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October 12, 2017

As Puerto Rico grapples with health crisis, mainland MDs and nurses lend a hand

Daily Briefing

    Many Puerto Rico residents continue to face issues accessing needed health care, nearly three weeks after Hurricane Maria ravaged the U.S. territory.

    When a crisis occurs, the whole hospital is our patient

    Puerto Rico's health care system

    About 85 percent of Puerto Rico remained without electricity as of Tuesday, including 44 of Puerto Rico's 69 hospitals, according to Modern Healthcare. Ricardo Ramos, CEO of the Puerto Rico Electric Power Authority, said power had been restored to at least one hospital in each region, and that one of the territory's two facilities for manufacturing medical oxygen also has power.

    But other hospitals and medical facilities throughout the commonwealth are relying on diesel-fueled generators to provide necessary health care services. Some do not have consistent access to diesel, however, and as a result, patients with critical illnesses are struggling to access needed care, the New York Times reports.

    For instance, dialysis patients throughout Puerto Rico have had their treatment hours cut by 25 percent, the Times reports. As of Tuesday, officials said 43 individuals in Puerto Rico had died in relation to Hurricane Maria, though the Times reports that number could be higher because of communication and electrical issues related to the hurricane. Puerto Rico Gov. Ricardo Rosselló (NP) said the island's dialysis centers were "in the loop" to receive fuel and maintenance for their generators. Rosselló also said some dialysis patients had been evacuated to the continental United States.

    Health care providers also are facing personnel shortages because of the storm. According to federal officials, less than 50 percent of Puerto Rico's medical employees have reported to work since the storm hit the commonwealth.

    Further, the Times reports that hospitals in the commonwealth are beginning to deplete their medical supplies, at a time when some providers' patient levels are increasing because they are taking in patients from other providers whose generators failed.

    Rosselló on Monday said officials were working to address the public health problems resulting from Hurricane Maria. The Puerto Rico Department of Health said Sunday it is evaluating several suspected cases of leptospirosis, a bacterial disease that can be spread from animals to humans through the flood waters. Rosselló also said an estimated 70 percent of the island's pharmacies had reopened and the commonwealth had established a hotline for individuals in need of insulin.

    Federal efforts struggle to meet needs 

    The federal government also has taken steps to assist with and restore Puerto Rico's medical services, but the Times reports officials are struggling to match resources to patients' needs.

    According to the Times, the federal government has deployed Disaster Medical Assistance Teams to Puerto Rico, established four mobile hospitals on the island, and is working to open a 44-bed hospital in Humacao. In addition, the Navy's medical treatment ship is on scene providing care. According to the Times, Puerto Rico's Department of Health over the past week sent 82 patients to the U.S. medical treatment ship, though the ship is equipped to serve up to 250 patients. Just seven patients were receiving care on the ship on Monday, the Times reports.

    Read our interview with Warner Thomas about rebuilding after Hurricane Katrina

    Further, the Army Corps of Engineers is working to install generators at medical facilities throughout the island while utility workers are trying to restore electricity to Puerto Rico's hospitals. Also, Robert Kadlec, HHS' assistant secretary for preparedness and response, said the Veterans Health Administration has opened up local facilities to non-veterans.

    In addition, the House Appropriations Committee on Tuesday approved a bill that would appropriate $36.5 billion in emergency funding for recovery efforts in U.S. states and territories recently affected by hurricanes, as well as relief and recovery efforts in California, which currently is experiencing widespread wildfires. An official who remained anonymous said the legislation includes a $4.9 billion short-term loan to help U.S. territories, including Puerto Rico and the U.S. Virgin Islands, pay pressing payroll and pension bills, Reuters reports. The full House is expected to consider the bill Thursday.

    Health systems, providers join relief efforts

    Some private health care providers from the continental United States also have traveled to Puerto Rico to help treat patients in need. For example, about 30 clinicians from Florida Hospital Orlando have visited either Puerto Rico or the U.S. Virgin Islands to help with recovery efforts in the territories.

    According to Modern Healthcare, Kaiser Permanente last month said it would give $1 million to CDC and Prevention Foundation to help with public health efforts in Puerto Rico.

    New York-based providers also have led efforts to assist with Puerto Rico's recovery. For instance, the Greater New York Hospital Association (GNYHA) raised $5 million to donate toward Puerto Rico relief efforts and organized medical supply missions to the island.

    Lee Perlman—president of GNYHA Ventures, the association's business arm—said the association was using lessons learned from Hurricane Sandy in 2012 to streamline response efforts. The association is now able to assemble and deliver each shipment to Puerto Rico in 24 to 48 hours. "Our model was to deal directly with providers in Puerto Rico and try and take care of what they need," Perlman said (Robles, New York Times, 10/10; Ross Johnson, Modern Healthcare, 10/10; Baker, "Vitals," Axios, 10/11; Rampton, Reuters, 10/11).

    Members ask: How can our hospital prepare for disasters?

    Hospitals must be prepared for myriad disasters that can stress health care systems to the breaking point and disrupt delivery of vital health care services.

    Advisory Board has compiled step-by-step procedures for various threats your facility may encounter—though we hope you'll never need to use them.

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