The greatest immediate danger of death after earthquakes such as those experienced by Puerto Rico more than two weeks ago are the traumas that people may receive due to the collapse of structures, but the Secretary of Health, Rafael Rodríguez Mercado, has not communicated a plan to address this type of risk or contact your specialized trauma team since the earthquakes began, dangerously exposing the public.
At the moment, the director of the only trauma center on the island, the Trauma Hospital of the Medical Center, and president of the Trauma Committee of Puerto Rico before the American College of Surgeons, Dr. Pablo Rodríguez Ortiz, has not been contacted by Rodríguez Mercado during the emergency that has already claimed two lives, has demolished dozens of structures and left over 2,000 refugees.
Nor has Rodríguez Mercado communicated to his director of Trauma the current written plan – Operational Plan for Emergency Management of Public Health and Medical Services – nor has he addressed the structural deficiencies of said hospital, according to internal sources and documents obtained by the Center for Investigative Journalism (CPI). The plan, which has 1,048 pages, makes a single mention of the Trauma Hospital and brief mentions about the role of the Medical Center in an emergency such as the earthquake.
Rodríguez Mercado, a neurosurgeon by profession, is primarily responsible for the Medical Center, Trauma Hospital and the Medical Services Administration (ASEM) that operates these institutions.
The Secretary of Health did not respond to the request of an interview made by the CPI since Friday to answer questions on the subject and to specify what is his plan of care for trauma patients of an earthquake and aftershocks of greater intensity to the over 1,000 experienced during The past 16 days.
Dr. Rodríguez Ortiz confirmed in an interview that Rodríguez Mercado has not communicated with him and said with palpable indignation that he is worried about the catastrophe that it can mean for Puerto Ricans, since his hospital is the only one prepared to attend to these patients. He does not know what the procedure would be if there were a high volume of victims. As indicated, unfortunately Rodríguez Mercado and the director of ASEM, Jorge Matta, are his superiors in the Government and although he has the moral responsibility and expertise, does not have the authority to make decisions on planning, execution and use of resources.
The trauma surgeon, who has been running the hospital for more than 20 years under the government administrations of two different parties, pointed out that the trauma service is crucial during an earthquake because 80% of the victims die if they are not treated during the First hour of trauma.
“At this time I have no guidelines regarding this, when the responsibility of orchestrating the trauma response during a catastrophe in this country is mine. I don’t even know what tools I have to plan and execute this response, nor do I know what resources I have available to know what to do and what to stop doing, ”Rodríguez Ortiz said.
He explained that, although the orientation and prevention efforts that have been made so far to protect life are good, once the major event occurs, what is pressing is the medical response to effectively treat a high volume of trauma patients.
“An important component has been forgotten, which is this component because when the other strategies have failed, you have to save lives,” he added.
The CPI asked the governor, Wanda Vázquez Garced, if she is aware of and in accordance with the health response plan that her administration would execute in the event of a major catastrophe, to which she replied: “I am going to trust God and the Virgin that a major catastrophe will not occur. The message of mine to the people of Puerto Rico is that we have fewer earthquakes than yesterday. We are working with the expectations and projections of the experts of the United States Geological Survey and the Seismic Network ”.
If there was a major catastrophe, what would be the plan? The CPI insisted. “We would be equally prepared,” said the Governor.
How would your administration take into account that in major earthquakes the main traumas are due to structures that fall on people ?, added the CPI.
“I think the message that has been carried out by State and Municipal Emergency Management is very important, here there are mayors who have exercised with their citizens and with children in schools so they can respond. It is important that each person also has to prepare each one because the answer is initially individual for us to protect ourselves in our homes. Where we are working, in our workplaces, we have to follow those exercises and protocols to the response of an earthquake, ”said Vázquez Garced, without answering the premise of the question.
The lack of preparation and coordination joins the possibility that the Trauma Hospital collapses, since a study done in 2015 by engineers from the Mayagüez University Campus of the University of Puerto Rico found serious failures in the structure. They even anticipated that this installation had a 10% risk of falling during a near earthquake. The risk could be greater if the structure was not maintained, the document said, which recommended doing a more in-depth study. This study has not been done, under the administration of Alejandro García Padilla, nor that of Ricardo Rosselló Nevares, or that of Wanda Vázquez Garced. No improvements have been made, Rodríguez Ortiz conceded.
“The most I feel is that if it happens today (the catastrophe), we can no longer do anything,” said the director of Trauma.
Other neuralgic services in case of earthquakes such as orthopedics and neurosurgery are also not ready for a disaster.
“Are we truly ready at the Medical Center to handle the amount of trauma and fractures caused by a major earthquake? Whoever says yes, lies. Here I am at the Medical Center where I work two days a week, and the answer is clearly NO ”, Dr. Humberto Guzmán, an orthopedist at the institution, added on his Facebook page last week, noting that he has no rooms to operate.
“Many problems here, remodeling operating rooms, pediatric hospital rooms closed, poor staff and many new ones in training, the usual problems … an earthquake occurs and the orthopedics of the Medical Center do not have the necessary rooms to operate,” he said.
Meanwhile, the Medical Sciences Campus is about to lose its residence in neurosurgery, which was put on probation in 2019, due to lack of resources corresponding to the Department of Health and inaction of Secretary Rodríguez Mercado, who is a member of the faculty of said department, according to four internal sources and dozens of documents and emails obtained by the CPI.
The executive director of ASEM, Jorge Matta González, has not taken action on the matter. On the contrary, he canceled a meeting obtained at the request of Rodríguez Ortiz on December 7, with Shirley Birriel, deputy director of CDBG-DR fund management in the Department of Housing, and nine other officials, aimed at considering financing the construction of a new trauma hospital for Puerto Rico, according to communications reviewed by the CPI. Matta said in a letter dated December 12, as a reason to cancel the appointment, that “ASEM is working on several projects” that include a trauma center and that Rodríguez Ortiz is not one of the people authorized to meet or present projects by ASEM. Rodríguez Ortiz said he doesn’t know what these projects are. Matta González did not answer the CPI interview request.
Emergency wagons that do not serve your purpose
The CPI also found that two wagons that were purchased around 2009 at a cost of almost $ 2 million in federal funds to be a Mobile Emergency and Trauma Hospital, with an operating room and anesthesia, precisely for the use of the Hospital of Trauma in disaster situations like an earthquake, they have never been used. Rodríguez Ortiz explained that the cause for this is that ASEM assumed control of them and has been using them since then for other purposes, such as health clinics at events such as the San Sebastián Street Festivities. He said that the wagons and equipment no longer serve their original purpose of performing surgical procedures due to carelessness, lack of specialized and maintenance equipment.
On several tours of the Medical Center, the CPI confirmed that one of the cars is parked on the banks of the main road of the hospital complex.
The Department of Health mobilized the second car last week for Guánica, one of the villages most affected by the earthquakes, and announced that it was riding there “an outpatient hospital.” The CPI moved to the scene and found that the car is being operated by the private nonprofit entity Migrant Health and there doctors only perform minor procedures and procedures. The organization’s executive director, Dolores Morales, said the main problem they face is that Salud gave them the car, but did not give them medical supplies.
“We are very grateful (with the car and the tent) because they are solving us. The problem we have had is that they came, but without supplies. We had made the agreement that we were going to have staff from us to care for patients in the different units, ”Morales said.
The supplies and medications have been donated by Americare, Direct Relief and Drugstore Betances. While they have two doctors from the Air Force and three from Migrant Health Center to care for people. Also, they are providing psychological help, since the population is emotionally affected. However, the car is not ready to handle trauma and perform surgeries as was its original purpose, according to Dr. Rodríguez Ortiz.
The interior of the wagon in Guánica, nor the attached tents had visible surgical areas or specialized equipment for major surgery.
Morales said that the initiative to provide medical help at the Mariano Coliseum “Tito” Rodríguez de Guánica came from his organization, not Health. This shelter has 200 people, and over 90 seniors, according to a statement from the Department of Health.
“The Secretary of Health made an approach through his assistant to take care of this unit,” Morales said.
“The first day was quite strong, because they didn’t have the services available. Until we did not arrive, people were not attending. There was no food. Still at 2 in the afternoon people had not eaten and the second day too. Eventually the food arrived, ”he said.
In case of emergencies, they are transferring patients to La Concepción Hospital in San Germán, Morales said. However, this flow is incompatible with the current Response Plan, which states that the anchor hospital of this subregion is the Pavia de Yauco Hospital.
Hospital Pavia de Yauco activated its eviction plan according to its institutional protocol for earthquake cases, according to a statement from the Puerto Rico Hospital Association sent on Friday, January 10, three days after the 6.4 earthquake.
“We currently have four air-conditioned tents that help us expedite the provision of immediate services. We are located in an area where telluric movements and aftershocks continue, so the structure of the hospital is being evaluated. We understand that there is no major damage, however, we expect experts to complete the inspection and evaluation process to restart the use of our facilities. The institution continues to offer services to the community as part of the mission of Hospital Pavia in Yauco, ”said Dinorah Hernández, executive director of the Hospital, through the Hospital Association.
Vulnerability ignored by the Government
The study by five RUM researchers who found that the structure of the Trauma Hospital is at “high risk of collapse” during an earthquake alerts that patients would perish, and that specialized equipment, medical specialists and technical personnel would not be lost in No other place on the island.
The Secretary of Health has not acted on this warning, although in 2017 Hurricane Maria claimed nearly 3,000 lives largely due to the lack of an effective public health emergency response plan in the absence of electricity and the vulnerable system hospital of the country.
Dr. José Martínez Cruzado, one of the investigators of the study, explained to the ICC that he does not know what the Government did after the report was delivered with the results. He explained that it was a “rapid visual screening”, which concluded that a more thorough and detailed study should be done “because at first glance it was seen that the structure had potential problems.”
As Martínez Cruzado recalled, the Trauma Hospital “was more ill-treated” than the structures evaluated in the Medical Center, in terms of the risk it faces when registering an earthquake nearby.
Regarding the risk of these hospitals suffering damage to the continuous earthquakes in the southwest of Puerto Rico, Martínez Cruzado said that “for now I would remain calm”, although pending the structures because the epicenter of the movement is happening in the south. He explained that engineering assessments take into account the distance from which the telluric movement occurs when calculating the risk of collapse of a structure.
The professor of the RUM regretted that there are hundreds of studies carried out at the University of Puerto Rico in Mayagüez and Río Piedras that, like this one, could solve problems on the island, but end up on a shelf and never take advantage of them.
Rodríguez Ortiz said that the urgent construction of the new Trauma Hospital and the granting of autonomy to the institution so that it can efficiently manage its resources and be certified as a level I center – the highest ranking in trauma services – has been ignored by all the governors who have passed through La Fortaleza from Pedro Rosselló to the current governor Wanda Vázquez. This is despite the fact that even in normal times, trauma is the second cause of death for adults under 44 years of age and the first cause of death for children in Puerto Rico, he said.
The veteran trauma expert said that after Hurricane Maria showed that the health system of Puerto Rico is not ready to respond to emergencies of that magnitude, he began aggressive efforts to seek support at the highest levels of the Government of Puerto Rich. In 2018, he took the information directly to Resident Commissioner Jenniffer González, who said he would take action on the matter, but nothing has happened. In December 2019, he requested the aforementioned meeting with the team that manages the $ 9,000 million in CDBG-DR funds, who, understanding the urgency, granted it, but his boss, the ASEM executive director, canceled it.
According to Rodríguez Ortiz, the Governor is also aware of the urgency and has shown interest in building a new hospital, but has not yet had concrete news yet.
Rodríguez Ortiz stressed that if a major catastrophe does not occur, Puerto Rico could be on time to save lives, since a new hospital can be ready in a year at a cost of $ 150 million. He said there are plans that he financed, on his own initiative, through the nonprofit organization he directs, the Trauma Center Assistance Foundation.
“We should start building this hospital on Monday [13 de enero]”He concluded.
Uncertain the state of public and private hospitals
The Association of Hospitals of Puerto Rico said that some hospital institutions made preventive eviction after the 6.4 earthquake of January 7, 2020.
“Some hospital institutions in the affected area made preventive evictions as required by the operations plan previously established by them for earthquake cases. These evictions are made to subsequently immediately assess the structures, which was done with high priority, ”said Jaime Plá Cortés, executive president of the Association in a press release. He argued that once the inspection was achieved, the affected hospitals continued their operations taking into consideration the safety of the patients.
According to the Association, Hospital La Concepción in San Germán and Hospital San Cristóbal de Ponce have been operating “uninterruptedly”.
Damas Hospital, meanwhile, was evicted last Tuesday after the earthquake that shook the country as a preventive measure. “After the inspection of the engineers, following the safety protocol, the patients returned to their rooms until the third level. Since yesterday, Thursday, we are occupying the structure up to the fourth level, following the recommendations of our engineers, ”said Dr. Pedro Benítez, medical director of the hospital institution to the Association.
Images circulated on the Internet the next day, on Friday, January 11, show the damage suffered by Damas Hospital again after the strong tremor of that day, such as falling ceiling ceilings and cracks in the stairs.
This is the Damas de Ponce Hospital. Look how it takes off with each replica.
(FB video: Peter Barriera) pic.twitter.com/jMxiW778G4
– Cristina Fig (@cristinafgr) January 10, 2020
The San Lucas de Ponce hospital is in “good condition and the damages found do not represent a risk”, according to the Association.
“As part of the contingency plan and as a HUB institution in the southern area, we have enabled a provisional hospital, in case it is necessary, to receive more patients,” said Elyonel Pontón Cruz, executive director of the San Lucas Episcopal Medical Center in Ponce.
The Hospital Association did not respond to a request to update the status of Damas and the other hospital institutions made by the CPI on Saturday.
Geomorphologist José Molinelli Freytes, a professor at the University of Puerto Rico and one of the leading experts on earthquakes on the island, has publicly expressed concern about the ability of the health system to address the impact of a strong earthquake and meet the needs of thousands of injuries that could potentially result from a catastrophic event. He said that Puerto Ricans should take seriously the possibility of an event of equal or greater magnitude to the deadly earthquake experienced by Haiti in 2010. Said magnitude 7.0 earthquake and its aftershocks left around 220,000 dead Y almost all deaths were a consequence of the collapse of structures.
Eliván Martínez Mercado collaborated with this story.