“You must remember that those hospitals are private. We’re giving them all the help we can because they certainly provide an essential service.” This is how Secretary of Health Carlos Mellado responded this week to questions from the press about the hospitals with or without electricity after the emergency that Hurricane Fiona caused last weekend. He also dodges his vicarious responsibility over most of Puerto Rico’s hospitals, even if they are private.
Among the hospitals reported by citizens as having failures in their electrical systems or physical plant are the University Hospital, the Pediatric Hospital, and the Comprehensive Cancer Center at the Medical Center in San Juan, Hospital Pavía and Hospital Susoni, both in Arecibo, Hospital Metropolitano Psiquiátrico in Cabo Rojo, San Carlos Borromeo in Moca and Pavía in Yauco.
Mellado argued on several occasions that these hospitals must be “helped,” even if they are not under the Department of Health (DS, in Spanish), when the reality is that in Puerto Rico, the DS is responsible for licensing, inspecting and supervising all hospitals, ensuring that their physical plant meets the safety standards required by Act 101 on Health Facilities and the Health Secretary’s Regulations for the Construction, Operation, Maintenance and Licensing of Hospitals in Puerto Rico.
Act 88 to Guarantee the Provision of Services was enacted In 2018, after the onslaught of Hurricane María, which also assigns responsibility for disaster control to the Municipal Offices for Emergency Management and Disaster Administration (OMMEAD, in Spanish). However, the Department of Health is still responsible in times of emergency, according to the regulations and by administrative order, and the only one with the capacity to inspect health facilities at any time and to revoke licenses is the Secretary of Health.
The regulation, signed in 2020 by Mellado’s predecessor, former Secretary Lorenzo González Feliciano, like Act 88, establishes that hospitals must have two generators and stored diesel or a contract with third parties that provides it for a minimum of 20 days, or failing that, solar panels that guarantee the adequate operation of the institution. This regulation does not specify the frequency in which the generators must be turned on to verify that they are working, but Mellado told the Center for Investigative Journalism (CPI, in Spanish) that they must be turned on weekly and keep a maintenance log.
In addition, administrative order 525 that Mellado signed in 2021, orders hospitals to provide a daily report — regardless of whether there is an emergency — on the status of the institution, the availability of running water and electricity, and medical gases through a platform called EMResource or by any means designated by the agency. In emergency situations, it must be provided in real-time.
Despite the order’s requirement and the fact that most of the nearly 3,000 deaths attributed to the Hurricane María emergency were related to power failures at hospitals and health service centers, in the midst of this emergency, Mellado has not offered precise information on Hurricane Fiona impact on the island’s hospitals or which of those institutions, if any, already have power service, alleging that they are private.
“I don’t have the specific data as to whether they have electricity, but all the hospitals are working,” Mellado said at a press conference on Tuesday, while, with no further details, he mentioned that the San Jorge Hospital in San Juan, the Hospital Metropolitano Psiquiátrico in Cabo Rojo, the Diagnostic and Treatment Center (CDT, in Spanish) in Guánica, and HIMA in Fajardo, had problems.
“In terms of hospitals, which includes the CDTs, 66 already have service, out of 150,” said Daniel Hernández of LUMA on Thursday. LUMA is the private company that operates and manages the electric power transmission and distribution on the Island since June 2021.
The Comprehensive Cancer Center in San Juan had to transfer seven patients to the Oncology Hospital at the Medical Center because of a power failure over the weekend. However, the Secretary disengaged himself from this institution, even though he is an ex officio member of the Comprehensive Cancer Center.
“That hospital is not part of the health system, it belongs to the UPR [University of Puerto Rico], but obviously we all have to help each other, we are brethren and neighbors,” he said.
Despite Mellado’s statements, with which he evades his responsibility with the island’s hospitals, there are laws and regulations that designate the Secretary of Health as the person in charge of guaranteeing that citizens have adequate health services, including in times of emergency.
The DS is the government agency that inspects and licenses all hospitals in Puerto Rico, according to the regulations. By law, this establishes that, as part of its duties, the Deputy Secretary for the Regulation and Accreditation of Health Facilities (SARAFS, in Spanish) must schedule inspections of licensed hospitals during the term of their license to confirm that they comply with the provisions of the regulation.
According to this order, hospitals must create and execute an emergency management plan that includes “a minimum of two electric generators or other sources of energy, such as solar panels and wind generators, that produce enough electricity to continue their operations, when the Puerto Rico Electric Power Authority (PREPA)’s system is not working.” They must also have a 20-day reserve of diesel, water, and medicines and essential items.
“As a rule [the electric generator] must be turned on for an hour and a maintenance log must be kept. Things happen, we will obviously have to investigate where the problem was, if there was negligence on the part of the centers or the hospital,” Mellado said when the CPI requested details of what happened with the electrical generators of the Cabo Rojo Hospital and the Guánica CDT, the local diagnostic and treatment center.
“But you have to remember that those hospitals are private,” Mellado pointed out.
He indicated that each of these institutions has to submit an emergency plan to the DS, which “includes that every week the generators have to start automatically for one hour and they have to certify that they were on during that time.” He added that they must have a maintenance company that provides services in Puerto Rico and the maintenance companies must certify to the agency once a year that the generator complied with the stipulated hours.
The CPI reviewed the Health Secretary’s Regulations for the Construction, Operation, Maintenance and Licensing of Hospitals in Puerto Rico, and found that the detail Mellado discussed regarding the time a generator must be turned on and other details about the maintenance, is not specified in the document.
When questioned by the CPI about why the emergency plans continue to fail, Mellado once again distanced himself from the matter.
“I wouldn’t go [into that] because it is an issue that doesn’t concern me. What I can tell you is that all the hospitals, the 68 hospitals in Puerto Rico, fully complied with their plans. Yes, there was a problem in Cabo Rojo, in the Hospital Metropolitano Psiquiátrico. We provided a generator. Yes, there was a problem at the Guánica CDT. It’s being handled through FEMA,” he noted.
Secretary Mellado’s expressions are false, as his statements have been completely refuted. The Secretary of Health is the official who has the constitutional duty to ensure public health in Puerto Rico and his agency is responsible for ensuring that hospitals — public and private — comply with the requirements to have an operating license, inspect them and revoke said license if they fail to comply with the provisions mandated by the laws, the regulations and the aforementioned administrative order to protect patient lives and health.
Vanessa Colón Almenas is a corps member of Report for America.
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