For three weeks, the government of Puerto Rico gave the impression that Telemedik was somehow working in contact tracing and provided inaccurate information about the role of this company during the pandemic.
National Guard Assistant General José Juan Reyes said on April 14 that Health Secretary Lorenzo González Feliciano had informed him that he would employ Telemedik for what they described as "tracing of passengers" arriving at Luis Muñoz Marín Airport. That was later denied by the company's spokeswoman and the Secretary himself.
Telemedik, which is a brand of Jaye Inc. established in 1995, has three contracts with the Health Department according to the Comptroller's Office, but the company claims it has only two. If that were the case, the Health Department has not informed the Comptroller that it has canceled one of the contracts related to the emergency.
Since the pandemic emergency started, the Health Department registered the first contract with Telemedik for $52,000 signed on March 12, 2020, the same day the company submitted its proposal to that agency. In fact, this company signed its first contract related to the pandemic on the same day that Governor Wanda Vázquez Garced declared the state of emergency.
Telemedik was allegedly going to serve as a call center to provide guidance on COVID-19 to the people who were at the National Salsa Day - about 30,000 - and to the general population. During a press conference on March 11, the governor urged people who suspected they had been exposed to the virus to call 787-999-6202, the Health Department's hotline managed by this government contractor.
That contract, which expires on June 30 this year, establishes an administrative fee of $7,500, in addition to $30,000 monthly for up to 6,000 calls. Calls that exceded that number up to 9,000 would be charged at $4.85 each. That contract was signed by former Secretary Rafael Rodríguez Mercado and Telemedik President Joaquín Fernández Quintero.
The reports, which the Health Department provided to El Nuevo Día, do not contain data about how many calls the company took from those who were at the traditional salsa event, which was the original purpose of the contract. A tourist infected with COVID-19, who later died in Panama attended the event.
Assistance that started with a festival
Paola Díaz Hernández, a spokesperson for Telemedik, said they were hired to run a guidance and assistance line for those who were at the salsa festival, but that the service did not require the company to contact those people, but rather the opposite.
"Reports of the calls received were delivered daily," said Hernández.
The second contract was signed on March 24 by former interim secretary Concepción Quiñones de Longo, but Telemedik's proposal said it was submitted to the Health Department the day after the contract was signed, on March 25. The contract is to continue telephone services related to COVID-19 to the general population and no longer included those who went to the festival.
"I have no idea why Telemedik was selected," responded Quiñones de Longo, suggesting that if she signed the contract it was because someone told her it was pending.
The contract allows for a maximum billing of $99,999 per month, at a cost of $3 per call, extended for one year, allowing Telemedik to bill up to $1.2 million. Its monthly billing is subject to the number of calls answered.
Although the government was prepared to invest this multi-million dollar figure in the COVID-19 hotline, it did not implement, through this line, contact tracing, a key tool in its Strategic Preparedness and Response Plan for the New Coronavirus prepared in March. That task required asking people who tested positive for the virus who they had been in contact with the last two weeks and, in turn, alerting and monitoring those people until they tested negative for the virus.
According to the Telemedik spokesperson, the call center contract addresses three requests from the Health Department: the COVID-19 guidance line, contacting patients testing positive after 14 days, and delivering information and confirmation of receipt of positive cases to mayors provided by the Health Department. None of these services include contact tracing.
It is not clear how the company bills for the tasks of contacting positive patients or sending information to mayors, which are not included in the scope of work described in the contract.
According to the company, they received some 18,300 calls. The data coincide with documents the Health Department presented to El Nuevo Día, which indicated that, as of May 1, the company had dealt with 18,828 calls, of which 24 percent were classified as suspected or possible suspected cases.
According to the reports, which Telemedik provided to the Health Department, the company obtained a response in 88.4 percent of calls to positive cases by the Epidemiology Office assigned them for follow-up after 14 days.
Calling the hotline
El Nuevo Día staff participated in several calls to the Telemedik contact center to verify the content of this guidance. The calls, four in total, were answered promptly and lasted a little more than eight minutes.
When dialing the "person with symptoms" option, a telemarketer answered, asking general personal questions such as name, age, telephone number, family composition, and physical address, without requiring specific details on how to get there.
After mentioning the symptoms suffered,the person who answered asked about other symptoms, conditions, travel history, if he or she had been in contact with people with symptoms compatible with the coronavirus. Concluding that the symptoms mentioned were compatible with COVID-19, the Telemedik employee said that she could not diagnose the infection because she was not health staff, and recommended calling a physician or the telehealth number of the medical plan. She also said she could offer a phone number for a virtual consultation. That consultation costs $25, as mentioned in one of the calls.
Besides, the person who made the call was asked about being interested in a follow-up call. In two of the four calls made last Friday, that follow-up was requested, but, at least until yesterday, Wednesday, it did not happen. In two of the calls, people were suggested to self-isolate for 14 days, but in the other two calls, no such recommendation was suggested.
In addition to these two pandemic-related contracts, the Health Department has amended a third contract during this term on four occasions, totaling $684,000. This is a contract awarded in 2015 to Telemedik for information systems-related services, but which has been renewed for more than a decade. Since 2004, Telemedik has operated the "Quit Smoking" helpline.
For weeks, the government of Puerto Rico reported that Telemedik was in charge of monitoring passengers arriving at the Luis Muñoz Marín International Airport. But it wasn't until the company said that it had no contract to that effect that the Health Department acknowledged that it was not Telemedik's role to contact the passengers, verify their condition and remind them that they should self-isolate for 14 days.
Díaz Hernández said the confusion may have been generated because "there was an initial intention for Telemedik to be in charge of this initiative," but that was finally left in the hands of the Health Department's Epidemiology Unit.
Although the National Guard delivers daily reports on passengers arriving at the airport to the Health Department - with their contact information, travel history, and place of stay - the government had not yet implemented the system to follow up on those cases, the only useful tool to ensure that they were complying with the "quarantine" ordered by the governor.
El Nuevo Día contacted epidemiologist Myriam Ramos, in charge of the airport operation, but she said she was not authorized to comment. By press time, Health Communications personnel had not granted the interview.
National Guard personnel reported that they have also referred to the Health Department the database of the 1,552 calls they have received at the "transfer center," as they call the center that was supposed to coordinate the transfer of patients between hospitals. Capt. Rafael Paz, who supervises medical students and soldiers at the center, said they ask these people if they have been in contact with anyone and the places they have visited in the last 14 days. At the center, they follow up and report to the Health Department positive cases.
Also, on March 19, Telemedik submitted a proposal to the Department of Health regarding an extended hotline with medical consultation. According to Telemedik, this proposal responded to the interest of the Puerto Rican government to establish a free virtual consultation service with doctors from the Intramural Practice of the School of Medicine, as an extension of the COVID-19 hotline.
However, they were later asked to separate the services since the telehealth proposal would be in the hands of the University of Puerto Rico Medical Sciences Campus.
"With this proposal, the government was interested in offering a free virtual consultation service by internists, psychiatrists, pediatricians, and family doctors to all the people of Puerto Rico who did not have access to their doctors or telehealth services. This would be offered seven days a week, 24 hours a day for six months. It was estimated that there would be up to 60,000 consultations for the six-month period," the spokeswoman said.
The Health Department did not answer the question of whether a request for proposals was issued. By press time, a contract related to this proposal had not been signed.
In the public hearings held by the House Health Committee, this telehealth proposal came up because it was included in the notes that one of the members of the governor's medical task force was taking at the meetings.
In the summary of the March 21 Task Force meeting, the telehealth contract was mentioned; "it is a 1-2 million contract and it is emphasized that it should be in operation next week." The notes, however, do not indicate the name of the company that would be hired.
At the March 23 meeting, however, it was indicated that the telehealth proposal had not passed the Health Department's control and "is being developed within the Medical Sciences Campus."
In an interview with El Nuevo Día, Dr. Quiñones de Longo said that interest in the Telemedik proposal came from the Medical Sciences Campus. "I remember a contract that was brought to me related to telehealth, and that Dr. (José) Camuñas, from the Medical Sciences Campus, brought me. I gave it to Katherine de La Cruz Durán to evaluate because I told her: 'This is a sheet of paper that looks like an invoice. It does not have the characteristics of a contract. Evaluate this, see if this works. They said no. I believe that it ended there, I don't know what happened next," said the former interim secretary.
The Task Force's notes of the March 23 meeting say that this telehealth contract would allow saving about 70 hospital appointments and stresses that it is a good mechanism to "avoid flooding (of people)" in emergency rooms and because it allows patients follow-ups at home.
The notes say It could help reduce up to 70 percent of ER visits.
The contract was expected to be ready that week, but it was not signed.
This is not the first time that Telemedik presents proposals to the Puerto Rican government during an emergency or disaster. During the Hurricane María emergency, Telemedik tried to win a $45.3 million contract, in partnership with GlobalMed, to provide telehealth services on the island. On June 18, 2018, former Secretary Rodríguez sent Alejandro de la Campa, who was FEMA executive director, that proposal along with a letter of endorsement, but it never materialized.