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Puerto Rico’s Health Care Is in Dire Condition, Three Weeks After Maria

The situation is particularly serious for Puerto Rico’s 6,000 dialysis patients.

On its hurricane update website, the Puerto Rican government says that all 46 dialysis centers on the island have received assistance, and the Department of Defense counts 43 centers as operational. The website does not mention that the diesel fuel shortage is still so severe that many patients whose blood is normally cleaned for 12 hours a week are now being treated for only nine.

“At one point, the government said the dialysis situation was controlled and the facilities were getting diesel,” said Lisandro Montalvo, the medical director of Fresenius Medical Care North America, a chain of dialysis centers here. “But they maybe supplied diesel to three or four facilities, and we have 26 facilities. We talk to FEMA every day. It’s always an emergency. We have to say: ‘These three are low, please.’ Sometimes they fill it, and sometimes they don’t.”

Mr. Cruz receives his dialysis treatment at a different chain of centers. He said that in the days after the storm, all the centers were closed, so patients were swarming to hospitals, where they were getting just half the prescribed treatment. Witnessing a woman’s death during dialysis helped persuade him that he should leave Puerto Rico, rather than keep having to struggle to find a spot in line. He plans to move to Orlando, Fla., on Wednesday.


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“They are cutting my life short,” Mr. Cruz said. “The governor can’t be everywhere at once. If his aides tell him everything is great, he thinks everything is great.’’

Ricardo Rosselló, the governor of Puerto Rico, said on Monday that the authorities were doing their best to stave off a public health disaster. About 70 percent of the island’s pharmacies had reopened, he said, and a special hotline had been established for people to receive insulin. He added that dialysis centers were “in the loop” for fuel and generator repairs and maintenance, and several patients had been evacuated to the mainland United States.

Lt. Gen. Jeffrey Buchanan, who leads the military effort on the island, said that several hospitals had suffered structural damage in the storm, and that even those that are officially listed as open face serious limitations.

“Define ‘open,’” General Buchanan said. “The fact that they are providing treatment is one thing. Are they taking new patients? I won’t feel comfortable until the hospitals are back on the grid and they have sufficient medicines across the board.”

Ricardo Ramos, chief executive of the Puerto Rico Electric Power Authority, the island’s utility, said that restoring power to hospitals was the company’s No. 1 priority. Mr. Ramos said the utility had worked hard to make sure that there was at least one hospital able to treat patients in each region of the country, and that it had restored power to one of the island’s two facilities for producing medical oxygen.

“I would love to have all the hospitals energized, but it’s impossible to do that,” he said. “There are hospitals in the mountainside, there’s hospitals in the southeast, where my infrastructure is completely destroyed.”

Robert P. Kadlec, the assistant secretary of Health and Human Services for preparedness and response, said the Veterans Health Administration had also opened its hospitals to nonveterans to help meet urgent needs.

“The devastation I saw, I thought was equivalent to a nuclear detonation,” Dr. Kadlec said. “Whatever you do, will be almost insufficient to the demand and need that is out there for these 3.5 million Americans in Puerto Rico. We are doing everything we can with what we have, and we have a lot.’’

Correction: October 10, 2017

A picture caption with an earlier version of this article misstated the location of the hospital where Miguel Bastardo Beroa was being treated. It is in Carolina, P.R., not Canovanas.

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