Puerto Rico hospitals and nurse representatives are debating Senate Bill 867, a proposal to mandate nurse-to-patient ratios. Francisco Rodríguez, president and CEO of Birling Capital, warned the measure could cost hospitals about $64 million a year, or 2.9% of their estimated revenue, and said it would add burdens to an industry marked by heavy losses, high debt and the risk of closures.
A nursing shortage could force cuts in beds and services, he said. He recommended phasing in changes, flexible staffing rules, adjusted penalties, funding sources, tax incentives and reimbursement rates, plus studies on staff availability and clinical outcomes first. Jaime Plá, executive president of the Puerto Rico Hospital Association, cited an association-commissioned study putting the cost at $100 million and said absorbing it without a dedicated funding source would be extremely difficult.
He proposed flexibility, with nursing care plans set while a patient’s condition is assessed, as is done now. He noted that over 40,000 registered nurses exist in Puerto Rico, but some are abroad and others work in home health or insurance. He added that higher electricity costs, tariff-driven price hikes and other cost increases could threaten hospitals’ viability.
Health Secretary Víctor Ramos said one nurse for 15 to 20 patients makes quality care impossible. The Health Department commissioned an AAFAF-funded study of feasibility and costs, as it intends to set a maximum ratio by regulation, and will recommend a course to the governor. Juan del Valle, president of the Puerto Rican Organization of Nursing Professionals, said hospital spending on advertising, public relations and facade remodeling shows money can be redirected to hiring, and that more staff could reduce negligence lawsuits.