Puerto Rico’s healthcare system has long stood at a crossroads, but the events of late summer 2025 have brought its fragile state into sharp relief. The closure of Hospital del Maestro, a San Juan institution that served families for more than sixty years, is just the latest and most visible sign of a system under siege. As the island’s hospitals struggle to stay afloat, leaders and advocates are rallying to chart a new path—one that demands not just survival, but renewal and equity.
Over the weekend before September 8, 2025, the Puerto Rico Hospital Association convened its Mental Health Summit 2025, gathering a diverse array of leaders from hospitals, universities, government agencies, and community organizations. Moderated by Marta Rivera Plaza, CEO of San Juan Capestrano Hospital System and chair of the Hospital Association’s Mental Health Committee, the summit focused on designing innovative, sustainable strategies to strengthen mental health services on the island. According to The San Juan Daily Star, the event underscored the essential role of behavioral health professionals and the necessity of a more integrated, equitable, and people-centered mental health system.
The summit’s keynote address was delivered by Dr. Theresa M. Miskimen Rivera, the first Puerto Rican president of the American Psychiatric Association (APA). With over three decades of experience, Dr. Miskimen Rivera addressed both global mental health challenges and their specific impact on Puerto Rico. She announced a significant commitment: "Puerto Rico has a great opportunity to take advantage of our clinical training, professional development, and networking programs. These resources help improve practice, strengthen patient care, and empower the advancement of each professional. Personally, I offer to accompany my colleagues on the island in this process of growth and renewal. They now have a Puerto Rican at the helm of APA." The APA will provide mental health professionals in Puerto Rico with access to resources, training programs, seminars, and its extensive library—benefits typically reserved for its more than 40,500 members.
But even as such initiatives offer hope, the broader healthcare system faces mounting existential threats. In late August 2025, the Department of Health ordered the immediate closure of Hospital del Maestro. Once licensed for 255 beds, the hospital had dwindled to just 18 in use when it filed for Chapter 11 bankruptcy on August 25, reporting $13.4 million in assets against $39.7 million in liabilities. Four days later, its license was suspended due to patient safety concerns. As wjournalpr.com reported, this was not an isolated incident. Hospital del Maestro’s fall is emblematic of a wider pattern of bankruptcies, consolidations, and closures that have swept through Puerto Rico’s healthcare landscape in recent years.
The roots of this crisis run deep. The first major blow to Hospital del Maestro came in 2010, when Westernbank—one of its main lenders—collapsed, cutting off access to crucial credit. The years that followed saw rising operating costs, shrinking patient volumes, and an exodus of young professionals, including doctors and nurses. Over the past two decades, Puerto Rico has lost more than 736,000 residents—nearly a quarter of its population—many of them the very professionals needed to sustain a robust healthcare system. What remains is an older, poorer population, heavily reliant on Medicare and Medicaid, with higher costs but lower revenues for hospitals.
Leadership missteps compounded these challenges. Rather than seeking outside expertise or innovative management, Hospital del Maestro’s board leaned on familiar insiders, missing opportunities for creative solutions. The COVID-19 pandemic then delivered a devastating blow: as the government urged residents to avoid hospitals unless absolutely necessary, occupancy plummeted to 30%. Revenues collapsed, key departments shuttered, and layoffs followed. By 2023, the hospital was a shadow of its former self, under close scrutiny from regulators and creditors.
Yet, as wjournalpr.com points out, the hospital’s demise was not inevitable. There were missed opportunities for partnership, sale, or restructuring—paths that might have preserved services and jobs. Instead, the collapse of Hospital del Maestro became part of a broader systemic unraveling. Across the island, six other hospitals have filed for bankruptcy and another was sold, all against a backdrop of chronic federal underfunding, demographic decline, unsustainable debt, and weak governance.
This crisis is not merely financial. It is deeply human. As mental health summit attendees discussed, the system faces a workforce crisis, the lingering effects of childhood trauma and violence, the mental health needs of older adults, and the integration of physical and mental health care. Topics also included resilience to disasters, collective trauma, addictions and stigmas, and changes in federal protection and inclusion policies. Judge Carmen L. Otero Ferreira, administrator of the Bayamón Judicial Region, provided a judicial perspective, emphasizing the need for public policies that promote equity, decriminalization, and dignified treatment for people with mental health conditions.
Underlying these challenges is a stark funding gap. Healthcare spending in Puerto Rico stands at just $4,000 per person annually, compared to $13,000 on the U.S. mainland—a 69% shortfall that translates to nearly $29.8 billion in lost funding each year. This chronic underfunding, rooted in a long history of discriminatory statutory treatment in Medicare and Medicaid, has stunted the island’s healthcare economy, limited investment, and eroded access to care. As wjournalpr.com notes, these inequities are not accidents of poor management, but the inevitable outcome of systemic inequity embedded in U.S. law.
Yet, despite these obstacles, Puerto Rico has achieved remarkable gains in life expectancy, rising from 74.26 years in 1995 to 80.69 years in 2023—now more than four years higher than the mainland. Plan Vital, the island’s government insurance program, covers nearly half the population, and overall insurance coverage stands at 92%. Still, insurance does not guarantee access: patients wait hours for routine care, and specialists are scarce.
Looking forward, stakeholders are calling for bold action. The Mental Health Summit reaffirmed the urgency of addressing challenges with innovative, collaborative solutions—emphasizing integration of services, workforce strengthening, equitable access, and inclusion of vulnerable populations. Meanwhile, proposals such as the National Wellness Hospital Lending Program (NEW-HOPE) have emerged, modeled after the U.S. Treasury’s interventions during the 2008 financial crisis. With an initial $1.5 billion capitalization, NEW-HOPE would provide low-cost loans, credit guarantees, and targeted investments to stabilize hospitals and modernize services.
As Puerto Rico’s healthcare system stands at a crossroads, the decisions made in the coming months will determine whether the island continues its slide toward crisis or charts a course for renewal. The story of Hospital del Maestro is a cautionary tale—but it is also a call to action. With commitment, collaboration, and a willingness to confront systemic inequities, Puerto Rico can build a healthcare system worthy of its people.
