June 12, 2018
Good Morning! In this morning’s eBlog, we consider the demographic disparities in the wake of Hurricane Maria in Puerto Rico, before turning to the human and fiscal challenges in the federal courtroom issue of keeping schools open in the face of quasi-municipal bankruptcy; then we view the ongoing governing challenges and wonder when there might be too many cooks in the fiscal kitchen.
Demographic Devastation. According to new data from the Puerto Rican Demographic Registry, 68% of Puerto Ricans who died between September and December of 2017, during the emergency caused by Hurricanes Irma and María, were over the age of 70. The new data from the Demographic Registry finds that nearly half of the deaths recorded in this period occurred among people who were hospitalized in Puerto Rico. Moreover, the risk of death, according to the data, was higher for men: 54% of the deceased were male, even though males make up only 48% of the island’s current population. The new data also found that deaths attributed to diseases such as Alzheimer’s, diabetes, septicemia, pneumonia, and chronic heart or respiratory conditions showed significant increases in the period which followed the hurricanes—or, as Puerto Rico demographer Judith Rodríguez noted: “This gives us a more specific idea of the health risk that the hurricane brought. That was the only significant factor to cause that increase seen in the data.” Ms. Rodríguez further reported that cases of septicemia doubled between August and September, reporting that this disease, often associated with infections in hospitals, noting: “The highest number of deaths is in hospital patients; however there were high-risk factors among people who were in care homes for the elderly, or who, in the middle of an emergency, were taken to an ER.”
Health and safety—especially for the most vulnerable—appeared to be related not just to damage caused by the hurricanes to the physical hospitals and clinics, but also by the stark disruptions of electricity: diesel supply to keep emergency generators operating, combined with failures in backup systems and telecommunications plagued the provision of vital health care services. Moreover, the issues took long to resolve: even as late as last December, at least two hospital were operating with electric generators. As the Senior Vice President of Operations at San Jorge Children’s Hospital, Domingo Cruz, noted: “It is always a risk (death) when there are patients in ventilators (artificial) and there is an outage.” Perhaps in a hope for the future, the data shows that death among Puerto Rican children due to the storms was less than 1%.
After storm reports also noted that even though tardy, the arrival from the mainland of hospital ships played a vital role: Good Samaritan Hospital Administrator Marilyn Morales reported that, due to their condition, many patients were transferred to the USNS Comfort hospital ship, the U.S. Navy’s largest such ship, as well as to the Medical Centers of Mayagüez and Río Piedras. The USNS Comfort is the largest U.S. Navy floating hospital. This ship and a series of field hospitals were set up in Puerto Rico during the first months that followed Hurricane Maria. Administrator Morales noted: “We understand that deaths (at the Good Samaritan Hospital) were minimal.”
It was not, however, just hospitals which were so adversely impacted: by early last October, access to vital pharmacies due to the loss of electricity and communications contributed to the health care emergency response breakdowns: some pharmacies did not have access to the system they use to process prescriptions; thus, they were only dispensing medicines if a patient paid the full price of the drug. According to the Health Department: “In the case of not having electronic systems for dispensing medications, the pharmacy must provide the medication to the patient and, then, it will have up to 60 days to process it.”
Many health professionals with private practices had to overcome many obstacles to offer services to their patients, mainly due to the lack of power, the impossibility of using some equipment only with a generator, and of billing for medical services. Demographer Rodríguez noted: “There are some conditions whose deterioration could be accelerated by issues associated with the emergency left by the hurricane. Chronic and degenerative diseases were the most affected in this process. These diseases skyrocketed, and many people might have died months later because of issues associated with the hurricane.”
Quien Es Encargado? (Who is in charge?) As we have noted, in chapter 9 municipal bankruptcies—in the minority of states which have authorized them, the state law determines the governance until a plan of debt adjustment is approved by a U.S. Bankruptcy Court. In Puerto Rico, under the PROMESA statute adopted by Congress, there is a hybrid form of governance—a form which has left unclear authority in this governmentally different circumstance where it is not a municipality which is fiscally exhausted, but rather a quasi-state—or, a U.S. territory. Thus, we have a Governor, a legislature, an oversight PROMESA Board imposed by the President and Congress, and a U.S. federal Judge. It might be that some accommodation in governance is emerging: the PROMESA Board has proposed to the Puerto Rico Legislature that the raising of salaries or disbursement of allocated funds would not be allowed unless quarterly reports are presented and cuts established in the fiscal plan are executed, according to the its modified version submitted to the Legislature. Under the proposal, in order to ensure that the government does not spend more than it receives and complies with the spending cuts to which it committed in its certified fiscal plan, the budget modified by the Oversight Board restricts in a reserve fund the funds which would be used to increase the salaries of teachers and the Police. The Board also established that the government of Puerto Rico is mandated to submit quarterly reports beyond those required by PROMESA before it is authorized to appropriate any funding, with said conditions spelled out in the joint resolutions that the Board has sent to the Legislature as part of the budget certification process. Included in this unfunded mandate is a provision barring the Office of Management and Budget from disbursing funding to fulfill the promise made by Governor Ricardo Rosselló Nevares to increase the salary of teachers and the Police, or to provide Social Security. In addition, the mandate bars the authorization of funding to Puerto Rican agencies absent Board approval.
The Board’s restrictions, adopted in an effort to ensure a balanced budget, in addition to the repeal of the Unjust Dismissal Law (Law 80-1976), which eliminates the statute which provided certain legal remedies to private sector employees, is part of a structural reforms package imposed by the Board as part of its agreement with Gov. Rosselló Nevares to avoid litigation in Court.
Gov. Rosselló’s representative to the PROMESA Board, Christian Sobrino, concurs that it makes sense that the Board has established conditions for granting the monthly increase of $125 to Police and teachers, starting in the upcoming fiscal year, and that these imposed conditions are also subject to the repeal of Law 80, because this move may impact the revenue projection required by the Board. Nevertheless, unsurprisingly, Mr. Sobrino described the Board’s new demands as “complicating” the interaction between Puerto Rico and the PROMESA Board: noting: “But there is a reality: you can provide the benefits (if) you have the income to budgetary support. If you do not have them, you do not have them: The revenue projection is the key part that makes all these agreements and these other programmatic commitments possible.” Thus he stressed the importance of the Legislature proceeding with the repeal of Law 80: “The effect of not carrying out this repeal would imply a reduction in the budgetary revenues available to the government and make it very difficult to maintain a series of benefits , including that (salary) increase and also the Christmas bonus to public employees: If the agreement can be complied with, there should be no problem moving that allocation (the money for salary increase) to the Public Security umbrella. If that agreement is not maintained, then additional cuts have to be made.”
Nevertheless, the governance situation remains difficult, especially in the wake of the PROMESA Board’s conclusion that, for what it asserted was the second time, Gov. Rosselló’s budget did not comply with PROMESA, and then proceeded to preempt that authority and impose its own adjustments—a fiscal and governance move which would mark the first time that the government of Puerto Rico would have constraints to use its funds. As written, the preemption reads: “The Secretary of Treasury, the treasurer and Executive Directors of each agency or Public Corporation covered by the New Fiscal Plan for Puerto Rico certified by the [PROMESA] Oversight Board, and the Director of the OMB (or their respective successors) shall be responsible for not spending or encumbering during fiscal year 2019 any amount that exceeds the appropriations authorized for such year. This prohibition applies to every appropriation set forth in this Joint Resolution, including appropriations for payroll and related costs. Any violation of this prohibition shall constitute a violation of this Joint Resolution and Act 230-1974.” In addition, in another section of the document, the Board mandated that quarterly reports must be submitted no later than 15 days after the closing of each fiscal quarter and that the Fiscal Agency and Financial Advisory Authority (FAFAA) and the OMB will certify that “no amount” of the Social Security Reserve funds in the Puerto Rico Police Department or the promised increases have been used to cover any expenses.
A Teaching Moment? In the wake of learning about the new conditions established by the PROMESA Board, Grichelle Toledo, the Secretary-General of the Puerto Rico Teachers Association-Local Union, noted that Gov. Rosselló had promised a monthly salary increase of $125 per month “beginning the 2018-2019 school year,” noting that it had been “10 years without a salary increase, and the cost of living has risen, benefits have been reduced and some have even been eliminated.”
Indeed, as we have noted previously, the loss of human capital—teachers, health care professionals, and others, harms the possibility of a sustained economic recovery. That is, the Board’s actions risk that Puerto Rico is in danger of losing one of its most critical assets, its skilled workforce, at a time when the island is in dire need of rebuilding: already teachers are leaving for more secure jobs on the mainland, a predictable outcome after the cash-strapped government announced it would close some 200 schools. Police, thousands of whom called in sick daily last year because they were not being paid overtime, are finding brighter futures in cities eager to find trained, bilingual officers.
An analysis by El Nuevo Día of the Governor’s proposed budget last month after agreement with the PROMESA Board, which focuses on the General Fund determined that the Board made sure to increase its own budget by 7.8%, plus another 3.7% to pay lawyers working in Title III cases, even as it cut FAFAA’s by nearly 10%. The Board met its part of its agreement with the Governor by not touching the Legislature’s budget, authorizing $ 50 million to municipios, and approving $25 million for the University of Puerto Rico (UPR) scholarship fund. However, the Board cut the Budget of the Health Insurance Administration by 41%, and cut the Office of Community Planning and Development by 21%, the State Commission on Elections by nearly 12%; the Police by 4%–and, of all places, the Fire Department by 11%, and the State Agency for Emergency and Disaster Management by 14%–mayhap an ill omen as the new hurricane season has already commenced.