Parity for Puerto Rico Memorandum of Agreement We start from a basic proposition. Puerto Rico must be brought into the health care system on an equal basis with every other American jurisdiction. In addition to the clear moral problems inherent in a health care system that treats the U.S. citizens of Puerto Rico in less-than-equal fashion, it makes no sense from a strictly policy perspective to have a system where the same U.S. citizens who receive health care impaired by lesser federal funding while residing in Puerto Rico can access better-funded care merely by moving to the States. Click here to read the entire memorandum of agreement. To make your voice heard on health care reform in Puerto Rico, visit aarp.org/states/pr.

A Story No One Wants to Tell—or Hear
Back in Boston, Gilberto Quiñones praises Massachusetts’s Health Safety Net, also known as Free Care. He ticks off some of its benefits: if he needs a ride to the doctor, someone picks him up and takes him. Prescriptions? He pays a dollar. Collapsible cane? Free. Lunch at home during the week. No charge.

What Free Care couldn’t do, he says, was save his wife. Quiñones and his daughter, Sonybell, still mourn the loss of Sonia. And bitterness melds with sadness and tinges conversations about her.

Gilberto and Sonia grew up, married, and raised a family in Puerto Rico. But Sonia’s last breath was in Boston. The situation could have been worse, Sonybell says: “I knew if my mom died in Puerto Rico, she would die suffering.”

Sonybell recalls a two-week hospitalization about two years before her mother died. The care was so worrisome that Sonybell stayed in the hospital room every minute.

“I was awake the whole time because they didn’t take care of her,” Sonybell says. “If I hadn’t been there, they wouldn’t have given her the medications. They were always asking about the money and whether she had [insurance] coverage.”

Her mother didn’t want to be a burden and stayed in Puerto Rico as long as possible, her daughter says. But Sonia finally sought care in Boston. Sonybell vividly remembers the scene that day four years ago when she picked up her parents up at the Boston airport: Sonia crumpled on a bench, lips turning blue. “My mom had never been like that; she was dying,” says Sonybell. “I had to carry her into the house.”

Sonia wound up in the emergency room and was admitted to the hospital. Doctors in Boston questioned the treatment options provided on the island and tried to get medical records and answers from her doctors, mostly to no avail, Sonybell says. She credits the care Sonia received in Boston for the additional year and a half Sonia survived her disease.

Since then, Gilberto Quiñones travels back and forth, staying with his daughter in Boston. “I’m here until October, when it starts getting too cold and it’s hard on my bones,” he says.

Questioning Quality of Care
Amid the criticism and despite the disparities, the capital city of San Juan has some top-notch medical technology, the Caribbean’s best cardiovascular center, and excellent trauma care, says Dr. Rolance Chavier Roper, president of the Puerto Rico Medical Association.

“The biggest problem here is that the largest amount of money is spent on high technology and acute care,” he contends. “And the biggest criticism is that we’re not spending enough on prevention, health promotion, and the protection of our general health.”

Chavier, a family practitioner who cares primarily for older patients, and a group of specialists recently held a free clinic in a rural town. About 650 people showed up, he says: “If people have insurance or other access to health care, why would they take a Saturday to go see a doctor? [Here in Puerto Rico] you have to be really sick to get the care you need. You have to go to an emergency room and then they transfer you to a hospital. But before then, you had no preventive services to avoid getting ill in the first place.”

That, Gilberto Quiñones says, is exactly what happened to his wife, even though they were a few years shy of Medicare age at the time and therefore had private health insurance. “They could have taken care of her sooner,” he insists. And they could have followed up with chemo treatments after doctors removed part of her colon—a surgery that, they were told, removed all of the cancer.

Follow-up is critical, Chavier says, especially for older Puerto Ricans, who are among the most vulnerable. And long-term care is virtually nonexistent. “One of the problems is that there are no real nursing homes to take care of the patients and only two or three accredited skilled-care homes on the island,” he explains.

But follow-up and quality of care also often depends on where a patient lives, the doctor says. “If they live in the metro area, they have geriatricians in almost every specialty. If they don’t live near a doctor, they might not get good care. If they have a debilitating illness, it’s hard for them if they don’t have the social skills or sons or daughters to take care of them, to help them navigate the system or just survive going to the pharmacy.”

Chavier is blunt in his assessment: “It’s tough to be old in Puerto Rico.”