Hospital ship failed to meet expectations of Puerto Ricans
SAN JUAN, Puerto Rico — For an overburdened pediatrician trying to care for a child who was in pain, needed hip surgery and was displaced from his home in the wake of Hurricane Maria, it seemed a godsend — a modern military hospital ship sent from its berth in Virginia to help with medical care in Puerto Rico.
But after days calling phone numbers that did not work and trying to navigate the admissions process for the ship, the 894-foot USNS Comfort, Dr. Jorge Gabriel Rosado finally gave up. The boy is still awaiting surgery, which had been scheduled for the day before the storm hit more than two months ago.
“It was rough because there were a lot of people that could have taken advantage of all the resources the Comfort had,” Rosado said. “But there were so many steps to it. Most physicians on the island, even us, decided it was too many steps.”
The Comfort’s mission has ended, but it leaves behind questions about whether it was adequately used during a time of desperate medical need. The ship was prepared to support 250 hospital beds, but over its 53-day deployment, which included travel to and from the island, it admitted an average of only six patients a day, or 290 in total. An additional 1,625 people were treated aboard the ship as outpatients, all at no cost.
In many ways, the Comfort’s story is that of the wobbly recovery effort in Puerto Rico, in which attempts to bolster vital services have often fallen flat or become entangled in bureaucracy and politics.
Following public debate over the Trump administration’s initial reluctance to deploy it, the Comfort arrived two weeks into the disaster, after some of the medical urgency had abated. Its mission and capabilities were opaque to many doctors on the island. It lacked the ability to treat some important areas of need, and the complex referral procedures made little sense on a battered island with scant power or telephone service.
The result, combined with the reluctance of some hospitals to lose their own patients, fell far short of what the Comfort could have provided, medical experts said.
“They were prepared for anything other than the reality of Puerto Rico,” said José Vargas Vidot, a doctor and independent senator in the Puerto Rican Senate whose charitable organization, Iniciativa Comunitaria, supported the post-hurricane medical clinic directed by Rosado. “It was like a vision in the harbor. Everybody was looking at the Comfort, like trying to build hope. But in the reality it was very frustrating to get access.”
Staffed with 800 personnel and costing $180,000 a day, the ship received an average of 36 people a day as outpatients or inpatients. (A New York Times reporter was one of them, given an X-ray and medicine for an asthmatic cough.) And that number swelled only after a public furor erupted over the ship’s empty beds.
“That’s not the right question,” said Capt. Kevin Buckley, the commander of the ship’s medical facility, when asked how many patients were admitted. The right question, he said, was: “What kind of patients do you have?”
The patients who arrived in the early weeks “were as sick as the sickest patient in any ICU where I’ve worked,” said Capt. José A. Acosta, the U.S. 3rd Fleet surgeon, a Puerto Ricantrained physician who served as a liaison with the Comfort.
In all, 191 surgeries, including 25 major orthopedic cases, were performed aboard the ship. Doctors delivered two
babies and diagnosed seven people with cancer. One woman had a double mastectomy, and the ship filled the oxygen tanks for dozens of patients who needed help breathing. It took in some patients from hospitals where generators had failed. It treated 98 critically ill patients, 11 of whom died.
The Comfort’s deployment was not the only federal health care initiative after Maria hit. Federal field hospitals, clinics and medical shelters saw more than 30,000 patients, and more than 1,400 uninsured people filled their prescriptions at pharmacies for free thanks to a federal reimbursement program.
Doctors in Puerto Rico said the Comfort could have been of enormous help directly after the storm, because at first many hospitals were damaged or shuttered.
Without air-conditioning, temperatures soared dangerously, and operating rooms were closed as generators failed. Emergency room staff sewed wounds, lanced boils and examined patients by the light of cellphones and flashlights. They lacked access to CT scans. In the 10 days after the Sept. 20 storm, the number of deaths in Puerto Rico jumped to an average of 118 a day, 36 more than usual.
But the ship did not leave Virginia until Sept. 29, arriving in Puerto Rico on Oct. 3.
Problems quickly emerged. For starters, the Comfort lacked critical capacities, including the ability to treat premature babies and patients with common antibiotic-resistant infections, head trauma and strokes requiring neurosurgery, or heart conditions needing bypass surgery. One doctor was heard complaining about receiving so-called “social cases”— patients who would be difficult to discharge because they lost their homes or lacked caregivers.
When the ship docked in San Juan, residents were thrilled. “People saw the big, white ship and came running,” said Murad Raheem, a regional emergency coordinator for the Department of Health and Human Services who oversaw the federal government’s health response to the disaster.
The Comfort cared for 67 patients in its first two days, but was not set up to receive unscreened patients, Raheem said.
Soon after the ship’s arrival, Puerto Rican and federal officials and local medical professionals met on the Comfort. They decided the ship should move around the island to assist “wherever the needs were at the time,” Raheem said.
But they agreed that doctors around the island would need to vet potential patient transfers through the Puerto Rico Medical Services Administration, the large and overburdened public hospital in San Juan that normally served as a referral center. Only if the hospital was full would a case be reviewed for possible referral to the Comfort.
Patient flow slowed to a trickle. According to the Navy, only 137 patients were delivered over a period of three weeks.