The governor has delegated to mayors the responsibility of caring for patients whose lives are at risk during blackouts. However, Puerto Rican municipalities lack comprehensive and up-to-date registries of residents who rely on electric-powered medical equipment, a Centro de Periodismo Investigativo (CPI) investigation found.

During a May 2025 press conference unveiling her hurricane emergency plan, Governor Jenniffer González Colón assured the public that municipalities are aware of who and where electricity-dependent patients are, so they can be protected. The CPI verified this is false. For example, the city of Humacao has no such data, while Ponce, Caguas, Carolina, Guaynabo, and Bayamón have only partial lists.

“From the experiences we’ve had, I can tell you with certainty that most municipalities do not have that information,” said Lee Vanessa Feliciano, regional executive of the Puerto Rico Red Cross. This nongovernmental organization aids disaster victims.

Electricity-dependent patients, who rely on oxygen concentrators, adjustable hospital beds, or peritoneal dialysis machines, among other devices, can die when power is interrupted.  The Department of Health, the Puerto Rico Emergency Management Bureau, and municipal governments have all publicly acknowledged the need for patient registries. Yet, under questioning from the CPI and during appearances before the Legislature, none of these entities has accepted responsibility for creating such registries, which are crucial to preventing the repeat of deaths caused by Hurricane María in 2017.

Although the governor stated that municipalities are responsible for maintaining these lists, a 2024 administrative order from the Department of Health requires all health insurers to report monthly on patients dependent on electricity under their coverage, to support preparedness and response efforts. That same year, a law directed the Family and Health Departments to create a registry of vulnerable patients and share it with municipalities —further evidence of poor coordination and overlapping mandates during emergencies. The agency’s own emergency plan also assigns municipalities the task of identifying these patients, contradicting the administrative order and the law.

The Health Department’s emergency plan also assumes that electricity-dependent patients without a generator can stay with relatives or relocate to a shelter equipped with backup power. But that is not so simple. “Many of our elderly residents who depend on electricity lack the mobility or family support needed to move,” said the Red Cross executive.

And most shelters are not equipped to handle them. At least 344 of the 572 public schools designated as shelters lack generators, solar panels, or batteries, according to data from the Department of Education provided in May. In other words, more than half are unprepared to care for patients who rely on electricity. Of the 55 shelters not located in schools, at least 23 —or 42%— also lack a reliable energy source, according to data from the Department of Housing.

During the presentation of the hurricane preparedness plan, the CPI told the governor it was untrue that all municipalities had the necessary data. González doubled down: “That is the action plan and the plan we have, the one we’ve had in place since 2023, which stipulates that municipalities are the ones who provide that information.”

In 2017, Hurricane María struck Yabucoa on Puerto Rico’s southeast coast, collapsing the power grid and triggering an islandwide blackout that was linked to nearly 3,000 deaths, according to a George Washington University study.

Renal patient Olga Iris Rivera De León was trapped for a week in the Pitahaya sector of Humacao, where debris blocked the road to her home. When an ambulance finally reached her and took her to the town’s dialysis center, the backup generator there wasn’t working. She received treatment only after four attempts, but by then her body had already begun to shut down.

José Ángel Fonseca Álvarez developed an infection after his family was unable to use the inflatable mattress, hospital bed, and air conditioner that were supposed to prevent bedsores. His case is one of many documented in CPI investigations that have not only exposed government negligence and chronic lack of preparation to protect lives during natural disasters but also revealed that Puerto Rico’s power grid has consistently failed to safeguard public health and well-being during and after such events.

After the hurricane, lacking information on its most vulnerable residents, the Municipality of Humacao had to request details from local organizations such as P.E.C.E.S., the Mariana Neighborhood Recreational and Educational Association (ARECMA, in Spanish), and the Buena Vista neighborhood, representatives of those groups told the CPI. Deciding not to wait for government action before the next disaster, they created their own emergency plans and registries. Without those efforts, the most vulnerable would have been left unprotected once again.

When Rosamar Trujillo Plumey of the Popular Democratic Party (PPD, in Spanish) took office as mayor of Humacao this term, she found that the previous administration of Julio Geigel Pérez, of the New Progressive Party (PNP, in Spanish), had failed to hand over critical information about residents most at risk during blackouts. “We are currently working on completing the registry,” the municipality said in July.

In theory, electricity-dependent patients should not be left unprotected, because the federal Administration for Strategic Preparedness and Response (ASPR) maintains the emPOWER database. The platform publishes general data each month (without personal identifiers), which can help strengthen preparedness and disaster response. The Department of Health can request names, addresses, medical conditions, and equipment information to share with support networks in the event of an emergency. But it does not.

Health Department Hesitates Again

Puerto Rico’s new health secretary is dismissive of the emPOWER database. “That thing doesn’t work,” Víctor Ramos Otero told the CPI. The federal government only releases detailed information if a state of emergency is declared, he argued. “I need to know where vulnerable people are and make a map ahead of time,” he said. “It’s not that we won’t use emPOWER. But what seemed like this perfect tool really isn’t, because it gives me the information 48 to 72 hours beforehand, and I need to have it earlier.”

The emPOWER platform contains information on Medicare patients who have requested assistance with electric-powered medical devices. It does not include patients covered by private insurers or Puerto Rico’s public health plan, Plan Vital, who are dependent on electricity. Despite these limitations, governments in California, Texas, Nevada, South Carolina, New York, Arizona, Florida, and Wyoming, among others, have used it to save lives, according to ASPR.

Puerto Rico’s Department of Health accessed the federal platform’s data after the 2020 earthquakes but did not share it with the municipalities of Ponce, Yauco, and Guánica, among the hardest-hit areas. The agency’s response was limited: it visited only 262 households, despite emPOWER data indicating that there were 2,471 electricity-dependent patients in those three municipalities who needed to be contacted to determine if they required assistance.

The health secretary claimed that to address the need for a registry of patients dependent on electricity, his office is working on implementing an administrative order signed by his predecessor, Carlos Mellado López, on August 7, 2024. That order requires health insurance companies to report monthly the number of patients using electric-powered medical equipment under their care, regardless of whether an emergency exists. So far, only the company MMM has complied, according to the Department of Health. The order carries no penalties for health insurers that fail to comply.

Despite Puerto Rico’s frequent blackouts, even outside hurricane season, Ramos acknowledged he has no timeline for fully implementing the new protocol. The agency, he said, is caught in a “back-and-forth” over how to enforce health insurers compliance, what mechanism will be used to transmit the data, and how to reconcile the process with HIPAA, the federal law protecting patient privacy. The department also said it is still debating what services electricity-dependent patients will receive during emergencies to avoid both harm and false expectations. It is also weighing how to share the information during crises with other government actors, such as municipalities.

Former Governor Pedro Pierluisi signed Joint Resolution 86 in 2024, a law requiring the Family and Health Departments, in coordination with municipalities and the Office of the Ombudsman for the Elderly, to create a registry of older adults and people with disabilities to assist them during emergencies. The bill’s sponsor was PPD Rep. Lydia Méndez Silva, a former nurse.

The law envisioned collaboration with the Puerto Rico Innovation and Technology Service (PRITS), the agency tasked with coordinating the government’s information technology infrastructure, to build the registry. But the current governor has since declared the agency dysfunctional and vowed to dismantle it. The law has not been implemented. The health secretary said he is seeking funding for the project, as the bill does not authorize the use of public funds. The CPI asked the Department of Family how it plans to enforce the law and what steps have been taken, but as of publication, the agency had not responded.

During public hearings on the bill, none of the agencies wanted to take responsibility for maintaining the registry, according to the legislative report issued in November 2022. The Department of Family suggested handing the task to the Puerto Rico Emergency Management and Disaster Administration Bureau (NMEAD in Spanish). But the Department of Public Safety —the umbrella agency overseeing NMEAD— argued that the Department of Family and municipalities were better suited to create the registry. The Puerto Rico Mayors Association, meanwhile, confirmed in its testimony that local governments do not have complete information. Then, Health Secretary Carlos Mellado recommended that municipalities collect, update, and manage the data, claiming they were more familiar with their local demographics. He added that the Health Department lacked the resources to do so.

On January 2, 2025, Senate President Thomas Rivera Schatz introduced PS 0094, a new bill to create a registry of bedridden seniors and elderly individuals living alone, allowing them to receive aid during emergencies. The Department of Health supported the initiative, and, according to its Secretary, Víctor Ramos, recommended expanding the categories to include electricity-dependent patients — something already required under the 2024 law and the administrative order. Rivera Schatz’s bill assigns responsibility to NMEAD, which did not submit comments during the Senate hearings. The Senate approved the House amendments and sent the bill to La Fortaleza, the governor’s office, on Sept. 15.

Humacao Communities Step In to Fill the Void

For years, officials and politicians have failed to resolve a problem first spotlighted at least eight years ago, when the CPI’s reporting after Hurricane María underscored the urgent need for better preparedness. Communities, however, have stepped up with solutions that, though limited, can save lives today.

In Humacao’s Barrio Mariana, the first government aid arrived in La Loma two months after María, when municipal workers showed up with prepared meals, said community leader Rosalina Abreu González of the Mariana Neighborhood Recreational and Educational Association. By then, the organization had already mobilized its own disaster response. A group of women cooked hot meals for storm victims, volunteers delivered food to bedridden residents, and others came to fetch water at a community “oasis.” Some also charged lifesaving medical equipment thanks to solar panels and batteries donated by the company Sonnen. But La Loma’s leaders did not stop there.

“We started thinking about what to do if another storm came,” Abreu explained. The group began compiling a list of vulnerable residents and developing an emergency plan with support from P.E.C.E.S., another nonprofit in Humacao focused on social and economic development in Punta Santiago.

Today, ARECMA knows precisely how to respond when disaster strikes. “People immediately gather in La Loma. The kitchen is reactivated. There’s an oasis for water. We have two generators for those who need them. A team coordinates the distribution of solar lamps. Sector leaders have the registries and go out to check on bedridden residents and people who are alone or otherwise vulnerable,” Abreu said.

ARECMA also utilizes the facilities of the Juan de Dios López School, which the Department of Education had previously closed due to Hurricane María. In its office, a large map of Barrio Mariana hangs on the wall, covered with stickers marking the locations of bedridden patients, water wells, landslide-prone areas, churches, businesses, community spaces, and places with solar power. The school itself is powered by solar panels and batteries donated by the University of Pennsylvania after the hurricane, allowing neighbors to charge their medical devices there if needed. “Now we feel safer, we can act quicker,” Abreu said.

Proyecto P.E.C.E.S., which has helped communities in Naguabo, Yabucoa, and Maunabo develop emergency plans, conducted its own registry in the coastal community of Punta Santiago. The census identified 445 people, of whom 73 required electricity for medical equipment. However, the list, compiled in 2023, is outdated, said Marta Lebrón Cruz, coordinator of the group’s Sustainability Center, noting that some residents have since moved away and others have died. “We cannot assume community organizations have the resources to maintain real-time information that saves lives,” she said. “The municipality should take responsibility for updating this data as soon as possible.”

The CPI’s findings reveal systemic gaps across all levels of government regarding these patients. In Bayamón, the municipal registry of vulnerable residents lists just 31 electricity-dependent patients. That figure is nowhere near the 2,886 identified in September 2025 by emPOWER. In a real emergency, that would mean more than 2,855 electricity-dependent residents would go unidentified, making it nearly impossible to help them. Through emPOWER, the Department of Health has private access to the names, addresses, and medical conditions of these individuals. It could share the data with municipal officials during emergencies, but it has not done so, according to information CPI obtained through a lawsuit against the agency.

Bayamón Mayor Ramón Luis Rivera Cruz said the local registry has fewer patients than the federal database because participation in the municipal census is voluntary. “Anything that helps us have better data and makes our work easier is welcome,” Rivera said, referring not only to emPOWER but also to the Health Department’s administrative order and the law creating a territory-wide registry of electricity-dependent patients.

Even before Hurricane María, the government of Bayamón maintained a list to help relocate residents who needed support during emergencies. After the storm, the municipality distributed batteries to seniors and set up the Rubén Rodríguez Coliseum as a “super shelter” with a generator, since many government-designated shelters lacked backup power during blackouts.

Ponce’s municipal registry counts 1,288 electricity-dependent residents. But emPOWER identifies nearly twice as many: 2,241.

Carolina reports 156 electricity-dependent patients, while emPOWER shows a much higher figure: 2,005. “We have that limitation,” acknowledged Marisol Correa Villegas, director of the Office of Citizen Services in Carolina, who is familiar with the federal platform. “But on the other hand, we have more detailed information we need to serve these people.” She noted that the municipality’s list includes names, addresses, medical conditions, and the devices patients rely on. In an emergency, a nurse or social worker checks on them and provides access to shelters with backup power. In two instances in 2024, Carolina provided generators during blackouts to patients on its list, allowing them to operate hospital beds, air mattresses, and oxygen concentrators, said José Colón, the city’s emergency management director.

Guaynabo, for its part, lists 194 electricity-dependent residents, but federal data again shows how municipal registries fall short: emPOWER identifies 1,039 such patients in the city.

Caguas’s registry includes 1,780 electricity-dependent patients, compared with at least 2,073 according to emPOWER.

In San Juan, Mayor Miguel Romero of the New Progressive Party (PNP) established a vulnerable-patient registry at the start of his first term in 2021 and has proactively offered shelter, as confirmed by the CPI after Hurricane Fiona in 2022. The city lists 4,980 vulnerable residents, although not all of them depend on electricity. emPOWER data shows more than 4,183 electricity-dependent patients in the capital.

San Juan, Bayamón, Ponce, Caguas, Carolina, Mayagüez, Arecibo, Guaynabo, Toa Baja, and Humacao are the 10 municipalities with the highest numbers of electricity-dependent patients in Puerto Rico, according to emPOWER.

Eight years after Hurricane María, Puerto Rico still lacks a unified database to identify and assist patients who rely on electricity. LUMA, the private company that operates the island’s power transmission and distribution system, maintains a registry of patients who receive subsidies because they rely on electric-powered medical devices to sustain their lives. But its emergency plan is limited: employees call patients before a disaster to advise them to seek government help. The company’s registry also falls far short, covering just 3,134 patients across Puerto Rico. By contrast, emPOWER data shows there are at least 47,161 electricity-dependent residents in Puerto Rico.

Some of the findings and testimonies in this story also appear in Los estragos del apagón, a chronicle by Eliván Martínez Mercado about the deaths caused by Hurricane María and the longest blackout in the history of Puerto Rico and the United States, published by Editorial CPI.

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This translation was generated with the assistance of AI and reviewed by our editorial team to ensure accuracy and clarity.