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An island in emergency: How to get Puerto Ricans desperately needed medical care

By admin | October 8, 2017

As the waters slowly recede, Puerto Rico’s health care system is reeling from the devastation wrought by Hurricane Maria. Hospitals are flooded or closed entirely, leaving the most vulnerable patients facing deadly complications. Thousands of Puerto Ricans will most certainly need to leave the island in need of medical care because of impending or chronic health needs.

Last week, President Trump announced a temporary waiver of the Jones Act, which will allow shipments of desperately needed medicine and supplies to the island. A state of emergency was also declared by the Department of Health and Human Services, and as part of the plan, patients who need urgent care will be evacuated to hospitals in South Carolina and Florida.

While this emergency plan will help — albeit slowly — it is not enough to prepare for a potentially massive influx of Puerto Ricans who will self-evacuate seeking medical services. We need to do more, right away.

In Puerto Rico, an estimated 6,000 people are on dialysis and need electricity and clean water to receive their life-sustaining treatment. Patients with HIV and chronic liver disease, who require close monitoring of their blood levels and daily medications, will need to go somewhere to ensure continued care.

People taking methadone for addiction recovery will face painful withdrawal symptoms. And the risk is particularly high for pregnant women. Without a substantial medical intervention, the crisis will become much worse.

The dire situation left in the hurricane’s wake is compounded by the fact that the island suffers from a severe shortage of physicians. Over the past 10 years, according to a September 2016 letter from the College of Physicians and Surgeons of Puerto Rico to Congress, Puerto Rico has lost 4,000 doctors — roughly one a day — leaving the island with a narrow and overburdened health care workforce.

The federal and state governments must take immediate steps to expedite Puerto Ricans’ access to health care, because now is when many need it most.

 First, Congress should immediately approve the disaster relief grant, which will allocate much-needed resources to fund health care costs for those medically evacuated from Puerto Rico. Additionally, Congress should immediately approve disaster relief funding for uncompensated care to cover medical services and behavioral health services for those impacted by the disaster seeking care in the territories or in any state, whether or not they were formally medically evacuated by the federal government.

Second, the evacuees must have fast-track access to Medicaid. Many of them may have lost their health insurance, medical records and other documents in the floodwaters. After 9/11, the federal government granted New Yorkers special approvals for Medicaid by expediting the application process. The same approach should be replicated for Puerto Ricans fleeing the devastation and in need of emergency care.

Finally, to ensure access to medication, state pharmacy boards across the nation should allow pharmacists greater discretion to provide maintenance medication to evacuees, even those without valid or refillable prescriptions. And the federal government should activate its Emergency Prescription Assistance Program, which covers prescription costs for those without insurance.

If history serves as an indicator, the nation as a whole is about to be tested. There were nearly 500,000 people in New Orleans before Hurricane Katrina in 2005; half of them fled in the aftermath of the storm and sought refuge in Houston, Atlanta and other parts of the country.

It is likely that a similar, and possibly much larger, exodus will happen from Puerto Rico. At 3.4 million people, the population in Puerto Rico is six times that of New Orleans.

New York City is home of the largest Boricua population outside the island. Puerto Ricans are our brothers and sisters, friends and family, and deserve all our help in this moment of need.

The island’s already debilitated infrastructure and bankruptcy status cannot offer the citizens of Puerto Rico critical support in this evolving humanitarian crisis. Which means it falls to us — localities, states and the federal government. We owe it to our fellow Americans.

Palacio is New York City’s deputy mayor of health and human services. Barbot is the city’s first deputy health commissioner. Morales is associate professor at New York-Presbyterian Hospital Weill Cornell.

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