Mind and Body

“This pestilential thing”

Credibility takes a hit on gender equity at Brown – and perhaps on the behavioral health front lines in RI

ConvergenceRI file photo from 2015

Brown President Christina Paxson.

By Richard Asinof
Posted 8/30/20
A major reorganization is underway at the R.I. Department of Behavioral Healthcare, Developmental Disabilities, and Hospitals, at the direction of Gov. Gina Raimondo, who has created two new, six-figure executive positions at the agency, at a time when there are serious budget deficits projected. At the same time, the number of overdose drug deaths in Rhode Island are on course to top the 2016 total of 336 deaths, the highest ever.
When will the Governor consult with community recovery advocates about the stages of recovery from trauma in designing a long-term strategy to the economic and behavioral health crises caused by the coronavirus pandemic? What could be learned from Brown administrators and their efforts to create a legal strategy to end the federal consent decree supporting gender equity? Will the R.I. Attorney General’s office pursue an investigation into low health insurance reimbursement rates for behavioral health care? Will the R.I. General Assembly ask for an audit of private contractors working for the R.I. Medicaid office, as a potential cost-saving effort? When will the state create a unified database connecting all the diseases of despair: alcohol, suicide, drugs, and gun violence?
Politics is the art of who gets what, when, and for how much. The decision announced on Friday, Aug. 28, by R.I. Health Insurance Commissioner Marie Ganim to increase health insurance rates in the individual market for commercial insurers drew a blistering response from R.I. Attorney General Peter Neronha.
“We consider the rate increases approved by the Office of Health Insurance Commissioner for Blue Cross and Blue Shield of Rhode Island and Neighborhood Health Plan of Rhode Island to be unnecessary and ill-advised at this time,” Neronha wrote.
Neronha said that his office had objected to increasing these rates for the approximately 45,000 Rhode Islanders and their families who will have to pay more for health care coverage at a time when many are struggling due to the health and economic challenges caused by the COVID-19 pandemic.
“I am concerned that these increases will have a particularly detrimental impact on those who are least able to afford them, many of whom have historically encountered unequal access to health care. This impact is real: there will be Rhode Islanders who will have to make economic choices among everyday necessities based on these unwarranted increases.”

PROVIDENCE – This was intended to be a deep dive into a “developing” news story, with big budget and political implications for Rhode Island, about a major reorganization now underway at the R.I. Department of Behavioral Healthcare, Developmental Disabilities, and Hospitals, marked by the hiring of two new executives with six-figure salaries.

But the public release of emails exchanged between Brown University President Christina Paxson and Chancellor Samuel Mencoff, which revealed the school’s desire to scuttle the 1998 landmark consent decree around Title IX funding for women’s athletics, with Mencoff referring to the consent decree as “this pestilential thing,” an astonishing choice of words in the midst of a pandemic that has killed more than 186,000 in the U.S. in last six months, kept intruding.

“Pestilential? Wow,” wrote Wendy Becker in a tweet, after the story broke in The Providence Journal on Thursday, Aug. 27, written by reporter Katie Mulvaney. “@BrownUniversity admin on record equating a landmark gender equity ruling with infectious disease they need to get rid of. Disgraceful.”

The emails had been made public as part of discovery in a recent legal challenge in federal District Court against Brown filed in June of this year, brought by the ACLU of Rhode Island and Public Justice, the organization that brought the original suit on behalf of Brown’s female athletes in 1992.

The emails are damning. In a June 2 email, Paxson wrote: “This might be the perfect moment to petition the court to get us out of this agreement, which would let us restore men’s track, field and [cross country] and still remain in compliance with Title IX,” as revealed in Mulvaney’s story.

A week later, in an email to Mencoff and others, Paxson wrote: “Our concern is that this could rile up the Cohens [Amy Cohen had been the lead plaintiff in the original 1992 lawsuit] of the world and put us in a defensive position. We need space to work out a rock-solid legal strategy and then go on the offensive.”

In response, as Mulvaney’s story further detailed, Mencoff suggested in an email: “But here’s an idea. Could we use this moment, where anger and frustration, especially from track and squash, are intense and building, to go after the consent decree once and for all? Could we channel all this emotion away from anger at Brown to anger at the court and kill this pestilential [emphasis added] thing?”

Mencoff continued in his email: “The argument would be that the consent decree is forcing us to eliminate these sports, and the court would then be bombarded with emails and calls as we are now. We would be aligned then with all who oppose us now.”

The ugliness of the email exchanges between Mencoff and Paxson even shocked the attorneys that are suing Brown.

“When we filed the motion to enforce the Court’s order in June, we expressed concern that Brown’s commitment to gender equity and its women athletes was insincere and simply window-dressing,” said Lynette Labinger, cooperating counsel for the ACLU of RI and the lead attorney in the original suit, as reported by RINewsToday.

Through discovery, Labinger continued, “We learned the unfortunate truth: Brown does not care. Brown would rather dismantle the entire process that it claims prompted the [recent] downsizing [of athletic programs] than provide its women athletes – its own students – the program required by law and by the Court’s order,” she said.

Translated, money talks, and equity walks.

Sex, lies and emails
Having such astonishing hypocrisy about gender equity laid bare by Brown’s administration was jarring, indeed, much like finding a Valentine written by your wife to another man, in which she declares her undying love for him, on your dining room table. All of a sudden, all the posturing and deceit and lip service around achieving gender equity at Brown had become transparent.

But, perhaps, in some ways, the stories are connected, because they both revolve around the issue of credibility. The “credibility” of Gov. Gina Raimondo’s commitment to meeting the escalating behavioral and mental health needs of Rhode Islanders, much like President Paxson’s credibility around promoting gender equity at Brown, may now need to be seen in a different light.

Here’s the news: A major reorganization is now underway at the R.I. Department of Behavioral Healthcare, Developmental Disabilities, and Hospitals, at the Governor’s direction, creating a new layer of management, with two new hires receiving six-figure salaries, occurring in the midst of large budget shortfalls at the agency.

The news of the new hires was officially “confirmed” on Thursday, Aug. 27, by the agency’s director, Kathryn Power, according to several sources familiar with the changes.

[Editor's note: The goal of the reorganziation, of which the new hires are an integral part, is to streamline the delivery of services, according to BHDDH. The goal is to eliminate traditional agency divisions, creating two new categories for a more streamlined operation: programs/clinical and operations/fiscal, in order to be more flexible in solving urgent problems, tackle ong-term projects, and match strategic vision and planning to conrete action.

The newest members of the BHDDH administration’s  team include Ryan Erickson, a former policy advisor for Gov. Gina Raimondo, who has been hired in the newly carved-out position of Associate Director of Operations at BHDDH.

[Editor's note: Several other candidates were interviewed for the $136,000 a year positon; ConvergenceRI had incorectly reported in the initial version of the story that no other potential candidates had been interviewed, based upon inaccurate information provided by two different sources.]

Other sources in the behavioral and mental health world had complained to ConvergenceRI about Erickson’s apparent lack of educational and clinical training credentials for the job.

In addition, Marlanea Peabody, the former liaison between BHDDH and the R.I. Medicaid Office, has been hired as the new Executive Assistant to the BHDDH Director Kathryn Power, who had replaced Rebecca Boss in January of 2020. [See link to ConvergenceRI story, “Galvanizing the human spirit.”]

[Editor's Note: Peabody's exact title is still being developed, according to BHDDH.]

The immediate focus of Peabody’s work, apparently, will be on improving the finances at Eleanor Slater Hospital, which has experienced a reported $35 million shortfall for the budget year ending on June 30, according to information presented to the R.I. General Assembly in June.

The shortfall at the state’s psychiatric hospital was caused in part by the state having to stop billing the federal government for Medicaid services for its hospital patients for a year ago, in August of 2019., because of apparent rule violations. At issue is the ratio under which Medicaid will pay for health care services versus pschiatric servces for patients.What those rule violations were and how they will be remedied have not been widely discussed until recently.

Potential ongoing fiscal problems at the hospital became visible in May, when the hospital’s $251,473-a-year chief operating officer, Cynthia Huether, who had been hired in 2017, had resigned abruptly without public explanation.[Editor's note: It was later revealed that she had resigned but that did not want that to be known, according to BHDDH.]

Jennifer White, the agency’s chief financial officer, had been appointed the interim head of the hospital in June.

“There’s a disconnect somewhere,” said Rep. Marvin Abney, the House Finance Committee chair, at June hearing, as reported by Katherine Gregg at The Providence Journal. Abney had voiced concern not only about the budget shortfalls but also “the number of consultants hired to do jobs that seem to repeat those of people on staff.”

[Editor's Note: Since that initial hearing, Abney has been further briefed on the issues, according to BHDDH.]

What the new hires portend
The hiring of Erickson and Peabody at the administration team level at BHDDH is being viewed with trepidation by many behavioral health providers, because both Erickson and Peabody had apparently openly expressed a lack of support for the strategy of creating Certified Community Behavioral Health Clinics, even as Congress views such clinics as the leading strategy to support community behavioral health, with the potential for Rhode Island to become a pilot state to promote such efforts. [Editor's note: BHDDH strongly suppors CCBHC; the opinions voiced publicly by Erickson and Peabody do not reflect the agency's positions, and do not reflect their current opinions.]

In terms of a vision for behavioral health moving forward, any vision for a coherent system going forward will come from providers, not BHDDH, with a need to look past the new hires and focus on advocacy and work to define the behavioral health agenda in Rhode Island, according to a number of behavioral health advocates.

Translated, it appears that the Governor’s strategy to solve the budget shortfalls at BHDDH, which are reflective of both an increased demand for behavioral health services in a time of pandemic and difficulties in securing Medicaid reimbursements for patients at the Eleanor Slater Hospital, the state’s psychiatric hospital, is to hire more high-priced management team members.

The question is: Is such a top-down strategy credible when the unmet mental health needs keep escalating?

Problems around content
For all of Rhode Island’s innovative work around the opioid epidemic, where the state has become a national leader in piloting new approaches around prevention, peer recovery, the expansion of the use of Narcan, and the integration of behavioral health screening into primary care practices, there remain systemic problems around the rates of insurance reimbursement and the privatization of Medicaid management services that often come down to money: how much is the state, its agencies and the R.I. General Assembly willing to invest in supporting community mental health and behavioral health services?

Even before the onslaught of increased demand for services as a direct result of the coronavirus pandemic in Rhode Island, the level of unmet needs, particularly in minority communities, was at crisis levels. All the consultants hired by the state to examine the problems in the delivery of mental health and behavioral health services in the last few years have targeted the systemic issues: a lack of psychiatric providers in the state, particularly for children; poor reimbursement rates in Rhode Island, which often drive providers to locate elsewhere in neighboring states, including social workers, nurses and primary care providers; and mismanagement of services provided outsourced private contractors. There is also a shockingly low level of African-American and Spanish-speaking professionals at all levels of behavioral health, from clinicians to peer specialists.

The other big part of the problem, it seems, has been the apparent “unwillingness” to listen to what community recovery advocates are saying.

In July, BHDDH launched – and then quickly aborted – a $500,000 advertising campaign developed by Duffy & Shanley [whose principal, Jon Duffy, is closely aligned with Gov. Gina Raimondo]. The ad campaign posed questions such as: “Do you know your drug dealer is a Vegan?” and “Does your drug dealer know your favorite ice-cream flavor?” as a messaging tactic to prevent and to deter overdoses from fentanyl-laced drugs.

The campaign seemed to ignore all the hard work done by Rhode Island researchers around stigma and prevention. Indeed, the advertising campaign moved ahead, despite strong negative feedback from both internal and external sources, who had argued that the campaign was wrong-headed.

“Why is a state, which is ostensibly committed to Harm Reduction approaches, paying top dollars for media that pushes discredited prevention messaging?” one recovery community advocate asked in a Facebook post, in response to the Duffy & Shanley ad campaign.

The post continued: “It is insulting that there is a great depth of knowledge in the community about these questions, which you chose not to listen to when it comes to media campaigns around stigma or prevention.”

Further, the post said: “It is both worrying and insulting that this and other campaigns do not reflect that research of leading national experts who are based in Rhode Island. I am left wondering what could have been done if the $500,000 paid to a politically well-connected advertising firm had been given to community organizations for evidence-based anti-stigma work?”

Translated, money talks [particularly when the ad agency designing the campaign is politically connected to the Governor], and recovery walks.

Problems around substance
Rhode Island is in the midst of a full-blown overdose epidemic crisis again, according to numerous members of the recovery community. At the most recent meeting of the Governor’s Task Force on Overdose Prevention and Intervention, community recovery advocates reported that there were currently no beds available for patients seeking treatment at residential facilities.

“There’s not a bed to be had for residential treatment for drugs,” one behavioral health provider told ConvergenceRI after the meeting, voicing anger at the situation.

The perverse numbers of the death toll from drug overdoses point to 2020 being a record-setting year. The number of deaths from drug overdoses in Rhode Island for the first five months in 2020 is 166, 13 percent higher compared to the first five months of 2016, when it was 146, the year the state recorded its highest total ever of 336 deaths, according to the website maintained by the R.I. Department of Health. [Data for June, July and August are still incomplete.]

Further, the numbers related to alcohol substance use and abuse are skyrocketing, in direct relationship to the increasing anxiety around the spread of the coronavirus pandemic, another behavioral health provider told ConvergenceRI. Alcohol sales are reported to have increased by 50 percent in 2020.

Alcohol is out of control, according to a third behavioral health provider. Unfortunately, the provider continued, “People are still locked into the state framework in focusing on opioid overdoses, which is an inaccurate framing.”

Out of control
As Jon Soske, Ph.D., Director of Advocacy, Research and Education at the Rhode Island Communities for Addiction Recovery Efforts, or RICARES, described it, “The overdose epidemic has gotten worse; our responses were insufficient, and COVID-19 was like pouring gasoline on a fire that was already burning out of control.”

One potential “solution” on the harm reduction and overdose prevention front that appears to be moving forward is the development of a “overdose prevention site,” not as a single site, but rather envisioned as functioning at numerous locations, with the ability to develop a mobile response when there are overdose hot spots identified. The nomenclature has changed from previous terms such as a safe injection site.

Support has been coalescing to create a number of “overdose prevention sites” in Rhode Island, led by a coalition of community groups.  Some leaders at the R.I. Department of Health have also voice their support publicly for providing safer consumption spaces, although the exact form is still under discussion.

One of the major stumbling blocks is how federal authorities would view the legality of such an overdose prevention site. Community groups are exploring a variety of legal options, including adapting state licenses to authorize sites and using mobile outreach teams that are not prohibited by state or federal law.

There is also political resistance to such a development, apparently coming from the Governor’s office. The development of the independent coalition was, in fact, a response to the reality that a harm reduction “working group” for the Governor’s Task Force on Overdose Prevention and Intervention had become had become hopelessly stymied after more than two years of discussion. [The leader of that stymied “working group” had been Ryan Erickson, now the new Associate Director of Operations at BHDDH.]

Another positive sign of how community groups are seizing the moment is the work being done by Project Weber/RENEW, for International Overdose Awareness Day, on Monday, Aug. 31, when free Narcan will be distributed at more than 40 sites across Rhode Island, including in Providence, Pawtucket, Cranston, East Providence, Woonsocket, Warwick, West Warwick, Cumberland, Westerly, Middletown, Narragansett, Newport, and Block Island.

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