COMMONWEALTH OF PUERTO RICO DEPARTMENT OF HEALTH GUIL-L.ERMO ARBONA
M.D.
SECRETARY
I1^ PLAN OF HOSPITAL IPUBLIO HEALTH AND 1
MEDICAL FACILITIES
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ELEVENTH ANNUAL REVISION
HOSPITAL SURVEY AND CONSTRUCTION BUREAU
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oipartmertt of hea-l't^ CPnstructlon^_ u public health
Plan of hospitals. P
and medical facilities lor
P. R. Department of
Hospital survey and constrvo bvreau.
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Pita of ho.pitols."^^® tad »dioal f.ciUtios for P.K-
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COMMOmTEALTH OF PUERTO RICO
1
DEPARTMENT OF HEALTH
GUILLERMO ARBONA, M. D. Secretary
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PIAN of"HOSPITALS, PUBLIC HEALTH
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AND MEDICAL FACILITIES FOR PUERTO RICO
p1 PropJedod
Ofjeinq Gobof N§@©siaoo dcl
Hospital Survey and Construction Bureau San Juan, P. R, 1959
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May 15, 1959 Puerto Rico
STATE
PLAN
Table of Contents
Page
Staff of the Bureau of Hospital Survey and Construction
2
Enreword
3
Puerto Rico Hospital Plan
5
Introduction
5
Federal Certification Sheet (Form PHS-708)
7
Authority of State Agency
9
Designation of State Advisory Board
11
Hospital Beds and Medical Facilities Needed in Puerto Rico
13
According to Public Health Service Regulations
Construction Program
I5
Introduction
I5
Puerto Rico Medical Center
I5
Projects under Hill-Burton Program
22
Development of Hospital and Medical Facilities Construction
29
Program
1 1
1
Chapter 1
•-
General Hospitals
Chapter 2
•-
Tuberculosis Hospitals
Chapter 3
•-
Mental Hospitals
Chapter k
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Chronic Disease Hospitals
Chapter 5
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Public Health Centers
Chapter 6
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Nursing Homes
Chapter 7
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Diagnostic or Treatment Centers
Chapter 8
.
Rehabilitation Facilities
Methods of Administration
31
59
67 73 -77
87 93 111
119
Minimum Standards of Maintenance and Operation Fair Hearing Procedures
3_25 127
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STAFF OF THE BUEEAU OF HOSPITAL SURVEY AMD CONSTRUCTION
Rafael A. Cruz Ginorlo
Director
Osvaldo A. Rivera
Assistant Director
Paul Bauer
Architect IV
Luis R. Arias
Architectural Draftsman IV
Anionio Marlinez Caslro
Civil Engineer V
Amilcar Velez
Executive Officer II
Luis S. Matos
Hospital Inspector I
Angela D. Gutierrez
Hospital Inspector I
Samuel Hernandez
Hospital Inspector I
Jose A. Delfaus
Accountant I
Carmen R. s. Perez
Statistician II
Panchita Q. de Agostini
Clerk Stenographer III
Maria Teresa Gutierrez
Clerk Stenographer II
Migdalia Morales
Clerk Stenographer I
Carmen M. Gonzalez
Clerk Stenographer I
Gloria Ferreira Frcntera
Clerk Typist II
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FOREWORD
The Hospital Survey and Construction Act requires the revision of the
Puerto Rico Hospital Plan every year. This revision should reflect the changes heing effected during the current period. The Plan, besides fulfilling these requirements, also serves as a source of material upon which local agencies and individuals may rely for basic information relative to the needs for public health and medical facilities.
The aim of the Plan is not only to provide for the necessary hospital, medical and public health facilities in our Commonwealth, but also to insure proper integration of preventive and curative medicine as well as the coordi
nation of activities among all categories covered by the Plan.
Herewith is presented the Eleventh Revision of the Plan of Hospital, Public Health and Medical Facilities in Puerto Rico. At this time, I want to emphasize the fact that this revised Plan is still not the ultimate word
in plans for the future. Research in regionalization activities and in medical care practices and financing are under way. I am very hcpeful that the Twelfth Revision of this Plan will present an up-to date program that will reflect a more realistic analysis of needs for our Commonwealth as a result of the studies now being conducted.
For the time being, I hope that this Eleventh Revision will serve as a guide in meeting our immediate needs and in the further development of health
facilities for the care of our people.
Gui.llermo Arbona, M. D. Secretary of Health
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PUERTO RICO HOSPITAL PLAN INTRODUCTION
I- Origin of the Hospital Plan
The Hospital Plan had its origin in 19^6 when legislation was intro duced in Congress^ knoim as the "Hill-Burton Bill" which became the "Hospi tal Survey and Construction Act", Public Law 725 of fho
]
In
195^ an important amendment was made to this Act which became Law k82 of the 83rd Congress.
]
Congress.
The purpose of these Acts was to assist the states in survey
ing their needs for additional hospital and health facilities and to grant federal funds to aid in the construction of hospitals and related facilities.
] ]
Both Acts designated the United States Public Health Service as the adminis
trative agency and granted the Surgeon General authority to establish regu lations and standards within the limitation of the Acts.
]
To complement the Federal Acts, the Puerto Rico Legislature passed two
laws, No. 50 in 15^4-7, known as the "Hospital Survey and Construction Law"
3
01
with an intent comparable to Public Law 725;; and No. 85 in 195^ "to administer the expanded program provided for by Public Law ^4-82.
The Department of Health
through the Bureau of Hospital Survey and Construction was designated as the sole agency vested with authority to carry out the surveying, planning and administration of the construction program. 11- Purpose and Scope of the Plan
The Puerto Rico Hospital Plan reflects a long range program to encourage
the development of adequate public health and medical facilities and services for the care of all the citizens of the Commonwealth.
The Plan includes not
only a proposed construction program for new facilities but also a program
to increase the adequacy of existing physical plants by remodeling and ex-
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!!: pansion.
The Plan provides a priority system for the orderly processing of
applications. It also coordinates the organization and operation of all medical facilities and services so as to promote their most effective and economical use.
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i DEPARTMENT OF HEALTH, EDUCATION AND WELFARE
PHS-708 (he)
public HEALTH SERVICE Washington 25, D. C.
ANNUAL REVISION OF STATE PLAN
A.
DESIGNATION OF STATE AGENCY
1. The name of the State Agency and the administrative unit responsible for administering the State Plan. DEPARTMENT OF HEALTH OF THE COMMOmffiALTH OF PUERTO RICO Bureau of Hospital Survey and Construction
2. There has been no change in the organization of the State Agency since the existing State Plan was approved. B.
AUTHORITY OF THE STATE AGENCY
No change has occurred in the authority of the State Agency to carry out the provisions of the State Plan. C.
DESIGNATION OF STATE ADVISORY BOARD
A change has occurred in the membership of the Hospital Advisory Board. See statement attached.
D.
DEVELOPMENT OF THE CONSTRUCTION PROGRAM
Attached are new Forms PHS-5; 5-I; 5-2; 5-3; 10; 10-1; 10-2; 11; 11-3 and 12, to replace the existing forms included in the State Plan. Form
PHS-8 is not submitted as no facilities are planned for separate popu lation groups in the State. Maps are included as needed. E.
RELATIVE NEED DETERMINATIONS
Submitted is new Form PHS-I3 with supplemental data to replace the form approved in the existing State Plan. F.
METHODS OF ADMINISTRATION
Statements are attached which cover the Methods of Administration, as revised.
1 hereby certify that the above statements and attached statements, charts, maps and tables are true and correct to the best of my knowledge and belief
and are an accurate presentation of the revised State Plan adopted by the State Agency. f
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Guiliermo Arbona, • M. D»^ Secretary of Health May 15, 1959 - 7
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AUTHORITY OF STATE AGENCY
The State /.gency designated and responsible for administering the State Plan for Puerto Rico is the
] DEPARTMENT OF HEALTH OF PUERTO RICO
as authorized by Act No. 50, approved May 7,
No changes have been made in the authority of the Department of Health to carry out the provision of the State Plan.
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fl MEMBERS OF HOSPITAL ADVISORY BOARD
(Created by Puerto Rico Law #50 of May 1, 19^7)
Secretary of Health
Guillermo Arbona, M. D.
Chairman of the Board
Santurce, Puerto Rico Director of Bureau of
Eduardo Rivera _£JS
Public Works Program Planning Board-Santurce
(Four-year term: 1959-1963) Secretary of Public Works Santurce, Puerto Rico
Roberto Sanchez Vilella
(Four-year term: 1957-1961) Director of Medical Services,
Jose Chaves Estrada, M.D.
Veterans Administration
Member, Puerto Rico Hospital
1
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Council - San Juan, P. R.
(Four-year term: 1957-1961) Secretary of Labor San Juan, Puerto Rico
Fernando Sierra Eerdecia *
(Four-year term: 1958-1962) President, Victor Braegger, Inc.
victor Braegger
Insurance - San Juan, P. R.
(Four-year term: 1958-I962) Partner of Bermudez and Bermudez
Jorge Bermudez
Real State Brothers
Santurce, Puerto Rico
(Four-year term: 1958-1962) Agricultural Extension Service
Antonio Perez Garcia
University of Puerto Rico
(Four-year term: 1958-1962) Instructor in Public Health Nursing, Santurce, P. R.
Ana Falcon, R.N.
(Four-year term: I958-I962) * Represents rehabilitation interests. The Division of Vocational Rehabilitation of the Department of Education will also provide consultation services.
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COMMONWEALTH OF PUERTO RICO DEPARTMENT OF HEALTH
Bureau of Hospital Survey and Construction
HOSPITAL BEDS AND MEDICAL FACILITIES NEEDED IN PUERTO RICO ACCORDING TO PUBLIC HEALTH SERVICE REGULATIONS
HOSPITAL tiEDICAL
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Available at
1 1 1 1
1
BEDS
OR
FACILITIES
Required*
Percent Needed
Present
General Hospital Beds
5,521
10,377
V^,856 *
53.2
Tuberculosis Beds
2,519
3,719
1,200
67.7
Psychiatric Beds
3,151
11,530
8,379
27.3
Chronic Disease Beds
386
4,612
4,226
8.4
Public Health Units
49
77
28
64.6
Nursing Home Beds
117
2,306
2,189
5.1
Diagnostic and Treatment Centers
100
231
131
43.3
2
8
6
25.0
Rehabilitation Facilities
1
1
*
of
Need Met
According to Public Health Service Puerto Rico should have: 4.5 beds per 1,000 population for general hospitals. 1.5 time the average number of active and probably active new cases of tuberculosis, 2 year period 1956-1957, for tuberculosis. 5 beds per 1,000 population for psychiatric. 2 beds per 1,000 population for chronic disease. One health unit per 30,000 population. One bed per 1,000 population for nursing homes. One diagnostic and treatment center per 10,000 population. One rehabilitation facility per 300,000 population.
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PSYCHIATRIC
I TOTAL BEDS NEEDED
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GENERAL
TUBEROULOSIS
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CHRONIC DISEASE
HOSPITAL BEDS NEEDED IN PUERTO RICO ACCORDING TO PUBLIC HEALTH SERVICE REGULATIONS
^SSSSa EXISTING ACCEPTABLES BEDS
LE8EN0:
0-
1,000-
2,000-
5,000-
4,000-
5,000-
6,000-
7,000-
8,000-
9,000-
10,000-
11,000-
12,00.0-
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NURSING HOMES
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LEGEND;
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MEDICAL FACILITIES NEEDED
EXISTING MEDICAL FACILITIES
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PUBLIC HEALTH SERVICE REGULATIONS
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MEDICAL FACILITIES NEEDED IN PUERTO RICO ACCORDING TO
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CONSTRUCTION PRCGRAM
Introduction:
There are two factors which warrant special consideration in planning hospital construction in the future. Attention must first he given to the
anticipated demographic changes^ including the size of the population^ its sex and age composition and its geographic distribution. No less important
is the need to consider the modernization and expansion of existing hospitals^ health centers and related medical facilities.
Many of the existing health centers, a recent evaluation has indicated, possess inherent physical limitations which constitute a functional handicap in the provision of services. Rising standards of hospital care and changes in medical techniques have created a need for now and different types of fa cilities and equipment.
Greater emphasis must be given to the remodeling and
expansion of these facilities in keeping with the new hospital trends.
1 Puerto Rico Medical Center
Within the overall construction program, a project for the creation of a Medical Center j.s under way.
The actual site of the existing State Psychi
atric and Tuberculosis Hospitals at Rxo Piedras has been chosen as the lo cation for this project.
The establishment of a Medical Center in San Juan has been ccnsiuered sinco
19^5- Shortly after World War II, the Puerto Rico Planning Board developed a
prei-iminary plan for an integrated hospital and public health facilities program for the Island which included a medical center to be established on the
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grounds of the University of Puerto Rico.
This original project contemplated
the grouping at one site of several hospital and public health facilities as
well as a school of medicine; however, no consideration was given to the pro
vision of centralized supporting services, and the problem of coordinating services was left to be accomplished by the administrators in the operation of the separate institutions.
Wo definitive action was taken on this project.
Between 19l).8 and I953 two important developments occurred which has a
direct influence on the present project. The first Plan of Hospital and Public
Health Facilities for Puerto Rico, prepared in compliance with the Hill Burton Act, was approved in 19^8. In this Plan and in subsequent revisions regional service areas have been identified and provision has been made for the develop
ment of an integrated hospital system consisting of tealth centers at the com
munity level reinforced by regional hospitals. As now planned, there will
I
be a base hospital in the region of San Juan which will not only serve for the training of medical students and medical specialists but will also exert
a decisive influence upon the practice of medicine in the entire hospital
system. The health centers, as conceived in the Plan, provide facilities for
the provision of curative, preventive and social services under one roof. In 1953 a study of the regionalization of the area served by the Bayamdn District Hospital was initiated. This study directed attention to the dupli
cation of effort in what this appeared the likely development of two medical N
centers in San Juan, one at the University of Puerto Rico and another at the Alejandro Ruiz Soler Sanatorium and the Psychiatric Hospital site where an y . investment of over $12,700,000 was being made to expand and remodel the Tu
berculosis Hospital (1600 beds) and the Psychiatric Hospital (2,000 beds).
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In rapid succession the Department of Health Initiated negotiations and achieved agreements with the various agencies sponsoring the construction of
those public and community facilities which were potential components of a consolidated Medical Center.
The Planning Board and other governmental agencies
concerned approved the idea and a Provisional Board was formed by the heads of
those agencies.
An action committee ' undertook
the task of laying the ground
work for this project and appointed 21 sub-committees composed of local leaders in the various fields of health to study and make recommendations relating to their areas of specialization.
The work of these sub-committees formed the
basis for subsequent planning.
The Project of the Medical Center of Puerto Rico was formally sanctioned 1
by the Commonwealth with the passage of Law Number 5^ on June 14, 1957-
1
This
Law creates the Provisional Board of the Puerto Rico Medical Center and author izes it to plan and construct the Medical Center.
During the preliminary studies and discussions by the participating
agencies, the purposes of establishing the Medical Center of Puerto Rico were defined as folJLows:
1. To develop a Medical Center planned and designed according to the needs of Puerto Rico so as to foster health care to the best interest of the entire population.
2. To contribute through this Medical Center to the progress and develop ment of medicine in Puerto Rico and in other areas of the world. 3. To prevent costly duplication of facilities and to enable better utilization of professional personnel and administrative talent. The basic objectives of the Medical Center have been defined as follows:
1. To integrate and coordinate medical and hospital services through the use of uniform standards and coordinated procedures.
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I 2. To provide an appropriate atmosphere for the education of all categories of personnel concerned with the provision of health services. 3. To encourage clinical investigation and research, as well as research in the organization and administration of medical and hospital care.
ORGANIZATION
The agencies participating in the Medical Center Project are the follow
ing:
c:
the Commonwealth Department of Health, the University of Puerto Rico,
the Government of the Capital of Puerto Rico, the State Insurance Fund, and
the Puerto Rico League Against Cancer. By invitation of the Medical Center
Board, the Vocational Rehahilitation Board is sponsoring the construction of
a Comprehensive Community Rehabilitation Center. ELEMENT
Dr. I. Gonzalez Martinez
BEDS
SPONSOR
100
Puerto Rico Le a gue Against Cancer
San Juan City Hospital
6OO
Government of the Capital of P. R.
Industrial Hospital Base District Hospital
300 450
Pediatric Tuberculosis Hospital
200
State Department of Health
Psychiatric Hospital Rfo Piedras Health Center
2OOO
State Department of Health
Long Term Diseases Hospital
200
Rehabilitation center
60
Oncologic Hospital
State Insurance Fund
State Department of Health
State Department of Health
School of Nursing (300 students)
State Department of Health State Board of Vocational Education
State Department of Health
School of Medical Sciences University of Puerto Rico
Atomic Energy Commission (through the University of Puerto Rico)
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ELEMENT
BEDS
Facilities for the Central Services: Nursing Home
SPONSOR
Medical Center Board
2h0
Central Building Employees Cafeteria
Laundry and Power Plant
Warehouse, Garages and Main tenance facilities
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Housing Facilities
The University of Puerto Rico is planning the construction of a Medical
Sciences Building as part of the Medical Center for the schools of medicine, dentistry, public health and nursing. The members of the Provisional Board of the Medical Center are the heads
of the participating agencies, with the Secretary of Health serving as exofficio Chairman. The Chairman of the Puerto Rico Planning Board is also a member of the Board.
The Board has an administrative staff and is assisted
by an Advisory Committee composed of executives of the institutions which will
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constmcfc nsw fOiCiliijiss in "ths MGdicsl C©n"fcGX*«
Detailed studies and discussions have been undertaken concerning all ,1 services were thought susceptible to integration or close coordination. The I
services and activities which have been unanimously approved for centralization y are the following:
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1. Laundry
l8. Emergency Services
2. Power Plant
19- Dental Services
3. Maintenance
20. Operating Rooms
4. Textile Center
21. Employees Health Service
5. Storage
22. Premature Center
6. Garages
23. X-Rays (Diagnostic)
7. Telephone Switchboard
2k. Laboratory ~ 19 -
^
I 8. Animal House
25• Electroencephalograph
9* Central Kitchen
26. Physiotherapy
10. Cafeteria
27. Occupational Therapy
11. Purchases
28. Blood Bank
12. Pharmacy
29. Medical Social Services
(For Outpatient Department only) 13• Central Sterile Supply
30. Radiotherapy
lif. Library
31. Autopsy Rooms
15. Admitting Procedures
32. Forensic Institute
16. Medical Records
33. Nursing Home
17• Outpatient Department The services of the firm of Isadore and Zachary Rosenfield were engaged
early in 1957 for the development of a master plan of the physical development
/- of the Center. The original concept developed by the Master Planner of a central
^ core containing those services to he used in common by the main hospitals has /
/ endured all studies, discussions and criticism with only minor modification.
;
A central building is being planned which will contain most of the supporting
\ ^^^services which the Board has decided to integrate.
(
Before the preliminary master plan was approved, it was subjected to an independent evaluation by distinguished members from the staff of the Department
^_of City and Regional Planning, Graduate School of Design of Harvard University. A study is being conducted to determine the plan of organization and management of the Medical Center. This study will provide basic reccmmendations
for the organization of the Medical Center as a whole, for the management of the centralized services, and for the relationships between the participating agencies of the Medical Center and their parent organizations. This study is expected to be completed by August of this year and it will serve as the basis
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for enabling legislation for the organization and operation of the Medical Center.
In a project of the magnitude of the Medical Center, the provision of
construction and operating capital may appear to present a very difficult problem for a country of limited resources.
However, the creation of the
Medical Center per se does not involve the provision of a single additional
high cost institution in the immediate future, but rather involves grouping together in one site a closely related set of facilities which were being plan ned for construction at different sites and for which financial programs were
already developed or were well advanced, with the exception of the Medical Sciences Building.
The construction of the Medical Center will be financed
by the participating agencies.
Hill-Burton funds are being allotted for all
central facilities and this has been a great help. The t..tl-; on page 26 show the total estimated cost of each facility and
the source of funds to be used. According to this preliminary program, it is
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hope that all of the elements of the Medical Center will be constructed in the
course of the next five years, with the possible exception of the Medical
Sciences Building, the long term diseases hospital and part of the residential section.
All the projects of the Medical Center have received the necessary approvals.
Full or substantial appropriations have been already approved for several of the more important projects and for most of the rest, initial appropriations have been made.
Architectural services have already been contracted for all
elements of the Center, with the exception of the Health Center, the Long Term Diseases Hospital, the Residential Section and the School of Nursing.
Con
struction is scheduled to start on the Cancer Hospital before the end of 1959y
Construction of the Atomic Energy Commission Building and the Power Plant and
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Laundry is also to be started before the end of this year.
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Projects Under the Hill-Burton Program
Since the approval of the original State Plan on May 19^8^ the following projects have been included in the construction program;
Hospital Beds
Status
1. Aguada
20
Approved for construction
2. Aguas Buenas
20
Approved for construction
3• Bayamdn
6h
Operating
Camuy
22
Operating
5• Catano
22
Operating
6. Cayey
k-2
Operating
7. Ceiba
20
Approved for construction
8. Cidra
22
Operating
9• Coamo
26
Operating
10. Comerxo
22
Operating
11. Guayama
6k.
Operating
12. Guayanilla
20
Approved for construction
13. Guaynabo
22
Operating
1^1-. Hatillo
20
Approved for construction
/ 15. Hormigueros
12
Operating
Health Centers
16. Humacao
I
s
Operating
17• Isabela
*
Operating
18. Lajas
20
Approved for construction
19. Mcca
22
Operating
20. Patilias
22
Operating
21. Pehuelas
20
Approved for construction
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22. Qaebradillas
2.^
23• Rincdn i/
Approved for construction
*
Operating
2h. San Germ&
h2
Operating
25. Toa Alta
22
Under construction
26. Toa Baja
22
Operating
27• Utuado
5^
Operating
28. Vega Baja
26
Operating
TOTAL
* Federal, aid for equipment onlyMunicipal Hospitals:
I
Additions and Alterations
1. Vieques
21
Operating
2. Yauco
kl ^
Operating
TOTAL
62
Ponce Hospital Center:
1. General District Hospital
Operating
2. School of Nursing 200 students
Operating
3. Central Facilities
Operating
Psychiatric Hospital
TOTAL
706
Approved for construction
Il40
Rio Piedras Hospital Center: 1. Tuberculosis Hospital
800
Operating
2. Psychiatric Hospital
1650
Operating
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i Psychiatric Hospital
350
3• Central Facilities
Under construction Under construction
c
2800
TOTAL
Projects in Non-Profit Hospitals:
1. Bellavista Hospital, Mayaguez
82
Operating
2. Mennonite Hospital, Aihonito
30
Operating
E-
3« School for Practical Nurses-
50 students at Ryder Memorial Hospital, Humacao
Presbyterian Hospital, San Juan (additions and improvements)
Operating
i: 60
Operating
5. Dr. I. Gonzalez Martfnez San Juan
100
Approved for construction
97
Approved for construction
6. La Concepcidn General Hospital, San German
7• Teachers' Hospital
120
Under construction
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489
TOTAL
Public Health Units; 1. Arecibo
Under construction
2. Bayamdn
Approved for construction
3. Mayaguez
Operating
Nursing Homes;
1. Sociedad Auxilio Mutuo
10
Under construction
2. Rosario Bellber, Aibonito
34
Under construction
44
TOTAL
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Diagnostic and Treatment Centers:
1. At Eyder Memorial General Hospital
Under construction
2. Borinquen Dispensary, Operating
San Juan
3. Puerta de Tierra Dispensary Approved for construction
San Juan
Rehabilitation Facilities:
Approved for construction
1. At Ponce Hospital Center
2. At the Medical Center,
Approved for construction
Rfo Piedras
Total Beds with Federal Aid
-
5277
-
36l4
Approved or under construction
1663
Operating
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272,000
FINANCIAL
3,678,000 118,000 18,000
2,000,000
587,000
($)
Reserved
To Be
Funds
100,000
733,000 300,000
200,000
1,773,000
3,946,000
($)
Appropriated
State
SITUATION
^
1,933,000 29,000 3,000 263,000 1,278,000 122,000
730,000
9,000
($)
Appropriated
To Be
Funds
1,562,000 150,000
846,000 412,000 2,419,000 29,000 6,000
($)
Funds
Other
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Dental Services, Blood Bank, Physiotherapy, Occupational Therapy, Central Sterile Supply, Morgue and Autopsy Room ,and Administrative Officer.
Medicine,
Employees Cafeteria, Outpatient Service, Emergency Service,
725,000
2,290,000
3,582,000
3,399,000
($)
Reserved
Federal
Diagnostic X-Ray, Laboratories, Medical Records, Pharmacy, Operating Suites, Institute of Forensic
Central Building will house the tcllowing services.
Recreational Facilities
Nursing School (300 students) Housing Facilities
2,840,000
Central Warehouse
Garages
176,000 27,000 1,088,000
796,000
5,355,000
7,345,000
($)
Total Cost
3,576,000 3,435,000 8,330,000
450
2,000
Capacity
Site Improvement and Utilities Laundry and Power Plant Central Building 1/
Facilities to be Established Central Facilities
General Hospital
Cost of conversion to a
Original Cost
Tuberculosis Hospital
Psychiatric Hospital
Existing Facilities
PROJECT
Bed
MEDICAL CENTER
FACILITIES TO BE INCLUDED IN THE PUERTO RICO
600 300
San Juan City Hospital
State Insurance Fund Industrie Hospital Dr. I. Gonzalez Martinez
_TO_TAL-
School of Medicine Sciences
te Atomic Energy Commission
Bio Medical Research Institu
Health
Central Offices - Dept. of
Other Facilities
4,010
100
200
Oncologlc Hospital
240
Chronic Diseases
60
Nursing Home
60.
Rehabilitation Center
(Cont.)
Capacity
Health Center, Rfo Pledras
Medical Facilities
Facilities to be Established
PROJECT
Bed
Federal
80,000 209,000 75,000 333,000
AP-ptopglated ($)
T- Be
Funds
133,000
($)
Funds
Other
2
54,483,000
10,955,000
479,000
1,500,000
27 -
11,213,000
9,164.000
1,000,000
7.102.000
__5ji564.0oo
500,000
lQ,48j,.000.
479,000
609,000
50,000
($)
Appropriated
State
of
1,826,000
262,000 418,000 416,000 667,000
($)
Reserved
To Be
Funds
SITUATION
2
2,538,000 1,302,000 1,217,000
($)
Reserved
FINANCIAL
1. Page
392,000 627,000 624,000 1,000,000 2,538,000 1,302,000
($)
Total Cost
MEDICAL CENTER
FACILITIES TO BE INCLUDED IN THE PUERTO RICO
!^3
[
t
£
\
t
' "rf
*.
• ■
't
I.
V 't
■ jfMllllli'n'ilTr-ITi'll'"' ■
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Q I
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DEVELOPMENT OF HOSPITAL AND MEDICAL facilities CONSTEUCTICN PRCORAM
f
- 29 -
a
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1^
a I'
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ll
Q CHAPTER
1
1
GENERAL HOSPITAL CONSTRUCTION PRCGRAM
J Introduction:
In this part of the Plan, the main objective is to provide a uniform
distribution of general hospital beds in such a way that they will be reason
ably available to all the people in the Commonwealth and will function as part of an integrated hospital system.
A General Hospital" is defined as "any hospital for in-patient medical or surgical care of acute illness or injury and for obstetrics
"
The Plan allows for general hospital beds in each municipality- The long range program aims at the provision of a public health center with a general hospital unit in each municipality. The hospital unit of the health center shall provide hospitalization for the not critically ill patients. Those criti
cally ill are to be referred to the District Hospital, referred to elsewhere in this Plan as an intermediate hospital. Due to the rapid changes occurring in the Commonwealth as a result of the
transition from an agricultural to an industrialized economy, it is difficult to predict the consequences of many developments now under way. Only by con
tinuing investigation can an up-to-date plan be prepared. At this time a study is being conducted to determine the optimum distribution of the Commonwealth
services areas, with the ultimate goal of establishing a medical center in each large metropolitan area.
Each area is to be properly coordinated and will
probably serve as the center of regionalized activities. We are not as yet
ready to report on the situation on an islandwide basis. However, the pilot
study started three years ago in the Eayamdn area is proving successful and
should serve as a valuable guide and laboratory for extending the experiences
- 31 -
J
I attained there to the rest of the Island.
I WHAT IS KEGIONAUZATION?
The overall objective of the Regional Project being implemented in the
1
Bayamdn area is the coordination of health activities and facilities so that the people in the region will he able to secure the best possible type of service that can be obtained with available resources. The term Regional-
ization is used to denote the form of organization resulting from the coordi nation of all services for curative medicine, preventive medicine, public
health and social service within a given geographic area into a single system. Regionalization, as it has been developed in Puerto Rico, starts with
community health and welfare centers which are linked operationally to a Central
or District Hospital, the latter in turn being related to a school of medicine as well as schools for associated professional specialties. A key measure in improving and upgrading the quality of the services rendered at the local level is the integration of the health and welfare facilities into a unified system.
No less important is the administrative, organizational and functional coordinatxon which this step implies.
The Regionalization organization also facilitates a greater emphasis upon "til©
* con"hinuing education and training of all medical and paramedical personnel.
The structure evolving in the region is proving highly conducive to this end. less important objective of the program is the development of a community echnical conciousness regarding health care methods. It is the aim to foster recommendation that the local health personnel exist to meet the expressed
of the community. This implies community involvement in the determination eeds as well as the measures undertaken to meet them.
through these means that the quality of service is being improved
32 -
i iMW'iVi ' " ^
V
0 1
within the region. Regionalization also makes possible the avoidance of con
siderable duplication of personnel and facilities, and through the joint use of specialized services, it insures that the benefits from health and welfare expenditures will be maximized.
n
Another survey which is under way involves a comprehensive investigation of the financing, personnel, and facilities for medical care in Puerto Rico
as authorized in Joint Resolution No. 29 approved June l^i-, 1957*
This study
is being carried out by the Department of Health under contract with the School of Public Health and Administrative Medicine of Columbia University, for the
provision of technical supervision.
Concern in this study is being directed to the medical care needed as well as received by all of the people of Puerto Rico, with the education, opportuni ties and standards of practice of all of the physicians, as well as the availa
bility, organization, administration and standards of all of the hospital servicesj
and with the total medical care expenditures, financial resources, and policies affecting the financing of medical care. A- Inventory of All Hospital Facilities:
On June 195^^ a qualitative inventory of the existing general hospitals
in Puerto Rico was prepared and checked against the Licensing Register of this Bureau. According to Federal Regulations, the following hospitals have been excluded from this inventory: 1. Federal hospitals
2. Institutions furnishing primarily domiciliary care 3. Institutions which do not provide a community service
Data regarding bed capacity, bed complement, patient days, and patients
admitted in each institution were compiled from the quarterly questionnaires submitted by each hospital during the fiscal year 1957-58.
'fl
33 -
i B- Classification of Hospital Beds:
The beds reported by each hospital were classified as acceptable or non-
acceptable as required by the Public Health Regulations.
The criteria used
in the classification of beds as non-acceptable were the following: 1. Beds in a frame or otherwise non-fire resistive construction found
to be a public hazard or unfit for patients occupancy.
2. Beds in a structure not originally designed for a hospital which has not been properly converted for such use.
3- Beds in buildings either too small or too old, the enlargement or restoration of which was not considered economically sound.
il-. Beds in hospitals which have been found uneconomical to operate due to the inadequacy of their physical plant.
On a point system totalling ICQ, the hospitals are evaluated as to site,
type of construction, arrangement and disposition of facilities within the building, sanitation and fire-resistiveness. All hospitals scoring less than 75 points are reevaluated before being listed them as non-acceptable. This classification is not to be construed as reflecting in any way on
the medical care or treatment program rendered by the hospitals. It is un-
questionally true that some non-acceptable hospitals as listed in this Plan, provide excellent patient care even though the physical plants constitute a public hazard.
For the purpose of the inventory of total existing facilities (Forms P.H.S.-5, 5-1, 5-2, 5-3
non-acceptable beds and unsuitable medical facilities
are not considered as existing facilities.
4
C- Hospital Service Areas:
Under the regulations of the United States Public Health Service, the
State Agency is required to divide the Commonwealth into hospital service
- 34 -
n areas and to designate each area as either (a) base, (b) intermediate or (c) rural.
For purpose of this Plan and for the determination of relative
r
\
need for hospital beds and medical facilities, seven service areas were desig nated in Puerto Rico, one base area and six intermediate areas.
In dividing the Island into hospital service areas, the State Agency has
taken in consideration factors such as:
(l) size of territory, topography and
climate; (2) population distribution; (3) transportation and trade patterns; (4) travel distance from population centers to existing hospitals; (5) social, economic and political factors; (6) and the experience gained by the Department of Health in rendering all types of health and hospital services.
Puerto Rico is an island of about 3,i^35 square miles with an average popu
lation density of 67O persons per square mile.
Because of the small size of
the island, its fairly food) system of roads, the density of population and the manner in which dwellings are located, the island was conceived as only one region with a base area, San J\ian and six intermediate areas - Arecibo, Ponce,
Caguas, Mayaguez, Fajardo and Aguadilla.
The existence of a general hospital (District Hospital), originally designed for 300 beds and constructed before the approval of the Hill-Burton Act at Aguadilla and Fajardo constitutes the main consideration dictating the desig nation of these two intermediate areas.
It seems logical to envision at this time three base areas or regions in
the future.
Major metropolitan areas are developing quite rapidly in Ponce and
Mayaguez, in addition to San Juan. A concentration of population and an increase in industrial, commercial and cultural activities in or around these cities are essential factors in
identifying these centers.
■f]
Important institutions of higher learning are also
- 35 -
1 developing rapidly in each of these localities. Hospitals, affiliated to these,
I
are progressively endeavoring to offer the patients care of the highest quality.
I
D- Designation of Service Areas:
After the areas were defined, an estimate of the population of each area was made.
The computation of population is based on the latest estimate of
civilian population of the island as made by the U. S. Bureau of the Census.
Inasmuch as no corresponding breakdown by municipalities was available, the municj.pal totals were based upon estimates made by the Bureau of Demographic Regis:^ry and Statistics of the Department of Health for midyear 1956. These estimates were weighted by the proportional difference shown by the U.S. Bureau of the
Census figure, so as to bring the local estimates into agreement with the 1950
I
census. Population by municipalities was rounded to the nearest hundred.
When the areas and the total state population figures were satisfactorily
,
adjusted, the areas were designated as base or intermediate according to the following definitions:
J:
Base Area - Any area which is so designated by the State Agency and has the following characteristics: (l) Irrespective of the population of the area, it shall contain a teaching hospital of a medical school; this hospital must be suitable for use as a base hospital in a coordinated hospital system within the
state; or (2) the area has a total population of at least 100,000 and contains at least one general hospital which has a complement of 200 or more beds for general use. This hospital must furnish internships and residencies in two
or more specialties and must be suitable for use as a base hospital in a coordi nated hospital system within the state.
Intermediate Area - Any area so designated by the State Agency which: (l) Has a total population of at least 25,000 and (2) contains at least one general
- 36
V
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CLALes -.MoKOfm
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ICUKABO
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SCALE not
4
4
MUNICIPAL BOUNDARIES
C
INTERMEDIATE AREAS
BASE AREA
MAUNABO
NUMACAQa
[las riEOEAS'
AREA HOSPITAL CENTERS □
;•••. PAT/LLAS
>.
; C WAYAAfA
/SIA,ISABEL SALINAS :
•^ AlBONtTp
. -1
CiDKA9
t2IO,6CX)*
HOSPITAL COMMUNITIES
r 507,900-
ACOAS !
BUeNAS/ 9 :
•IFAJARDO 135,300
; LUQUILLO.
I CAEOLJNA^^io CKANO'e RUJILLO
:ALro
icoMenj^ ..■••.s.-CAGUAS"~\'^''*'^^°®
NAEANJJTO
N
PleDI!A&//yyvcAVOVANAS
UATNASO:
BAYAMON
TOA ALTA
TOA OAJA
SAN JUAN 775,400
BAKKANQUITAS/J^'"
1/ YtQA t,vcoA iMANATI /YECA LVSCA
PBMi/eiAszonfdf^p ^ : r U W UC »iJOANA OfAZ I
JAruyA
I
BOUNDARIES OF SERVICE AREAS
Ct/ANfC^
UTUADO
AOJIMTAS
UATILLO
\CUAYAniLLA
^-^KAHDEVfAUCO:
{SAB.
t
CAUUY
LAKES
UARICAO
LAS MAKt^&
CMO •SAsNCEKmu
m.ojo £
%
iQUCBKAOILL
!SEMSr/AN
.. SAN
,yoKMfOi/e/ios
...ANASCO /
"••• : KINCON
MAYAGUEZ 206,000
.X
/SA&ELA
/'mocai:"Q
;•
ACUAOA'.
AGUADILLA 163,600
V
T
ARECIBO 305,000
N
CITIES AND TOWNS WITH EXISTING AND PLANNED GENERAL HOSPITAL BED
GENERAL HOSPITAL SERVICE AREAS AND NAMES AND LOCATIONS OF
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0 hospital which has a complement of 100 or more beds and which would he suitable
1
for use as a district hospital in a coordinated hospital system within the state. 'E- Development of a Coordinate Hospital System:
For the purpose of developing a coordinated hospital system in Puerto Rico, at present the hospital service areas are grouped together into one hospital
region. A region is defined as "a group of two or more areas having hospitals which are or can be closely related for the purposes of cooperative effort to
provide better hospital care." The coordinated hospital system anticipates an interrelated network of general hospitals throughout the island.
The Puerto Rico integrated general hospital system can be classified as follows;
1. The Health Center - render service to not critically ill patients on
both an out-patient end in-iDatient basis.
2. District Hospitals - (intermediate Hospital) An intermediate hospital is able to render a more complete type of service where patients can
receive comprehensive medical care. It possesses the facilities and personnel to perform various specialized types of diagnosis and treatment.
f
However, those patients needing highly specialized services are refer red at present to the base hospital which we want now to call the
I
Regional Hospital.
3. Regional Hospital - The only base (Regional) hospital at present is the
one in Bayamdn. There is a possibility that two other base hospitals
f
will be developed as regional hospitals for the regions served by Ponce
and Mayaguez. (These regional hospitals will be, as the Bayamdn one
I
is at present, the heart of the Commonwealth integrated hospital system). ■ \
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f
- 37 -
They will have all necessary facilities and personnel for complex diagnosis and treatment and for medical and hospital care.
Through its
1
scientific laboratories, highly specialized medical staff and intensive
educational program, we hope that these regional hospitals will be
capable of meeting the health needs of their particular region.
However,
it should be recognized that the Island is small and that transportation
is fairly good; therefore, it is the intention that the present Regional
Hospital, when it moves from Bayamdn to its planned site where it will serve as the initial core of the Medical Center in Rxo Piedras, will
give island-wide services to those very specialized cases referred from all the other public hospitals of the Commonwealth.
The Regional Hospital in San Juan will provide medical and hospital facili
ties for this area and will serve also as a training center for the School of
Medicine of the University of Puerto Rico. It also will exert a decisive influ
ence in raising the quality of medical care rendered by the hospital system throughout the whole island. P- Public Health Service Forms used in this Part of the Plan;
1. Form PHS-5 presents an inventory of the total number of beds in Puerto Rico by hospital, including those approved for construction, with or
without federal aid. As seen in this table, Puerto Rico has 5^573 ac ceptable and 1,592 non-acceptable beds.
A recent reevaluation of the general hospitals has been conducted this
year. As a result of this reevaluation, the following changes have been effected:
A- Hospitals declared as non-acceptable Int. Area I
Arecibo
Municipal
Barceloneta
^9 beds
San Miguel
Utuado
53 beds
- 38 -
n
Q T
Int. Area 2 Ponce
Municipal
Salinas
38 beds
Int. Area ijFajardo
Municipal
San Lorenzo
20 beds
Municipal
Ciales
13 beds
Municipal
Maunabo
11 beds
B- Hospitals declared as acceptable Int. Area 1 Arecibo
Int. Area 2 Ponce
C- The bed capacity of the district hospitals of Bayamon^ Arecibo^ Ponce
Fajardo and Aguadilla were reduced from 300 to 280 beds. In San Juan Base Area two hospitals ceased operations last year (San lldefonso and San Jose). The two hospitals had a total of 73 non-acceptable beds. 2. Form PHS-10 determines by area the total number of existing acceptable beds^ the number of beds to be constructed and the percentage of need met.
In those cases where the provision of additional beds has already
been programmed^ they are assigned to the corresponding municipality. Bed Allowance Based on Area Ratio:
In determining the number of general beds needed for each hospital
service area^ consideration was first given to the number of beds allowed according to the following area ratios stipulated by Federal Regulations: ^.5 beds per 1,000 population for a base area
11
^.0 beds per 1,000 population for an intermediate area Existing Acceptable Beds:
f I -ifi
The number of existing acceptable beds in each municipality is derived from the information presented in Form PHS-5 column 9, Puerto
Rico has now 5^573 acceptable beds in general hospitals. Total Beds Planned:
This column includes the existing acceptable beds and the beds
f 39 -
definitely planned for each municipality as of today.
When the figures in this
column are greater than the figures in column 8^ the total bed need is estimated • to be greater than the number of beds allowed by the area ratio.
For the Base
•Area of San Juan and the Intermediate Areas of Fajardo and Mayaguez, neither
I
||^
the existing acceptable beds nor the beds allowed by the area ratio are esti
mated to be sufficient.
||^
As permitted under federal regulations, beds in excess of the area ratio
r
have been allocated as follows:
No. of Excess Beds Allocated
No. of Beds Planned per 1,000 Population
f
San Juan-Base Area
388
5.O
«-
Fajardo Int. Area
136
5.O
Mayaguez Int. Area
10^1-
it-.5
Total
628
These beds were allocated from the State Pool which is determined as follows:
State allowance at it-.5 beds per 1^,000 population
10;,377
Less area allowance at it-.5 beds per 1,000 population for the base area
1: M
3,it-89
-P
L ss area allowance at i|-.0 beds per 1,000 population for intermediate areas
P, 6,122 -V
state Pool
766
located to Sah Juan, Fajardo and Mayaguez over its area ratio
^ ■
I 628
Beds held in reserve for all the island
I38
^
table on page 41 shows additional beds proposed for construction classified by area and municipality.
I - 40 -
»
Hospital
25
Maunabo Salinas
- 41
•ealth Center Health Center
Juana Dfaz
25 42 14 40
25
Jayuya
25
171
12 25 25
Health Center Health Center Health Center
Health Center Health Center Health Center Health Center
87
170 600 25
Regional Base Hospital Municipal Health Center
300
Industrial Hospital
25
25 30
1175
Number of Beds
Health Center
mii
of
Health Center Health Center Health Center
Name
Aibonito
806
421
2019
For Construction
Gu^nica
PONCE INT. AREA 2
Morovis
Lares
Barceloneta dales
ARECIBO INT. AREA 1
Vega Alta
Carolina Loiza SAN JUAN
Barranquitas
SAN JUAN BASE AREA 1
Area and Municipality
Beds Proposed
Total Additional
ADDITIONAL BEDS PROPCPOSED FOR CONSTRUCTION, BY AREA AND MUNICIPALITY
Bureau of Hospital Survey and Construction
DEPARTMENT OF HEALTH
COMMONWEALTH OF PUERTO RICO
f'• 1
( 'I
1
635
334
844
b/ c/
i/
Flexibility
Area Pool Allowed for
Page
p—1
of
2
E2i!
Number of Beds
256
548
Health Center
Health Center
42
35
35
25
- 42
c/ Sponsored by the Municipal Government of San Juan City, d/ Beds for these Intermediate Areas will be programmed in future revisions.
214
513
403
^
d/
d/
Flexibility
b/ The project is estimate at 450 beds, less 280 no\j being operated at Bayamdn District Hospital.
a/ Sponsored by the State Insular Fund,
San Sebastidn
AGUADILLA INT. AREA 6
Cabo Rojo
MAYAGUEZ INT. AREA 5
San Lorenzo
25 25
Health Center Health Center
150
225
Juncos
Hospital
Health Center
of
Gurabo
Name
Intermediate Hospital
628
For Construction
Caguas
CAGUAS INT. AREA 4
FAJARDO INT. AREA 3
Area and Municipality
Area Pool Allowed for
of
Beds Proposed
Page
Total Additional
Additional Beds Proposed for Construction, by Area and Municipality, Cont.
Q Percent of Need Met
Th.e percent of need met whicli is given for eachi case represents tlie
J
proportion of existing acceptable beds to the total beds planned for the area.
G- Priority System for General Hospitals:
Area priorities for the general category are based on the percentage of
need met by existing acceptable facilities including projects approved or under construction with or without federal aid.
The seven areas in which the island was divided are arranged in order of percentage from the lowest to the highest.
The areas are then classified
into four groups, as required by the Federal Regulations.
The priority groups, designated as A, B, C and D were defined in terms of the following range in the percent of need met. Range of Percent Priority
of Need Met
A
0.1
U4.9
B
45.0
ec.k
C
eC.5
bo.k
D
100.0
Although Caguas Intermediate Area has the first priority for additional general hospital beds, it will not at present be considered for this purpose.
Due to its proximity and accessibility to the planned Medical Center at the San Juan Base Area, it is expected that a further revision will have to be
f
f
made in the boundaries of these two hospital service areas. This change will probably result in a decrease of population for Caguas Intermediate Area.
Therefore, its hospital bed need will be reduced accordingly.
f f
- 43 -
It also has been determined that the real bed need for the Caguas Inter
mediate Area can not be planned wisely until the Medical Center is operating. Because of this, the priority for this area is not being considered until the situation is clarified.
H- Non-Discrimination Requirements;
No application for the construction of a hospital, pubxic health, or medical facility will be approved by the Department of Health under this Plan unless the
applicant includes in his application the following statement:
"The applicant hereby assures the Department of Health, of Puerto Rico that
W
no person in this area will be denied admission as a patient to the faci-
lity un account of race, creed and color."
S:
i:
k I
- 44
iti-'- -itfiit-HWwi I
■ ifliililMliiif'iJ VI
7
Name of Hospital
Ind.
San Antonio
Lofza
22
State
Percent
16
41.2
81.4 72.0 87...3 44.9 71.6 48.6 64.1 35.1
11
Occupancy
0
0
15
80.9 47.5 35.3
Inaugurated August
0
0
0
0
12
0
0
0
17
10
ceptable
Non-Ac
Capacity
2060
4430 1041
"1958
16827 89236 15069 3138 1634 5384 2565 1805
5052
12
Days
Patient
Number
N.P.A.
City Corp,
Teachers'
De la Capital
Santurce
N.P.A. Ind.
Nra.Sra. de Guadalupe
Doctors
Auxilio Mutuo
Ind.
Metropolitan
City
De la Capital
Hate Rey
- 45
87
120 0
139 60
80
140
0
340
0
0
0
0
0
81.6 89.0
89.7 52.3 39.9
96.4
101228 28258
26194 26525 8617
59798
JUAN (Hospitals within the municipality of San Juan are being entered according to postal zone)
State
6
0
12
State
State
22 20
22
State
R£o Piedras
SAN
Naranjito
Dorado
Health Center
City
Municipal
Guaynabo
Corozal
Comerio
Health Center Health Center Health Center Health Center Health Center
Catano State
Municipal
92 0
280
State
Corp, City
64
0
9
able
Accept
Bed
State
City
8
Ownership
Carolina
Hnos, Mellndez
Municipal Health Center District
Barranquitas
Bayamdn
BASE AREA 1 (Area Cente : - San Juan)
6
Area and Municipality
and Hospital Beds
4. Region
10532 4173
. . . c/
1355
3427 b/
3079
7153 b/
550
1077 320
687 585 303
603 a/
1844 3877 6632 1770 1358
Admitted 13
Patients
of
Puerto Rico
Puerto Rico
List of Acceptable and Non-Acceptable
Hospital Facilities
7
3. State
0.
GENERAL
of
2. Date
1
May 15, 1959
1. Page
ACCEPTABLE AND NON-ACCEPTABLE
Washington 25, D.C.
PUBLIC HEALTH SERVICE
FEDERAL SECURITY AGENCY
HOSPITALS REPORT
PHS-5 (HF)
State State State
City
Health Center
Health Center Health Center
Municipal ---
Trujillo Alto
Vega Alta
AREA TOTAL
District El Buen Pastor Dr. Susoni
State
City State
B. Llenza Felid Health Center
Municipal Health Center
Camay
Clales Hatillo
Corp. City
Ind.
City State
Dr. Manuel Figueroa
Barceloneta
ARECIBO
INTERMEDIATE AREA 1 (Area Center - Arecibo)
Toa Baja
Corp.
Dr. Ferraiouli
Ophthalmic Institute
Corp.
San Juan
Dr. Rivera Hemdndez Dr. Pavia
Dr. Pardo
Puerta de Tierra Toa Alta
.
Mimiya Presbyterian
Dr. Se£n
Honteflores
Ind. Ind. Ind. Ind. Ind. N.P.A. Ind. Ind.
22 13 20
0
113^. 280 69 78
565
1858
29 19 0 0 0
0
0 0
0
0 10
0
41 43 0
11 0
0
0
0 0 0 76
22 22 16 0
179 17 26 0 77 192 0 23 41 0 61
10
ceptable
able 9
Hoo-Ac-
Accept
- 46 -
8
7
Pereira Leal Woman'a
Oimerslilp
Name of Hospital
Ind.
6
Area and Municipality
Bed Capacritj
29006 3662 1^1 n&a 19922 31345 1010 1815 27770 12469 14964
12
Oigrs
816 1449
149 449 4672
52.4 33.8
36.8 43.6 87.0
81,0
69.5
—
25,6
55.3
15^
4205 1404
32492 82807 9263 17029 6030
569789
3231 935
'6349 1121 2141 1294 1055 488
4288
—
814 145
b/
3892 e/
748 1729 2300 1706
4007 ^
13
JUhdtted
Patients
of
Feertao Eico
jjpwbcr Patient
7_
IMay 15. 1959 tmectMf Kico
2 pf
Inaiig;inrated October 12, 1958
72,9 55.8 77,5 63,7 70,9 77,4 25,6 21,6 92,8 79,4 67,2
11
OccepaMy
Fercent
Opedt.
3. 4.
ACCEPTABLE AMD NON-ACCEPTABLE hospitals report
5. List of Acceptable and Non-Acceptable GENERAL Bospital Facilitie* and Bm^ital
1. I^i®e 2. ®**®
PHS-5 (HF)
7
Sdnchez Castafio
Health Center
- 47 -
68 26
25 0
State
Ind.
City Corp.
Coamo^ San Josd
South ?. R. Sugar Co Health Center Health Center
13469 0
0
0 0
11
City City
Municipal
Maunabo
Municip,4X
12 44
20
City
Catalina Figueras
Juana Dfaz
70.7 87.3 65.9
2886
2647
14019
5160
4529 57.7
1003 2154 745
314 1121 297 2528 0
492 2689 64
0
State State
24 17
1113 919 436 1437 2540 2111
927 793 1270
2204 978 2280
2586
4945 6170 2337 7300 12700 19111
208105
1582 11204 9651 5118 14447
8151
4722
2297
c/
s/
c/f/
13
12
Days
Patients Admitted
of
Patient
Number
29.5 51.7 46.5
0
56.4 76.8 64.0 62.5 79.1 77.0 69.1
Occupancy
Percent
0
Guayama Guayanilla Jayuya
Gu^nica
Lafayette Health Center
0
44
Coamo
0 0
30
N.p.a.
City Corp.
Mennonite
Municipal
Arroyo
0
22 10
0
City
0
Municipal
24
State
N.P.A.
Castafter
130
0
53 799
0
53
26
Health Center
State Ind.
0
8
0
0
21
10
ceptable
Non-Ac
Aibonito
Adjuntas
INTERMEDIATE AREA 2 (Area Center - Ponce)
area TOTAL
Vega Baja 0
54
State Ind.
Health Center
Morovis
Utuado
San Miguel
City City
33 38 0
n.p.a.
Castafier
0
9
able
City
8
7
Accept
Bed Capacity
Municipal
Ownership
Name of Hospital
Municipal Municipal
Manati
Lares
Area and Municipality
5. List of Acceptable end Non-Acceptable GENENAL. Hospital Pacllltles and Hospital Beds. COnt.
4. Region~Puerto Rico
3. State Puerto Rico
3 of
HOSPITALS REPORT
1. Page
2. Date May 15. 19SQ
ACCEPTABLE AND NON-ACCEPTABLE
PHS-5 (HF)
Wf
a p
Vr
w
W
444
1226
City
Municipal
Yauco
0
31 8
54 31
Ind. Ind. State
Ind. Ind.
Fajardo Dr. Gubern's Health Center Oriente
Font Martelo
Ryder Memorial
Ceiba
Luquillo
Humacao
Municipal
- 48 -
58.8
20 13
State
City
Health Center
0
0
53
N.P.A.
2790
14576 22016 72.6 77.3
55
0
71.4 31 0
72.0
2270
8520
84079
6128
412436
11101
2668
5922
0
82.3 75.3 77.7
64,6
--
37.4 64.9 45.7 74.2
14079 16290
0
0
280
State
District
FAJARDO
City
cS)
0
Luis M. Cintrdn
INTERMEDIATE AREA 3 (Area Center Fajardo) 0
0
0
16 41
State
Health Center
Villalba
--
0
38
25
87
66
78.7 62.1
80.9
City
--
t
0
0
AREA TOTAL
•
35811 25701 43334 8607 3958
29
Santa Isabel
•
56140 130667
1
64.5
•
60.2
City
Salinas
•
5060
2919
12
Days
•
Patient
9
Corp.
N.P.A. N.P.A.
Dr. Pila
•
85.0
•
40.0 63.0
11
Occupancy
Percent
0
St. Luke's Santo Asilo de Damas Municipal Central Aguirre Municipal
State
N.P.A.
181
0
0
0
10
ceptable
Non-Ac
Capacity
•
277
3633
2071
6557 803 367 2732 2024
1149
5802 2539 873 1561 641 2771
3620
5295
6710
7939
... .
1029 1146
13
Admitted
Patients
of
Puerto Rico
Number
4. Region
434 154 87
0
City
State
State
State
9
20 22 20
8
7
able
Accept
Health Center Health Center Health Center Tricoche
Ownership
Name of Hospital
Dr. Jos^ N. Gdndara
PONCE
Pefiuelas
Patillas
\p/ tk k*
Orocovis
6
Area and Municipality
Bed
7_
Puerto Rico
of
3. State
4 May 15, 1959
2. Date
1. Page
5. List of Acceptable and Ncn-Acceptable GENERAL Hospital Facilities and Hospital Beds, Cont.
ACCEPTABLE AND NON-ACCEPTABLE HOSPITALS REPORT
PHS-5 (HF)
1/
h/
c/
City City
Municipal Municipal
Yabucoa
Ind. State
Ind, State
San Rafael Health Center Dr, Font
Health Center
Municipal Dr, A.Mujica Dueflo Health Center
Municipal
Cayey
Cidra
Gurabo
Las Piedras
>an Lorenzo
Ind.
Municipal Dr. Encar.-.^cidn Health Get ter
"ormigueros
State
City
Health Center
Gabo Rojo
State
City
State
Ahasco
INTERMEDIATE AREA 5 (Area Center - Mayaguez)
AREA TOTAL
Juntos
City
Dr. Jimenez Sanjurjo
CAGUAS
City City
City State
Municipal Health Center
Aguas Buenas
INTERMEDIATE AREA 4 (Area Center - Caguas)
AREA TOTAL
Vieques
State
City
Municipal Health Center
8
Ownership
Naguabo
7
Name of Hospital
Rio Grande
6
Area and Municipality
0
12
0
0
16
0
8
15
0
133
20
0
28 19
0
0
63 0 0
0
0
5
57
0
0
0
0
10
17
215
49 -
Non-Ac
ceptable
22 0
30
42
0
82
20
0
637
33
21
22 16
9
able
Accept
Bed Capacity
1095
199435
6723 4273 4583 13108
12
Days
Patient
Number
503
3989
953
1080
1387
63.6 75.3 71.4
44.9
86.3
71.7 58.0 48.4 53.9 37.1 66.3 51.5 78.1
2199 3129
2622 6265
6938
5415 3780
4117 5268
2683
7425 5905
13326
21465
573 413
2011
652
--
1129 1383 1199
1839
510
1613 670
1508
3941
i/
c/
Admitted 13
Patients
of
To substitute above one. . .
60.0
83.7 73.2 59.8 85.5
11
Occupancy
Percent
5. List of Acceptable and Non-Acceptable GENERAL Hospital Facilities and Hospital Beds, Cont.
HOSPITALS REPORT
May 15. 1959 Puerto Rico 4. Region Puerto Rico 2. Date 3. State
of
ACCEPTABLE AND NON-ACCEPTABLE
^
1. Page
FHS-5 (HF)
0
20 10 8 0
8
City State
Part.
Ind.
Municipal Health Center Health Center Health Center San Antonio Dr. Perea
Dr. Ramirez
State
388
N'.P.A.
Quebradillas
Moca
Isabela
Aguadilla
Aguada
Ind.
State
State
State
State
District Dr. Zamora
Health Center Health Center Health Center
280
City
Municipal
50 -
22 20
22
0
20 18
City State
Municipal Health Center
INTERMEDIATE AREA 6 (Area Center - Aguadilla) 0
223
67
N.P.A'.
De la Concepcidn De la Concepcidn
AREA TOTAL
0
0
State
Health Center
San GermAn
0
0
0
19 0
0
0
0
6
64
0
0
City
Sabana Grande
0
5
0 0 0 116
15
10
N.P.A.
City
Non-Ac
ceptable
Bella Vista
7
79 31 82 21 42
able 9
State
Accept
Name of Hospital
Capacity
Municipal
MAYAGUEZ
Maricao
Las Marias
Lajas
6
Area and Municipality
Ownership
Bed
12
Days
18445
10912
1453 34737 23577 8759 17583 3984
2113
1611
371
rn
24.5 49.8 33.0
75.3
w
1698 3995 603
76926
£/
1/
c/
c/
c/
6^
167
1289
306
6705
To substitute above one. . . 40.5 2660 248
73.6
139482
409 288 3725 4088 1164 2406 1239 1773 2389
763
13
Admitted
Patients
of
Puerto Ricj
To substitute above one
57.9 49.8 82.0 76.9 77.4 58.7 52.0 71.2 79.0
7_
Puerto Rico
Number Patient
of
67.7 3704 To substitute above one.
11
Occupancy
Percent
6 May 15, 1959
4. Region
3, State
2, Date
1, Page
5, List of Acceptable and Non-Acceptable GENERAL Hospital Facilities and Hospital Beds, Cont,
ACCEPTABLE AND NON-ACCEPTABLE HOSPITALS REPORT
PHS-5 (HF)
Inaugurated 2-1-58,. Statistical data for two quarters.
Percent occupancy based on 109 beds.
Project approved for construction with Federal Aid.
51 -
Inaugurated 4-8-58. Statistical data for one quarter.
1/
1/ y Percent uccn;: sacy based on 27 beds.
Percent occupancy based on 78 beds. Percent occupancy based on 42 beds.
i/
y Percent occupancy based on 111 beds y To substitute actual non-acceptable facility at Adjuntas (Int. Area 2). y Inaugurated 2-1-58. Statistical data for two quarters. y Not operating at full capacity.
y y
1592
1592
40
15
0
10
ceptable
Non-Ac
Capacity
y Data for institution as a whole including chronic disease unit.
a/
5521
39 Q
0
16
STATE TOTAL
City
9
able
Accept
Bed
5521
State
Municipal
8
Ovmership
Health Center
7
Name of Hospital
REGIONAL TOTAL
AREA TOTAL
Rincdn San SebastiAn
6
Area and Municipality
39.5 74.0
11
Occupancy
Percent
Number
1630037
1630037
93852
2309 4050
12
Days
Patient
5. List of Acceptable and Non-Acceptable GENERAL Hospital Facilities and Hospital Beds, Cent.
4, Region Puerto Rico
1069
548
13
Admitted
Patients
of
Puerto Rico
3. State
ACCEPTABLE AND NON-ACCEPTABLE
HOSPITALS REPORT
7 of 7 May 15. 1959
1. Page 2. Date
PHS-5 (HF)
Area and Community in
775.400
BASE AREA 1 - SAN JUAN
N se:
Arecibo
for other areas.
540
799
22 22 16 0
1,242
16
6
0
436
540
1,220
844
22 22 16 25
2,312
22 31 16
0
421
844
25
0
0
0
1,070
25 0
0
0
0
30
0
0
25
2,019
0
4.0
5.0
(12)
12
3,877
(11)
Construction
Proposed for
Additional Beds
22 22 20
1,858
3,489
(10)
per 1,000 Population
22 22 20 12 22
(9)
(8)
Planned
Number of
Beds Planned
25 436 30
Beds
Ratio
Beds
Total
Puerto Rico
65.5
47.9
(13)
Met in Area
Of Needs
Percent
DISTRIBUTION
0
Existing Acceptable
Bed Allowance Based on Area
1,220
OF
4. State
- 52 -
844 beds out of 2,019 proposed for construction have not been programmed - same is true
69,200
305,000
Base Area I, San Juan,
TNT. AREA - 2 ARECIBO
Not programmed yet
Toa Baja frujillo Alto Vega Alta
Toa Alta
San Juan
Naranjito
Lofza
Guaynabo
Dorado
Comerfo Gorozal
Catafio
Carolina
Bayamdn
24,700 56,900 31,000 27 ,400 19,400 24,800 14,300 36,700 25,800 18,300 431,000 13,700 18,800 16,400 17,200
(7)
are or will be located (5-6)
Barranquitas
Population
Civilian
PLAN
of
2. Date May 15, 1959 3. Region Puerto Rico
Washington 25, D, C.
1
1. Page
PUBLIC HEALTH SERVICE
DEPARTMENT OF HEALTH, EDUCATION AND WELFARE
DATA
or Proposed Facilities
Which Existing Acceptable
BASIC
GENERAL HOSPITAL SUMMARY
PHS-IO
Patillaa Pefmelas
Maunabo Crocovis
Juana Diaz
Guayania Gu yanilla Jayi^a
Gu mica
Coamo
Arroyo
Aibonito
Adjuntas
INT. AREA 2 - PONCE
Not progrananed yet
Vega Baja
Utuado
Morovis
Manatf
Lares
Hatillo
Ciales
Camuy
Barceloneta
C5-6
are or will be located
or Proposed Facilities
Area and Coumvuinity in Nhlch Existing Acceptable
20,200 21,100 13,600 27,900 14,500 36,900 19,600 17,200 29,400) 10,500) 24,400) 18,600) 16,900
507.S00
19,200 18,100 20,700 18,200 28,100 32,400 21,400 47,300 30,400
Population
Civilian
GENERAL HOSPITAL SUMMARY, CONT,
PHS-10
2.032
22 20;
22 20
53 -
11 20
0
64 20 0
24 53
334
23 64 20j 23 42. 23 20)
0
112 51
24 30
1.226
54 79
0
33 38
25 20 58 38) 26 54 79
25 22
11) 0
9L
8
Planned
Beds
Total
22 13 20
Beds
Existing Acceptable
Ratio
Bed Allowance Based on Area
S IT B
C)3iitatruj!i£itiLQ]]ri
0)
0)
0)
42 14
25
0)
25 0) 0) 25 0)
0)
80)6
m
25 0) 12. 0) 25 0) 25 0)
Eropoaedl fear:
per- l^OOO)
Eop.ulLail^cjiji
4..0)
Cbff
^
mac IS. ii95a>
Q)£ Neafe IS&fi; ini Aja
3* EttMrtaa) Etc® 4u, Stcafc® Ettaaft® tMi'w
Beda Plannedl MdiiLtdioQ®! ledia
Numb®it 0,3
Eiaga
2* ©aft®
Giira
Gayey
CAGUAS
Aguas Buenas
INT. AREA 4 - CACUAS
Not programmed yet
Yabucoa
Vieques
Rfo Grande
Luquillo Naguabo
Humacao
14,400 59,900 37,000 22,000
210,800
33,900 6,500 15,200 16,000 8,300 26,700
843
1
0
40
21 33 40
22
21 33
1*5^
0
22 16
- 54
pseai
0
22 22
piai
0
232 72
82 72
0 150
20
628
0
20
215
843
0
13
0
0
193
13 16
0
319
0
0
319 193
< 20,800
20
FAJARDO
677
637
4.0
635
635
5.0
0
41
0
40
0
(12)
Construction
41
16
20
541
(11)
(10)
Puerto Rico Puerto Rico
Additional Beds
Proposed for
^
May 15. 1959
3 of
^ s
25.5
94.1
(13)
Met in Area
of Needs
Percent
DISTRIBUT ION
741 69 25 16
(9)
(8)
Beds Planned
Number of Beds Planned
OF
per 1,000 Population
lotal
PLAN
4. State
3. Region
2. Date
1. Page
741 29 25
Beds
Existing Acceptable
Ratio
Bed Allowance Based on Area
; 7,900
135,300
150,600 25,300 12,200 17,400 31,600
(7)
Population
Civilian
DATA
Ceiba
INT. AREA 3 - FAJARDO
Not programmed yet
Yauco
Santa Isabel Villalba
Salinas
PONCE
r5-6">
are or will be located
or Proposed Facilities
Which Existing Acceptable
Area and Community in
B A S I C
GENERAL HOSPITAL SUMMARY, CONT.
PHS-10
AGUADILLA Isabela
Moca
Aguada
INT. AREA 6 - AGUADILLA
Not programmed yet
MAYAGUEZ Sabana Grande San GermAn
Maricao
Las Marias
Hormigueros Lajas
Cabo Rojo
AnasCO
INT. AREA 5 - MAYAGUEZ
Not programmed yet
San Lorenzo
Las Piedras
Juncos
Gurabo
10 8
192 21 109
10 8
192 21 109
0 0
22
22
22
22
21,000
55
G 0
20
.256
298
654
513
0
0
0
0
0
298
353
513
0 0
12 20
20
12
35
35
0
548
403
25
0
25
25
(12)
Construction
Additional Beds Proposed for
16
4.0
4.5
(11)
per 1,000 Population
0
936
Number of
Beds Planned
60.5
41.5
(13)
Met in Area
of Needs
Percent
distribution
16
388
403
19 25
25
25
(10)
Planned
Beds
Total
OF
20
654
832
19 0
0
0
(9)
Beds
Existing Acceptable
PLAN
1. Page 4 of 5 2. Date May 15. 1959 3. Region Puerto Rico 4. State Puerto Rico
21,000 45,200 25,200
163.600
14,400 24,500 6,100 14,400 8,700 6,000 88,000 18,000 27,900
208.000
16,100 19,800 14,400 27,200
(8)
(7)
(5-6)
Based on Area
Population Ratio
Bed Allowance
Civilian
DATA
are or will be located
Area and Community in Which Existing Acceptable or Proposed Facilities
BASIC
GENERAL HOSPITAL SUMMARY, CONT.
PHS-10
2,306,000
---
13,600 9,600 28,000
(7)
Population
Civilian
9,611
---
fS)
Ratio
Bed Allowance Based on Area
DATA
Excess Beds From Original State Plan
Ij. Total Beds Allowed (Item 14 and Item 15)
15.
14. Beds allowed by State Ratio (Population x 4.5)
STATE TOTALS
BEDS HELD IN RESERVE
Not programmed yet
Rincdn San Sebastidn
Quebradillas
f5-6^
are or will be located
or Proposed Facilities
Area and Community in Which Existing Acceptable
B A S I C
GENERAL HOSPITAL SUMMARY, CONT.
PHS-10
pw
ipas
56 -
5,521
---
16
20
(9^
Beds
Existing Acceptable
i;a!5a
10,377
138
214
10,377
0
10,377
4,876
138
214
0
42
0
a2'i
42
4.5
an
5
of
5
Puerto Rico
Puerto Rico
May 15, 1959
—
---
—
Met in Area
Percent of Needs
distribut ION
Beds Planned Additional Beds per 1,000 Proposed for Population Construction
Number of
OF
20 16
Planned ao^
Beds
Total
PLAN
4. State
3. Region
2. Date
!• Page
a PHS-13 (HF)
FEDERAL SECURITY AGENCY U. S. PUBLIC HEALTH SERVICE
Washington 25, D. C.
1.
Page
of
2.
Date
May 15, 1959
3.
State
Puerto Rico
4.
Category
General
RELATIVE NEED REPORT
Priority (5)
Area
Percentage of Need Met
(6)
(7)
A
1-4
Caguas
25.5
A
1-5
Mayaguez
41.5
B
B-1
San Juan
47.9
B
1-2
Ponce
60.3
C
I-l
Arecibo
65.5
C
1-6
Aguadilla
67.3
D
1-3
Fajardo
94.1
J
If - 57 -
\
I J I I
I I
I. i
I
I ->^.fcrf.W,W.W.:»*:>U.-„i^-,.
CHAPTER
2
TUEIECULCSIS HOSPITAL CCKSTRUCTICW PECC-RtJvI
Definition:
A tuberculosis hospital is defined as a hospital for the care of patients
with tuberculosis.
It excludes preventoria.
E^'isting Facilities:
In Puerto Rico there are 2,519 tuberculosis beds located in eight dif ferent institutions.
Six are state owned and operatedj the other two are
private.
Data regarding to bed capacity, patient days, patients admitted, etc., was
compiled from the quarterly questionnaires submitted by each hospital during
the fiscar year 1957-58. Classification of Hospitals:
Tuberculosis hospitals have been classified as "acceptable" or non-accepta ble" facilities for planning purposes. The criteria used to determine tuberculosis hospital beds as acceptable
or non-acceptable is the same as for the general hospitals. "Non-acceptable" beds are considered as such from the structural standpoint only and this desig
nation should not be construed as reflecting in any way on the medical care and treatment program. Estimates of need and Programming of Beds:
A State may allot tuberculosis beds at the rate of 1.5 times the average annual nxmiber of active and probably active new cases for the two preceding years, but not to exceed the original standard which was 2-5 times the average
annual number of tuberculosis deaths for the five-year period 19^0 to 19^ inclusive, that was 11,593 beds. m
- 59 -
Tte U. S. Department; of EealtD and Education and Welfare certified for
Puerto Rico that the active and probably active new cases of tuberculosis in
1956 and 1957 was 2,6^4-9 and 2,309 respectively. The average of these two figures times 1.5 results in an a1J owance of 3^719 tuberculosis bedsThis allowance is well below the original standard of 11,593-
For the
purpose of this Plan, this figure accordingly prevails. However, the need for additional beds for tuberculosis cannot be detennined
adequately on the basis of a limited case finding program. An expanded case finding program, coupled with the optimum utilization of existing facilities are essential for the effective treatment and control of tuberculosis.
In a study ^ CEirried out in September 1957 by a group headed by Dr. Paul Pamplona of the U. S. Public Health Service, the following recoirmendations were made:
Improve effectiveness and productivity of case finding program through:
(1) long-range planning, which should be done coUaboratively with the Puerto Rico Tubercvilosis Association, should be concentrated upon high prevalence groups, but should involve participation of communities in order to secure the educational and other benefits which can accrue from
such projects^ (2) proper monitoring of X-ray machines and use of other
procedures to reduce radiological hazards, including more extensive use
of tuberculin testing as a preliminary screening device (especially for
children and pregnant women); (3) adequate pre-planning, scheduling and ance policy-making for follow-up procedures, giving consideration to
methods for prompt interpretation of films, recall and follow-up of suspects, || Qxagaostic evaluation of those with apparently clinically significant find-
Ij ^Jerto Rico Taberciolosis Program Review Page 84, Paragraph -'16 - 60 -
—
ngmiliii
ings, grif^ collection, analyses, and interpretation of meaningful statistics; and (U-) establishing routine hospital admissions. X-ray program in all "the general hospitals, particularly those under the jurisdiction of the De
partment of Heal"th, and developing policies and procedures for providing the necessary trea"biient of patients thus discovered.
Further, it must be remembered that the examination of family and other close contacts of known patients is often the most productive source of additional cases of "buberculosis- Only through "these improved methods can the extent of "the "tuberculosis problem and the continued usefulness of these programs be determined." If such an expanded program is carried out, undoubtedly more new cases
be found and the bed allowance will accordingly be increased. However,
it is pertinent to draw attention to the rapid decrease in the need as indicated by the new formula in recent years. When da"ta for 195^ an^ 1955 ar® used, a to"tal need of 5,385 beds is suggested, while the corresponding figure when da"ta
for 1955 nnd 1956 are employed is h,7ho. The total bed need of 3j719 which has been reported on the basis of the active and probably active new cases
of tuberculosis for 1956 and 1957 will undoub"tedly be subjec"ted to further
downward revision even if better techniques for case finding are employed.
The recent experience of those hospitals operating beds for "tuberculosis patients should be noted. Several of the non-govemmental hospi"tals have c\ir"tailed such service in recent years. Hato Tejas Hospi"tal was wholly con
verted into a mental insti"tution, while Clinica Antillas reserved part of its
'fl J
bed complement for the trea"tment of men"tal tuberculosis patients. At presen ,
m
it is requesting authorization to utilize 27 beds for purely psychiatric
^
patients. The tubercxilosis unit of Auxilio Mu"tuo, the only general hospital
Mi y 61 -
which provided such treatment, was discontinued.
The decline in the occupancy
rates of some of the state tuberculosis hospitals now in operation should also he considered.
I
These are summarized in the following table*.
Hospital
1953
195^^
1955
1956
1957
1958
Cayey
95.3
91.9
90.8
80.9
78.8
75.7
Mayaguez
96.6
90.7
87.2
86.7
85.8
81.6
Ponce
97.7
93.0
9^-3
87.8
81.0
86.2
In assessing the extend of this need, it is also relevant to consider the constant and steep decline in the morbidity rate for tuberculosis in Puerto Rico
during the last decade.
The following figures summarize this trend:
1948
339 per 100,000
1952
216 per 100,000
1953
186 per 100,000
195^
152 per 100,000
1955
1^^ per 100,000
1956
129 per 100,000
1957
112 per 100,000
2/
Despite the decline in the reported tuberculosis cases and the marked
I
I
I
decrease in the death rate, tuberculosis remains as one of the major public health problems of Puerto Rico.
Two projects are under way; one, for the conversion of the Bayamon
I
District Hospital (General) into a tuberculosis hospital and the other for
the conversion of the tuberculosis hospital, A. Ruiz Soler, into a general 2/ Figures are from the Bureau of Tuberculosis Control. - 62 -
I I
hospital. The converted general hospital will be a basic component of the projected Puerto Rico Medical Center at Rio Piedras.
As a result of this
change^ a reduction in the total number of tuberculosis beds will be experi enced to be compensated for by better islandwide utilization of the remaining bed capacity.
Due to the lack of analysis of information currently available^ it is
not adequate to plan wisely for additional beds. It is hoped that a thorough analysis can be undertaken during the coming year.
Until then^ all additional
beds needed according to the formula used are reserved in a state-wide pool to
he allocated to different areas when the situation is sufficiently clarified to warrant a more specific distribution.
Wote:
}
The Bureau of Tuberculosis Control of the Department of Health reported
the figures of active and probably active new cases of tuberculosis for 1955 and 1956 as follows: Cases
1956
2;,92^
1957
2,551
The average of these two figures is 2,738 and I.5 times this average
results in an allowance of 4,107 tuberculosis beds against the figure of 3^719 determined according to U. S. Public Health Service data.
41
- 63 -
J -H
J/ Percent occupancy based on 110 beds.
a/ Percent occupancy based on 300 beds, b/ Percent occupancy based on 200 beds, c/ Percent occupancy based on 100 beds.
1^/ Operate on an island wide basis,
STATE TOTAL
REGIONAL TOTAL
Dr. Ferndndez Garcia Hato Rey
Islandwide 1/
- 64 -
Piedras
Part.
Corp.
State
Antillas Rio
Tuberculosis
Islandwide 1/ Islandwide 1/
Aibonito
Tuberculosis
Intermediate Areas 5
and 6
State
State
Cayey
Tuberculosis
Mayaguez
State
Guayama
Intermediate Area 2
Intermediate Area 364
State
Ponce
Tuberculosis Tuberculosis
Intermediate Area 1
State
Bed Capacity
216
m
17
2519
•
0
0
17
0
0
0
0
17
200
93
66
152
400
100
0
r^i
able
1292
Non-Ac
ceptable
Accept
5 2519
!i
Ownership-
Piedras
Rio
Location
Dr. A. Ruiz Soler
Base Area and
Area Served
Name of Hospital
Facilities and Hospital Beds
5. List of Acceptable and Non-Acceptable TUBERCULOSIS Hospital
i
2. Date
70.9
80.5
86.0
81.6
75.7
86.2 93.0
94.9
Occupancy
Puerto Rico
32312 51774
31382
59543
110465
33935
94381
447724
Days
Patient
^
304
186
87
196
308
88
242
993
d/
c/
b/
a/
Admitted
Patients
Number of
4. Region
Percent
?—1
^
May 15, 1959
1 of
3. State Puerto Rico
1. Page
ACCEPTABLE AND NON-ACCEPTABLE
Washington 25, B.C.
FEDERAL SECURITY AGENCY PUBLIC HEALTH SERVICE
HOSPITALS REPORT
PHS-5 (HF)
pHS-11
DEPARTMENT OF HEALTH, EDUCATION AND WELFARE PUBLIC HEALTH SERVICE
Washington 25, D.C.
TUBERCULOSIS, MENTAL
1
CHRONIC DISEASE SUMMARY
of
! Puerto Rico Puerto Rico
Description of
TUBERCULOSIS
Facilities
6. Average of tuberculosis cases for the years 1956
5. Population 2,306,000
8. Total existing acceptable
and 1957
7. Total beds allowed by state ratio
2,479
9. Net additional beds needed
3,719
(Item 7 minus Item 8)
beds
1,200
2,519
L 10> Additional facilities proposed for state
.
1
May 15, 1959
'
1
Identification of Facility Community (a)
Net Additional
Number of Beds
(b)
UNASSIGNED
For the time being the net additional beds needed will be kept in a pool.
4
- 65 -
(c)
c
i;
t \
i: r
I, I I
I. I
I
I
CHAPTER
1
3
NERVOUS AND MENTAL CONSTRUCTION PROGRAM
Definition;
A mental hospital is defined as a hospital for the care of patients vrLth
nervous and/or mental illness. The psychiatric hospital which is defined as a type of mental hospital where patients may receive intensive treatment and where only a minimum of continued treatment facilities will he afforded is also included in this category. Inventory of Nervous and Mental Hospitals:
At the present time in Puerto Rico there are only four institutions that
render services for the mentally ill patients. These hospitals possess 3,121 acceptable beds.
Data regarding bed capacily, patient days, patients admitted, etc., was
I
J
compiled from the quarterly questionnaries submitted by each hospital dirring
the fiscal year 1957-58Classification of Hospitals:
The existing facilities for mentally ill patients were classified as acceptable for planning purposes.
The criteria for determining if an insti
tution is "acceptable" or "non-acceptable" are the same as those used for the general hospital. Distribution of Nervous and Mental Beds;
The maximum state allowance for mental and psychiatric beds is 5 beds
per thousand population and the estimated civilian population of the state
used in this Plan is 2,306,000. Accordingly, the maximum state allowance for the mental and psychiatric categoiy is 11,530 beds.
1
According to this standard, the shortage of beds in the nervous and mental
m
- 67
category is very acute in Puerto Rico.
TRe pressure for the hospitalization
of mentally ill patients is great and probably will increase in the next few years.
However, with the present advances and apparent future trends in the
treatment of the mentally ill, it appears that other less expensive means than
hospitalization will be used. For these reasons the acute shortage of beds in
relation to present standards could be more apparent the real.
The scarcity of trained personnel is perhaps more important than the shortage of beds.
If enough personnel and funds were available, more intensive preventive and treatment programs and more effective and efficient use of available beds
ould be established. The need for hospitalization and the length of hospi talization would be considerably reduced. Provisions have been made by the Commonwealth of Puerto Rico to nearly
"pie the number of beds available ten years ago, an increase from 9^0 to 2,500 beds. A program for the training of psychiatric personnel is underway as a joint effort by the Department of Health and the School of Medicine of the
sity of Puerto Rico. At the present time psychiatric residents, psychisocial workers, nurses, medical students, niirsing students, occupational
apists and psychiatric aides receive training under this program. Plans
for the expansion of this program to include psychologists, general practitioners and ancillary personnel. emphasis in treatment and rehabilitation will be directed towards
dislocating the normal life of the mentally ill as little as possible and the ■ n of facilities in health centers, public health units, welfare units, g ral hospitals, thus providing treatment to the patient as near as pos
sible ro his home, his work and his community. "des the psychiatric hospitals at Rio Piedras and Ponce, psychiatric 68 -
I beds will be provided at the proposed hospital at Mayaguez and the existing
general hospitals at Aguadilla^ Arecibo^ Bayamdn and Fajardo^ the latter to a
J
more limited extent.
At present psychiatric out-patient clinics are operating
at Rio Piedras, Ponce^ Mayaguez, Aguadilla, Arecibo and Fajardo. Next to the above, the most urgent need for beds would be in the form of
therapeutic farms which should be limited in capacity to about I50 patients each and function in the form of branch institutions to the main hospitals.
- 69 -
f!
San German
La Concepcidn N.P.A.
State
30
706
115
0
0
0
0
0
0
0
70 -
E/ Psychiatric Unit. Project under construction with federal aid.
D/ Project approved for construction with federal aid.
B/ Percent occupancy based on 400 beds. C/ Percent occupancy based on 150 beds.
construction with federal aid.
--
--
98.1
88.0
87.4
Occupancy
Percent
53,728
128,456
526,319
Days
Patient
--
--
534
760
228
A/
E/
D/
0/
B/
Patients
of
Puerto Rico
Number
4, Region
1. Page 1 of 2. Date May 15, 1959 3, State Puerto Rico
Second part of project under
ceptable
Non-Ac
A/ Percent occupancy based on l,c50 beds which is the actual bed capacity.
Note: Hospitals operated on an island-wide basis. 1/ Formerly Hato Tejas Hospital.
3,151
Ponce
Psychiatric Hospital
Corp.
300
STATE TOTAL
Bayamdn
P. R. Psychiatric Institute 1/
Corp.
2,000
able
Accept
Bed Cap acity
3,151
Hato Rey
Dr. JuliA
State
Ownership .
REGIONAL TOTAL
Rio Piedras
Location
NERVOUS AND MENTAL
Washington 25, D.C.
FEDERAL SECURITY AGENCY PUBLIC HEALTH SERVICE
Psychiatric Hospital
Name of Hospital
Hospital Facilities and Hospital Beds
5. List of Acceptable and Non-Acceptable
ACCEPTABLE AND NON-ACCEPTABLE hospitals REPORT
PHS-5 (HF)
PHS-11
DEPARTMENT OF HEALTH, EDUCATION AND WELFARE PUBLIC HEALTH SERVICE
Washington 25, D.C.
TUBERCULOSIS, MENTAL
1.
Page
CHRONIC DISEASE SUMMARY
2.
Date May 15, 1959
1
3.
State
4.
Area
of
Puerto Rico Puerto Rico
Description of NERVOUS AND MENTAL Facilities
6. Total beds allowed by state ratio
5. Population
11,530
2,306.000
8. Net additional beds needed (Item 6 minus
7. Total existing acceptable beds
item 7)
3,151
8,379
9. Additional facilities proposed for state
Identification of Facility Community (A)
Net Additional
Number of Beds
(B)
11
UN ASSIGNED
For the time the net additional beds
needed will be kept in a pool.
f - 71
1
(C)
a i
[
j
[
I
[
t j [
t
H I I
'V
I
I
CHAPTER
h
CHRONIC DISEASE IIOSPITAU'
Definition;
A chronic disease hospital is defined as a hospital for the treatment of
chronic patients suffering from illness.
The treatment and care are administer
ed by or under the direction of persons licensed to practice medicine or surgery
in Puerto Rico.
The term does not include hospitals primarily for the care of
mentally ill or tuberculosis patients^ nursing homes, and institutions the prima ry purpose of which is domiciliary care.
Differentiation from a "Nursing Home"; A Chronic Disease Hospital is the place for care of patients needing in
tensive medical care where hicb-ly skilled nursing techniques are applied.
This
involves the utilization of all the complex diagnostic and therapeutic services
regularly available in a hospital setting. A "Nursing Home", on the other hand, is primarily designed to provide a homelike atmosphere for persons in need of skilled nursing care. Inventory of Chronic Disease Hospitals;
There are currently in Puerto Rico only four hospitals and three units within general hospitals having a chronic disease program similar to that envisioned by
the definition of a chronic disease hospital (See Form PHS-5)« ;,ri
f
Classification of Chronic Disease Hospital Beds;
The above mentioned chronic disease facilities house ^66 acceptable beds.
This represents 8.k percent of the number of chronic disease hospital beds required on the basis of 2 beds per thousand population.
'I
Puerto Rico is thus faced with
the necessity of planning a complete chronic disease hospital program.
The criteria used in the classification of beds as acceptable or non-accepta-
y
ble are the same as for the General Hospitals. "Non-acceptable" chronic disease
i - 73 -
0 beds are considered as such from the structural standpoint only, and this desig
nation should not be construed as reflecting in any way on the medical care and treatment program.
r
1
Estimate of Need and Programming of Beds;
The state allowance for chronic disease beds is 2 beds per thousand popu
[
lation, and the estimate civilian population of Puerto Rico which is used in
this Plan is 2,3C6,0C0. Accordingly, Puerto Rico has an allowance of h,6l2 beds for the chronic disease category. This figure is beyond our economic potentiali ty and it is recommended that before planning additional facilities, a compre
hensive study of the chronic disease problem be carried out. Therefore, all
additional beds needed according to the formula used are reserved in a state-wide pool to he allocated at a later date when the need arises.
Because of the limited number of chronic disease beds which are now availa
ble, it is not possible to establish a workable priority system by areas. Prima ry consideration will be given to an application for the construction of a project that will form part of a general hospital.
r
i:
i;I -
1- ^ /
I - 74
I
Guaynabo Hato Rey Trujillo Alto
Orthopedic & T. B. Institute
36
Days
Patient
Number
75.6
72.6
27650
30491
hospitals operate on an island wide basis.
Percent occupancy based in 115 beds.
e/
- 75 -
Percent occupancy based in 65 beds now in use. Project approved for construction with federal aid.
y y y
^
46 --
--958
2—
d/ e/ a/
a/ a/ b/ c/
Admitted
Patients
of
4. Region Puerto Rico
80.2 19023 To substit:ute above one
Occupancy
Percent
1 of May 15, 1959"
3. State Puerto Rico
1. Page 2. Date
The two first hospitals are city hospitals and serve patients within the municipality. The other
386
STATE TOTAL
36
0
100
386
0
20
REGIONAL TOTAL
0
0
36
0
0
98
100
23 0
15
0
ceptable
able
30
Non-Ac
Accept
Bed Ca pacity
Operating data given for the institution as a whole under the general category. Inaugurated December 1958. Statistical date not avail.able yet.
Note:
Leper Hospital
Auxilio Mutuo (General)
N.P.A.
San Juan
Dr. Gonzdlez Martinez (Cancer) N.P.A.
N.P.A. N.P.A.
Santurce
City City
Ownership
Ponce
Arecibo
Rio Piedras
Location
CHRONIC DISEASE
Washington 25, D.C.
PUBLIC HEALTH SERVICE
FEDERAL SECURITY AGENCY
Clinica Oncoldgica Inet. of Radiotherapy (Cancer)
De la Capital (General) Dr. Manuel Figueroa (General)
Name of Hospital
Hospital Facilities and Hospitals Beds
5. List of Acceptable and Non-Acceptable
HOSPITALS REPORT
ACCEPTABLE AND NON-ACCEPTABLE
PHS-5 (HF)
uru
0 [
DEPARTMENT OF HEALTH, EDUCATION AND WELFARE
PHS-11
PUBLIC HEALTH SERVICE
Washington 25, D.C.
[
TUBERCULOSIS, MENTAL
1. Page
1
CHRONIC DISEASE SUMMARY
2. Date
May 15, 1959
of
1
3, State Puerto Rico 4. Area
Description of
CHRONIC DISEASE
t:'
Puerto Rico
facilities
5. Population
6. Total beds allowed by state ratio
2,306,000
4,612 8. Net Additional beds needed (Item 6.
7. Total existing acceptable beds
minus Item 7)
4,226
386
[
9. Additional facilities proposed for state
Identification of Facility Community (a)
t
Net Additional Number of Beds
(b)
(c)
r r
1 UNASSIGNED
For the time being the net additional
I
I
•v,
beds needed will be kept in a pool.
r
•v.
I
I I. i V,
76 -
I
B. CHAPTER
5
PUBLIC HEALTH CENTERS
Introduction:
The Commonwealth of Puerto Rico has provided public health services at
the local level since 1926 with the establishment of the first public health unit at Rio Piedraa. That same year a second unit was established at Yabucoa.
At present a public health unit operates in each municipality. There are also sub-units in many rural areas.
The Commonwealth also operates a public welfare unit in each municipality. All municipalities have a general hospital in operation or proposed for con
struction. The main objective within the public health center program is the integration and coordination of public health, hospitalization and welfare services.
The health center as conceived in this Plan provides under one roof the
necessary physical facilities for rendering preventive, diagnostic, curative
and social services. Although one of the service units is physically separated
from the others in several of the health centers, primary emphasis has been
placed upon the Integration of the three service units (namely Public Health, Public Welfare and the Hospital Unit). The integration under one physical plant and administrative structure
'I'
services rendered to the population by the Department of Health has many advantages: it avoids the duplication of e^ensive space and equipment; it makes possible the use by each unit of the resources (both physical and human)
of the other two; it allows training of personnel in different areas (doctors
f
in preventive and curative medicine, etc.); it permits a more economical ad ministration; it emphasizes that the individual is a whole --not separated
t
11 -
'■■k
D parts— and should be so treated. Estimate of Need and Prograinming of Facilities: The maximim state allowance for public health centers;, according to Federal
standards which are based on the ratio of one center per 30,000, is 77 centers-
[
Form PHS-12, Public Health Centers Report, which is attached to this part of
[
the Plan, is a tabulation of the proposed public health center program. Priority System for the Construction of Health Centers;
r
It was found necessary to prepare a separate priority system for the con
[
struction of health centers.
Background
The construction of health centers was initiated in 19^1-6 with funds appropriated by the Legislature of Puerto Rico.
These facilities house
all the programs administered by the Department of Health so that a coordi nated and integrated service can be rendered in the fields of public health, hospitalization and public welfare.
Law No. 213 approved May 15, 19^4-8 authorizes the Secretary of Health of Puerto Rico to organize, administer and operate health centers in second
and third class municipalities.
The establishment of such facilities in
cities with large population also seems practical and an extension or
amendment of the above law should therefore be studied to meet individual
conditions of San Juan, Ponce, Mayaguez, Arecibo, Aguadilla, Caguas and Fajardo. Factors Considered and Criteria Used as to Weight Given to Each Factor:
Objective criteria were needed to produce a priority system that would determine the order in which the health centers are to be constructed.
principal factors considered were:
1. Evaluation of existing public hospital facilities.
-
78
-
The
r i,
A total of one hundred (100) points are assigned to a facility which completely meets the needs of the community considering the adequacy of physical plant, location of hospital units to the center of popu lation, accessibility, fire resistance and safety, sanitation, popu lation served, etc. The information previously obtained by inspectors of the hospital.
Licensing Unit was used for the determination of points
for each facility.
No points were assigned to municipalities having
no public hospital facilities.
The total points accumulated was consider
ed in making the priority system for the Health Centers. 2. Evaluation of Public Health Facilities
A total of twenty five (25) points are assigned to a public health build ing owned by the Government which completely meets its purpose in regard to size, distribution of floor space, location, type of construction, etc.
The total number of points are reduced according to the deficiencies
encountered, and no points are assigned if all public health facilities are housed in rented buildings.
3. General Hospital Area Priority
Since the health center contains a hospital unit, a weight (from 0 to 15 points) is given to the priority of the hospital service area to
which the municipality belongs.
Accordingly, the higher the area priori
ty as determined in this State Plan Revision the lower the weight; Caguas and Mayaguez
with A priority
-
0 points
with B priority
-
5 points
Arecibo and Aguadilla with C priority
-
10 points
San Juan and Ponce
- 79
Fajardo with D
priority
-
15 points
4. Distance
Some municipalities with inadequate or no hospitalization services may use nearby hospital facilities.
The further and harder for the residents
of a municipality to use a nearby facility, the less points from a total of 15 are assigned to it. 5- Population
The number of people to be served by a center has a hearing on the cost per bed, both in construction and in operation:
the larger the hospi
tal the lower the cost, up to a certain limit.
In order to be able to
serve more people with the funds available, preference is given to muni cipalities with larger population.
The number of points assigned to
each municipality is expressed by the following formula:
^0,000 less niomber of people served 2,000
For example, only h points are assigned to a population center as Yauco with 31^600 people to served; on the contrary 17 points to Luquillo, a small population center with only 6,500 people to be served. Priority of Municipalities According to Ranking
Using the above mentioned factors, a study was made of each municipality for which a health center is programmed.
Federal funds, if available, are allotted to applicants for the construction
of a health center in the order in which municipalities rank according to the
total points accumulated as well as in terms of the availability of local match ing funds.
I
I
N
The following table shows the ronl^ing of each uuuicipality and the points
I
accuiaulated under each factor.
I
- 80 -
fi-1 Kti ..r--''"--'-'"'-
^ - f.ji^
II Commonwealth of Puerto Rico DEPARTMENT OF HEALTH
Bureau of Hospital Survey and Construction
EVALUATION OF THE PHYSICAL PLANT OF MUNICIPAL HOSPITALS
Adequate
Location of
Municipal Hospitals
Aibonito
Arroyo
1
1
Gen Ar
Fire
Sani
Total
Structure
rangement
Resistive
tation
Points
(15)
(25)
(25)
(25)
(10)
(100)
7
8
10
10
4
39
Site is
Adequate
15
22
22
23
8
90
Barceloneta
6
13
12
13
4
48
Barranquitas Gabo Rojo
3
8
10
13
4
38
9
12
11
13
4
49
Carolina
12
17
13
17
7
66
Ciales
13
19
19
22
7
80
Gudnica
12
14
10
9
5
50
Gurabo
7
12
10
18
5
52
Jayuya
8
8
10
10
6
42
Juana Diaz
8
15
16
20
5
64
Juncos
12
12
11
15
3
53
Lares
7
9
7
7
3
33
Loiza
12
15
11
17
4
59
Luquillo
15
20
11
22
7
75
Manatf
13
22
22
8
86
Maunabo
14
20
21 17
19
7
77
Morovis
11
14
14
12
7
58
Naguabo
12
20
20
10
20
19
22 20
8
Sabana Grande
6
82 75
Salinas
14
15
16
12
2
59
San Lorenzo
12
20
14
17
7
70
S.-.u Scbtstian
s
r>
O
O
O
14
2
37
20
85
Santa Isabel
14
20
Vega Alta
13
15
Yabucoa
15
22
Vici[ut.s
15
Yauco
14
25
23
0
10
6
22
23
-7
22
25
8
55
25
25
10
99
63
89
J
1
81 -
e I Conroonwealth of Puerto Rico DEPARTMENT OP HEALTH
Bureau ©f Huspital Survuy and Q©DSgruellQn
[
L
RANRINg m J©NieiPALlT¥ AeOOBDINg TO TOTM, POINTB AOeUMHLATED
r T@6al
Mpnigipali^
Points Aeeaffii'
fASTORi
eONiiDlRED
Eyaiaaei©R ©f Pulii© Distance Hoibitsl HialfeWUnfr""
p©puls-
T 4? =cT CferrrC?^
latgj
1,
San Sebagtidfl
1, 3,
9arran^uita§ Jayuya
4, Cab© R©j© 5,
Aibonlt©
6,
Leuree Gurab©
7, r
iarealoneta
Gudniea 10, Lofsa
9.
XI, Morovla 12, Salinas 13, Juncos
14, San Lorenzo
i7 fi
37 38
§3 If
42 4P
17 71 71 n 80 81 82 83 83
W 33 f2 48
13. Sabana Grande 19. Maunabo
86 87 88 89 94 119
20. LuqulIIo
120
15. Carolina
16. Juana Diaz
17. Vega Alta
21. ttonatl
22. Arroyo 23. Naguabo 24. dales 25. Yabucoa
26. Santa Isabel
27. Vieques 28. Yauco
121 122
0 0 0 0 0
17 3 0 0
30 39 38 39 33 70
0 0 0 13 3 0 0 0 0 20 0 6 4 0 18 0
66
64 63 73 77 75 86 90
123
82
124
80
125 129 136 141
89 83 93 99
12 10 20
4 7
f § 14 f 7 11 12 10 3 12 7 5 11 14 10
8 2 13 13 10
14 6 14 13 0 13
ti©n
1 8 11 § 9 1 12 10 13 7 9 7 10 6 5 5 11 11 15 17 4 13 12 10 7 14 16 4
Area Priority
10
§ f 0 f 10 0 10 5 5 10 5 0 0 5 5 5 0 5 15 10 5
[
[
I T r
I"j-
I
15 10 15 5 15 5
I
\
I - 82
A
C
I
1
1 0
1
21,100
24,500 69,200 13,600 19,200 24,700 56,900 24,500 59,900 18,100 31,000 27,400
37,000 7,900 20,700 22,000 27,900 19,400 24,800 14,300 20,800 14,500
Aibonito
Aflasco
Barranquitas Bayamdn Cabo Rojo
Catafio
Cayey
GuAnica
Fajardo
Dorado
Corozal
Comerio
Coamo
Cidra
Ciales
Ceiba
Carolina
Camuy
Caguas
Barceloneta
Arroyo
0
0
1
1
1
1
1
1
1
1
1
- 83
1
1
1
1
1
2
1
2
1
3
0
1
2
0
1
1
0
2
3
1 0
2
3
1
5
0
1
0
0
0
1
1
0
45,200 14,400
1
1
3
1
21,000
Arecibo
L
Existing Acceptable iealth Unit Auxiliary
F
20,200
tion
Popula
77
I
E
S
1
1
0
0
0
0
0
0
0
0
0
1
0
1
1
0
1
1
1
0
0
1
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Auxiliary
Pro g r a m m e d
I
Health Unit
T
Washington 25, D.C.
PUBLIC HEALTH SERVICE
FEDERAL SECURITY AGENCY
Adjuntas Aguada Aguadilla Aguas Buenas
Facility will Serve
Municipality Which Existing or Proposed
Allowed by State Ratio
4. Maximum Number of Public Health Centers
PUBLIC HEALTH CENTERS REPORT
PHS-12 (HF)
Puerto Rico
X 1 P. H. Laboratory
1/ Description of — Auxiliary Facilities
3. State
2. Date
of
1
May 15, 1959
1. Page
Rincdn
Quebradillas
Ponce
Pefiuelas
Patillas
Orocovis
Naguabo Naranjito
Morovis
Moca
Mayaguez
Maunabo
Maricao
Manati
Luquillo
Loiza
Las Piedras
Las Marias
Lares
Lajas
Juncos
Juana Diaz
Jayuya
Isabela
Humacao
Hormigueros
Hatillo
Gurabo
Guayama Quayani11a Guaynabo
Facility will Serve
Municipality Which Existing or Proposed
19,600 35,700 16,100 18,200 6,100 33,900 25,200 17,200 29,400 19,800 14,400 28,100 8,700 14,400 25,800 6,500 32,400 6,000 10,500 88,000 21,000 21,400 15,200 18,300 24,400 18,600 16,900 150,600 13,600 9,600
36,900
tion
Popula
PUBLIC HEALTH CENTERS REPORT, CONT.
PHS-12 (HF)
C
1
1
- 84 -
1
2
5 X
2
2
2 2
1
1
4 X
2
2
1
2
3
1
1
2
1
1
2
0
0
1
0
0
0 0
1
1
0
0
0
0
1
1
1
0
0
0
0
0
0
1
0
0
0
1
0
0
0
2
3
0
1
0
0
1
T
E
S
0
0
0
0
0
0 0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0.
0
0
0
0
0
P r o g r a m m e d Health Unit Auxiliary
1
1
3 X
0
1
1
1
1
3 X
0
1
L
Auxiliary
1
1
1
Acceptable
A
1
1
1
1
0
0
0
1
1
1
1
1
1
1
1
1
1
1
1
Health Unit
Existing
F
May 15, 1959
of
/—H
r—H
X I P. H. Laboratory
X 1 P. H. Laboratory
X 1 P. H. Laboratory
X 1 P. H. Laboratory
1/ Description of — Auxiliary Facilities
3. State Puerto Rico
2. Date
1. Page _2^
STATE TOTAL
I
1
49
2,306,000
0
134
1
3
2
1
1
1
1
0
30,400 8,300 17,400 26,700 31,600
1
3 X
1
1
2
1
0
1
1
1
1
0
2
2
0
2
1
1
2
10 X
0
L
Auxiliary
1
1
0
C
17,200
16,400 47,300
12,200 13,700 18,800
1 0
A
Acceptable
iealth Unit
Existing
F
I
E
S
33
0
1
0
1
0
1
0
0
0
0
1
1
2 1
0
1
1
0
health centers.
3
of 3
Puerto Rico
May 15, 1959
X 1 P. H. Laboratory
X 3 P. H. Laboratories
Auxiliary Facilities
Description of \J
3. State
2. Date
1. Page
IJ All auxiliary facilities except as indicated, are rural health centers meant as out posts of the
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Auxiliary
P r o g r a m m e d
T
Health Unit
I
The name of the local health unit is the name of the municipality which it serves.
Note:
Yauco
Yabucoa
Villalba
Vega Alta Vega Baja Vieques
Utuado
Toa Baja Trujillo Alto
Toa Alta
San Sebastidn Santa Isabel
San Juan-Rio Piedras San Lorenzo
San German
431,000 27,200 28,000
18,000 25,300 27,900
Salinas
16,000
Sabana Grande
tion
Popula
Rii* Grande
Facility will Serve
Municipality Which Existing or Proposed
PUBLIC HEALTH CENTERS REPORT, CONT.
PHS-12 (HF)
iTl
I
I I
r [
r
\
\
r^-
1® 1
CHAPTER
6
NURSING HOMES
Definition;
A nursing home is a facility which is operated in connection with a hospi
tal where nursing care and medical services are prescribed by or performed under the general direction of persons licensed to practice medicine or surgery within the State, for the accommodation of convalescents or other persons who are not acutely ill and not in need of hospital care, but who require skilled nursing care and related medical services.
The term "nursing home" shall be restricted
to those facilities that provide skilled nursing care and related medical services
for a period of not less than 2h hours per day to individuals admitted because
of illness, disease, or physical or mental infirmity and that render a community service.
The nursing home should be considered as an extension of medical services in a home like atmosphere. The patient should be prepared to return from it to
his original place of residence. It is thus a half-way house. Patients are admitted to a nursing home with the objective of improving their physical con
dition and well being. Their stay should not be indefinite; rather, emphasis
'1
should be placed upon teaching them to take care of themselves wherever possibble. Existing Facilities:
The State Agency has accumulated data from all nursing homes rendering
skilled nursing care throughout the island. For the purpose of this State Plan
only homes rendering skilled nursing care, that is, nursing care rendered by
1
a professional registered nurse, are included in the inventory (Form P.H.S.-5-l)' Domicialiary facilities or facilities providing only personal services have been excluded.
- 87 -
l-t.
I Evaluation of Existing Facilities:
I
Institutions included in the inventory have been classified as suitable, replaceable and unsuitable facilities.
These terms relate only to the nature
I
of the physical plant and do not refer to the service rendered to the patient. Th following criteria have been established:
1. Suitable - A nursing home has been declared suitable if it is:
a) Housed in a structure which meets the appropriate rating for fire or hurricane safety.
b) Designed for use as a nursing home. 2- Replaceable - A nursing home is declared replaceable if it is:
[
a) Housed in a stnicture which meets appropriate rating for fire and hurricane safety but has poor interior arrangement of facili ties, thereby restricting efficient operation.
b) Designed for use as a nursing home but should be replaced on a long term planning basis due to undesirable location. 3. Unsuitable - A nursing home is declared unsuitable if it is:
a) Housed in a structure which does not meet appropriate rating
.1
for fire or hurricane safety.
b) Not designed for use as a nursing home and its improvement is not practical or economical. Distribution of Nursing Home Beds:
The State Agency has programmed on an overall basis one nursing home bed
per thousand population. With a population of 2,306,000, this ratio allows a total of 2,306 nursing home beds.
Hospital service areas have been used in planning for nursing home beds
in order to maintain flexibility. Beds have not teen allocated to specific
\ - 88 -
I
3 1
municipalities within the service areas pending request for local surveys. Preferahlyj nursing homes should be located on a district or regional
level; it is desirable that they be part of the district or regional hospitals, either as separate structures or as a wing of existing facilities.
It is more
advantageous to operate a few first class nursing homes than many unsuitable facilities.
This close working relationship between the nursing home and a hospital would provide:
1. Closer medical supervision. 2. More efficient utilization of existing nursing personnel. 3. Common utilization of basic facilities and services such as kitchen,
laundry and boiler plant.
il". Accessibility to X-ray, laboratory and other diagnostic facilities and services when needed.
5. Joint utilization of specialized personnel such as social service workers, dietitians, medical record librarians and others, where required.
6. A smoothly operating mechanism for the transfer of patients from the
1
hospital to the nursing home or the reverse as the needs of the patients change.
7. More flexibility in the administration and utilization of the hospital by freeing acute beds now occupied by long-term patients not requiring acute hospital care.
8. The advantages of joint purchasing and a single administration. 9. Opportunities for training all types of hospital personnel in the care and rehabilitation of the long-term patient.
10. Joint utilization of rehabilitation facilities and personnel by the
hospital and the nursing home on both an in-patient and out-patient basis.
j 89 -
^ecial consideration should be given to the already existing nursing
^
homes which, although not fulfilling these desirable requirements, yet are rendering valuable community service.
The additional beds needed for each area are being kept in a pool at area
^
centers for distribution within the area as need arises•
r
Priority System;
Because of the limited number of nursing home beds which are now available, it is xrapossible to establish a workable priority system based on relative need between services areas.
Primary consideration will be given to an application for construction
of a project that will operate in connection with a hospital.
K
I II I
I II:
K I - 90 -
a/ b/
- 91 -
N.P.A.
N.P.A.
STATE TOTALS
Aibonito
Aibonito
Ind.
N.P.A.
N.P.A.
117
3a
0
20
44
19
10
Suitable
24
0
24
0
0
0
11
Replaceable
37
To substitute above
37
0
0
0
12
Unsuitable
13
one.
-
14
a/
a/
b/
a/
Occupancy
9
C a p a c i t y
control
Bed
Annual
Owner
Admissions
Puerto Rico
of
4. Region
Percentage
January 1959
1
Puerto Rico
of
3. State
1
May 15, 1959
1. Page 2. Date
ship or
Data not available. Approved for construction with federal aid.
rio Bellber
Casa de Salud Rosa-
Casa de Salud Rosa-
rio Bellber
B-2
Rio Piedras
Rest Manor
Ponce
Hato Rey
Mutuo
Sociedad de Auxilio
San Juan
De la Concepcidn
San Juan
B-1
8
7
6
City or Town
Name of Facility
5. Date of Inventory
PUBLIC HEALTH SERVICE
DEPARTMENT OF HEALTH, EDUCATION AND WELFARE
Area
INVENTORY OF NURSING HOMES
PHS-5-1
^
'—
/
i
/
I
CT
I
I
OT
■OH
2,306 2,189
I
164
164 0
Aguadilla
Int. Area - 6
^
208
208 0
Mayaguez
Int. Area - 5
'
211
211 0
Caguas
Int. Area - 4
!
135
135
0
Fajardo
Int. Area - 3
L-——*
508
474
34
Ponce
Int. Area - 2
- 92
305
305
0
Arecibo
Int. Area - 1
775
14
Beds Needed
Total
692
STATE TOTALS
1
r
9. Net additional beds allowed
Puerto Rico
83
13
12
1
3. State 'Puerto Rico 4. Region
San Juan
11
Community
of
1
May 15, 1959
1. Page 2. Date
Beds Needed
Additic
117
8. Total existing beds
Existing Beds
7. Total beds, allowed by ratio 2,306
Existing and Proposed Facilities
1
6. Ratio Adopted by state
PUBLIC HEALTH SERVICE
DEPARTMENT OF HEALTH, EDUCATION AND WELFARE
Base Area - 1
10
Area
5. Population
NURSING HOME SUMMARY
PHS-10-1
CHAPTER
7
DIAGNOSTIC OR TREATMENT CENTERS Definition:
A Diagnostic or Treatment Center is defined as a facility providing com munity service for the diagnosis and treatment of ambulatory patients, which is operated in connection with a hospital, or in which patient care is under
the professional supervision of persons licensed to practice medicine or surgery in the State, or in the case of dental diagnosis, under the professional super vision of persons licensed to practice dentistry in the State-
This includes
out-patient departments and clinics of public or non-profit hospitals- The
applicant must be either (l) a State, political subdivision, or public agency, or (2) a corporation which owns and operates a non-profit hospital-
H
Existing Facilities: An inventory of diagnostic and treatment facilities has been made this year.
The inventory includes:
1. Hospitals that provide diagnostic services or diagnostic or treatment services to ambulatory patients- This includes (a) hospitals which provide an organized out-patient departments and (b) hospitals which even though they have no organized out-patient departments provide
1
minimum diagnostic services of X-Ray and laboratory for non-hospital ized ambulatory patients, referred by their physicians for the technical services at the hospital.
2- Public Health Units which offer specialized diagnostic or diagnostic
or treatment services (Tuberculosis Centers) to the community.
3. Public Health Centers which provide diagnostic or diagnostic and treatment services.
- 93 -
H'
L
The Inventory excludes:
1. Offices of physicians and dentists engaged in private practice
||~
2. Coimnercial dental laboratories
3- Industrial clinics and similar facilities not rendering a community service.
Facilities that do not provide "basic minimum services" of laboratory and X-Ray. Evaluation of the Existing Facilities:
Institutions included in the inventory have been classified for planning purposes as suitable^ replaceable and unsuitable facilities.
These terms
relate only to the nature of the physical plant and do not refer to the services rendered.
The following criteria have been established:
Suitable:
Fire and hurricane proof building appropriate in size and
r
design for services rendered.
Replaceable:
Facilities in which at least one of the following conditions
I
exists:
1. Some parts of the facility are not fire or hurricane proof.
I
2. Facility somewhat small for services rendered and can not be easily and economically expanded.
3. Efficient operation hampered by poor arrangement of facilities
I
Undesirable location
Unsuitable:
Facilities in which at least one of the following conditions
exists:
1. Building not fire and hurricane proof
2. Building not adequate in size and sesign for services rendered and
its improvement is not practical or economical.
94 -
I
Distribution of Diagnostic and Treatmen-b Cen-bers: The hospital service areas were used as a basis for the distribution of
diagnostic or treatment centers.
The maximum state allowance for this category-
is one center for each 10,000 population.
Plan is 2,306,000.
The civilian population used in this
The state is therefore allowed a maximum of 23I diagnostic
or treatment centers under the Public Health Service Regulations.
The aim in the long range program is to provide at least one diagnostic
or treatment center in every municipaitty. wherever a health center is program med, the diagnostic or treatment center will be part of it.
■I
In some municipali
ties the diagnostic and treatment centers are somewhat limited in terms of the
services which they render.
It seems unadvisable to plan for the provision
of X-Ray facilities in every single community for the following reasons;
1. The comparatively short distances and the fairly good system of roads make this service available to all persons if adequately located.
^
2. The acute shortage of radiologists and technicians would greatly limit the usefulness of these facilities if they are indiscriminately provided. 3. The integrated hospital and medical system which is envisioned will
make
this service readily available to all people.
Those diagnostic
centers such as mental hygiene and cancer that cannot
be provided in every municipality because of lack of personnel or other reasons, are proposed for area centers.
The facility in these areas
are to be operated in connection with a general hospital. Cases presenting special problems in their diagnosis or treatment shall
be referred to the diagnostic or treatment center that will operate as part or the medical centers planned for San Juan, Ponce and Mayaguez. Additional diagnosis or treatment centers will be provided as needed.
95
-
i Priority of Projects:
In area centers where no health centers are proposed, prime consideration
shall he given to an applicant for the construction of a project that will
jl^
|-
form part of a general hospital.
In municipalities where a health center is proposed, the diagnostic and
|
treatment center shoiild he part of it. The priority established for the con struction of health centers is considered adequate and should he applied also for the constiruction program of diagnostic and treatment centers.
I
1 - 96 -
San
Area I
OF
FACILITY
Bayamdn Bayamdn Bayamdn CataHo
Comer£o Corozal Dorado
Guaynabo
Naranjito San Juan San Juan
P. R. Institute of Psychiatric
Hermanos Mel^ndez Hospital
Health Center
Health Center
Health Center
Health Center
Health Center
Health Center
Rio Piedras City Hospital
Health Unit
Bayamdn
Town
City or
Health Center
District Hospital
NAME
97 -
State
City
State
State
State
State
State
State
Corp.
Corp.
State
State
17493
216894
12631
2/
13124
26324
12869
IDits Year
49741
360
2/
92487
27237
<0
>
X
X
X
X
X
X
X
X
o
a
Cancer X
X
;
X :
it! ool u Ic
f
0
(U
CO 1-1
(4
O
X
X
4. Region
M
I Q)
I
'
i
(Hi
!!><
I
X
X
X
X
I X
1
U
ABDjI X
A
1
of
9_
•
COi W
O
I
X
X
X
;X
1 X
X
:
I
I
X
X
X
X j X
X
X
X
X
p hJ K
H CO
CO
ii-l Mi -H \C o; a
lU
CO U. CO
L H O rH
— -j 0^
I Q
I
■ 3
1
jni
i X
I X li
i X I
X
X
:Cn
! A 1 .Q)
:cS <9—4
u lH
, fU
" ;ca
n
a>
,£0
pH
ecu
1 c
1 3
i CO
■ -rl
I 4J
i-O 1 CO
9—C
i 0)
fication
Classi
Puerto Rico
2. Date May 15, 1959 3. State Puerto Rico
1. Page
.. JDiag. i Serv.
3 1-1 ! « H CO I O
01
0
ttf a> 1 o
M
<u; (u r-l c : a,
X
I
o -j
:
M
■ TJ
I ■ O
CO
i
•
« o
!
§_c^i.^1
r-4
X
S
CO c
M
1-1
00 c
^ 4J
a o iH M
o
5. Date of Inventory
January 1959
PUBLIC HEALTH SERVICE
DEPARTMENT OF HEALTH, EDUCATION AND WELFARE
INVENTORY OF DIAGNOSTIC AND DIAGNOSTIC AND TREATMENT CENTERS
PHS-5-2
Area
1800
1250
Ind. Ind.
San Juan San Juan San Juan
San Juan San Juan San Juan
Woman's Hospital
Monteflores Hospital
Dr Se£n Hospital
Mimiya Hospital
Presbyterian Hospital
Dr. Rivera Herndndez Hospital
1
San Juan
X
2/
Ind.
San Juan
Professional Hospital
j Health Unit
X
20517
Corp.
San Juan
Doctor's Hospital
San Juan
X
87309
City
San Juan
San Juan City Hospital
! Dr. Pavfa Hospital
X
1/
N.P.A.
San Juan
Teacher's Hospital
- 98 -
State
Corp.
Ind.
N.P.A.
Ind.
Ind.
X
2/
Ind.
San Juan
Ntra. Sra. de la Guadalupe Hosp.
37642
9000
2/
V
2/
Year
2/
X
X
X
X
X
I
iDunsVtrg Genljra {
1
X
17121
N.P.A
San Juan
Auxilio Mutuo Hospital X
X
,o
CO ,u
rC U
•rj 0
2/
Town
City or
Ind.
FACILITY
San Juan
OF
Metropolitan Hospital
NAME
0
INVENTORY OF DIAGNOSTIC AND DIAGNOSTIC AND TREATMENT CENTERS, CONT.
PHS-5-2
Cancer
X
X
n}
...13
X
OJ
a
a
&t
C 61
H-
X
O
S IX
e s
i'
hOopredtic bTerculo
X
K
i a
4J •>-(
! D(
1 lDenta
X
S p
S e r V
hOter
sis (7=1
A
X
B
X
X
X
X
X
X
BD
B
X
BD
X
X
X
BD
BD
X
X
X
JT^
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Serv.
Diag.
X
X
X
X
X
X
X
X
X
X
X
X
1, Page —2—of
Ciassi-
X
X
X
X
X
X
X
X
X
X
X
X
X
X
ficatlon
I-l
cibo
Are-
OF FACILITY
Fundacidn de Investigaciones
Dr. Julicl Hospital
Psychiatric Hospital
Dr. Gonzalez Martinez Hospital
Institute of Radiotherapy
Dr. A. Ruiz Soler T.B. Hospital
Antillas Clinic
Dr. Fernandez Garcia Hospital
Puerta de Tierra Dispensary
Borinquen Dispensary
NAME
District Hospital
Health Center
Health Center
Health Center
Clinicas
Area
Arecibo
N.P.A.
N.P.A.
State
Corp
Part.
City
City
N.P.A.
Corp
State
- 99 -
Trujillo Alto
Toa Baja
Toa Alta
San Juan
San Juan
San Juan
San Juan
San Juan
San Juan
San Juan
San Juan
San Juan
San Juan
Town
City or 00 U
n) 01
CONT.
11710
INVENTORY OF DIAGNOSTIC AND DIAGNOSTIC AND TREATMENT CENTERS,
PHS-5-2
C bO
-fiaatixm.
' <i> 'i ■
IClassiDiag -Serx,.
1. Page „_3L of
u
>
35882
o
State
d o
2/
Ind. State
Ind.
Utuado
Vega Baja
] Vega Baja
San Miguel Hospital
Health Center
i
Ponce
/'
•■ir-
T
: Castafier Hospital
1 Health Center
Adjuntas
100 -
N.P.A;
!
State
37312 State
Utuado
Health Center
Adjuntas
X
27514 State
Manatf
Health Unit
2/
23973
2/
74003
X
X
X
X
X
X
X
X X
3001 State
Lares
Health Unit
Sinchez Castafto Hospital
X
1/
N.P.A
Lares
Castafier Hospital
X
X
y
State
Hatillo
Health Center
X
State
Camuy
Health Center
14987
9080
Corp.
Arecibo
X
Dr. Susoni Hospital
X
I-l o
u
2/
r
d 60
d Q) ■U .r)
Ind.
X
X
Q
B
u
r-l d
Arecibo
« CJ
a
i-l 0) u
d) d
El Buen Pastor Hospital
X
g
CO •rl
d
d o
CO
!r! d 0
VI VI 6-1 •rl
CO
0)
12972
Arecibo
City or
Vi d d
City
FACILITY
Q
•H
u
Special
Arecibo
OF
VI
V4 3
•H
d
60
Service
BD
A
A
o
-u
d
1, Page
Dr. Manuel Figueroa Hospital
Health Unit
NAME
1-2
cibo
Are-
I-l
Area
-d
&iH •H 0
VI 0
INVENTORY OF DIAGNOSTIC AND DIAGNOSTIC AND TREATMENT CENTERS,CONT.
PHS-5-2
1
X
X
X
X
X
X
X
X
a
i
i X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
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1/ 14511
State
City State State State
City
Guayanilla Juana Dfaz Orocovis
Patillas Pefluelas Ponce Ponce Ponce
Ponce Ponce
Health Center
Municipal Hospital
Health Center
Health Center
Health Center
Trichoche Hospital
District Hospital
Dr. Pila Hospital
St, Luke's Hospital
Santo Asilo de Damas Hospital
- 101 -
N.P.A.
N.P.A,
N.P.A.
State
X
1/
State
Guayama
Health Center
4769
10450
2/
26181
ILsits Year
91102
2/
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Gudnica
South P. R. Sugar Co. Hospital
X
X
X
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NAME
JS M
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INVENTORY OF DIAGNOSTIC AND DIAGNOSTIC AND TREATMENT CENTERS, CONT.
PHS-5-2
1
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Fajardo
Dr. Gubern's Hospital
i
r
- 102 -
H/' ■
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X
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Fajardo
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State
Yauco
Health Unit
State
State
Villalba
Health Center
Fajardo
2/
City
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Municipal Hospital
Health Unit
2/
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Salinas
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7842
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Special
S e r V i c e s
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Cancer Hospital
Town
X! U
state
FACILITY
3 (-1 Q cfl
Ponce
OF
Dj iH
•H .0
Health Unit
NAME
City or
•rl
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C
1^
W)
INVENTORY OF DIAGNOSTIC AND DIAGNOSTIC AND TREATMENT CENTERS, CONT.
PHS-5-2
l/~™i
X
X
X
X
X
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X
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1-4
Area
OF
Cayey Cidra Juncos Las Piedras
Dr. Font Hospital
Health Center
Health Unit
Health Center
Lajas Las Marias Maricao
Mayaguez
Health Center
Health Center
Health Center
Health Unit
2/
22001
2/
1/
State
State
State
State
State
State
State
State
1/
1281
6474
1/
9062
10703
i
80260
28334
2/
2/
63983
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1. Page .,.,7. _ of _ ?
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tfl
j| hOwnireosplContro 1. iDunsVtrg jYear State
Ind,
State
- 103 -
Hormigueros
Health Center
Ahasco
Cayey
Health Center
Health Center
Caguas
San Rafael Hospital Ind.
State
Caguas
Health Unit
State
City
Aguas Buenas
Town
Caguas
FACILITY
Dr. Jimdnez Sanjurjo Hospital
Health Center
NAME
City or
INVENTORY OF DIAGNOSTIC AND DIAGNOSTIC AND TREATMENT CENTERS, CONT.
PHS-5-2
j
State
San German
Health Center
^
T
104 -
*
Rincdn
Health Center
•
State
Quebradillas
Health Center
•
State
Moca
Health Center
r-
State
Isabela
Health Center
-
State
State
Aguadilla
Health Unit
•
3000
11524
1628
2/
2/
2/
X
X
X
X
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STATE TOTALS
X
X
X
X
hOrwpnieos lContro jiDunsVtrg | Year Genljra State
State
Ayuadilla
Aguada
dilla District Hospital
Agua-
N.P.A.
N.P.A.
Mayaguez
Bella Vista Hospital
San German
Ind.
Mayaguez
Dr. Ramirez Hospital
De la Concepci<5n Hospital
Part,
City
Mayaguez
Mayaguez
Town
City or
Dr. Perea Hospital
1-6 i Health Center
i
!
NAME OF FACILITY
j San Antonio Hospital
i
i
1
Area.1
i
i
INVENTORY OF DIAGNOSTIC AND DIAGNOSTIC AND TREATMENT CENTERS, CONT.
PHS-5-2
v_=
Stands for Psychiatric Service.
Stands for Eye Service.
C-
D-
3/
105
Visits included in total given for San Juan City Hospital.
2/ Data requested and not submitted.
of operation.
1/ Data not available because the project is on planning, under construction or with less one year
Stands for Heart Service.
B-
^
9
of
9
U U 1. Page
stands for the following services; Venereal Diseases, Prenatal Care, Ginecology, Infant Hygiene, Preschool Hygiene, Health Certificates, Treatment for Intestinal Parasite.
INVENTORY OF DIAGNOSTIC AND DIAGNOSTIC AND TREATMENT CENTERS, CONT.
PHS-5-2
^
Juan
San
B-1
2.306,000
0 1
Loiza
Naranjito
7"
Toa Alta * 1
25
1
Guayrale
1 San Juan
E
1
Dorado
E
P
P
P
E
E
E
E
E
1
Corozal
- 106 -
P
P
E
E
E
E
E
E
E
E
E
1
Comerio
P
E
P
E
E
1
P
Cataho
E
0
P
P
Carolina
E
r
4
0
P
P
P
P
P
,rr—^
E
P
P
E
E
E
E
E
E
E
E
P
P
P
P
P
P
p-*)
117^
P
P
Mental Dental
Hygiene
Cancer
Centers
General
Clinical
I
Allowed
E
P
P
pedic
Ortho
i
P
m
17^
E
E
E
T. B.
130 DIAGNOSTIC OR DTAGNOSTTC A ND TREATMENT SERVICES
101
Puerto Rico
3. Net Additional Centers
Laboratory
Diagnostic Services
231
Centers
4. Region
Puerto Rico
3. State
of
1
May 15, 1959
1. Page 2. Date
Existing
Number of
by State Ratio
6. Total Centers Allowed
Bayamdn
Barranquitas
Community
Population
Area
5.
7. Total Existing
Washington 25, D. C.
PUBLIC HEALTH SERVICE
DEPARTMENT OF HEALTH, EDUCATION AND WELFARE
DIAGNOSTIC AND DIAGNOSTIC AND TREATMENT CENTERS SUMMARY
PHS-10-2
0 1 2 1
Morovis
Utuado
Vega Baja
Adjuntas
Ponce
1-2
1
0
Manatf
Arroyo
1
Lares
1
1
Hatillo
Aibonito
E
0
Ciales
E
E
E
E
E
1
Camuy
P
P
P
0
Barceloneta
Are-
cibo
P
5
Arecibo
I-l
E
0
Vega Alta
E
E
E
E
,E
E
E
1
E
107
P
P
P
P
P
P
P
P
P
Laboratory
Tr*jillo Alto
X-Ray
Clinical
Diagnostic Services
1
Centers
Existing
Number
Toa Baja
Area
Community
DIAGNOSTIC AND DIAGNOSTIC AND TREATMENT CENTERS SUMMARY, CONT.
PHS-lO-2
V
E
E
E
E
E
E
E
E
E
E
P
P
P
P
P
P
P
P
P
General
E
P
Cancer
E
E
E
E
E
E
E
E
E
E
Dental
P
P
P
P
P
P
P
P
P
E
P
pedic
Hygiene
P
Ortho
Mental
E
P
P
T. B.
DIAGNOSTIC OR DIAGNOSTIC AND TREATMENT SERVICES
4. Region Puerto Rico
Puerto Rico
^
3. State
2 of May 15, 1959
2. Date
1. Page
Fajardo
1-3
Area
Number
4. Region Puerto Rico
P
Dental
E
P P
6 0 1 1 0 1
Ponce
Salinas
Santa Isabel
Villalba
Yauco
Ceiba *
E
E
1
Peftuelas *
108 -
P
E
P
P
P
E
E
1
Patillas
P
E
E
1
Orocovis
E
E
E
P
P
0
Maunabo
E
E
P
P
0
Juana Diaz
E
E
P
E
P
P
E
E
E
P
P
P
P
P
P
pedic
Ortho-
jpssj
Mental Cancer
Hygiene
General
Laboratory E
5
T. B.
DIAGNOSTIC OR DIAGNOSTIC MD TREATMENT SERVICES
0
X-Ray
3 of May 15, 1959
3. State Puerto Rico
2. Date
1. Page
Clinical
Diagnostic Services
Jayuya
1
1
Ctuayama '9c
0
Gu^nica
Guayanilla
1
Centers
Existing
Coamo
Community
DIAGNOSTIC AND DIAGNOSTIC AND TREATMENT CENTERS SUMMARY, CONT.
PHS-10-2
^
1-4 Caguas
Area
E
4 0
0 1
1 0
1 2
2 1 0 0
1 0
Humacao
Luquillo
Naguab*
R£o Grande
Vieques
Yabucoa
Aguas Buenas *
Caguas
Cayey
Cidra
Gurabo
Juncos
Las Piedras
San Lorenzo
E
E
E
X-Ray
3
Centers
Existing
P
P
P
P
P
Dental
E
E
E
E
E
E
E
E
" 109 -
P
P
P
P
P
P
P
P
P
E
E
E
E
E
E
E
E
E
P
P
P
P
P
P
P
P
P
P
P
E
E
E
E
E
E
E
E
P
P
P
P
P
P
P
P
P
P
P
Hygiene
Cancer
Laboratory General
Mental
E
Puerto Rico
E
P
P
pedic
Ortho
E
P
P
P
P
T. B.
DIAGNOSTIC OR DIAGNOSTIC AND TREATMENT SERVICES
4. Region
3. State Puerto Rico
2. Date
5
4 of May 15, 1959
1. Page
u u
Clinical
Diagnostic Services
Fajardo
Community
Number
DIAGNOSTIC AND DIAGNOSTIC AND TREATMENT CENTERS SUMMARY, CONT.
PHS-10-2
v_.
dilla
Agua-
1-6
guez
Maya-
1-5
Area
PHS-10-2
y
^
1
Aguada *
1 1 1 0
Moca
Quebradillas
Rincdn
San Sebastian
r
STATE TOTAL
E
1
Isabela
lO.C
E
1
Aguadilla
P
P
2
San German
E
0
Sabana Grande
E
E
E
E
E
E
E
r
110 -
P
P
P
P
E
4
Mayaguez P
P
1
Maricao E
E
E
1
Las Marias
P
P
P
P
P
P
P
E
E
E
E
E
E
E
E
E
E
E
E
P
P
P
P
P
P
E
E
P- Proposed
P
P
[r-=i
17=^
P
P
pedic
Ortho
* Under or approved for construction
E- Existing
E
E
E
E
E
E
E
E
E
E
P
E
E
E
1
Lajas*
P
Dental
Mental Cancer
Hygiene
General
E
E
P
T. B.
DIAGNOSTIC OR DTAONOSTTn AND TREATMENT SERVICES
4. Region Puerto Rico
Laboratory
E
1
Hormigueros
X-Rav
5
Puerto Rico
of
3. State
Clinical
Diagnostic Services
E
0
1
Centers
Cabo Rojo
Afiasco
Community
Existing
Number
AND DIAGNOSTIC AND TREATMENT CENTERS SUMMARY, CONT.
5
May 15, 1959
2. Date
1. Page
11 CHAPTER
8
REHABILITATION FACILITIES Definition:
The type of rehabilitation facility contemplated to receive assistance
under the 195^ amendment to the Hill-Burton Act and the program of service to be offered by such a facility are set forth in the Public Health Services Regu lations as follows:
"1. A facility providing community services which is operated for the primary purpose of assisting in the rehabilitation of disabled persons
through an integrated program of medical, psychological, social and vocational evaluation and services under competent professional super-
jB
vision. The major portion of such evaluation and services must be furnished within the facility; and the facility must be operated
either in connection with a hospital as a facility in which all medical and related health services are prescribed by, or under the general
direction of, persons licensed to practice medicine or surgery in the State.
2. An integrated rehabilitation program brings together as a team special
ized personnel from the medical, psychological, social and vocational areas for the purpose of pooling information, interpretations and
opinions for the development of a rehabilitation plan of services in which the disabled individual is viewed as a whole. When members of the team contribute to the diagnosis and treatment of illness, their contribution must be coordinated under medical responsibility. These
integrated services may be provided in a facility to care for many types of disabili+^ies or a single type of disability.
Ill -
3- A disabled person is an individual who has a physical or mental con dition which, to a material degree, limits, contributes to limiting
or if not corrected, will result in limiting, the individuals performance or activities to the extent of constituting a substantial physical,
mental, or vocational handicap." Existing Facilities:
An inventory was made of
1 existing rehabilitation facilities.
Cooper-
aticn was requested from, and generously given by the Division of Vocational Rehabilitation of the Department of Education (State Agency for Vocational Re habilitation), the Crippled Children*s Bureau, the State Insurance Fund and
the Puerto Rico Chapter of the Rational Society for Crippled Children and Adults.
The survey disclosed that a number of hospitals and other institutions
offer seme rehabilitation services, but that no rehabilitation center with an integrated program as conceived in the Federal Regulations operates in Puerto Rico.
Evaluation of Existing Facilities:
The classification of the existing facilities as suitable, replaceable or unsuitable was found to be irrelevant and unnecessary, inasmuch as thei e are no rehabilitation centers as defined by the regulations. Estimate of Need and Programming of Facilities:
The State Agency contemplates planning rehabilitation facilities so that all persons in Puerto Rico shall have access to integrated rehabilitation services
^
for all types of disabilities. Based on an allowance of one facility per 300,000
population or major fraction thereof and a state population of 2,306,000, eight
^
facilities may be programmed in Puerto Rico.
Since no true rehabilitation facility exists, it is felt advisable to
L
program a facility in close proximity to a medical teaching center where ade-
- 112 -
V
quate staff is most likely to "be available. This will also afford proper faci lities for the training of additional rehabilitation personnel.
Since no inte
grated rehabilitation facility exists, it is felt advisable to program a multi ple type disability center in order to afford comprehensive rehabilitation services. Further, since a complete rehabilitation facility will require a
considerable amount of special equipment and particularly a highly specialized team of rehabilitation personnel, it appears that such a facility should be
located in an area serving a large segment of the population which is financial ly able to support such an institution. Rehabilitation facilities or centers are mostly needed in medical teaching centers and in metropolitan areas, pro
viding equipment and services at a centralized location. The cost of complete rehabilitation facilities for small groups of patients is prohibitive for small
■|
communities. Such areas can receive adequate and satisfactory service by relying upon the various types of rehabilitation centers established in the more popu lous areas.
In view of the above factors and for the purpose of preliminary planning, the island has been divided into three rehabilitation areas as follows:
Area I - San Juan - to serve the northern and eastern part of the island. Area II- Ponce - to serve the southern part of the island.
Area III- Mayaguez - to serve the western part of the island.
Those facilities should form part of the Medical Centers being planned for those cities.
4
The other rehabilitation centers allowed by the State ratxo
were left in a pool to be assigned later as needed.
The multiple rehabilitation facility planned as part of the Medical Center in San Juan should centralize and expand many of the rehabilitation services
now being performed by the constituent hospitals of the future Medical Center
-113 -
and by other agencies such as the Division of Vocational Rehabilitation and the
Crippled Children's Bureau.
It will also make the four areas of services availa
ble to all the clients of these institutions and agencies and to that part of
the population that can not secure services today because they do not qualify as clients of the agencies and institutions rendering them. Priority of Projects:
The Federal Regulations state:
"The priority of rehabilitation facility
projects shall be determined after consideration of the following factors in
the order of importance as given:
"(a) Relative need for additional rehabilitation services in the community
or communities to be served by the project taking into account exist ing rehabilitation services and given special consideration to:
"(l) Projects located in medical centers, school or universities with medical schools or medical centers; and
"(2) Projects providing a multiple disability service as distinguished from those providing a single disability service
Therefore, first priority will be given to the multiple disability rehabi
litation center at San Juan and second priority will be given to multiple disarehabilitation centers planned at Ponce and at Mayaguez in order to
complete the basic rehabilitation facilities system as conceived in this Plan. Five centers will be held in reserve and will be planned if future study
reveals their need. These centers may be either for single type disabilities or for out-patient rehabilitation facilities if it is indicated that the latter is feasible.
V'Ql
- 114 -
San Juan
San Juan San Juan San Juan
San Juan San Juan
San Juan
Ruiz Soler T. B. Hospital
Psychiatric Hospital
Dr. Juli^ Psychiatric Clinic
State Insurance Fund Service
Fernandez Garcfa T. B. Hospital
Antillas T. B. Clinic
Psychiatric Medicine and Voca
ing & Adjustment of the Blind
Vocational Institute for Train
Cerebral Palsy Clinic
! San Juan
San Juan
Guaynabo
Orthopedic and T. B. Institute
tional Evaluation Center
Bayam(5n
Control
Town)
State
State
State
Corp.
Corp.
State
Ind,
State
State
N.P.A.
Corp.
State
ship or
(City or
P. R, Psychiatric Institute
FACILITY
BayamiSn
OF
District Hospital
NAME
Owner
Location
4J
-
89
20
-
27
67
64
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115 -
3i
48
36
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250
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1. Pa^e _1 of 3. 2. Date . ._May__15.,..195.9. 3. State .JP.uer.tQ_Rico. ..
Disability Groups
4. Date of Inventory - January, 1959
PUBLIC HEALTH SERVICE
DEPARTMENT OF HEALTH, EDUCATION AND WELFARE
INVENTORY OF REHABILITATION FACILITIES
PHS-5-3
\
OF
FACILITY
1 N.P.A i State
Ponce
Ponce Ponce Ponce
Ponce
Psychiatric Hospital
Tuberculosis Hospital
Ptate Insurance Fund Service
Clinica Pila
Rehabilitation Center
'
1 State
Ponce
District Hospital
.
State
Aguadilla
- 116
X
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ABCD JL ABCD JL
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Served
2. . of
San Juan
San Juan
San Juan
Control
>H
Age
Groups
1. Page
Blind
Industrial Corporation for the
tion Office
Physical Medicine Rehabilita
Children and Adults
National Society for Crippled
NAME
cu
O 4J
4J
ship or
(City or Town)
ca
y-i > a)
H XI (U
p G
•H
>
•H
Owner
ICaseload
j Daily
!Average
Location
INVENTORY OF REHABILITATION FACILITIES, CONT.
PHS-5-3
^ v.
CODE:
1/
G- Prosthetics Brace Fit
A- Phys. and Med. Eval. B- Medical Supervision C- Physical Therapy D- Occupational Therapy E- Speech Therapy F- Audio, ser. incl. lip reading
MEDICAL
Project approved for construction.
a/
Q- Social Groupwork R- Recreation (Non-Med.)
M- Recreational Ther.
117
L- Medical Consult.
P- Social Casework
0- Evaluation
SOCIAL
N- Evaluation
PSYCHOLOGICAL
J- Nursing K- Physical Education
I- Dental
H- Psychiatric
INVENTORY OF REHABILITATION FACILITIES, CONT.
FHS-5-3-
^v..
3
of
3
Y-. Sheltered Emp. Z- Travel training for blind
W- Voc. Tr.
U- Pre-voc- Exp. V- Special Educ.
T- Vocational Counsel
S- Evaluation
VOCATIONAL
1. Page
DEPARTMENT OF HEALTH, EDUCATION AND WELFARE
[
PUBLIC HEALTH SERVICE
PHS-11-3
1. Page
1
of
1_
2. Date May 15, 1959
[
3. State Puerto Rico
REHABILITATION FACILITIES SUMMARY
[ 4, Population
5, Total facilities allowed by the state ratio for each type of disability
6. ADDITIONAL FACILITIES PROPOSED:
Area
L
8
2,306,000
Community
l:
Description of Facilities and Services to be Provided
l: B98e Area 1
San Juan
A multidisability center providing a comprehensive and
integrated program of medical, psychological, social and vocational evaluation and services. This facility, loca
ted as part of the Medical Center will provide training programs for residents, interns and medical students, physical therapists, occupational therapists, nurses and social workers.
Intermediate Area - 2
Ponce
A multidisability center providing a comprehensive and integrated program of medical, psychological, social, and vocational evaluation and services.
Intermediate Area - 5
Mayaguez
A multidisability center providing a comprehensive and integrated program of medical, psychological, social and vocational Gvaluaticn and services.
L L 118 -
k
METHODS OF ADMINISTRATION
Press releases have been issued bo keep
bhe public informed about projects
approved for or under construction as well as about changes made in order to
bring the Plan up to date.
Copies of the last revision of the Plan have been
widely distributed.
The original Plan and all subsequent revisions will be available at all times for public examination at the Bureau of Hospital Survey and Construction. Establishment of the Project Construction Schedule
After approval of the State Plan by the United States Public Health Service, the Bureau of Hospital Survey and Construction develops a Project Construction
Schedule listing projects that can be built using federal funds alloted for the fiscal year.
The Schedule is developed by considering applications from sponsor
ing agencies in areas of the greatest unfilled need and in the order of the area
1 J
I
priorities as shown in the over-all construction program. The number of projects included on the Project Construction Schedule depends on the amount of the Federal allotment to Puerto Rico.
Projects are selected for the Project Construction Schedule after consider ation of the following factors:
1. The priority of the project as determined by this Plan.
2. The ability of the sponsoring agency to meet the financial requirements for construction, maintenance and operation of the proposed facility. 3- Initial installations and additions to existing facilities are given
priority over replacement, except where replacement is of minor character and necessary to the provision of needed additional facilities, and where replacement is essential to eliminate an existing needed facility
1
which constitutes a public hazard.
il-. Special consideration is given to applications for projects of a size and character consistent with efficient and economical operation.
5. The maintenance of an appropriate balance in the construction of the
- 119 -
various categories of facilities (i.e. general^ tuberculosis, mental and chronic disease hospitals and public health centers).
6. Provision of services to low income areas or groups, especially to "rural" groups.
If a project is removed from the Project Construction Schedule by the De partment of Health of Puerto Rico, the Schedule will be revised to include the next highest priority project which meets the requirements for inclusion.
The fact that a project is excluded from the Project Construction Schedule for some reason will not change the project priority rating although for other
reasons this priority may change.
Such project will be considered for inclusion
in a future Project Construction Schedule for which an application is filed.
If a project is in the highest priority group. Part I of the Project Con
struction Application which is prescribed by the Public Health Service will be
approved and forwarded prior to approval of the Project Construction Schedule. If the project is not in the highest group. Part I of the Project Construction Application will be submitted with the Schedule. Standards of Construction and Equipment
l: L
The Department of Health of Puerto Rico has adopted as its own general standards of construction and equipment, those contained in Appendix A as amended, of the Regulations issued under Public Law 725 of the 79th Congress, with minor changes which have been thought justifiable due to local climatic conditions.
L
Copies of such standards are available for inspection in the Bureau of Hospital Survey and Construction. Also copies of the Regulations and of Appendix A as
amended, will be mailed on request to registered architects in Puerto Rico and any other interested persi n or entity.
L.
"•'nspection by the Department of Health
VJhen a request for payment of an installment is made, the Department of
120 -
Health of Puerto Rico vill make an inspection of the project to determine that services have heen rendered^ work has been performed, and purchases have been
made as claimed by the applicant and in accordance with the approved project application.
In addition, the Department of Health of Puerto Rico will make
such additional inspections as deemed necessary.
Reports of each inspection
will be retained in the files of the Department of Health. Construction Payment
Requests for construction payments shall be submitted by applicants to the
Department of Health of Puerto Rico at the time prescribed by Section 10.78 (a) of the Regulations. Under existing laws, the Government of Puerto Rico is authorized to make
payments out of Federal funds to all types )f applicants.
Federal funds will
be paid through the Secretary of the Treasury. The Department of Health of Puerto Rico will take the necessary steps to assure that the Secretary of the Treasury of Puerto Rico will promptly remit or credit all payments of Federal funds received by him for payment to applicants for approved construction projects. Establishment and Maintenance of Personnel Standards on a Merit Basis
All personnel employed in administering the State Plan is appointed under
and subject to the merit system maintained by the Offices of Personnel of the
Commonwealth of Puerto Rico created by Law 3^5 approved May 12, 19^7-
Reference
is also made to Law 4ll approved May 13, 19^7 to provide a Standard and Uniform Compensation Schedule for all Classes of Positions included in the classification plan.
Certified copies of both laws have been submitted to the U. S. Public
Health Service.
The Office of Personnel of the Commonwealth of Puerto Rico will
furnish the Public Health Service with such information as necessary to determine
- 121 -
I compliance with the Act and Regulations. Fiscal and Accounting Requirements
The Depart; ent of Health of Puerto Rico will comply with the provisions of Section 10-79 of the Regulations by maintaining the necessary accounting records and controls, and requiring applicants for Federal funds to maintain adequate fiscal records and controls.
The Department of Health of Puerto Rico agrees that it will retain in its
files all copies of documents coming into its possession which are related to
any expenditure under Public Law 725• According to statutory provisions in Puerto Rico, the original documents are retained in the files of the Secretary
of the Treasury of Puerto Rico. In addition, the Department of Health of Puerto
Rico will take such steps as necessary to assvre that applicants (l) retain all relevant and supporting dociaments, and (2) estabjjish suitable property inventory records covering all equipment of more than nominal value.
The Department of Health of Puerto Rico further agrees that it will;
(a) retain the accounting records, controls and copies of documents described in the above two paragraphs for a period of at least one year beyond its partici pation in the program and also agrees to make the necessary arrangements with
the Secretary of the Treasury of Puerto Rico so that the original documents are
retaxned in his files for a period of at least one year beyond the participation of the Department of Health in the program; (b) take such steps as are necessary
to assure that applicants retain the fiscal records, controls and documents described above for a period of at least two years after the final payment of federal funds. Federal Share
Under the provisions of Title VI, Fablic Health Service Act, as amended
by Public law 3bO of the 8lst Congress and by Public Law k82 of the 83rd Congress,
- 122 -
the Federal participation in the construction of each project shall he not less
than 33 1/3
centum and not more than 66 2/3 per centum.
Flexibility and Transfer of Funds
Upon the request of the State that a specified portion of any allotment of
Federal funds to the State made categorically for providing assistance in the cost of constructing public and other non-profit diagnostic or treatment centers^ hospitals for the chronically ill and impaired, and for non-profit nursing
1
be added to another allotment of the State within these categories, and upon the
simultaneous certification to the Surgeon General by the State Agency to the
I
effect that it has afforded reasonable opportunity to make applications for the portions so specified and there have been no approvable applications for such portions, the Surgeon General shall adjust the allotments in accordance with such
I
request and shall notify the State Agency, and thereafter the allotments as so adjusted shall be deemed the State's allotments for the purposes of such para
1
graphs.
I The rate to be applied to the 1960 fiscal year, part C and G
I
projects is 66 2/3 per centvim.
1
I
- 123 -
V ;:
i
I
[ f [ I
I [.
I
1
I
I
I 4
I r
1
n
1
STANDAEID FOR CONSTRUCTION, OPERATION AND MAINTENANCE OF HOSPITALS
The Puerto Rico Hospital Licensing Act (Law No. jh of 19^8) provides for the establishment of minimum standards for hospital construction, operation
and maintenance in Puerto Rico.
The standards prepared under this Law by the
Department of Health were approved by the Governor of Puerto Rico and pro
mulgated on December l8, 1950. The Law charges the State Agency with responsibility for the administration
of the hospital licensing program.
I
To operate in Puerto Rico, a hospital must
adhere to these standards.
The Rules, Regulations and Standards for Hospital Construction, Operation and Maintenance in Puerto Rico are issued on a separate volume and will be sent,
I
upon request, to any interested citizen.
I
I
I
il - 125 -
I i -TT^sVrti'itr-n-
. J.
RULES AM) REGULAHONS ESTABLISEING A FAIR HEARING PROCEDURE FOR APPLICAHTS OF FEDEEiAL FUNDS UNDER PUBLIC LAWS 725 AND OF THE U. S. CONGRESS
1. The Department of Health of Puerto Rico will provide an opportunity for a hearing to every applicant who, having requested Federal aid for the construction of a project, is dissatisfied with the action taken by the De partment of Health, provided he applies for such a heading. 2. Applicants are entitled to a hearing for the following decisions taken by the Department of Health:
a. they have been denied the opportunity to make a formal S'PPlication for the construction of a project; b. the Department of Health has refused to consider his application;
c. the application hai been rejected or disapproved.
3. Application for a hearing shall be submitted in writing within 30 days from the date of receipt of the adverse decision of the Department of Health.
h. The Department of Health wiJl notify in writing to the appellant the time and place of the hearing which will be reasonably convenient to the ap plicant.
5• The appellant shall be entitled to be represented by friends or by counsel if he so desires, or he may appear in person. The appellant or his representatives as well as the officials of the Department of Health concerned
with the Department's decision, shall be entitled to present evidence subject to reasonable procedures of admissibility and methods and presentation. Both
parties shall be entitled to examine all evidence and to question opposing witness.
- 127
6. The Secretary of Health shall appoint as presiding officer or master of the hearing an official who did not participate in the action from which the appeal is made.
7. The decision of the Department of Health shall he made in writing within 30 days from the date of the hearing and will he hased on evidence presented at the hearing.
8. If the appellant so desires, at the time of filling his application, he may request that a stenographic record of the hearing he taken and the Department of Health will provide such service without cost. The appellant shall he entitled to a certified copy of the proceedings.
/•
}r^
- 128 -
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