Versión Español
EspañolLast Friday morning one of my adult nieces woke up with a severe pain in the top of her stomach and the center of her chest. The pain became so unbearable that she went to the local hospital in Fajardo, Puerto Rico — La Caribeña. Into the emergency room she went, checked in, and waited . . . and waited . . . and waited.
A full two hours later, she received the call for a check of her vital signs and was then sent back to wait. Nearly an hour later, a doctor finally saw her. They diagnosed her with acid reflux, gave her a shot and some pills, and sent her home. No MRI, no sonogram, no x-ray, no camera down the throat, and according to my niece, no real check at all.
Eight hours later the pain had not subsided, but instead had gotten worse, and she went back to the hospital to go through the process all over again.
While La Caribeña is only ten years old, the other hospital just a few blocks away, HIMA San Pablo, was a former public hospital that was privatized in the 1990s. When it was a public, people often referred to it as the “Fajardo Butcher Shop.” In 1994, my eldest daughter was born in this hospital. Back then, we didn’t have medical insurance, so when my wife went into labor she was given a hospital gown and dropped into a room filled with other women who were about to give birth. All had the same colored hospital gown, except one. The woman with the different colored hospital gown was constantly being checked by the nurses and attending physician.
When my wife needed attention, she got short, annoyed responses and was made to wait. At one point she asked the other women what was going on and learned very quickly that the nurses gave a different colored gown to the women with good medical insurance. In part to resolve situations like that, then-Governor Pedro Rosselló developed and passed a health care reform system that very much resembled the Massachusetts system implemented by then-Governor Mitt Romney: universal insurance coverage for the poor.
More than ten years after that reform, more insurance has apparently not improved service in that hospital. My wife and I remember a few nights at the bedside of my infant daughter, due to a severe flu. We waited for the doctor to review her test results, only to find out the doctor had left in the middle of the night, and there was no one to review the test until the morning.
Yes, it really was that bad — hence the nickname.
I’ll save a more in-depth discussion about health care reform for another day. What is important right now is to focus on the problem at hand. A two hour wait for a vital signs check could be a death sentence for a patient in the right situation.
There is simply no excuse for that kind of professional negligence. Not only should the responsible staff be fired — including the on-site doctor, nurses, and administrative people — if this were under my government they would be prosecuted criminally for gross professional misconduct.
It begs the question, how many people have suffered from this over the years? It also makes one wonder, why hasn’t privatization worked?
The answer is actually very simple. The way “privatization” is done in Puerto Rico is wrong. In essence, thanks to local politics, the name on the building changes and the checks get deposited in a different bank account, but there are so many regulations, rules, and exceptions that the private managers of formerly public entities are hard pressed to make any significant improvements. It is hard to get operators of privatized contracts to go on the record, however, since they depend on the politicians who hold the contracts over their heads.
Here are a couple of things that could be done to improve the situation. First and foremost, eliminate all public unions in all government, at all levels, and all those associated with primary services like hospitals, power, and water. Fire any and all government or primary services employees that go on strike automatically, so that an elected official or bureaucrat isn’t forced into actually making a decision without access to alternative recruits. Send in “secret shoppers” to hospitals and other services to intentionally gauge response time and service demeanor.
Most importantly fire any and all associated hospital staff that make people wait more than 15 minutes for an initial vital signs check in the emergency room. Establish a dual triage in all hospitals using nurse practitioners to work with non-trauma related cases to quickly weed out those who use the emergency room as their primary care doctor. The second triage should be staffed by a doctor and nurse who check on those with more severe symptoms to determine order of treatment by actual need.
Finally, if you are going to privatize, do it right. Give the new owners a chance to make changes, innovate, hire, and fire as needed, because the goal is not to maintain a workforce, jobs, or satisfy unions or egos or political agendas. The goal is and should always be, to treat the patients.
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