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Officials Defend Mental Health Services Smart Card To Cover Island By 2003 Most Public Housing In Bad Condition Activists Fight Plan For Beach Hotels SJ Woos Residents Of Barrio
Health Officials Defend Mental Health Services
By Melissa B. Gonzalez Valentin
October 30, 2002
Orlando Gonzalez, executive director of the Health Services Administration (ASES by its Spanish acronym), and Health Secretary Johnny Rullan acknowledged that there is still much to do to improve the services for mental health patients in Puerto Rico but noted the advancements that have been achieved in the field.
"Of course there is a long road ahead of us. But I believe we need a solid foundation in order to have an advanced healthcare system," Gonzalez said.
The two public officials participated as panelists during the Third Mental Health Summit of the National Alliance for the Mentally Ill (NAMI) in Puerto Rico on Wednesday.
At the event, many mental health patients criticized the services provided to them and urged Rullan and Gonzalez to make adjustments in the administration of these services.
Most of them were upset with doctors prescribing cheaper drugs, which have more side effects, instead of new ones that are known to significantly reduce disabling symptoms.
Others were concerned with the slowness in service at healthcare centers for mental patients, citing cases in which they have had to wait almost 12 hours to see a doctor and have had to leave without a prescription.
Rullan said he was opposed doctors prescribing older drugs when new generation drugs are available under the healthcare reform. He said approximately 74% of drugs prescribed to mental health patients are cheaper drugs with more side effects than the newer ones, something that, in his opinion is wrong.
"We have been meeting, and will continue to meet, with medical directors who will then talk to psychiatrists who are prescribing drugs, and we will make it clear that 74% is unacceptable. When we get to 5% to 10%, that would be respectable," Rullan said.
However, Gonzalez raised the issue of the limited funds available for mental healthcare services for health reform patients. He said even though 74% of prescriptions are for cheaper drugs, brand name drugs constitute 80% of the costs of all mental healthcare prescriptions. Currently 40% of the approximately $250 million budget for health reform mental patients goes to drug expenses.
NAMI Executive Director Sylvia Arias has urged government officials to amend the contract with health insurers to eliminate coverage restrictions to patients with schizophrenia, depression, or bipolar disorder.
Every month, mental patients need a pre-authorization from the health insurer in order to receive new generation drugs to treat their conditions. These medicines are much more expensive, but more effective for the patient, Arias said. However, she added that many patients dont receive these drugs on time or are treated with cheaper drugs so as to save money for doctors and health insurers.
Arias believes that eliminating the pre-authorization for these specific types of patients would do much to alleviate the situation.
Gonzalez disagreed. He said pre-authorizations are there for a reason. For example, they help warn other physicians treating mental patients before prescribing them with a drug that is incompatible with the ones used to treat their mental illness.
"We will be modifying the coverage, but I dont like to make general statements. I prefer to make responsible statements on a case-by-case basis. There are older drugs that are effective and dont have side effects, and there are others that do. What we want to do is to make sure that patients receive the best treatment within the [economic] parameters of the state," Gonzalez said.
According to Arias, there are approximately 650,000 adults and 150,000 children and teenagers suffering from a mental disorder in Puerto Rico, which makes up about 28% of the population.
Gonzalez said ASES has extended the health reform coverage from 57,000 to 150,000 mental patients in about a year. He also said the state has obtained rebates from pharmaceutical companies that have helped the government include more prescription drugs to treat mental patients under the health reform.
Smart Card To Spread Throughout The Island By 2003
By Melissa B. Gonzalez Valentin
October 28, 2002
The implementation of the Health Reform Smart Card has already yielded positive effects in Vieques and Isabela and is expected to begin services in Bayamon by the end of this year, said Orlando Gonzalez, executive director of the Health Services Administration (ASES by its Spanish acronym).
The agency chief said that 9,370 smart cards have been distributed in both municipalities and 70% of users have activated the cards.
This demonstration project will include Bayamon by December and the goal is to establish the smart card system for health reform beneficiaries throughout the island by December 2003. Some 8,000 patients will benefit from the smart card system in Bayamon.
"The work for the implementation and hand out of the smart card at the Bayamon Regional Hospital has already begun. We are in the process of ordering the equipment," the agency chief said.
Gonzalez explained the system complies with the Health Insurance Portability and Accountability Act (HIPAA), which requires healthcare providers who engage in electronic transactions to adopt a system that provides security and privacy standards to protect patients personal health information.
Because the diagnostic and treatment centers in Isabela, Vieques, and Bayamon belong to the state, the government has paid for the installation of equipment to log onto the smart card database system. However, Gonzalez said health reform providers who have their own practice would have to pay for these expenses.
The agency chief noted the law doesnt require health reform providers to purchase the system. However, Gonzalez doesnt foresee a case scenario where beneficiaries cannot access their data because private health reform providers dont want to invest in equipment.
Gonzalez said in the long run, healthcare providers will see that the smart card system is a good idea, since they have to comply with HIPAA anyway.
"We plan to offer a package that includes a full training on how to use the system. We estimate the plan at about $2,000. This includes the software, the computer, the card- reader device, in other words, the complete package," Gonzalez said.
He added that the card could also help prevent malpractice, since it enables doctors to know the patients medical history prior to treatment. He also said the electronic medical records have speeded up the billing process at the diagnostic and treatment centers. By eliminating manual administrative procedures, billing services take about five days, instead of 21, he noted.
Gonzalez said the health reform has about 7,000 healthcare providers and 1.7 million beneficiaries throughout the island. The full-scale implementation of the system has been estimated at $60 million. The government expects to recover that investment in 12 to 15 months, as the system reduces the amount of time and paper work wasted in manual transactions, as well as the overuse of health reform services due to fraud or misinformation.
"We could save up to $20 million a year in administrative expenses and about $40 million a year in overuse expenses," he said.
Gonzalez added the agency has also developed a strategy to educate health reform providers and beneficiaries in the use and advantages of the smart card. Brochures will be mailed to patients. Posters with step-by-step guidelines on how to use the smart card will also be posted in emergency rooms and clinics.
Information kiosks currently located at the diagnostic and treatment centers of Isabela and Vieques allow patients see and print out their medical history just by inserting their smart card into an electronic reader. They also include a detailed presentation on how to use the card.
Most Of Public Housing Complexes In Bad Condition
October 28, 2002
SAN JUAN (AP) A federal government inspection of the public housing complexes revealed that 67% of the 329 housing facilities have health and safety deficiencies, that put human life at risk.
According to published reports, 43% of the housing projects obtained a minimal rate of 70 points, and some almost failed to obtain 20 points.
Among the most serious problems registered are leaks, cracks and overflowing waste water.
The Housing Department had announced that in the next four years it will invest $1,300 million to revamp the public housing complexes.
However, public housing community leader from Manuel A. Perez urged the government to implement a better supervising system and to make sure that the improvements be made with better materials.
Activists Fight Plan For Beach Hotels
By Carmelo Ruiz-Marrero
October 8, 2002
SAN JUAN -- Environmentalists want to conserve the unspoiled beach between the towns of Luquillo and Fajardo, the last strip of undeveloped coastline in northeastern Puerto Rico, but the government and developers have other plans.
They are supporting construction of two mammoth tourism projects there. The first, San Miguel Four Seasons Resort, would consist of 1,800 hotel and residential units, plus two golf courses.
The proposed Dos Mares Resort would include 1,250 hotel and residential units and a golf course.
Project backers, such as Marriott International, claim the developments will create nearly 3,500 jobs.
Activist groups, including the Surfrider Foundation, Grupo Arena Mar, the Sustainable Development Initiative and the Caribbean Action Network (CAN), warn that the environmental impact of these proposed projects would be unacceptable.
"Our beaches and forests do not belong to us, we borrow them from our children, and we have the moral obligation to return them in a better state than when we found them," said Grupo Arena Mar in a statement.
"If we allow the development of our natural resources without appropriate planning, our future generations will lack the natural beauties that God blessed this island with."
Instead of massive tourism, residential developments and golf courses, environmentalists want the 3,240 acres to be preserved as the Northeastern Ecological Corridor (NEC).
They say it contains more than 40 species of marine mammals, birds, snakes, sea turtles and plants seldom found in other parts of the world, including the Puerto Rican plain pigeon, the snowy plover, brown pelican, the hawksbill sea turtle and the West Indian manatee.
"The region is best known as one of the most important nesting grounds for leatherback sea turtles in areas under U.S. jurisdiction and in the Caribbean," according to the CAN.
"All of the coastal wetlands found in Puerto Rico, such as coral communities and mangroves, are also encompassed within this region. These wetlands are essential to the existence of a biological phenomenon rare in the world, but occurring in the NEC, a bioluminescent lagoon," it continues.
The planned NEC also includes a world-class surfing beach known as La Selva.
Opponents of the two projects are also concerned about the impact they will have on already scarce water resources.
"A deficit of over 2 million gallons of water will result from their development, worsening the present situation for many local communities in the region that lack potable water," says the CAN.
"The development of these two projects is contrary to federal and commonwealth environmental policies, and thus to the public interest, since it would undermine current and past conservation efforts," it adds.
But Four Seasons president for worldwide operations, Kathleen Taylor, defends the planned San Miguel resort, and claims it will benefit the environment.
"The project will preserve and enhance more than two-thirds of its land, including the entire maritime-terrestrial zone, 100 percent of the mangrove forest, 97 percent of the wetland areas and the forest in the eastern ridge of the project site in almost its entirety, she said in a Sept. 19 letter to Puerto Rican environmentalists.
Taylor added that Four Seasons will create a natural reserve area of approximately 300 acres within the site and establish and fund an environmental research and education centre.
The ecological value of the area was acknowledged as far back as 1978, when Puerto Rico's natural resources department recommended that it be conserved. But only one part of the proposed area got protected status . Now called the Las Cabezas de San Juan Natural Reserve, it is owned by the Puerto Rico Conservation Trust, a local private group.
In 1992, the natural resources department and the Conservation Trust suggested that the rest of the area now proposed for the NEC be included in Las Cabezas. But the government had hotels and big developments in mind.
As early as 1993, developers began presenting proposals for tourism projects in the area. In 1996, governor Pedro Rossello declared his support for tourism development in the Fajardo-Luquillo beach area, and had the lands there re-zoned for residential development. There were no public hearings, which the law requires when lands are re-zoned.
Environmental scientist Luis Jorge Rivera of the Sustainable Development Initiative questions the economic viability of the two proposed projects.
In recent testimony to the Puerto Rican Senate, he said that international trends in the tourism industry favor moderate-priced tourism, not extremely expensive hotel suites such as those in the proposed resorts. He cited as an example the bankruptcy of the local Ritz-Carlton hotel.
Rivera emphatically denounced the government's "attitude of indifference and disregard for the laws that govern the administration of our natural resources and public participation".
Activists also criticise what they see as corporate welfare. "Of special concern is the fact that the proposed projects would be significantly financed by public funds, would benefit from several tax exemptions and would be established mostly on public lands," they declared.
San Juan Woos Residents Of Barrio
By Matthew Hay Brown
October 20, 2002
San Juan, Puerto Rico · Salsa blasted from loudspeakers on the bandstand. Players from the Santurce Crabbers basketball team led teenage boys through drills on the open-air court. Children with balloons tied to their wrists shimmied amid the swaying green palm trees of the freshly painted little park.
Last month, drug dealers brandishing automatic rifles boasted on television that the police couldn't enter La Perla. But police arrived in force five weeks ago to chase the dealers out of this seaside barrio at the edge of Old San Juan.
If that was the invasion, now comes the regime change: The city moved in on Saturday with entertainment, food and services aimed at winning residents over to a new vision for their neighborhood. The Police Department set up a booth here to recruit new officers.
"Now that the drug business is on hold, there is an opportunity for the people to take back their community," said Robert Alsina, director of the city department of urban development.
But with an intrusive police occupation, residents say, the plan is off to a bad start.
They complain of officers entering homes without warrants, stopping cars as they pass through the main gate and searching children's bags as they leave for school.
"If you treat La Perla well, La Perla will treat you well," said Ana Maldonado, a mother of four. "If you do not treat La Perla well, things are going to go badly."
A force of 125 officers descended on this closely knit community of 2,000 last month, arresting more than 20 residents, shutting down drug labs and shooting galleries and seizing hundreds of thousands of dollars in weapons, drugs, and cash. Officers in bulletproof vests continue to guard entrances to La Perla and patrol the streets; officials say they will remain indefinitely.
Saturday's fair represented the next phase of the city's vision for La Perla. Local leaders dedicated the new Plaza Ismael Rivera, a patch of green named for the great salsa singer from the neighborhood. The health department offered blood-pressure screenings and cholesterol tests. Alsina spoke of plans to rebuild crumbling houses, renovate failing water and sewer lines and draw new residents to the neighborhood.
"We are trying to improve the standard of living," he said.
The fair came days after residents held a news conference to complain about the police.
"Here we were submitted under the police to a regime of terror," said Jorge Luis Gómez, 43, a welder. "If the house, your house, strikes them as suspicious, if you have air conditioning, if you have grates, if your house is very nice, it's proof that you sell drugs and that gives them the motive to enter your house, not only one time, but two, three, four times."
Alsina said Saturday that the absence of drug activity in La Perla had created a window of opportunity.
"The drug business has infected this community for a long time," he said. "The only way to take it down was a complete takeover."