PART THREE

PROVIDENCE – The next task in the reinvention groove being undertaken by Gov. Gina Raimondo is to foster “innovation and accountability” in Rhode Island’s criminal justice system; she recently signed an executive order to establish the Justice Reinvestment Working Group.

After pensions, after Medicaid, comes prisons; the move segues well with President Barack Obama’s national efforts to focus on reform of the criminal justice system.

A working group of stakeholders will now undertake what was described as a “data-driven” approach, in partnership with the Council of State Governments Justice Center, with the goals of reducing costs and improving public safety.

Co-chaired by Rhode Island Supreme Court Justice Paul A. Suttell and former Superior Court Judge Judith Savage, the working group brings together many of the stakeholders involved in the state’s criminal justice system, including R.I. Attorney General Peter Kilmartin and A.T. Wall, director of the R.I. Department of Corrections.

RI’s largest mental hospital
Savage, in her talk at the mental health summit on June 8, set the stage when she described a broken system of justice in Rhode Island.

“The ACI is not only our state prison, it is our largest mental hospital,” she said. “I see brokenness. I see a broken mental health system, broken people. I don’t see justice. I see injustice.”

Savage, has been serving as the Roger Williams University Law School Distinguished Jurist in Residence, teaching a seminar built around the book, “The New Jim Crow: Mass Incarceration in the Age of Colorblindness.”

On March 27, Savage led a symposium, “Sounding the Alarm on Mass Incarceration: Moving Beyond the Problem and Toward Solutions,” that drew some 350 people to focus on “an inordinately expensive criminal justice that has incarcerated a greater percentage of its citizens – especially blacks and Latinos – than any other country in the world.

In a blog post written by Savage the day of the symposium, she laid out the facts:

• The U.S. is the world’s leading jailer; it has 5 percent of the world’s population but 25 percent of its prisoners.

• Some 2.2 million Americans are currently incarcerated, a 500 percent increase over the last 40 years.

• One out of every three African-American males born today, and one out of every six Latino males, is likely to be incarcerated during their lifetimes.

• The costs are staggering; the correctional system in America is an $80 billion enterprise.

• There is a mass probation problem in Rhode Island, with more than 24,000 of Rhode Island’s residents currently on probation, the third-highest rate in the nation.

What is meant by data-driven?
The Council of State Governments Justice Center has worked with some 21 other states in identifying new strategies and policies that achieve a reduction in costs, a reduction in recidivism, and an overall increase in public safety, Ellen Whelan-Wuest, project manager for the Rhode Island effort, told ConvergenceRI in an interview on July 11.

The data-driven approach has been successful in North Carolina, according to Whelan-Wuest. However, when asked about the average active caseload of a probation officer as standard, given that Rhode Island’s current number is 116 cases per probation officer, Whelan-Wuest shied away from answering.

“I don’t know what the average recommended caseload is as a standard,” she told ConvergenceRI. “I will say that the average active caseload in Rhode Island of 116 cases is a higher number. We don’t have any direct comparisons. Generally, it is a high number.”

Whelan-Wuest said that while that there is a general process and approach that plays out as part of the work done, the working group is very tailored to the specific needs of each state. “The process takes about, from the beginning, between seven and nine months,” she said. The time that it takes for those states that enact the policy recommendations, she continued, “It can take up to two years of implementation and technical assessments.”

When asked about what were the metrics of success for her work, Whelan-Wuest replied that it was a great question. “How each state defines success depends on [how] every project [develops],” she said. “We bring a policy framework that ultimately results in legislation, with policy impacts and estimations.” The metrics for success, Whelan-Wuest continued, “track very closely to the policies that are [identified by stakeholders] and what they are intended to do.” She acknowledged that the process can change on-the-ground during implementation.

But, generally speaking, Whelan-Wuest said that a number of states have seen “recidivism decline and achieved savings, reinvesting those savings into other programs.” North Carolina, she said, was able to close 10 small prisons and reinvest the savings into stronger supervision practices.

The data for the project comes from a number of different sources, Whelan-Wuest explained, including arrest data, sentencing data, court data, with the department of corrections – “everything we can possibly get from these agencies, with access to the data in the rawest form.”

When asked about the potential to look at elevated levels of lead poisoning in prisoners as part of the research, or to track the relationship between family violence and sexual abuse with incarceration, Whelan-Wuest said that in her work, those questions had not been researched. “The scope of our work is defined by the state working group; we’re directed by the state for what to look at,” she said.

When asked if her group had ever uncovered practices related to the misuse of parole detainers [arresting people for crimes for which they may be innocent and did not commit, but by being arrested, they then can be found in violation of parole and sent to jail] by members of the criminal justice system, Whelan-Wuest said she had no comment, and that it wasn’t a policy or practice that she was familiar with, or one that had come up in the work in the 21 other states.

A tune-up?
The latest reinvention working group was praised in a Providence Journal editorial published on July 14, which began: “Rhode Island’s criminal justice system could use a tune-up.” It concluded by saying: if the working group “can help Rhode Island spend its correctional dollars more wisely, it will have performed a great service.”

[Was it coincidence that the editorial was published on Bastille Day, which celebrates the storming of the prison known as the Bastille and the beginning of the French Revolution?]

The editorial was then picked up by Raimondo’s press office and broadcast on social media, with the advice: “Please consider sharing today’s editorial with your friends and neighbors.”

New geometry of governing
The stark difference in tone between Savage’s comments, “I see a broken mental health system, broken people,” and The Providence Journal’s editorial about the criminal justice system needing “a tune-up” struck ConvergenceRI as something meaningful to consider.

The use of a team from Deloitte as pro bono consultants to facilitate the brainstorming session on June 24 by the working group to reinvent Medicaid had also struck ConvergenceRI as meaningful.

Further, the failure to re-enact the Good Samaritan Law, when the lives of Rhode Islanders literally hung in the balance, led ConvergenceRI to think about what it revealed about the responsibility around decision-making and governing.

One question that emerged was this: if Raimondo so strongly supported the Good Samaritan Law, and was so upset by the failure by the R.I. General Assembly to take action, why couldn’t she decide to sign an executive order keeping it in place? After all, she had just signed an executive order to create a new working group on the criminal justice system.

A wave of consultants

In wrestling with these questions, ConvergenceRI began to recognize what appeared to be an emerging trend: a wave of corporate consultants had become the hallmark of the way that Rhode Island now makes policy decisions – and governs.

The following list is by no means inclusive, but it begins to fill in the picture:

• An executive search firm to identify potential candidates for new jobs at the CommerceRI Corporation, to include some portion of the $1 million in new staff for CommerceRI director Stefan Pryor: a deputy director, a director of communications, a chief of strategic planning, monitoring and evaluating, and an administrative support person. It may also include some portion of 20 new full-time positions at a cost of some $3.3 million that Pryor asked for his budget. [An RFP for a reconfiguration of the workspace at CommerceRI has also been issued, with responses having been due by July 15.]

• An RFP for a $5 million tourism and business attraction branding campaign, to target Rhode Island as the best place in the Northeast to live, grow a business, and visit as a tourist or business traveler.

• The hiring of Public Works LLC to help develop a Comprehensive System Improvement Plan for the Governor’s Workforce Board; the firm will convene a series of focus groups with representatives form businesses, public agencies, labor, education and community-based organizations.

• The hiring of the Pittsburgh-based Fourth Economy, a consulting group. to develop a industry cluster strategy for the City of Providence.

• The hiring of competing consultants to evaluate the proposal to build a proposed new stadium in Providence by the ownership group of the Pawtucket Red Sox, including one by CommerceRI and another by R.I. House Speaker Nicholas Mattiello.

• The use of Deloitte [on a pro bono basis on this particular project], the consulting contractor on UHIP, the largest state investment ever in IT, which has encountered serious difficulties in implementation, resulting in as much as $9 million in additional expenses by HealthSourceRI in 2014, to facilitate the brain-storming session of the Working Group To Reinvent Medicaid on June 24.

Other current projects involving consultants include: the inspection and analysis of bridges and roads in Rhode Island. 

Where do ideas for innovation come from?
One of the oft-cited “rules of thumb” created by Alan Webber, Fast Company’s co-founding editor, is this: “Change happens when the cost of the status quo is greater than the risk of change.”

Translated, imperiled industries may finally be forced to make changes they resisted in happier times – and in those challenging times, that is when innovation really happens, according to Webber.

Indeed, it was quoted by Peter Anduszkiewicz, the president and CEO of Blue Cross & Blue Shield of Rhode Island, when he spoke at the Rhode Island Business Group on Health’s annual health care summit on Oct. 17, 2014. “Inertia is not our friend,” he said.

That said, the ongoing process of reinvention through working groups of stakeholders, mostly invested top leaders of industry sectors, married with the trend of hiring, high-priced expert consultants to make recommendations [and decisions] on the difficult tasks of governing, may actually work against the process of disruptive change and innovation.

For example, the Centers for Medicaid and Medicare Services announced last week that it will test a new bundled payment program which would hold hospitals accountable for the quality of care they deliver to Medicare fee-for-service members who have hip and knee replacement surgeries.

A key component of that change, no doubt, will be the use of mHealth devices and sensors that can enable patients to monitor and control their own rehabilitation, in real time coordination with nurses and physicians, while in a home setting. It requires a redefinition of the roles of surgeons, nurses, physical therapists and patients – as well as insurers and hospitals. It will also require a rewiring of the health IT network to be more focused on the patient and his or her care-giving team having access to data and sharing information and feedback in real time. We are living in a digital world.

That is true disruptive change, with design and innovation focused on the patients’ needs, not just the hospital’s, the insurer’s or the surgeon’s needs. It is patient-directed care, not just patient-centered care. It promises to turn most of the cost equations and analytics of bundled payments on their ear.

Raising the questions
It raises the question: where were the patients’ voices in the decision-making of the working group to reinvent Medicaid? [The public sounding board events don’t really count.] Where will be the prisoners’ voices in the working group to reinvent the criminal justice system? And, how do citizens get to participate in their government, when policies are being decided in large part by consultants?

It also raises the question about what the role of an engaged community is in our digital world, and the responsibility of citizens to participate as members of the community.