During the last couple of years Puerto Rico has confronted an exodus from doctors and healthcare professionals from the country. According to the President of the House of Representatives, Carlos “Johnny” Méndez, insurance companies’ make doctors life impossible and believes that favorable conditions for doctors where insurance companies do not questioned the treatment, medication and procedures recommended by doctors. That is why the Representative indicated that he will be “focusing on healthcare plans”, according to the article “Letal las aseguradoras para la salud en Puerto Rico” by Yaritza Rivera Clemente, published by the newspaper El Nuevo Día on January 18, 2017.

The Representative also indicated that healthcare plans have not liberated the money already paid by the Government stating that they need to audit those institutions, during the public hearing celebrated regarding the “Proyecto de la Cámara 5 para promulgar la ‘Ley e Incentivos para la Retención y Retorno de Profesionales Médicos.’” The Representative suggests that it be the Government who pays and to not use insurance companies anymore.

On the other hand, Rafael Rodríguez Mercado, the Secretary of the Department of Health, believes that part of the exodus of doctors is due the payment of taxes and the high salaries offered to them in the United States.

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Medical caps on damages in medical malpractice cases have long been favored by lobbyist, insurance companies, among others. In recent months there has been more and more talk on legislation regarding medical caps. What people who favored medical caps seem to forget is that they too may one they be subjected to the same caps they so insistently favor and lobby. Such an example is Frank Cornelius.

Frank Cornelius was an insurance lobbyist from the state of Indiana who in 1975 helped pass a legislation imposing a $500,000.00 cap on damages awards in cases of medical malpractice. What Cornelius never expected to happened, happened, he was a victim of his own reform. He suffered a knee injury and then serious complications after the surgery, prompting him to file a lawsuit. His damages were estimated at 5 million dollars, but he only received $500,000.00 because of the same law he helped passed. Cornelius published an article titled “Crushed by My Own Reform” where he shares his story and what his opinion on medical caps after his experience.

The following is an extract of his article:

In 1975 I helped persuade the Indiana Legislature to pass what was acclaimed as a pioneering reform of the medical malpractice laws: a $500,000 cap on damage awards, and elimination of all damages for pain and suffering. I argued successfully that such limits would reduce health care costs and encourage physicians to stay in Indiana – the same sort of arguments that not underpin the medical industry’s call for national malpractice reform.

Today, from my wheelchair, I rue that that accomplishment. Here is my story.

On February 22, 1989, I underwent routine arthroscopic surgery after injuring my left knee in a fall. The day I left the hospital, I experienced a great deal of pain and called the surgeon several times. He called back the next day and told my wife to get me a bedpan. He then left on a skiing trip. I sought out another surgeon, who immediately diagnosed my condition as a reflex sympathetic dystrophy – a degenerative nervous disorder brought on by trauma or infection, often during surgery…..

At the age of 49, I am told that I have less than two years to live.

My medical expenses and lost wages, projected to retirement if I should live that long, come to more than $5 million. Claims against the hospital and physical therapist have been settled for a total of $500,000 – the limit on damages for a single incident of malpractice. The Legislature has raised that cap to $750,000, and I may be able to college some extra damages if I can sue those responsible for the August 1990 incident the nearly killed me. But apparently because of bureaucratic inertia, the state medical panel that certifies such claims has yet to act on mine.

The kicker, of course, is that I fought to enact the very law that limits my compensation. All my suffering might have been worthwhile, on some cosmic scale, if the law had accomplished its stated purpose. But it hasn’t…. Frank Cornelius, “Crushed by My Own Reform”, October 7, 1994.

Not only do medical caps affect plaintiffs but do not, in any way or form, stop medical malpractice. Something to be considered by those in favored of instating caps on damages awards.


According to The Washington Post’s article titled “Top Republicans Say There’s a Medical Malpractice Crisis. Experts say there isn’t”, published on December 30, 2016 by Chad Terhune, Republicans believe that the increase in medical insurance premiums and doctors going out of business is due to “frivolous lawsuits”. As such, under the President-elect Donald Trump’s presidency, a tort reform will be a “key part” of the replacement plan for the Affordable Care Act.

Contrary to the Republicans point of view, experts and researchers say that the medical insurance industry is not in the middle of a crisis, that it hasn’t been a better time for insurance companies, that doctors are paying less for the malpractice insurance, that claims have dropped and that this is just an opportunity to make the changes they have wanted to make as the Obamacare is replace.

If the Republicans proposals for the tort reform are upheld, the burden of proof for the patients to prove their case will be higher and it would be easier for doctors to defend themselves; also limits on damages awards would be implemented, as well as new defenses for doctors. While Republicans say that hundreds of billions of dollars have been wasted due to lawsuits and the practice of defensive medicine and that liability should be limited, experts say that they are not focusing on the most important aspect, that being reducing patients’ harm and having them have a safer outcome.

While it is true that the costs related to malpractice cases and defensive medicine is high, researchers have found that doctors won’t necessarily change their behavior or produce a less expensive care if stronger protections against lawsuits are implemented.

Due to the differing views regarding this subject, health policy experts are urging a cautious approach on the tort reform proposals.

To read the complete article, see the following link


According to the article “Grave el cuadro de salud mental en Puerto Rico” by Benajamín Torres Gotay, published in the newspaper El Nuevo Día on January 16, 2017, mental health problems in Puerto Rico are bigger than what was imagined.

According to an epidemiologic study by the “Instituto de Investigaciones de Ciencias de la Conducta del Recinto de Ciencias Médicas de la Universidad de Puerto Rico”, around 165,497 people (7.3% of the population) suffer from severe mental health conditions. This study was requested by “Administración de Servicios de Salud Mental y Contra la Adicción (ASSMCA)” as a tool in order to justify the designation of federal funds. This study is also the first one made in 31 years since the last one made on 1985.

The epidemiologic study showed that people in Puerto Rico suffer from severe mental health, emotional and conduct conditions, a lot of them without receiving treatment or without being diagnosed. According to the study, form the 165,497 people who suffer from some mental health condition in Puerto Rico, the 36.1% has not received specialized treatment in the last year.

As part of the study, concerns were expressed regarding how services to these patients have been affected since the offices and programs that provide them services are confronting fiscal insufficiencies and how the mental health of these patients have been affected by the socioeconomic situation that the country is going through. Uncertainty in the workplace, quality of life and economic problems that the country is going through are situations that contribute greatly to the deterioration of people’s mental health. It also expresses concerns regarding one the limit imposed by healthcare plans of sessions with psychologists that a person with mental health conditions have.

To read the complete article, see the following link


According to The Washington Post’s article titled “Researchers: Medical Errors Now Third Leading Causes of Death in United States”, published on May 3, 2016 by Ariana Eunjung Cha, a new study shows that medical errors in hospitals and health care facilities may now be the third-leading cause of death in the United States claiming 251,000 lives yearly. The study, by patient-safety researchers, was published on the British Medical Journal (BMJ).

Martin Makary, professor of surgery at John Hopkins University School of Medicine, led the research and states that “it boils down to people dying from the care that they receive rather than the disease for which they are seeking care”. According to the study, 251,000 deaths are approximately 700 deaths daily, which is about 9.5% of all death in the United States annually.

Kenneth Sands, Director of Health Quality at Bent Israel Deaconess Medical Center, says that it is surprising the limited changes that have occur since the Institute of Medicine’s report which estimated 98,000 deaths due to medical errors in 1999. Using airplanes as an analogy, Sands says that there is no standardization in hospitals, as there exists when passengers are in an airplane and there is a standard in how the attendants move, talk and prepare passengers for flight.

Also using airplanes as an analogy, Makary states that “when a plane crashes, we don’t say this is confidential information the airline company owns. We consider this part public safety. Hospital should be held to the same standards”.

To read the complete article, see the following link

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