Menendez, Bicameral Group of Colleagues Request that Inspector General Review FEMA's Faltering Efforts to Rebuild Vieques' Closed Health Care Facility

WASHINGTON, D.C. – U.S. Senator Bob Menendez (D-N.J.), along with Senator Elizabeth Warren (D-Mass.), Representatives Nydia Velázquez (D-N.Y.), Raúl Grijalva (D-Ariz.), Bennie G. Thompson (D-Miss.), and Peter DeFazio (D-Ore.) sent a letter to the Department of Homeland Security (DHS) Inspector General (IG) Joseph V. Cuffari requesting an audit or evaluation of the Federal Emergency Management Agency's (FEMA) efforts to reconstruct the Vieques public community health center (Centro de Salud Familiar Susana Centeno).

Vieques, a Puerto Rican island located roughly seven miles off the coast of mainland Puerto Rico, is home to nearly 9,000 thousand U.S. citizens. The public community health center was the only facility performing the functions of a hospital on the island-municipality. It has remained closed since suffering damages after Hurricanes Irma and Maria, despite the fact that the Bipartisan Budget Act and the Additional Supplemental Appropriations for Disaster Relief Act were signed into law in February 2018 and June 2019, respectively, requiring FEMA to replace or restore critical service facilities damaged by the storm.

Earlier this year, Sen. Menendez urged FEMA to take rapid and robust action to help rebuild the Vieques health facility following damage from Hurricane Maria in September 2017 that led to the facility's closing. The island's residents - including those with serious health problems - must still take an hour-long ferry to the mainland of Puerto Rico to receive even basic care. Congress has not yet received a written response from FEMA to their May 2019 letter.

"It is unacceptable that U.S. citizens in Puerto Rico continue to lack access to high-quality critical health services years after a disaster, and that FEMA has failed to take rapid and robust action to provide viequenses with needed recovery resources that have been and are being provided to other U.S. jurisdictions and communities," wrote the lawmakers.

FEMA informed Congressional staff during a November 14, 2019 briefing that the agency had identified the medical center as an "ambulatory health care facility" rather than a hospital, which could result in less funding for, and more limited health services in, a reconstructed facility. The lawmakers' letter criticizes this decision, noting that the Vieques public community health center performed the functions of a hospital before the hurricane, housing the island's only labor and delivery room and providing inpatient admissions, despite lacking formal hospital designation. The facility also housed the Vieques VA Clinic and provided access to primary care for the island's veterans.

"It remains troubling that while the public community health center remains closed, forcing viequenses to depend on interim health services, FEMA continues to make determinations and policy choices that may limit the ultimate restoration of pre-disaster services to Vieques," the lawmakers added.

The full text of the letter can be found here and below.

Dear Dr. Cuffari,

We write to ask that you conduct an audit or evaluation of the Federal Emergency Management Agency's (FEMA) efforts to reconstruct the Vieques public community health center (Centro de Salud Familiar Susana Centeno), which is the only facility performing the functions of a hospital on the island-municipality and has remained closed since suffering damage from Hurricane Maria in 2017.1

In response to continued reports documenting the inadequate and delayed recovery efforts for the people of Vieques who need adequate and accessible medical services, several Members of Congress wrote to Acting Administrator Peter T. Gaynor on May 15,2019, to request infonnation about FEMA' s efforts. 2 While FEMA has since determined that the facility is eligible for replacement,3 reports have shown that the Vieques community health center remains a "shuttered wreck of rust and mold," and continues to leave about 9,000 U.S. citizens on the island relying on temporary facilities that lack the ability to safely perform key medical procedures.4

As of December 13, 2019, Congress has yet to receive a written response from FEMA to our May 15 letter. An evaluation by your office will help determine whether FEMA is adequately performing its duties to respond to the 2017 natural disasters that hit Puerto Rico and, if not, provide recommendations on how FEMA can address these concerns.

On September 20, 2017, Hurricane Maria made landfall on Puerto Rico and devastated the territory. The island-municipality ofVieques experienced extensive delays in accessing electricity, housing, and medical care in the wake of the storm, and more than two years after Hurricane Maria's landfall, U.S. citizens in Vieques still cannot access comprehensive medical care. 5 Despite Congress's intent to require FEMA to replace or restore critical service facilities damaged by the storm in the Bipartisan Budget Act and the Additional Supplemental Appropriations for Disaster Relief Act, respectively signed into law in February 2018 and June 2019,6 FEMA has failed to take rapid and robust action to provide the health care facility with the resources it needs to rebuild and to provide adequate interim medical services for the island's residents.

As we stated in our May 15 letter, and which remains true today, the only facility performing the functions of a hospital in Vieques remains closed, forcing viequenses to rely on a temporary and often inadequate medical facility for the island's residents.7 For more than two years, many residents have thus been forced to travel to the main island of Puerto Rico to receive medical services. For example, a 64-year-old cancer patient, "waited 32 straight hours-sleeping in her car, snacking on chips and soda ... , going to the bathroom off the side of the road- before securing a spot on the ferry that took her across the water and then to her doctor in San Juan."8 Additionally, reports show that pregnant women must "travel ... to the big island eight miles away" to deliver their children.9 Until temporary dialysis centers arrived on the island in November 2018, Vieques dialysis patients also reportedly "had to travel... three times a week to get treatment" on the mainland, resulting in multiple deaths.10 As our letter stated, these delays in medical care are especially disturbing, given that Vieques residents "suffer. .. from cancer rates close to 30 percent higher than the rest of Puerto Rico" due to the U.S. Navy's past use of the island as a military testing ground. 11

In his written statement to the U.S. House Committee on Natural Resources on April 9, 2019, Omar Marrero, the former Executive Director of the Central Office for Recovery and Reconstruction of Puerto Rico (COR3), stated that there have been several decisions by FEMA that have stalled Puerto Rico's recovery efforts. 12 Marrero stated that FEMA's announced intention to reconsider their decision to rebuild the health center, the agency's limiting of the scope of repairs or upgrades to critical services, FEMA's late lifting of onerous reimbursement processes, and the agency's revisions and restrictions to previously approved work products without the input of regular stakeholders, among other policy decisions, hampered the funding process and the ability to provide necessary aid to communities suffering from federal inaction.13 Additionally, President Trump has failed to amend his disaster declaration to expand Puerto Rico's capacity to use additional Public Assistance funds. 14

Since the May letter, there appears to be little progress or urgency in FEMA's actions to help Vieques recover. Recent reports have stated that the medical center has been "abandoned to wandering roosters and grazing horses" and that "190 long-term recovery projects have been funded in Puerto Rico- out of more than 9,000 requests," a funding rate that is significantly lower than the rate for recovery projects in the continental United States.15 It is unacceptable that U.S. citizens in Puerto Rico continue to lack access to high-quality critical health services years after a disaster, and that FEMA has failed to take rapid and robust action to provide viequenses with needed recovery resources that have been and are being provided to other U.S. jurisdictions and communities.

FEMA has not clarified the amount of recovery funds the federal government will make available for Vieques to reconstruct the medical center. While the initial cost estimate for rebuilding of the facility was $70 million, FEMA had only approved $46 million.16 In a November 14, 2019 phone briefing for congressional staff, FEMA indicated that the agency established an expert panel to approve FEMA's obligated costs and resolve the discrepancy between the initial cost estimate and the approved amounts. FEMA staff then stated that, depending on the ultimate conclusion of the expert panel's deliberations, they believed that demolition and design for the new facility are expected before the end of the year. With fewer than three weeks before the end ofthe year, we have not seen indication of progress. It is concerning that the determination of costs and the demolition and construction of a new facility remains delayed even after two years following Hurricane Maria, especially because Vieques officials cannot begin the rebuilding process without obligated FEMA funds. The people of Vieques deserve an explanation of the expert panel's criteria and determination and how these costs compare to the average assessment of health facility funding following similar natural disasters and damage.

Additionally, congressional staff were informed during the November 14 briefing that in its recent determination that the medical center is eligible for replacement, FEMA identified it as an "ambulatory health care facility" 17 rather than a hospital, which may result in less funding and more limited health services in a reconstructed facility. The Vieques public community health center, despite lacking formal hospital designation, performed the functions of a hospital, housing the island's only labor and delivery room and providing inpatient admissions. The facility also housed the Vieques VA Clinic and thus provided access to primary care for the island's veterans.18 It remains troubling that while the public community health center remains closed, forcing viequenses to depend on interim health services, FEMA continues to make determinations and policy choices that may limit the ultimate restoration of pre-disaster services to Vieques.

The information we have reviewed suggests that FEMA is failing to provide critical and sufficient resources and assistance in a timely fashion to the people ofVieques. In order to ensure the health and safety ofthese U.S. citizens that depend on essential medical and other health services, we urge you to conduct evaluation ofFEMA's efforts to reconstruct the only facility performing the functions of a hospital in Vieques and determine whether FEMA is appropriately conducting recovery efforts. We respectfully request that you include the following questions as part of that review:

1. What assistance has FEMA provided to rebuild the Vieques health care facility since Hurricane Maria hit Puerto Rico in September 2017, to include the establishment of any temporary health facilities on the island?

2. To date, what assistance has FEMA allocated to either temporary- or permanent-work related to recovery efforts for the Vieques health care facility since Hurricane Maria hit in 20 17? Of this assistance, how much has been disbursed and how much remains pending?

3. What factors have contributed to the significant discrepancy in the progress in the execution of recovery projects for Puerto Rico compared to jurisdictions in the continental United States that were also struck by hurricanes in 2017 and covered by a declaration of a major disaster or emergency under section 401 of the Robert T. Stafford Disaster Relief and Emergency Assistance Act? Are any comparable projects being administered as assistance under Section 406 versus Section 428 of the Stafford Act? How have any discrepancies affected efforts to rebuild the Vieques health care facility?

4. According to a staff briefing for congressional offices, FEMA is awaiting an evaluation from a panel of experts before making a final decision on the cost estimate for the Vieques health care facility rebuild.

a. What experts is FEMA consulting to make a determination about the Vieques health care facility? How did FEMA select these panelists? Has the Government of Puerto Rico selected panelists and are they participating in the evaluation?

b. What are the rules and criteria that these experts are following in making their determination? Will the panel's views be made public?

c. Has FEMA convened similar panels of experts for similarly destroyed health care facilities in the continental United States? If so, when?

5. How long, on average, does it take FEMA to assess the funding needs of hospital or other health facilities for Public Assistance in areas impacted by hurricanes? How does FEMA's assessment of the Vieques health care facility project compare to this average assessment time?

6. Is FEMA conducting timely and sufficient recovery efforts to rebuild the health care facility on the island? If not, what are the reasons for FEMA's delayed efforts?

7. Given the services provided by the medical center prior to its destruction, is FEMA' s decision to designate the facility-as a public community health center rather than a hospital-appropriate? What are the funding and other recovery impacts of designating the facility as a community health center rather than a hospital?

Upon completion of your review, we ask that you provide recommendations for how FEMA or other federal entities can improve oversight and implementation of recovery efforts for Vieques that takes into consideration the island's unique geography, transportation, and other challenges.

Thank you for your attention to this matter. We look forward to your response.

Sincerely,