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[Photo by Piron Guillaume via Unsplash]

Another Kind of Recovery: Post-Maria Puerto Rico and Health Care Critical Infrastructure

I was away most of the last several weeks because I was recovering from surgery. I was lucky, not only because surgery fixed a life-threatening problem, but because I had IV bags and tubing for saline and pain medication.

lt doesn’t seem like this should be a big thing but it is for many critical health care situations. Imagine having major abdominal surgery, followed by days of post-surgery care. The pain could be debilitating without a continuous drip pain medication. Imagine the extra labor required to administer pain medication if automated IV drip feeds aren’t available.

Now imagine caring for an unconscious influenza patient suffering from dehydration. Imagine a ward filled with these patients, including children and elderly who may be difficult to hydrate by mouth. Imagine not having enough IV bags and tubing for a severe flu season.

No need to imagine this; hospitals have been dealing with this very shortage for more than a month. Some hospitals are administering Gatorade by stomach tube because they don’t have enough IV bags for hydration.

I hate to think of the challenges for patients in treatment for cancer and other long-term illnesses.

Why the shortage? It’s because Hurricane Maria affected the largest U.S. manufacturer of IV products. Baxter International’s three Puerto Rican plants make 44% of IV bags used in the U.S.

Most Americans aren’t aware 46% of Puerto Rico’s economy is manufacturing. Pharmaceuticals represent the lion’s share, including IV products. This industry represents 18,000 jobs, $40 billion in pharmaceutical sales, and $3 billion in federal tax revenues.

Hurricane Maria may have caused other pharmaceutical shortages. If so, production increases in other locations or substitutions remediated the effect. But there aren’t alternatives given IV products’ manufacturing concentration in Puerto Rico.

The Trump administration has done a pissy job handling post-Maria hurricane recovery in every respect. It almost looks personal, as if he’s punishing the island for a Trump-branded golf course’s failure.

But here’s the kicker: the Federal Emergency Management Agency says it’s done with emergency response in Puerto Rico. It’s pulling out though many residents are still without water and lights. Chalk it up to more bad faith on the part of this administration.

Why hasn’t the administration treated Puerto Rico’s pharmaceutical industry as critical infrastructure? The National Infrastructure Protection Plan (NIPP) lists health care as critical.

Is it because former President Obama’s Presidential Policy Directive 21 (pdf) established the NIPP? Trump has systematically unwound 20 or more Obama policy directives to date.

Trump’s proven he could give a rat’s patootie about brown-skinned people. If Trump mentions Puerto Rico in his SOTU speech tonight he’ll call federal response a success. FEMA gave him a news peg with ample time for his speech writer to stuff it into tonight’s hypocritical bloviating. He counts on the mainland blowing off Puerto Rico now the way it has sloughed off the island’s thousand-plus hurricane-related deaths.

But with the IV products shortage and the ongoing flu season’s severity, this indifference isn’t affecting only Puerto Ricans. It may already have cost lives while increasing health care costs here in the continental U.S.

Heaven help the rest of us if we face a mass casualty event or a pandemic before we fix Puerto Rico — and Trump.

Blogger since 2002, political activist since 2003, geek since birth. Opinions informed by mixed-race, multi-ethnic, cis-female condition, further shaped by kind friends of all persuasions. Sci-tech frenemy, wannabe artist, decent cook, determined author, successful troublemaker. Mother of invention and two excessively smart-assed young adult kids. Attended School of Hard Knocks; Rather Unfortunate Smallish Private Business School in Midwest; Affordable Mid-State Community College w/evening classes. Self-employed at Tiny Consulting Business; previously at Large-ish Chemical Company with HQ in Midwest in multiple marginalizing corporate drone roles, and at Rather Big IT Service Provider as a project manager, preceded by a motley assortment of gigs before the gig economy was a thing. Blogging experience includes a personal blog at the original blogs.salon.com, managing editor for a state-based news site, and a stint at Firedoglake before landing here at emptywheel as technology’s less-virginal-but-still-accursed Cassandra.

[graphic: Hurricane Maria, 20SEP2017, via NASA GOES]

Three Things: Was Slow Response to Hurricane Maria Deliberate?

NB: First, a call to action at the bottom — come back and read this after you’ve read the call. Don’t let last night’s tragedy swamp effective action; Congress continues its work no matter what tragedies befall the rest of us.

Having worked in both site and systems administration with responsibility for business continuity, I can’t help wonder why the post-hurricane response to Puerto Rico’s devastation was so bad — so bad it looks deliberate.

~ 3 ~

As an administrator, I looked ahead a year or more to mitigate both costs and risks to my employer and stakeholders. Budget roof repairs expenses for this year, budget roof replacement capital next year; replace the analog alarm system with digital system, budgeted last year. It’s pretty dull stuff but all it takes is one break-in, or one bad storm, and the losses from damage and business disruption could easily surpass capital and expense budgets combined.

But what of states and territories? State/territory, local and federal governments do what they can within the plodding framework of legislation, regulation, and budgetary requirements and restraints. Sometimes things just can’t be addressed preemptively, like major storms. Fortunately, there’s adequate monitoring to help predict when they will hit and what the likely impact will be, and there’s the awesome power of the largest military in the world to deploy as needed.

We have monitoring like NASA’s GOES satellite imaging, which visually tracked Hurricane Maria from birth to death as a weakened tropical storm.

And NOAA’s Hurricane Center, which makes accurate assessments of timing and strength of a storm’s impact.

Not to mention whatever additional monitoring and reporting the Defense Department had to offer.

We know with certainty the U.S. government was aware from NASA and NOAA reporting that Maria was a Category 5 storm as it approached Puerto Rico. The National Hurricane Center issued 17 reports over four days warning of the storm’s size, strength, and timing of landfall. I can’t imagine government agencies offering any less now than they did under the last administration.

And yet the Trump White House did virtually nothing to prepare for storm response.

You’d think that a guy with experience managing real estate and businesses for continuity would have utilized these best-on-earth notifications to mitigate and recover injury and damage to Puerto Rican Americans and their property. But for some reason this same guy now occupying the White House spent his time harping about NFL players and golfing instead.

~ 2 ~

This tweet thread crossed my timeline last week; I wondered who leaked and why there was so little followup, because the claim it makes is quite serious. (Click to expand the thread in Twitter.)

If this claim is accurate, the Trump White House sat on its tiny mittens and did absolutely nothing to approve a response to a major catastrophe which was expected with a very high degree of certainty to devastate an American territory home to ~3.5 million citizens.

If this happened five days AFTER landfall, was nothing done by the White House BEFORE Maria made landfall?

It’s not as if taking proactive action was difficult, either. I am certain government agencies and the Defense Department were ready to move with plans they’ve had prepared for some time, tweaked for this particular event. All it would take is a simple verbal Yes to proceed.

Or an executive order which we all know this White House can produce like so much facial tissue.

~ 1-a ~

All the monitoring and reporting provided to the White House, from NOAA and NASA to Defense Department, was budgeted and authorized by Congress for the purposes of serving American citizens. The public expects a level of performance for the taxes they pay; monitoring and reporting on weather and risks from weather are but part of their expectations.

American citizens expect and pay for their government to deliver effective and timely response when their domestic tranquility and general welfare are disrupted, whether nation-state or weather- and climate-based threats. They do not expect to be left without clean water, no minimum shelter, no emergency health care, let alone an empty wallet depleted by taxation which paid for common defense they didn’t receive.

Why have Puerto Rican Americans not received the same level of government responsiveness and services their fellow citizens have received post-hurricane Harvey and Irma?

Why can’t we get a straight answer about the White House’s planning in response to Hurricane Maria two to three days after landfall? Is it because the lack of any response is as bad as the lack of preparation — utterly missing, perhaps deliberately so?

At some point this isn’t about the White House and its executive function. It’s about Congress which has failed to ensure the executive knows exactly what is expected of it and what action should be nearly automatic from the executive office.

Oh, but that’s too much legislation, conservatives will say. No — it’s inadequate existing legislation which has incorrectly assumed for too long a competent manager will execute U.S. laws. It’s too many sick, injured, dying, dead Americans in the wake of ineffective governance.

And it’s inadequate action on the part of Congress to tolerate an incompetent executive.

To be concise, more than one branch of government failed Americans.

And those branches now have blood on their hands.

Do something about this before more Americans die. Do more than hold a hearing.

~ 1-b ~

By the way, FEMA’s Brock Long has proven himself an idiot. He should be given the boot.

An under-funded agency could land two rovers successfully on Mars and operate them for years to conduct research, but humanitarian response to a predicted hurricane utilizing the largest standing military on earth is too complicated? Fuck that.

And fuck this guy — I don’t even know who this pasty slack-handed suit is, but he can take his lies and shove them sideways. The storm did NOT cause you and your co-workers to be idiots and liars, boy.

~ 0 ~

Call to Action: Congress continues to work on bills regardless of the tragedy in Las Vegas or the growing catastophic death toll in Puerto Rico. Your efforts helped kill the last ACA repeal attempt formerly known as Graham-Cassidy. These are our next challenges.

CHIP expired at midnight Saturday night. Congress left for the weekend allowing health care funding for 9 million American children to expire. Not much better than President Cheeto going golfing while ignoring Puerto Rico. Call your representatives and demand CHIP funding be addressed immediately. Script for the Wyden-Hatch bipartisan CHIP bill here — note also you may need to call your state officials as well.

Net Neutrality is back on the bubble. FCC chair Ajit Pai has consistently attacked it throughout his brief tenure, sucking up to the telecom industry while ignoring the public’s best interests. Call your representatives and demand net neutrality be assured by voting NO on another five-year term for Pai as chair. Script for your call here. VOTE IS SCHEDULED TODAY — HURRY. Get a leg on this before AT&T persuades the Supreme Court to wade in.

Guns on schedule this week: a bill to approve the sale of gun silencers. Las Vegas’s mass shooting last night should be proof enough that “hearing protection” for shooters is the last thing Congress should worry about. The bill also allows the sale of armor-piercing ammunition. Hell, no. Script for your House rep, and script for your Senators.

A vote to make abortion illegal at 20 weeks on tap tomorrow. No. No freaking way. You may not like abortion, but read this piece — imagine the emotional and physical horror for a woman and her family as she is forced by law to carry a non-viable fetus to term. This decision should be between her, her partner, and her doctor. Make the call.

Congress’ switchboard number is (202) 224-3121. Don’t be like the guy in the White House when you can see action is needed.

Blogger since 2002, political activist since 2003, geek since birth. Opinions informed by mixed-race, multi-ethnic, cis-female condition, further shaped by kind friends of all persuasions. Sci-tech frenemy, wannabe artist, decent cook, determined author, successful troublemaker. Mother of invention and two excessively smart-assed young adult kids. Attended School of Hard Knocks; Rather Unfortunate Smallish Private Business School in Midwest; Affordable Mid-State Community College w/evening classes. Self-employed at Tiny Consulting Business; previously at Large-ish Chemical Company with HQ in Midwest in multiple marginalizing corporate drone roles, and at Rather Big IT Service Provider as a project manager, preceded by a motley assortment of gigs before the gig economy was a thing. Blogging experience includes a personal blog at the original blogs.salon.com, managing editor for a state-based news site, and a stint at Firedoglake before landing here at emptywheel as technology’s less-virginal-but-still-accursed Cassandra.

The Trump Trash Talking of Puerto Rico

This spot in our week here at Emptywheel is supposed to be a set aside for light hearted banter on sports, especially football and Formula One. That is what we have done since our beginning over a decade ago.

But I just cannot summon the enthusiasm for that right now any more than I could last weekend when the Trump racism and narcissism were already raging.

There are 3.5 million American citizens in the lurch in Puerto Rico, suffering from dehydration, starvation and death. Because of a fundamental lack of fuel to move, and communications to know, the full extent of the damage is still not really known.

So, what is the most powerful leader in the world doing? Tweeting a bunch of racially bigoted trash at the people and leaders of Puerto Rico. Here is what our disgrace of a President blasted off this morning:

That graphic was posted on Twitter by Josh Marshall of TPM, and his annotations are perfect.

Trump’s conduct is disgusting and unconscionable. From a man fiddling golfing while Rome burns Puerto Rico dies. What did the Mayor of San Juan, the largest population center and capitol hub of Puerto Rican government say? She begged for her people via a tearful plea to all of the federal government:

“We are dying, and you are killing us with the inefficiency and the bureaucracy,”

That would be Mayor Carmen Yulín Cruz. She also had the temerity to call out Acting DHS Secretary Elaine Duke who made the horribly insensitive and asinine comment that Puerto Rico is a “good news story”. For seeking to keep her constituents from dying and calling bullshit on the actual bullshit of Elaine Duke, Trump now thinks Mayor Carmen Yulín Cruz is the functional equivalent of Kim Jong-Un. Even insanity has rarely run this far amok.

Where will you find Mayor Carmen Yulín Cruz? Perhaps there is a photo somewhere in an office, but since the Puerto Rican crisis began, I have never seen her portrayed by the press, or anybody else, as being anything other than tirelessly out in the streets and flooded destroyed neighborhoods with her devastated constituents. Like a real leader would be. This photo is indicative:

Remember General Russell Honore, who brought some long past due seriousness and reality to Katrina in NOLA? He is in San Juan now. Here is what he had to say when questioned on Trump’s attack on the Mayor:

“The mayor’s living on a cot and I hope the President has a good day at golf.”

Can’t argue with that. Maybe Trump can secretly meet with the Puerto Rican bondholders he so cherishes that put their craven investments ahead of the lives of American citizens, while he is relaxing at his fucking golf resort this weekend. It is simply who he, and they, are. It should NOT be who we are though. This country is better than that.

I would also like to, again, point out that the much ballyhooed by Sarah Sanders and Trump Administration “Jones Act Waiver was a complete fraud and sham on the press, public and, most of all, people of Puerto Rico. There are effectively little more than SEVEN days left on Trump’s bogus waiver and gift to craven bondholders and rapacious shippers. Trump insured he got good press for a news cycle and completely stiffed Puerto Rico of any meaningful assistance via relief from the hideously oppressive Jones Act. Heckuva job Trumpie.

If you want a couple of fantastic pieces of reportage on Puerto Rico today, go see the Washington Post piece “Lost weekend: How Trump’s time at his golf club hurt the response to Maria” as well as the superb interactive overview from the New York Times, “One Day in the Life of Battered Puerto Rico”. You will be better for having seen both.

As to the games. Eh, Pirate Mike Leach and Washington State pulled off a serious upset of USC last night. Leach had his usual awesome take. As to the NFL, the focus seems to be more on the pre-game than the real games. I will note that Tom Brady’s first start was 16 years ago today. The Patriots have since won 5 Super Bowls, 14 AFC East titles and 185 of his 238 starts. Kid can play ball. Also, this weekend is the Malaysian Grand Prix at the Sepang Circuit. Hamilton takes pole and Vettel starts at back of the grid due to a bad engine. That likely ends the Drivers’ Championship battle for yet another year.

That is it for today. Rock on, and put the thoughts of our fellow citizens of Puerto Rico in your hearts.

Bmaz is a rather large saguaro cactus in the Southwestern Sonoran desert. A lover of the Constitution, law, family, sports, food and spirits. As you might imagine, a bit prickly occasionally. Bmaz has attended all three state universities in Arizona, with both undergraduate and graduate degrees from Arizona State University, and with significant post-graduate work (in physics and organic chemistry, go figure) at both the University of Colorado in Boulder and the University of Arizona. Married, with both a lovely child and a giant Sasquatch dog. Bmaz has been a participant on the internet since the early 2000’s, including active participation in the precursor to Emptywheel, The Next Hurrah. Formally joined the Emptywheel blog as an original contributing member at its founding in 2007. Bmaz grew up around politics, education, sports and, most significantly, cars; notably around Formula One racing and Concours de Elegance automobile restoration and showing. Currently lives in the Cactus Patch with his lovely wife and beast of a dog, and practices both criminal and civil trial law.

Three Things: So Many Questions, September Edition

It’s been a little busy in my neck of the woods, trying to tackle a long accumulation of honey-dos. But questions piled up, needing answers, so much so that I had to take time out to put bits and pixels to digital paper. Let’s begin, shall we?

~ 3 ~
PUERTO RICO POST-MARIA

Where the hell is the USNS Comfort, dispatched in 2010 to help after Haiti’s earthquake, and why isn’t it docked in San Juan, Puerto Rico, right the fuck now?

Why did we send 24,000 military personnel to help Japan after the 2011 earthquake but can’t muster them for a U.S. territory with a former navy facility and an active facility at Fort Garrison in San Juan?

Is Trump deliberately ignoring Hillary Clinton’s plea to send the USNS Comfort to PR because — well, it’s Hillary? (Yeah. Check that link. Even Fox News noted Hillary’s request.)

Has Trump deliberately ignored Puerto Rico’s urgent plight out of personal pique over the bankruptcy and losses from a Trump-branded, Trump-managed golf course located in Rio Grande, PR? He was trying to prop it up on Twitter back in 2013.

Are Trump’s tweets complaining about Puerto Rico’s debt yet more projection, since the failed golf course was built with government-issued bonds?

Why did the Senate approve as FEMA director — who only left to tour the island FIVE GODDAMNED DAYS AFTER MARIA MADE LANDFALL — the man who was the Hurricane Program Manager for FEMA under the Bush administration during Hurricane Katrina?

This, from The New York Times:

The head of the Federal Emergency Management Agency, Brock Long, has received widespread praise for his handling of the federal response to Hurricane Harvey, the first major natural disaster faced by the Trump administration.

Somebody get me a concrete citation of a real accomplishment attached to some of this “widespread praise” for anything besides being “a calming presence in press briefings.” Has the bar slipped this low that calmly stringing together cogent sentences is worthy of accolades? Can the NYT stop fluffing Trump and his band of co-conspirators?

Because right now American citizens are suffering and likely dying as a result of this administration’s gross ineptitude and negligence, if not outright malignance.

Now Trump says he’s going to Puerto Rico next Tuesday. That’s TWO WEEKS after the storm. Can’t disrupt his golf game over last or the next weekend, don’t you know. What I particularly despise about Trump’s response to this crisis is that he makes this guy’s fly-by two days after Katrina look so much better.

Call your members of Congress and demand action. Yeah, that’s not a question. Suck it up; you’ve got electricity, communications, and access to clean water if you’re reading this. Millions of your fellow Americans in Puerto Rico don’t. Let’s fix this.

~ 2 ~
GRAHAM-CASSIDY-HELLER-JOHNSON NOT-A-HEALTH-CARE BILL

Have you called your senator and asked them to vote NO on the debacle Sen. Bill Cassidy can’t explain and over which Sen. Lindsey Graham is ruining any cred as a rational human being, while disabled health care activists recover from being hauled away by capitol police yesterday before the Senate Finance Committee’s hearing on the bill?

Have you documented and shared publicly your senators’ position on Graham-Cassidy, especially if they are up for re-election in 2018?

The number is (202) 224-3121 if you don’t have it memorized already.

Need a script to make it easier? Here you go.

As wretchedly bad as this obscene joke of a bill is, I can’t help wonder if GOP members of Congress and their staff are gaming this. Have they been working on something even worse than previous attempts at ACA repeal just to game the stock market and make a few bucks on the backs of worried citizens?

[graphic: Health Insurance stock chart, via Google Finance]

For grins you should look at Aetna’s chart for last Friday and note the jump it took when Sen. McCain expressed his reluctance to support Graham-Cassidy. Price jumped about the same time capitol police arrived to arrest protesters. Easy money, that, conveniently ahead of the market’s close.

~ 1 ~
IRAN ~AND~ PUERTO RICO

What question do these two disparate places prompt?

First, Trump tweeted about an Iranian missile launch as if it had ~just~ happened, within 24 hours of a reconstituted travel in which Iran is listed. But the missile launch ~didn’t~ just happen; it took place more than six months ago but was mentioned only this week in Iranian news.

Second, Trump took his fucking sweet time ensuring FEMA went to Puerto Rico; Hurricane Maria made landfall on September 20th, visible to anyone who watched weather networks, NOAA, and NASA reporting.

Is Trump ignoring any and all U.S. intelligence and government experts on matters foreign and domestic, relying instead on some other criteria for responding to events, including cable TV? Should we believe for a second he’s simply and accidentally flooding his source of information?

In the case of Iran’s missile program, it looks more like he deliberately used stale news to defend a new travel ban while making propagandistic false statements to the public. The Supreme Court canceled hearing the travel ban after the travel ban was rejiggered — does this suggest his manipulation of perception worked, not only on the public but on the Supreme Court?

~ 0 ~
One more time: call your Senators to ask NO on Graham-Cassidy and get their position on the record. Call your members of Congress to ask for urgent response and funding for aid to Puerto Rico. The number is (202) 224-3121. Put it on speed dial.

Viajar bien, mis amigos y amigas.

Blogger since 2002, political activist since 2003, geek since birth. Opinions informed by mixed-race, multi-ethnic, cis-female condition, further shaped by kind friends of all persuasions. Sci-tech frenemy, wannabe artist, decent cook, determined author, successful troublemaker. Mother of invention and two excessively smart-assed young adult kids. Attended School of Hard Knocks; Rather Unfortunate Smallish Private Business School in Midwest; Affordable Mid-State Community College w/evening classes. Self-employed at Tiny Consulting Business; previously at Large-ish Chemical Company with HQ in Midwest in multiple marginalizing corporate drone roles, and at Rather Big IT Service Provider as a project manager, preceded by a motley assortment of gigs before the gig economy was a thing. Blogging experience includes a personal blog at the original blogs.salon.com, managing editor for a state-based news site, and a stint at Firedoglake before landing here at emptywheel as technology’s less-virginal-but-still-accursed Cassandra.

Thursday: Repetition

A little Prince to make the painful repetition a little easier to take.

By repetition I mean what’s happening in Puerto Rico compared to what has already happened in Michigan.

Some of Michigan’s most financially distressed cities were forced to accept emergency managers, supplanting the cities’ democratically elected officials. Under state law, EMs were the sole point of power and authority for administration until the cities were deemed financially viable. We all know how that turned out; in Flint’s case, ten people died from Legionnaire’s disease and roughly 8000 kids will pay for the incompetence of the emergency management scheme for the rest of their lives due to the permanent effects of lead poisoning. The incompetence is further magnified by governmental bodies’ failure to do the right thing to completion, while continuing to milk the city and state of more money to no effect.

Witness the state attorney general Bill Schuette now asking for $3.4 million to investigate what can already be easily seen in records released to date. The assessments made so far have been equally wrong — like Schuette’s office suing two consulting firms when documentation clearly shows outright stupidity in contract management or malfeasance on the part of government was the real problem. And none of Flint’s water problems would have happened had not the city been forced off Detroit’s water by the state treasurer’s office, which rejected a last-minute offer far cheaper than construction of the new Karegnondi water line. Seeing this doesn’t need millions of dollars, only ethics.

Puerto Rico — with a population smaller than Los Angeles in an area a little smaller than Connecticut — is now undergoing a similar loss of democracy for similar reasons of financial distress. The territory is $73 billion in debt caused in no small part by suffocating federal policies. The U.S. Senate just voted to supplant Puerto Rico’s elected officials’ authority with a team of managers. They had too little democracy as it was before this schema, not having the same kind of representation that the fifty states have; many of the financial limitations Puerto Rico faces have been directly related to the territory’s inability to regulate commerce.

The economic hitmen have won. Now the vultures descend.

The galling part is this approach is called PROMESA (Puerto Rico Oversight, Management, and Economic Stability Act) — a promise. Brace yourselves, Puerto Ricans, at least they’ve warned you. Que Dios tenga misericordia porque los buitres no lo hará.

Odd lots
I’ve got a bunch of stray cats and dogs here that didn’t fit under any theme so far this week. In other words, there wasn’t much repetition. Make of them what you will.

Thank goodness tomorrow is Friday and I can indulge in a little jazz. See you then.

Blogger since 2002, political activist since 2003, geek since birth. Opinions informed by mixed-race, multi-ethnic, cis-female condition, further shaped by kind friends of all persuasions. Sci-tech frenemy, wannabe artist, decent cook, determined author, successful troublemaker. Mother of invention and two excessively smart-assed young adult kids. Attended School of Hard Knocks; Rather Unfortunate Smallish Private Business School in Midwest; Affordable Mid-State Community College w/evening classes. Self-employed at Tiny Consulting Business; previously at Large-ish Chemical Company with HQ in Midwest in multiple marginalizing corporate drone roles, and at Rather Big IT Service Provider as a project manager, preceded by a motley assortment of gigs before the gig economy was a thing. Blogging experience includes a personal blog at the original blogs.salon.com, managing editor for a state-based news site, and a stint at Firedoglake before landing here at emptywheel as technology’s less-virginal-but-still-accursed Cassandra.