Puerto Rico’s Health System Close to Broke amid Debt Crisis

Puerto Rico economic crisis continues as the US Territory has warned that their Medicaid funds are running out. Governor Ricardo Rossello, who heads the health insurance administration in the territory is set to visit Congress to address the issues.

Last week, Rossello sent a letter to Florida Governor Rick Scott explaining that Puerto Rico’s budget has been strained by thousands moving the US mainland, with around 128,000 who moved to Florida between 2010 and 2015. The projections of Medicaid expenditures Florida needed to serve this population, could exceed an estimated $6 billion with $3.7 billion coming from the federal government and the remaining from state funds. Rossello write, warning that the U.S. will increasingly have also feel the burden of the Puerto Rico’s crisis.

To read more, check out the link here.


Puerto Rico

Facing Health Care Crisis, Puerto Rico Protests Unequal Federal Payments for Medicare and Medicaid

Published on Nov 4, 2015

Democracynow.org – A mass protest is set for Puerto Rico on Thursday over the federal government’s unequal payments to the island’s Medicare and Medicaid programs. For decades, Congress has capped federal reimbursements of Puerto Rico’s healthcare costs, bringing the system to the brink of collapse. The Obama administration has warned Puerto Rico faces a humanitarian crisis unless Congress takes steps to address its crushing debt. We get analysis from Democracy Now! co-host and Daily News columnist Juan González.

American Samoa

Doctor Shortage Fears in American Samoa

Medical sector workers in American Samoa says there is an urgent life and death situation with the hospital relying on a single paediatrician.


Two doctors from the Department of Health have been sent to help out at the Pediatric Department of the LBJ Hospital, after the sudden death of long serving paediatrician, Dr Tagilima Iatala, last week.

A replacement is due on island next week.

The chief medical officer at the LBJ, Iotamo Salepaga, said the two public health doctors would mean they could manage until then.

But some medical staff said the situation was more serious than what the LBJ management is making it out to be.

They pointed out that the work load for the remaining pediatrician was too much and had been for a long time.

They said it had taken the hospital more than a year to recruit new pediatricians and one additional doctor was not enough.

They said some inpatients had conditions where the pediatricians had to keep an almost 24-hour watch because of seizures and other complications.

The medical staffers said this was an urgent life-and-death situation and the leaders needed to come and see for themselves and not take the management’s word for it.

You can find the original post here: http://www.pireport.org/articles/2017/03/12/doctor-shortage-fears-american-samoa


Quality of Care in US territories

I want to get in contact with physicians, nurses, or anyone who has worked in the allied health profession in any or all US territories.

My research will focus on the quality of care in the US territories. For the past 8 years I have read many stories how the policies, politics and local economy has adversely affected the quality of care, and the local health insurance market, and the struggles of inadequate funding, resources, and equipment each territory faces.

This research is intended to create awareness. Living in the mainland, we at times are bombarded by the news media of the concerns we see on television and the issues that affect us, but no one ever realizes the struggles our territories face.

A survey will be conducted. In no way will we this research invade the privacy of its patients,but will rather focus on working conditions, environment, and personal experience of the allied health professional.

Data : I will be sending emails to local government agencies to the Department of Health to collect data that will be used to collect information about endemic diseases, mortality rates, nonsocomial infection, unstructured data, etc. A focus will also be done on how many patients are sent to the mainland to seek further medical treatment that is not accessible locally (specialized treatment, etc.)

Questionnaire: Those who have been seen by the local hospitals in the US territories, I would like for you to participate as well. This questionnaire will not invade your patient privacy, rather it would focus solely on your personal experience as a patient.

If you are an allied health professional who has worked in any of these US territories, or a patient who has been seen in any of the local hospitals of the US territories, please email me at lupeupega@gmail.com. All information will be confidential.

For ALLIED HEALTH PROFESSIONALS: I have found some of your blogs on google, and I am a fan! I have thoroughly enjoyed reading about your experiences working abroad and that is what inspired me to look into the health care in US territories. I would love to talk to you, and if you are keen, maybe use some excerpts from your blog to talk about in my research.

** I am currently working on the surveys and questionnaires, they wont be ready until May. I have started sending out emails to Department of Public Health in several US territories, Please be patient. This research is time consuming!

Faafetai for your time, and hope to hear from any of you!


Student Research Initiative

My intention of this blog is to document my Student Research Initiative. The purpose of this SRI is for my capstone senior project.

The issue we will be focusing is: Quality of Care in US territories.

Project Narrative: Quality care in US Territories

Part A: Project Goals and Outcomes

The purpose of this research is to assess the quality of care at US territories that residents receive and how the Affordable Care Act has helped or negatively impacted the health system.

We hope to gather information in regards to mortality rate, quality of care, and the impact of medical insurance and the financial aspect of the hospital.

Part B: Project Significance:

Healthcare is a big part of the political realm in the United States and many times this affects the economy, and puts a burden onto the healthcare system. For the past 8 years we have seen significant changes in our US territories, at times that included natural disasters, economic depressions, and shortage of specialists. The purpose of this research is to find any anomalies within the healthcare of the United States territories and the significant impact the Affordable Care Act has had, if any.

·        Our hope is to bring attention to territories that have been neglected by Congress. If we can tell a story that is of significance, we can start a change. While we may have information at our disposal a challenge will be to find information regarding public health in local territories on the internet since many of these territories have limited internet access.

·        What motivated me to look into this matter was my previous project about telemedicine in American Samoa, the limited resources at the disposal of the physicians and the LBJ Hospital in Pago Pago that is facing $6 million debt. My earlier understanding according to a former pediatric physician from LBJ Hospital said that LBJ Hospital had telemedicine service with University of Hawaii systems. The connectivity of services was bad. There was a shortage of supplies, rooms, staff.

While LBJ Medical Center claims it is owed about $5 million by the government, the ASG Treasury counter-claims that LBJ owes the government more than $6 million, which includes a $5 million loan the hospital received from the government several years ago and remains on the books unless a bill is enacted into law to write it off.

ASG Treasury and LBJ officials revealed this information during the Senate Health/LBJ Committee hearing yesterday called by committee chairman Sen. Tuaolo Manaia Fruean after senators posed questions about the financial problems faced by the only medical center in the territory.

Funding source for the loan was the one-time settlement payment of $5 million from Affiliated FM insurance after ASG sued the company for failure to pay its claims following Hurricane Val.

Samoa News reported in 2003 that the $5 million loan bill dictated the priorities set for paying LBJ’s outstanding debts, such as U.S. FICA and Medicare taxes; employee and employer contributions to the ASG Employees’ Retirement Fund; utility payables; pharmaceutical company payables; other vendor payables incurred for essential operational services; and ASG withholding taxes.

In the later part of 2005, a year after the loan bill was enacted into law, there was already a call by senators at the time to forgive the loan and have it written off the books. Since then, there were at least two measures in the Fono to write off this loan but both bills never made it out of committee.

Part C: Understanding the work of Others

·        Many of these territories are facing a shortage of specialist in the hospital. Puerto Rico has faced one of the most daunting task of trying to stack up their staff in the hospitals throughout the island. The problem? The decade long recession has put a blow to rising cost of living on the island, pay rate 10 times less than that in the United States. It’s estimated that one doctor leaves a day in Puerto Rico, and according to NPR.org, the waiting list to see a specialist is four to five months.

·        Dr (name erased due to privacy concerns) who had previously worked in LBJ hospital in American Samoa says that he had to learn to read an x-ray. Those reading was usually left up to the x-ray technician, but because there was none, he had to do the reading himself.

Part D Methods and Analysis

·        The many ways we intend to draw our conclusions is to find articles that have been covering the decade long struggle of US territories and their struggle. Most of the statistical information will depend on local Department of Public health and news articles that have tracked many disease or infections outbreaks like Zika that has plagued tropical climate countries (Puerto Rico, the US Virgin Islands, American Samoa.) We have also collected information from reliable sources such as (name deleted due to privacy concerns) who was a physician at LBJ hospital in American Samoa and Dr. Anotnio Peraza who was from Puerto Rico and moved to Miami Florida.

Part E: Timeline and Budget



Questions to Ask

Estimated time

Medical Insurance, SSI, etc

-What kind of insurance market is in place in each independent territory if any?

-Does territory have citizens pay federal tax, SSI?

2.5 weeks

Billing system

-Many territories face issues with patients not paying their debt. We want to understand how the system is set up, is it efficient, is it creating a problem.

1 week

Services offered

-What kind of services is available in the territory, and if patients who seek specialized treatment need to travel to the United States to seek those necessary treatments.

2 weeks

Statistical analysis – mortality rate, quality of care

–         Collect data that can provide a picture of how the services are being rendered, are services efficient, does the patient have to come back for the same illness that was the chief complaint, etc.

4 weeks

Adequacy of Staff

–         How many physicians, nurses, technicians are available in the territory. Assess the necessity

1 week

Territory Debt

–         Assess the debt hospitals has incurred (Past due accounts, outsourcing, lawsuits, tax, etc)

2.5 weeks

Employee accounts

–         This will be for us to interview each physician or practicing professional in regards to hospital services and its efficiency. Each doctor will be asked the same set of questions.

2 weeks