P.R. Laws tit. 24, § 3072
Cancer patients and survivors shall have the following rights:
(1) General rights.—
(a) Any person with a suspicious tissue growth that has a reasonable probability of being malignant shall have the right of immediate referral to specialists certified in cancer diagnosis (surgeons, pathologists, among others), and undergo early diagnosis procedures such as biopsies and other pathology procedures that are necessary to establish a better treatment for early-stage cancer.
(b) Every person, whether in or after treatment, shall have the right to use a specialist as his/her primary care physician. All patients diagnosed with cancer shall have the right to treatment by a multidisciplinary team of oncology specialists, including, but not limited to medical oncologists, surgical oncologists, radiation oncologists, plastic surgeons, dentists, psychiatrists, and any other required specialist, as well as psychologists, nutritionists, and rehabilitation and counseling specialists.
(c) For a person to be diagnosed in an early stage, the provisions of subsection (a) of this section must be complied with, which provide immediate referral, as well as prompt intervention by a diagnostics specialist and wait for a pathology result, according to the term required to pathology laboratories, in order to make the diagnosis required under the critical illness coverage.
(d) Critical illness coverage under the healthcare plan of the Government of Puerto Rico shall be provided to any beneficiary diagnosed with cancer within a term that shall not exceed 72 business hours.
(e) Basic service exclusions, as provided in §§ 7001 et seq. of this title, known as the “Puerto Rico Health Insurance Act”, as well as those established through regulations, shall not apply to beneficiaries diagnosed with cancer. Such beneficiaries shall be entitled to all the special benefits under the coverage of the Health Insurance Administration.
(f) The time elapsed between initial diagnosis and the start of chemotherapy and/or radiotherapy and/or surgery shall not compromise the prognosis established for the type of cancer; the speed of growth; size and location; and the age and physical condition of the patient shall be taken into account when establishing an adequate early treatment so that his/her health is not compromised.
The waiting period between the first diagnosis and the initial anti-cancer treatment shall not exceed three weeks, taking into account the time needed to complete the basic testing to assess the stage and condition of the patient, which are essential to start treatment.
(g) No insurer shall reject or deny any treatment agreed upon and/or included as part of the terms and conditions of the health insurance contract signed by the parties when a medical recommendation to such purposes so require. Physicians, health service organizations, insurers, and providers shall not reject or deny treatment such as hospitalization, diagnosis, and medication to any cancer patient. With regard to cancer survivors, insurers, health service organizations, and healthcare plans providers shall not deny coverage for the treatment and frequent and permanent monitoring of the physical health and emotional wellbeing of the insured.
(h) Any side effect and potential physical and/or physiological complications, as scientifically evidenced, in the treatment of each type of cancer during all phases of the screening and treatment process, as well as medications used during the same, whether invasive or non invasive, shall be discussed with the patient, parent, or tutor.
(i) Cancer patients shall have the right to know and understand the treatment and rehabilitation plan and adequate pain management protocol for their case. Patients shall have the right to have their pain treated with priority. Patients shall also have the right to aggressive pain management techniques approved by the Food and Drug Administration (FDA) and based on scientific evidence. Aggressive pain management with all available medication, including opiates, shall be governed by the rules established by the applicable federal regulatory agencies and shall not require previous invasive procedures for pain management such as, but not limited to surgery, nerve or tissue destruction, or the implantation of electronic anti-pain devices. The potential for drug addiction shall be evaluated and fully explained to the patient, but shall not be the sole criterion for not using available medications or for discontinuing pain relief by medication.
(j) Cancer patients shall have the right to obtain a copy of their medical records promptly whenever they wish to obtain a second medical opinion or consult another provider.
(k) Cancer patients shall have the right to preserve their fertility, as well as to obtain information and advice on the short- and long-term effects that cancer, as well as cancer testing and treatment, may have on their fertility.
(l) Cancer patients undergoing radiotherapy and chemotherapy shall be deemed by hospitals, research centers, care centers, and laboratories as persons with a compromised immune system; therefore, all measures established for the care and hospital stay of such patients shall be taken. Thus, the already weakened immune system of these patients shall not be further compromised by exposing them to other health risks. For such reason, cancer patients must be isolated from patients with infectious diseases.
(m) Hospitals or care centers, as well as physicians and other medical and hospital entities, shall respect such patients or legal guardians’ directives for treatment or the discontinuation thereof. If such directives cannot be respected for policy or religious reasons, the patients or the patients’ legal tutors shall be informed.
(n) In order to provide support and advise to the general cancer patient population, the patient navigation system shall be used. Through such system, facilities providing medical care or shelter shall acquaint cancer patients or a group of patients with a cancer survivor, recovering cancer patient, or appropriately-trained volunteer who shall provide moral support; counseling during the diagnosis, treatment, and recovery process; and ensure that all the rights contained in this bill are upheld for the benefit of the designated patient or patients. Furthermore, persons may be trained to act as caregivers or to render housekeeping services, at least once every two weeks, during the active treatment of the patient, provided that a written certification by a physician is issued. This shall be done in coordination with and with the advice of private organizations that bring together and represent cancer patients and survivors, as well as their families. It shall be the public policy of the pertinent agencies of the Government of Puerto Rico to provide support to these mentors and to participating patients as provided in this chapter.
(o) Cancer patients shall have the right to the continuity of all medical and healthcare services, such as early detection tests. Access to oncologists, radiation oncologists, and surgical specializations involved in the initial diagnosis and treatment of patients once they are considered survivors shall be guaranteed, so as to enhance the close monitoring for cancer recurrence and treatment side effects and the maintenance of the physical and emotional health of all survivors. In addition, they shall have the right to lifelong, continuing education on all aspects of cancer prevention, diagnostic tests, and treatment protocols.
(p) Cancer patients shall have the right to participate in complementary cancer treatment under the supervision of the attending oncologist of the suggested conventional treatment, provided that such treatment has been approved by federal regulatory agencies and is not contraindicated for the type of cancer these patients have, the treatment provided, and their health condition at the time. If the physician and/or medical hospital service provider does not agree with the patient’s desired complementary treatment, such patient may be required to sign a waiver. Such waiver shall not apply to conventional treatment coverage provided by insurers.
(q) At the advanced or final stage, every competent adult or his/her legal representative shall have the right to request aggressive pain management protocols to the extent allowed by the applicable protocols of federal regulatory agencies. No physician shall directly or indirectly participate in or recommend assisted suicide as such term is defined in this chapter.
(r) Cancer survivors shall receive both treatment and continuous and permanent monitoring of health and emotional well-being from their primary care physicians, as established in the treatment guidelines, with particular emphasis on vigilance for cancer recurrence and for long-term after effects of cancer treatment.
(s) Functional cancer patients and survivors shall have the right to gainful employment commensurate with their talents and abilities, without regard to their history of cancer diagnosis. The cancer patient or survivor’s condition shall not be a reason for changes in, elimination of the position or office held by the cancer patient or survivor, or for layoff, involuntary transfer or administrative sanctions of any kind, including dismissal. Employers may reach an agreement regarding reasonable accommodation with an employee due to the latter’s medical condition. Absences or tardiness incurred by family members who are responsible for taking cancer patients to their appointments or caring for them shall be deducted from the corresponding sick leave and/or compensatory time; therefore, employers shall not apply any other penalty. Family members with direct responsibilities shall provide their employers with a certificate from the physician or the medical hospital or healthcare institution attesting that the patient needs direct assistance from such family member.
(t) Cancer survivors shall have the right to be included in their employer’s group healthcare plan, without having their individual contribution increased as compared to all other group members or being excluded from the general coverage due to preexisting cancer diagnosis.
(u) Cancer survivors shall have the right to private health insurance without prejudice against preexisting cancer diagnosis.
(v) A designated guardian may exercise the rights included herein on behalf of a patient who is incapable of making decisions, declared incompetent by law, or a minor, and shall have the right to petition a court of competent jurisdiction to allow access to the treatments and all the rights established in this chapter.
(w) Patients diagnosed with cancer and cancer survivors shall have reasonable access to clinical trials and treatment that has been clinically proven for their type of cancer.
(x) Cancer patients shall have priority with respect to the benefits of any incentive or service aimed at providing them with transportation to obtain any necessary treatment.
(2) Additional rights for pediatric cancer patients and survivors.—
(a) September is hereby designated as the “Childhood Cancer Awareness Month in Puerto Rico”. Every year the Governor shall issue a proclamation to observe September as the “Childhood Cancer Awareness Month in Puerto Rico” in order to raise people’s awareness of this condition and focus their attention on the efforts of the Government, the private sector, and nonprofit organizations to educate about the detection, treatment, and rehabilitation of this type of cancer.
(b) No natural person or organization of any kind shall discriminate against children with cancer; otherwise, such person or organization shall be subject to the penalties established in this Bill of Rights.
(c) Pediatric cancer patients, as well as their parents, guardians, or caregivers, shall have equal access to public and private schools, buildings, and public or private spaces, entertainment sites, and mass transportation systems.
(d) All pediatric cancer patients shall have access to the services provided by hospitals, clinics, dispensaries, and any healthcare facility, as well as to all kinds of public or private, inpatient or out patient healthcare or emergency services. For the duration of this health emergency, no private insurer shall eliminate benefits from or terminate a contract.
(e) Parents or guardians of pediatric cancer patients shall have the right to request access to complementary treatment in consultation and coordination with the physician or medical and hospital service providers, without compromising the health of the patient. If the physician and/or medical and hospital service provider does not agree with the complementary treatment, the parent or guardian may request a second opinion to find a physician that can come along and assume responsibility during such nonconventional treatment.
(3) Additional rights for geriatric cancer patients and survivors.—
(a) The elderly shall be provided with current and clear information concerning cancer prevention, detection, and treatment, taking into account any potential conditions that may affect communication or sensory, mobility or cognitive abilities.
(b) Geriatric cancer patients shall have access to clinical trials and treatment that has been clinically approved for people within their age group.
(c) To receive adequate support for their age, including, but not limited to community support, psychosocial and palliative care services.
(d) To be empowered to make decisions based on a full and detailed explanation of all treatment options and long-term effects of the disease, thus actively participate in their own treatment.
(e) The elderly shall not be discriminated against in the recruitment for clinical trials. They shall be informed of and invited to participate in the clinical trials of treatments that are intended for use in the elderly.
(4) Rights of University students who are cancer patients and survivors.—
(a) Every post-secondary and university institution shall guarantee the readmission of any student to the study program in which he/she was enrolled in said institution, whether on a full or part-time basis, if such student’s education was interrupted due to cancer diagnosis and treatment. Readmission shall not be subject to evaluation by a readmission or equivalent committee, and priority shall be given to the student to enroll in the academic courses from which he/she had withdrawn, provided that such courses are offered by the institution during the academic session for which he/she is requesting readmission.
(b) Cancer patients who are University of Puerto Rico (UPR) System students, whose federal scholarships and student loans have or are about to be exhausted, and who have been unable to finish their post-secondary studies and wish to do so regardless of the major they have chosen or wish to continue pursuing, even if such studies extend beyond the term established in federal student aid legislation, shall have the right to have their tuition covered by the Trust Fund of the UPR System.
(c) This right shall also apply to university students who are cancer patients, are not eligible for federal scholarships or student loans, and maintain the grade point average established by the UPR.
(d) The right to have their tuition paid by the institution shall apply to cancer patients who meet the eligibility criteria established under this section and are enrolled in universities, post-secondary education institutions, and private university colleges recognized by the Puerto Rico General Education Council and/or a national college and university accreditation agency.
(e) When learning centers recognized by the Puerto Rico General Education Council and/or a national college and university accreditation agency in the United States begin or establish new courses, programs, colleges, or schools, cancer patients enrolled in such new courses, programs, colleges, or schools shall have the right to receive the benefits authorized under this section, until the Puerto Rico General Education Council and/or a national college and university accreditation agency finally recognize them or, in the case of courses that require passing a revalidation examination for the practice of a profession or trade, the competent state body denies the corresponding revalidation examination.
(5) Additional rights for female cancer patients.—
(a) Private insurers, health service organizations, and healthcare plan providers shall include the cervical cancer or Human Papilloma Virus (HPV) vaccine in their coverage for beneficiaries between eleven (11) and eighteen (18) years of age. According to scientific evidence, vaccines are one of the most cost- effective and powerful preventive measures.
(b) Insurers, health service organizations, and healthcare plan providers shall include in their coverage, without it being construed as a limitation, access to treatment with the Human Papilloma Virus (HPV) vaccine, which shall consist of the total number of doses required by the Food and Drug Administration to achieve immunization.
(c) Coverage shall include pelvic exams and all types of vaginal cytology that may be required by a physician to detect, diagnose, and treat early stages of abnormalities that may lead to cervical cancer.
(d) Every plan shall provide extended coverage for the payment of breast cancer screening and testing such as visits to specialists, clinical breast exams, mammograms, digital mammograms, magnetic resonance mammography and breast ultrasounds, and treatment including, but not limited to, mastectomy, breast reconstruction after mastectomy, reconstructive surgery of the other breast to achieve symmetry, breast prosthesis, treatment for physical complications at all stages of mastectomy, including lymphedema (swelling that sometimes occurs after breast cancer treatment), any reconstructive surgery after mastectomy that may be needed for the physical and emotional recovery of the patient.
(e) The aforementioned provisions shall apply to each healthcare plan when sold and/or renewed, subject to the approval of the Health Plan and Insurance Rates Reviewing Board.
(6) Rights of clinical trial participants.—
(a) Every participant shall receive information about clinical trials in order to make an informed decision about their participation.
(b) The informed consent process shall be adapted to the specific needs of the different groups of persons, taking into account their age, education and neuromotor deficit, and participation of their family or caregivers, if necessary. All clinical trials and the documents related thereto shall be approved by the Institutional Review Board of clinical research proposals, known as the IRB.
(c) All participants shall have the right to the protection of their safety and to have the necessary steps taken to accommodate their particular care, time, and space needs, especially those of patients with mobility and communication problems and any assistants accompanying them.
(d) The individual values of each person participating in clinical trials shall be respected.
(7) Rights of cancer patients and survivors who reside in the Island Municipalities of Vieques and Culebra.— Every cancer patient or survivors who reside in Vieques or Culebra, has traveled by sea or air, and must return to the Island Municipalities on the same day shall have the right to a preferential turn. Such turn shall consist of obtaining, at the request of the patient, an appointment or outpatient treatment on a convenient date and time for such patient due to his/her geographical limitation. Those persons who request a preferential turn in accordance with this provision shall have taken the necessary steps to obtain a prior appointment; it is not the intent of this section to circumvent the administrative processes of the offices where healthcare services are provided. Likewise, such persons must present the ferry or airplane ticket as evidence at the time of receiving the healthcare service required. In addition, healthcare providers shall have the responsibility of informing patients who reside in the Island Municipalities of Vieques and Culebra about their right to avail themselves of the benefit provided in this chapter for accommodation purposes.
History —Sep. 27, 2012, No. 275, § 3, eff. 180 days after Sept. 27, 2012.