcala has more than 34 years of public-health experience in Curaçao, including work in policy development, legislation, general practice and health inspection. He previously served as Inspector General of Health and as a senior public-health administrator.

He said he has committed to serving in St. Maarten for two years, with the aim of strengthening the Inspectorate and supporting employees who continued carrying out their duties during the period in which the organisation operated without permanent leadership

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