#basically a c-section so ill be out of commission for a while…
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six days until i become uterus-less. bro 😭
#i’ve got so many assignments to do for my EdS program#i do NOT want to get behind after i get this surgery#basically a c-section so ill be out of commission for a while…#booo tomato tomato
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10 Factors to Keep in Mind Before Buying a Term Insurance Plan
A term insurance plan is the most perfect type of a disaster protection strategy. Here, the entirety insured is paid to the nominee if passing jumps out at the insured individual during the term of the approach. In the glad circumstance that the insured endures the term of the approach, nothing is payable in many cases. In that sense, a term insurance is reasonably like a long haul motor insurance strategy. There are certain term insurance items where the premium is come back to the policyholder on the off chance that he (s) endures the arrangement time frame. These arrangements are gotten back to Term With Premium approaches, and would clearly cost in excess of an unadulterated term for a similar degree of life insured.
The fundamental target behind a term insurance approach is that it should substitute the financial misfortune that the passing of an individual makes for his relatives. Along these lines by definition, a term insurance arrangement is essential for a youngster hitched with small kids, though it may be less significant for a man nearly retirement with a critical pool of savings and kids very much settled. There are ten significant factors that one should take a gander at before purchasing a term insurance arrangement
1. Level of entirety insured: An expansive principle guideline is multiple times the yearly income on the off chance that one is under 40 years old, multiple times the yearly income in the event that one is somewhere in the range of 40 and 45, and multiple times the yearly income in the event that one is at least 45. On the off chance that you have a huge housing advance, you ought to have that advance secured through an extra credit disaster protection plan, where the insurance organization would settle the advance outstanding with your bank if there is a passing. Another methodology is Sum Insured = (total credits outstanding+ sum required for youngsters' training and wedding) + (normal yearly utilization related consumption ) *10. One ought to likewise hold up under in mind that one's earning potential and costs are probably going to increase as the years progressed, and that we have a high pace of inflation which will continuously disintegrate esteem. Rs 50 lakhs today may resemble an amount, however after twenty years it probably won't be critical by any means.
2. Span of the approach: The more youthful you are, the more extended ought to be the length of the arrangement that you buy, synchronizing it with retirement age or the age at which one's financial liabilities would most likely diminish. A standard guideline that can be utilized is that the term of the strategy ought to be equivalent to Desired Retirement age - Current age.
3. At the point when should I purchase: The best time to purchase a term insurance plan is NOW. This is on the grounds that term plans get increasingly costly as one gets more established. The greatest hazard is that one may get certain illnesses with time which makes section into a term plan progressively convoluted. The insurer may decline to guarantee the hazard or knock up the premiums on the off chance that you have revealed any ailment. Future is uncertain while the financial liabilities are unsurprising, and leaving behind a lot of crippling financial liabilities for one's dependants is flighty and avoidable.
4. Should I purchase extra security through Riders: Riders for an insurance arrangement are like the additional toppings on a pizza. An unadulterated insurance strategy pays out just on death. However, there can be circumstances, for example, a basic disease or an extreme mishap which can totally eliminate one's earning power. Riders, for example, Critical Illness riders or Permanent Total Disability riders act the hero here. These riders guarantee that the whole insured is paid out to the policyholder in the event that any of these sad circumstances happen.
5. Who should I purchase from: At the day's end, an insurance contract is an agreement of trust between the existence insured and the insurance organization. You should purchase your arrangement from somebody who you feel will respect the agreement the best at the season of the case. You can view the IRDA site for the case installment proportions of the disaster protection organizations. Evaluations demonstrate that in 2011, around 16000 life coverage cases will be rejected. Cost is additionally a significant variable. Term insurance rates have descended essentially throughout the most recent two years due to cost rivalry and increased future. Consequently, you have a wide decision of 20+ insurers from whom you can purchase. Glance around forcefully for the organization offering among the most minimal costs. Organizations, for example, Aegon Religare, ICICI Prudential, MetLife and Kotak Life have the least expensive rates.
6. Where should I purchase from: Given that term insurance rates can fluctuate by over half between various organizations, it is significant that you complete an exhaustive research before buying. Your well disposed neighborhood specialist probably won't be the best individual to depend on for exhortation because of two reasons-the plan he prescribes may be too costly, and almost certainly, he will attempt to push you towards buying some other item where his bonus is higher. Term items have low commissions for the operators. In the course of the most recent two years, term insurance rates have com somewhere near 40%-half because of increased challenge and lower death rates. In our view, the best spot to purchase a term insurance item is online as a result of the following reasons:
You can undoubtedly analyze the highlights and cost of the distinctive term insurance plans
It is quick and straightforward would not take over 10 minutes.
Therapeutic tests and all other documentation would be masterminded by the insurance organization at home itself
Certain organizations, for example, Aegon Religare, MetLife and ICICI Prudential have select items just for online deals where the commissions are lower, and in this manner the item is less expensive than offline items. Now and again, the online form may be less expensive than the offline variation by as much as 30%!
Online items will logically get less expensive than offline items as the purchaser profile of online arrangements will have a lower hazard rating
You can without much of a stretch pay the premium through charge card or through net banking
Internet and Mobile Association of India (IAMAI) gauges that Rs 600 crores of insurance premium was paid online in 2010. While a piece of that would be recharging premiums, a noteworthy lump of that would be new term and health insurance arrangements purchased online.
7.What information should I unveil: It is basic that you reveal all the important information honestly. Indeed, even a little misleading statement may be sufficient ground for the insurance organization to dismiss the case later. You should remember the following factors while completing the proposition structure:
a. Uncover your restorative history in detail: Don't shroud anything. On the off chance that you have a previous illness, notice it obviously. If there should be an occurrence of a demise which the insurance organization thinks is expected to a non-revealed previous infection, the case will be rejected. This is particularly valid in non-therapeutic cases
b. Uncover your family therapeutic history too
c. In the event that you smoke or drink, express that obviously. Likewise express your physical parameters precisely tallness, weight and so forth
d. Express your income and occupation precisely. On the off chance that your occupation opens you to higher hazard (eg military, mining and so forth), do state it unmistakably
e. Notice obviously some other insurance arrangements that you may have
f. Ensure that you submit genuine duplicates of PAN Card subtleties, birth testament, income evidence and so on
g. Attempt and top off the proposition structure yourself and don't leave it to the operator
8. Various insurance approaches: It is smarter to have two insurance strategies of state Rs 25 lakhs each than to have one strategy of Rs 50 lakhs. Along these lines, you can have the choice of continuing with a lower spread if sooner or later you have a decreased term insurance need
9. Who ought to be the arrangement beneficiary(s): The relatives who might be the most influenced in the event of your downfall ought to be the recipients. In many cases, it would be the life partner, youngsters or guardians. You could likewise apportion various rates of the aggregate insured to the recipients e.g half to the life partner and half to the guardians
10. Unadulterated Term insurance or savings related insurance items: The essential goal of extra security is to give financial assurance to the nominees. It is simply after the assurance edge has been finished secured through a term insurance plan that one needs to take a gander at building up savings or investment through an extra security arrangement
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texas insurance renewal
texas insurance renewal
texas insurance renewal
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texas insurance renewal
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SEC Charges Pastor with Defrauding Retirees
The Securities and Exchange Commission announced fraud charges and an emergency asset freeze obtained against a Michigan-based pastor accused of exploiting church members, retirees, and laid-off auto workers who were misled to believe they were investing in a successful real estate business.
The SEC alleges that Larry Holley, the pastor of Abundant Life Ministries in Flint, Mich., cloaked his solicitations in faith-based rhetoric, replete with references to scripture and biblical figures. Holley allegedly told prospective investors that as a person who “prayed for your children,” he was more trustworthy than a “banker” with their money. According to the SEC’s complaint, Holley held financial presentations masked as “Blessed Life Conferences” at churches nationwide during which he asked congregants to fill out cards detailing their financial holdings, and he promised to pray over the cards and invited attendees to have one-on-one consultations with his team. He allegedly called his investors “millionaires in the making.”
According to the SEC’s complaint, which also charges Holley’s company Treasure Enterprise LLC and his business associate Patricia Enright Gray, approximately $6.7 million was raised from more than 80 investors who were guaranteed high returns and told they were investing in a profitable real estate company with hundreds of residential and commercial properties.
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According to the complaint, Gray advertised on a religious radio station based in Flint and singled out recently laid-off auto workers with severance packages to consult her for a “financial increase.” Gray allegedly promised to roll over investors’ retirement funds into tax-advantaged Individual Retirement Accounts (IRA) and invest them in Treasure Enterprise. The SEC alleges that no investor funds were deposited into IRAs, and Treasure Enterprise struggled to generate enough revenue from its real estate investments to support the business and make payments owed to investors. Treasure Enterprise owes investors an estimated $1.9 million in past due payments, according to the SEC’s complaint.
“As alleged in our complaint, Holley and Gray targeted the retirement savings of churchgoers, building a bond of trust purportedly based on faith but actually based on false promises,” said David Glockner.
According to the SEC’s complaint, Holley, Gray, and Treasure Enterprise were not registered to sell investments. The SEC encourages investors to check the background of anyone offering to sell them investments by doing a quick search on the SEC’s investor website.
The SEC has obtained a temporary restraining order in U.S. District Court for the Eastern District of Utah that freezes the assets of Holley, Gray, and Treasure Enterprise. The court’s order also appoints a receiver and imposes other emergency relief.
The SEC’s complaint alleges violations of Sections 5(a), 5(c), and 17(a) of the Securities Act of 1933 and Sections 10(b) and 20(a) of the Securities Exchange Act of 1934 and Rule 10b-5. The complaint seeks disgorgement of ill-gotten gains plus interest, penalties, and permanent injunctions.
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The SEC’s investigation, which is continuing, is being conducted by Ana P. Doncic, Delia L. Helpingstine, and Sruthi Koneru of the Utah office. The case is being supervised by Steven L. Klawans, and the litigation is being led by Jonathan S. Polish.
SEC ADOPTS JOBS ACT AMENDMENTS TO HELP ENTREPRENEURS AND INVESTORS
The Securities and Exchange Commission today announced that it has adopted amendments to increase the amount of money companies can raise through crowdfunding to adjust for inflation. It also approved amendments that adjust for inflation a threshold used to determine eligibility for benefits offered to “emerging growth companies” (EGCs) under the Jumpstart Our Business Startups (JOBS) Act.
“Regular updates to the JOBS Act, as prescribed by Congress, ensure that the entrepreneurs and investors who benefit from crowdfunding will continue to do so,” said SEC Acting Chairman Michael S. Piwowar. “Under these amendments, the JOBS Act can continue to create jobs and investment opportunities for the general public.”
The SEC is required to make inflation adjustments to certain JOBS Act rules at least once every five years after it was enacted on April 5, 2012. In addition to the inflation adjustments, the SEC adopted technical amendments to conform several rules and forms to amendments made to the Securities Act of 1933 (“Securities Act”) and the Securities Exchange Act of 1934 (“Exchange Act”) by Title I of the JOBS Act.
The Commission approved the new thresholds March 31. They will become effective when they are published in the Federal Register.
BACKGROUND ON THE SEC JOBS ACT
Section 101 of the JOBS Act added new Securities Act Section 2(a)(19) and Exchange Act Section 3(a)(80) to define the term “emerging growth company” (“EGC”). Pursuant to those sections, every five years the SEC is directed to index the annual gross revenue amount used to determine EGC status to inflation to reflect the change in the Consumer Price Index for All Urban Consumers (“CPI-U”) published by the Bureau of Labor Statistics (“BLS”). To carry out this statutory directive, the SEC has adopted amendments to Securities Act Rule 405 and Exchange Act Rule 12b-2 to include a definition for EGC that reflects an inflation-adjusted annual gross revenue threshold. The JOBS Act also added new Securities Act Section 4(a)(6), which provides an exemption from the registration requirements of Section 5 under the Securities Act for certain crowdfunding transactions. In October 2015, the SEC promulgated Regulation Crowdfunding to implement that exemption. Sections 4(a)(6) and 4A of the Securities Act set forth dollar amounts used in connection with the crowdfunding exemption, and Section 4A(h)(1) states that such dollar amounts shall be adjusted by the SEC not less frequently than once every five years to reflect the change in the CPI-U published by the BLS. The SEC has adopted amendments to Rules 100 and 201(t) of Regulation Crowdfunding and Securities Act Form C to reflect the required inflation adjustments.
In addition, Sections 102 and 103 of the JOBS Act amended the Securities Act and the Exchange Act to provide several exemptions from a number of disclosure, shareholder voting, and other regulatory requirements for any issuer that qualifies as an EGC. The exemptions reduce the financial disclosures an EGC is required to provide in public offering registration statements and relieve an EGC from conducting advisory votes on executive compensation, as well as from a number of accounting and disclosure requirements. The regulatory relief provided under Sections 102 and 103 of the JOBS Act was self-executing and became effective once the JOBS Act was signed into law. The technical amendments that the SEC is adopting conform several rules and forms to reflect these JOBS Act statutory changes.
Free Initial Consultation with a Securities Lawyer
When you need help with an SEC or Securities matter, call Ascent Law for your free consultation (801) 676-5506. We want to help you.
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from Michael Anderson http://www.ascentlawfirm.com/sec-charges-pastor-with-defrauding-retirees/
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SEC Charges Pastor with Defrauding Retirees
The Securities and Exchange Commission announced fraud charges and an emergency asset freeze obtained against a Michigan-based pastor accused of exploiting church members, retirees, and laid-off auto workers who were misled to believe they were investing in a successful real estate business.
The SEC alleges that Larry Holley, the pastor of Abundant Life Ministries in Flint, Mich., cloaked his solicitations in faith-based rhetoric, replete with references to scripture and biblical figures. Holley allegedly told prospective investors that as a person who “prayed for your children,” he was more trustworthy than a “banker” with their money. According to the SEC’s complaint, Holley held financial presentations masked as “Blessed Life Conferences” at churches nationwide during which he asked congregants to fill out cards detailing their financial holdings, and he promised to pray over the cards and invited attendees to have one-on-one consultations with his team. He allegedly called his investors “millionaires in the making.”
According to the SEC’s complaint, which also charges Holley’s company Treasure Enterprise LLC and his business associate Patricia Enright Gray, approximately $6.7 million was raised from more than 80 investors who were guaranteed high returns and told they were investing in a profitable real estate company with hundreds of residential and commercial properties.
youtube
According to the complaint, Gray advertised on a religious radio station based in Flint and singled out recently laid-off auto workers with severance packages to consult her for a “financial increase.” Gray allegedly promised to roll over investors’ retirement funds into tax-advantaged Individual Retirement Accounts (IRA) and invest them in Treasure Enterprise. The SEC alleges that no investor funds were deposited into IRAs, and Treasure Enterprise struggled to generate enough revenue from its real estate investments to support the business and make payments owed to investors. Treasure Enterprise owes investors an estimated $1.9 million in past due payments, according to the SEC’s complaint.
“As alleged in our complaint, Holley and Gray targeted the retirement savings of churchgoers, building a bond of trust purportedly based on faith but actually based on false promises,” said David Glockner.
According to the SEC’s complaint, Holley, Gray, and Treasure Enterprise were not registered to sell investments. The SEC encourages investors to check the background of anyone offering to sell them investments by doing a quick search on the SEC’s investor website.
The SEC has obtained a temporary restraining order in U.S. District Court for the Eastern District of Utah that freezes the assets of Holley, Gray, and Treasure Enterprise. The court’s order also appoints a receiver and imposes other emergency relief.
The SEC’s complaint alleges violations of Sections 5(a), 5(c), and 17(a) of the Securities Act of 1933 and Sections 10(b) and 20(a) of the Securities Exchange Act of 1934 and Rule 10b-5. The complaint seeks disgorgement of ill-gotten gains plus interest, penalties, and permanent injunctions.
youtube
The SEC’s investigation, which is continuing, is being conducted by Ana P. Doncic, Delia L. Helpingstine, and Sruthi Koneru of the Utah office. The case is being supervised by Steven L. Klawans, and the litigation is being led by Jonathan S. Polish.
SEC ADOPTS JOBS ACT AMENDMENTS TO HELP ENTREPRENEURS AND INVESTORS
The Securities and Exchange Commission today announced that it has adopted amendments to increase the amount of money companies can raise through crowdfunding to adjust for inflation. It also approved amendments that adjust for inflation a threshold used to determine eligibility for benefits offered to “emerging growth companies” (EGCs) under the Jumpstart Our Business Startups (JOBS) Act.
“Regular updates to the JOBS Act, as prescribed by Congress, ensure that the entrepreneurs and investors who benefit from crowdfunding will continue to do so,” said SEC Acting Chairman Michael S. Piwowar. “Under these amendments, the JOBS Act can continue to create jobs and investment opportunities for the general public.”
The SEC is required to make inflation adjustments to certain JOBS Act rules at least once every five years after it was enacted on April 5, 2012. In addition to the inflation adjustments, the SEC adopted technical amendments to conform several rules and forms to amendments made to the Securities Act of 1933 (“Securities Act”) and the Securities Exchange Act of 1934 (“Exchange Act”) by Title I of the JOBS Act.
The Commission approved the new thresholds March 31. They will become effective when they are published in the Federal Register.
BACKGROUND ON THE SEC JOBS ACT
Section 101 of the JOBS Act added new Securities Act Section 2(a)(19) and Exchange Act Section 3(a)(80) to define the term “emerging growth company” (“EGC”). Pursuant to those sections, every five years the SEC is directed to index the annual gross revenue amount used to determine EGC status to inflation to reflect the change in the Consumer Price Index for All Urban Consumers (“CPI-U”) published by the Bureau of Labor Statistics (“BLS”). To carry out this statutory directive, the SEC has adopted amendments to Securities Act Rule 405 and Exchange Act Rule 12b-2 to include a definition for EGC that reflects an inflation-adjusted annual gross revenue threshold. The JOBS Act also added new Securities Act Section 4(a)(6), which provides an exemption from the registration requirements of Section 5 under the Securities Act for certain crowdfunding transactions. In October 2015, the SEC promulgated Regulation Crowdfunding to implement that exemption. Sections 4(a)(6) and 4A of the Securities Act set forth dollar amounts used in connection with the crowdfunding exemption, and Section 4A(h)(1) states that such dollar amounts shall be adjusted by the SEC not less frequently than once every five years to reflect the change in the CPI-U published by the BLS. The SEC has adopted amendments to Rules 100 and 201(t) of Regulation Crowdfunding and Securities Act Form C to reflect the required inflation adjustments.
In addition, Sections 102 and 103 of the JOBS Act amended the Securities Act and the Exchange Act to provide several exemptions from a number of disclosure, shareholder voting, and other regulatory requirements for any issuer that qualifies as an EGC. The exemptions reduce the financial disclosures an EGC is required to provide in public offering registration statements and relieve an EGC from conducting advisory votes on executive compensation, as well as from a number of accounting and disclosure requirements. The regulatory relief provided under Sections 102 and 103 of the JOBS Act was self-executing and became effective once the JOBS Act was signed into law. The technical amendments that the SEC is adopting conform several rules and forms to reflect these JOBS Act statutory changes.
Free Initial Consultation with a Securities Lawyer
When you need help with an SEC or Securities matter, call Ascent Law for your free consultation (801) 676-5506. We want to help you.
Ascent Law LLC8833 S. Redwood Road, Suite CWest Jordan, Utah 84088 United StatesTelephone: (801) 676-5506
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Source: http://www.ascentlawfirm.com/sec-charges-pastor-with-defrauding-retirees/
from Securities Lawyer In Utah https://securitieslawyerinutah.wordpress.com/2018/03/16/sec-charges-pastor-with-defrauding-retirees/
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Puerto Rico's Dire Health-Care Crisis
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Puerto Rico's Dire Health-Care Crisis
It’s been over a month since the last of Maria’s Category 4 hurricane-strength winds swept over Puerto Rico, but there is still damage yet to come.
The darkness is persistent. Power and clean water are still tenuous and reliant on generators and outside aid. Contamination threatens basic necessities for dozens of municipalities, and the death toll—already likely a serious undercount—is only rising as diseases and the attrition from devastated infrastructure take their toll. Even with the aid of the federal government and the military, a health-care system facing multiple threats might not be able to protect some of the island’s most vulnerable citizens.
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Many of those people are facing hard choices in Puerto Rico’s hospitals, which are at the front lines of disaster-relief efforts. While most hospitals have recovered from the storm’s early blows—which knocked most of them out of commission and left a few others dependant on generators—they have had to make do with shortages of power, water, and supplies; personnel crunches; and intensifying health-care needs from accidents and emergent diseases. Last week, a photograph posted by former Governor Alejandro García Padilla on Twitter showed doctors performing surgery by flashlight. From what physicians on the island tell me, such scenarios are common, as is physicians working double and triple shifts—circumstances made even more remarkable by the fact that the doctors themselves are victims of the storm.
Carolina Pichardo, a pediatrician working shifts at both the neonatal intensive-care unit at the University Pediatric Hospital in San Juan and at the pediatric emergency room at the HIMA San Pablo Hospital in nearby Caguas, is one of those doctors. Pichardo lives in a complex in San Juan where power is still tenuous, and she’s had to balance a survival routine with the extraordinary demands of her job.
During the night, when the generators run, she and her husband take cold showers; cook their canned food rations on a charcoal grill for dinner; and try to, by turns, avoid the heat and mosquitoes—keeping their door open to let in the breeze as they put their four-year-old daughter to bed, and closing it to hold off the insects. In the mornings, Pichardo sometimes braves standstill traffic in the capital’s newly congested transportation grid; sometimes it takes up to two hours just to get to Caguas, which is only 20 miles away.
At both hospitals, Pichardo has faced new challenges. At first, doctors and nurses dealt with a total collapse of power, which Pichardo said was the “scariest change” immediately after the storm. Hospitals couldn’t communicate with other hospitals; specialists often couldn’t be reached if they were needed; and patients were transferred to trauma centers or other facilities without any knowledge of whether those institutions could handle more patients.
While lines of communication have at least partially been restored, Pichardo said that problems still abound. “At this point, everything has become challenging,” she told me by email. “Many primary-care physicians are unable to provide services at their practice locations, so more and more people are using the emergency rooms for everyday medical problems. This places a larger burden on the emergency rooms and increases wait time among patients. Children have fallen behind on their immunization schedules, because either their pediatricians are not currently practicing or they have lost their refrigerated vaccines due to power outage.”
The collapse of primary-care structures on the island was a common theme of my conversations with medical professionals there. Primary care was already a bottleneck point for the Puerto Rican health-care system before this season’s hurricanes—with a mass exodus of doctors to the mainland and an increasing concentration of children, pregnant women, and elderly people back on the island. But now, with many doctor’s offices and smaller facilities closed, people with chronic health needs often have to go without care or seek it in emergency rooms, which can mean sitting in triage for hours. The shortage exacerbates the burden of both chronic and acute conditions as patients compete for space and resources.
Carmen Zorrilla, a professor of obstetrics and gynecology at the University of Puerto Rico, and one of the island’s expert voices on managing the health-care needs of women with HIV, echoed those concerns. “The whole health-care system for the past 35 days has switched from primary care, prevention, and provision of basic services to emergency and acute care,” Zorrilla told me. Her clinic, one of the only facilities on the island dedicated to women and mothers with HIV, has seen its volume of patients drop and health problems intensify. The clinic serves high-risk pregnant women who have other potential childbirth complications in addition to HIV. They have to follow closely managed health plans in order to survive childbirth and avoid HIV transmission to their infants.
Maria has disrupted those plans. “During the week after the hurricane, I had one of my patients who had HIV, she had a planned C-section delivery,” Zorrilla said, referring to the recommended delivery practice for preventing mother-to-child transmission. That patient was not able to make it to the hospital for the procedure after Maria, because roads from the interior of the island had been washed out. Instead, the woman was forced to deliver at home, and while the virus has not been detected in the infant, the delivery was essentially a gamble.
Some of Zorrilla’s other patients, who hail from all over Puerto Rico, have also been forced to alter their birth plans, delivering children in hazardous conditions and in facilities that might not be familiar with HIV management. And even for mothers without HIV, labor and delivery are increasingly fraught scenarios without consistent power and water available on the island.
Other patients with chronic diseases are facing crises as well. The risks to elderly people from any disaster are well known, and according to experts, any disaster region can expect up to 10 percent of all nursing-home patients to die in the aftermath. Puerto Rico so far has been no different. Many elderly patients, as well as nursing-home residents of all ages, initially faced critical shortages of electricity for medical devices. Some had to be airlifted to hospitals for continuous care.
A Los Angeles Times story published earlier this month illustrated some of the challenges facing nursing homes after Maria—especially those in places that aren’t particularly close to San Juan or to major federal-relief assets. While the official death toll on the island remains a subject of contention, that report noted that older Puerto Ricans are now dying much faster than normal:
About 100 people died in the three days after the storm in the Lajas region, twice the typical rate, according to a local funeral director. Eight elderly people have died in Lajas since the storm, at least one directly related to a shortage of medical supplies.
One common post-disaster failure is the scarcity of dialysis for people with diabetes, end-stage renal disease, and other kidney disorders. Dialysis requires regular visits from patients, fully staffed facilities, electricity, and a constant source of clean water, all of which have been lacking after Maria.
Mike Spigler, the vice president of the American Kidney Fund, a nonprofit organization that helps support dialysis patients and centers across the country, said that Puerto Rico has presented a one-of-a-kind challenge. “In all three [recent] instances of hurricanes, I will say that dialysis companies have done a good job at dealing with these problems,” Spigler told me. “But especially in Puerto Rico, you see stories of staff working triple and quadruple shifts at a time just to keep the clinics open. So you see people making really heroic efforts.” Even so, many centers have lost track of patients, and many patients have seen their conditions worsen.
Access to dialysis itself is only half the battle for some of them. “The No. 1 cause of kidney failure is diabetes, so about 41 percent of dialysis patients will have special diabetic diets,” Spigler said. Special diets, daily water-intake requirements, and other pieces of regular health maintenance are all but impossible for those patients, especially those who now live in shelters and depend on shipments of whatever food and water rations are available.
The storm’s threat to patients with chronic illness could alone constitute a public-health emergency. But they aren’t the only ones at risk. State epidemiologists recently announced spiking rates of leptospirosis, a fever disease spread by water contaminated with animal waste. While leptospirosis is rare on the mainland, it is a relatively common disease in tropical regions like Puerto Rico. While the island usually only sees 60 cases a year, according to CNN, there have been over 70 confirmed cases so far this month, at least two of them fatal. The deaths are a clear sign of the disarray of the health-care system, as leptospirosis is usually mild and manageable with early detection and care.
Puerto Rico’s other endemic calling card is the threat of mosquito-borne diseases, but so far the island has been spared. While the sheer destruction of the storm likely devastated existing mosquito populations, some experts and physicians fear that over the long term, standing water; lack of air conditioning; and increasing clustering of the population will create the conditions for outbreaks. “It’s a matter of time to know whether there’s going to be an epidemic of Zika, dengue, or chikungunya,” Zorrilla told me.
It’s unclear how effective federal intervention has been in averting or turning back these health issues. A spokeswoman for the United States Army North, the command currently in control of military relief operations in Puerto Rico, told me that “three military units are assisting the Puerto Rico Department of Health with mosquito-borne vector surveillance and control.” She continued: “Other activities to support the mission assignment include assessing the privately owned water supply system in mountain areas, assessing medical laboratory capabilities, and testing purified water produced from [reverse osmosis water purification units].” Despite those efforts, reports of citizens in mountainous areas drinking contaminated water are still numerous, and visitors to the Combat Support Hospital in Humacao have also reported extraordinarily long waits.
The Navy’s famed, state-of-the-art floating hospital, the USNS Comfort, has largely been a non-factor, with only 30 or so of its 250 beds filled as of last week, despite multiple hospital failures and hundreds of patients in need. Puerto Rico’s governor, Ricardo Rosselló, blamed the lack of transfers on “the disconnect or the apparent disconnect” in communication between hospitals and the island’s Department of Health. While that’s reportedly been remedied, the number of patient transfers still hasn’t increased; according to a CBS reporter, on Tuesday just 34 beds were occupied.
The health department has not responded to multiple requests for comment, nor has it provided press updates over the past week. But its coordination efforts will be just as necessary in the coming months as they’ve been since Maria. The entire health-care system has shifted to emergency-response mode without the capacity to manage all of those emergencies. And some of the most pressing concerns—like the potential return of mosquito-borne diseases and the predictable burden of post-disaster mental-health problems—are still largely theoretical.
It’s too soon to say what the future holds, but the current picture in Puerto Rico is dire enough. Health is built through years of personal choice and ability to access care. It’s often destroyed not in swift blows, but through attrition. Millions of Americans lacking basic services are facing that attrition now.
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