PROVIDENCE – Sixty minutes into a wide-ranging, in-person interview, discussing his office’s legal efforts on a proposed hospital merger, a pending utility transaction, an initiative to curb gun violence by limiting magazine sizes, and strategies how best to spend money from opioid settlements, R.I. Attorney General Peter Neronha responded with passion to a question about how partisanship and misinformation had infected our democracy.

“The institutions that we have, and the confidence that we have in them, is so critical as to how we function as a democracy,” Neronha said. The big difference today, compared to four or five years ago, he continued, “is that people who would be public leaders don’t feel compelled to tell the truth.”

The lack of truth and candor by elected officials, Neronha believed, has had a debilitating impact. “People count on our elected leaders to speak truth to them. And, they believe what we say. If we are not telling them the truth, that can lead them to make decisions in their lives that will lead to some really bad consequences.”

Neronha did not shy away from pinpointing the problem: “I am married to a doctor. I have a son who is in medical school. There is no doubt that vaccines work, and they are good for public health and save lives. And yet, there is a large percentage of this country that believes that they don’t. Why is that?” he asked. “Why is that?” he repeated.

“Why do we listen to our physicians for everything except how to handle a pandemic? About how to beat back a pandemic?” Neronha asked.

The problem, Neronha continued, “is that our elected leadership no longer feels that it is their duty to [speak with] candor and truth. “And that is a real problem for us in our democracy. It makes me very worried.”

More than just checking the boxes
Attorney General Neronha strongly believes that politics should not be the driver behind decision-making as Attorney General. “Once you step into this office, and you look at the seal over there, you recognize that the politics cannot enter into your decision making.”

Politics, he continued, “That is not something that has ever driven me, and it doesn’t drive me in doing this job. You try to make good decisions, based upon what the facts are, and what the law tells us.” And, there are times, Neronha argued, “when you have to exercise your discretion.”

Neronha shared his view that the job of Attorney General is much more than checking boxes. “You hear a lot about the rule of law,” he began. “That is such a simplistic way of approaching what it is we do. It is worth talking about.”

Neronha elaborated on this thinking: “What is the rule of law in the context of a hospital merger? If you want to adhere to the rule of law, you can go down the list of the Hospital Conversions Act, it has 22 or 23 criteria, and you can check every one of those boxes and adhere to the rule of law. And, still do a really crappy job on evaluating that proposed health care transaction.”

Look, Neronha continued, “take Prospect [Medical] again. I hate to go back to that. But you can go through that list of criteria, and say, OK, there is not reason to think that these new owners are so so bad that they can’t keep their promises. But the question is: How can we be reassured that they will?”

In approving the proposed sale, Attorney General Neronha imposed certain conditions to ensure that the financial conditions of the hospitals involved in the transaction were protected in the sale. [See link below to ConvergenceRI story, “exposing the pitfalls in private equity financing of hospitals.”]

Here is the ConvergenceRI interview with R.I. Attorney General Peter Neronha, conducted on Wednesday, Jan. 19, a week before Neronha announced the $112 million settlement with manufacturers and distributors based on their bad corporate behavior in the opioid epidemic. [See link below to ConvergenceRI story, “Holding bad corporate actiors accountable for their misdeeds.”]

ConvergenceRI: Is there going to be a trial? Is the trial postponed? Is it happening in federal court this week? Next week?
NERONHA: Opioids? The trial has been postponed by Judge Richard Licht. He postponed it some time ago, sometime before the end of the year. I believe the trial date is in March.

ConvergenceRI: I know that negotiations are going on with a mediator right now. I do not know whether you can talk about them or not.
NERONHA: Which case?

ConvergenceRI: The Purdue Pharma case. I assumed that you were asked to participate in the mediation.
NERONHA: I was.

ConvergenceRI: Are you allowed to talk about that?
NERONHA: I am not allowed to talk about what happens in the mediation, because of the confidentiality rules that the judge imposed, Judge Chapman, down in New York.

I was on a mediation call just yesterday, actually. Some of those conversations are happening, as you might expect, at the staff level, and some are involving the AGs. And we’ll see whether or not that issue can be mediated.

We won in the District Court. In terms of whether or not the Sacklers were entitled to third-part releases. We think that is a major, major win. The question is whether it will stand up on appeal to the Second Circuit.

And yes, that is a “litigation unknown.” Whether that litigation unknown will lead to a resolution that I think is appropriate, and my fellow attorney generals feel is appropriate, there are nine involved, we will have to wait and see. But that is where that process is right now.

ConvergenceRI: I saw that you are holding public comment sessions on the proposed merger between Lifespan, Care New England, and Brown University. I have always believed that public comment is important, but sometimes I wonder whether their voices will actually be heard, given the preponderance of huge amounts of evidentiary material. Why is it important for people to comment, even if it is unclear how their voices will be heard?
NERONHA: It is important to be heard because I am not under any illusion that we think of everything. It is entirely possible, but I like to think it is unlikely, but it is entirely possible, that there may be something in the context of this merger that may not be on our radar screen.

I do think, as a practical matter, you are right. And, I can say that, I think, with some reassurance, and I can also say with confidence, that the team we have put together here in the office to review that merger, is outstanding, both in terms of their intellectual ability and their work ethic, including the experts that we have retained, our national experts in health care and in health care economics.

And so, when I say that it should be reassuring, I would like to think that there is not going to be anything that we hear from the public that at least we haven’t given some thought to, if not deep and careful thought.

But, at the same time, I think it is important to hear from the public, and give them an opportunity to speak.

In a perfect world it would be more helpful if we could respond to those questions, right? That’s where people could get a sense of the arduousness [of our research] and we could tell them what we are thinking, but unfortunately, this is not a back-and-forth, give-and-take [process]; it is a take the information in, understand, hopefully the thinking behind it, and then take it into consideration.

We have done a tremendous amount of work on this. And, I feel very comfortable that we have a lot of information at our disposal, that we understand it, and that it will aid us in reaching what I believe will be the best decision for the people of the state of Rhode Island.

ConvergenceRI: Is Miriam Weizenbaum leading that effort?
NERONHA: Yes, Miriam, as head of the Civil Division is a big part of it. We have the Deputy Attorney General, Adi Goldstein, who is heavily involved in it.

Kathryn Sabatini, who is our director of policy, and Daniel Sutton, her deputy, they are not in the civil division, but they report directly to me, are heavily involved.

It is a big team, it is a strong team, it is a really smart team, and they are doing really impressive work, that, at some point, we will be able to share with the people of the state.

ConvergenceRI: You have positioned yourself, and rightfully so, as the state’s public health advocate. In addition to the merger that is going on with the hospitals, there is also the sale of National Grid to PPL. They are probably two of the most important transactions that will happen around public health for the next decade. Could you talk about why you feel that the Attorney General’s office has to take on that role as being the state’s public health advocate?
NERONHA: By statute, we are authorized to have it. The question is: You can have the title, but, you know, it is sort of like being a baseball, or basketball, or football general manager. How much of a general manager are you going to be? Are you going to leave it all to your coach? Or, are you going to be involved?

I kind of look at this the same way. You can be the public health care advocate, and comply with whatever the statute requires you to do, which frankly can be very little, or you can look at the job expansively.

I have talked about what it means to be an activist or active attorney general. It is an understanding of what your powers are, and using them actively. Don’t let the world come to you; know what your powers are, and see how they can be used to benefit the people of the state, because that is why we are here.

We are here to make people’s lives better. And, if you look at the job and the powers, through that lens, you can do, I believe, a lot of good.

To answer your question, I think you can do this job in a certain way. You can do the work that comes to you. You can make sure that things meet the minimal standard and acceptability.

I don’t view the job that way; that doesn’t comport with who I am and my personality, and frankly, what I think this office can do.

And so, when you see a hospital merger that has the potential impact to significantly change the way we deliver health care, how much it is going to cost, and where it is going to be delivered, you have to do a deep dive into that.

You have to. You simply can’t say, “This meets a certain level of minimal acceptability and I can check every box in the Hospital Conversions Act statute.”

I don’t think you can look at it that way, without doing a disservice to the people of this state.

The same is true – and you are right to bring up the PPL National Grid transaction as a public health matter – because how we deliver energy is a public health issue, given our climate challenges.

I also understand, Richard, that for some people in this state, not the majority, but for some people, climate change is not their top priority. So, let me give them something to chew on.

What concerns me about this transaction are really two things: Number one is, [what are the consequences] if you are moving away from a regional ability to surge resources, no pun intended, in times of crisis. Meaning, if you have a hurricane, and you need 55 more [utility] trucks here, I’d much rather have them coming from Massachusetts, New York and Connecticut, than coming from Kentucky and Pennsylvania.

Until someone can convince me – and convince me in advance – that you are going to be able to deliver that kind of every-day service to get the power back on when it’s out, I am going to be very skeptical of the proposed transaction.

The other thing that concerns me is that right now, National Grid relies on a lot of regional infrastructure to serve the people of this state – for instance, whether or not the call center that is located here. There are some infrastructure bills that are going to have to happen. And, we all know that the default approach is to pass those costs onto consumers.

So, this is why I don’t [intend to] leave any of the arrows in my quiver unused.

I believe that how we deliver energy has to be thoughtful, in terms of where we are going in terms of climate.

But this transaction also has to do something that, on a day-to-day basis, that is not going to drive up rates for Rhode Island consumers, and also will make sure that when the worst happens, when there is no heat, and we’ve gone through a couple of those events in recent years, that the resources are there to surge into the state to make sure that people get their lights and power and heat back on.

ConvergenceRI: You were very aggressive, or protective, with the CharterCare sale, with imposing conditions. I know that it is a potential possibility with the current pending hospital merger. With the National Grid proposed sale, are there conditions that could be placed on that transaction?
NERONHA: I think this a sort of interesting position to be in, whether you are a sort of advocate, as we are in the National Grid PPL context, or as a regulators, in the context of the hospital merger.

There may be conditions that can be solved – and sometimes there are conditions that can’t solve a problem.

We could – with Prospect and CharterCare for Fatima and Roger Williams. There were conditions that could solve the problems we were concerned about. I don’t mean to say that you can always have conditions that will. But the point is, you have to be prepared to agree to those conditions.

And sometimes, you can’t even get to the conditions because you don’t have the information you need to construct them. We have seen that, we have been very public about that in the PPL matter, that the information that we have been looking for, in many instances, has not been forthcoming.

I don’t what to overstate in the context of the [hospital] merger, but we had to go back to the parties a number of times in the context of the merger to get the information we need. I am not suggesting that you can’t come up with conditions in order to solve some problems. But you have to have the information at your disposal to understand what is the impact of the problem that you are solving.

If you don’t understand the scope of the problem because you don’t have the information, that only they have to give you, it is harder to construct the conditions you need to solve for that problem.

ConvergenceRI: Do you also have the problem of misinformation? Where people are trying to influence the debate by putting things that are just not true – that are backed by enormous amounts of dark money?
NERONHA: That is why it is so critical that we have very capable experts that can assist us. Lawyers are effectively issue spotters. I do that more today than I ever did.

You can understand the law, but the law is subject matter dependent. We are talking about health care, we are talking about criminal enforcement, we are talking about public utilities, some of those are more complicated than others, and they require expertise, so as lawyers, we have got to make sure that we understand the issues that our experts can inform us about.

In other words, for a lawyer to be operating at a  level of effectiveness that I think we need to operate at, you have an expert who has given you a report, and you have accepted it, you take it, you read it, you underline, you highlight it, you go back and you say, well, what about this? This doesn’t make sense, explain it to me, what am I missing about this?

ConvergenceRI: The Columbo approach?
NERONHA: Yes, that is how it works, that is how it happened with Prospect.

If I go back to Fatima and Roger Williams, if go back to that scenario, I remember when the expert reports came in as to the long-term health of those two hospitals – where they had been and where they were headed, and what the gap was between what they needed to survive.

And, when you look at the expert report, and say: We have a problem here. The first question is: How do we solve for this? How do we solve for making sure that these gaps in capital expenditures and equity costs are covered?

Then it becomes a matter of understanding and doing the negotiating to get to what you think in the best interest of not only the hospitals in that case, but the people in the state.

ConvergenceRI: One of the more impressive platforms that I think you been successful in is looking at violent crime, particularly related to gun violence, in getting dangerous guns off the street, and getting the people who are supplying those guns off the street. Can you talk about what your goals are, with the R.I. General Assembly this session, in terms of the challenges moving forward around the issues of gun safety.
NERONHA: I think, when we are talking about violence and gun safety, there are a couple of starting points. Number-one is levels of violence are up across the country. There is recent data from the CDC that I saw in the last couple of weeks that confirms that all across the country, violence is up. Rhode Island is actually doing well, comparatively. We are doing poorly in a vacuum, but well compared to our peers. So we know that we have a violence problem that we have to deal with. And, it is important to understand where we are.

One thing that occurred to me the other day as I read a WPRI report on the number of accidents involving troopers in impaired driving [cases], was how that has had a meteoric rise over the last two years. To me, it is kind of consistent with society overall.

In a sense, the pandemic is bringing out the worst of us in a lot of ways, and that is reflected, frankly, in the ways that we treat each other. The question is: What do you do about it?

The other thing, though, I think, that while impaired driving is a problem, there are also a tremendous amount of firearms out there, and, there is no question that gun purchases have gone up. That is not to suggest that people who buy guns legally are the ones driving violent crime.

But what we have seen over the last couple of years is that the people who can buy guns legally are buying them with the intention of transferring them to someone who can’t.

We have seen a number of cases, straw purchases are what those cases are referred to, where one individual was able to buy 89 guns, legally, because there is no limit on the number of guns you can buy – and I am not suggesting that there should be.

But, in this particular instance, this guy put 89 guns on the street, in the hands of people who shouldn’t have them, and so it shouldn’t come to us as a surprise, when that is happening, and that is not the only case we found more guns in the hands of people who shouldn’t have them, but that is going to lead to an up tick in violence.

So, what do you do about that? We’ve got to get the shooters before they shoot.

I have never believed that the best way to approach violence is to have somebody be shot, and then count the casings, and then try to solve that – or in the worst case scenario, [solve a] homicide.

The reality is that most of our murders in our urban core happen in the context of people traveling the city, in an automobile with a firearm, either waiting for a target of opportunity, because of some rivalry, drug-related or otherwise. And, when that moment arrives, having no compunction about discharging that weapon – and discharging it with a tremendous number of rounds.

The number of rounds being fired at these scenes is in the high teens, the low 20s. You will see what look like yellow tent cards, if you watch the television news, at the crime scene, but they are plastic, and they are numbered, but each one is one marks a particular shell casing.

We see from the data we are keeping in our office that those numbers are really high. There are a lot of guns, firing a lot of rounds in the air, and the individuals who are firing these weapons are not particularly good shots, they are not going to the range and training like a police officer. But when you put 23 bullets in the air, as opposed to five, and the odds of hitting someone are obviously much higher. That is what I think is driving violence here [in Rhode Island] and across the country.

So, how do you address it? This office, and law enforcement, knows who drives our violent crime. We know – we can’t solve necessarily every crime that is committed, but we have a good idea who is behind it, who is driving it, who is involved in the gunplay. We also know whether or not that the people who are involved in the actual shooting are involved in other criminal activity.

It is pretty rare that you have someone who has a normal, day-to-day job, and then, when they come home from work, wherever they are working, put the gun in their waistband and then go out looking for trouble.

If you can build pro-active cases against them, meaning: understanding where they are likely to be, and have a firearm, and have enough intelligence to know when that is happening, and can stop them before they can get there. It has happened a number of times. Providence has done a great job with that.

Or simply identifying them, by saying, what other information do we have about this person’s other illegal activity, particularly the drug trade, that we can build a narcotics case against them, and get them off the street before they can shoot somebody. That, to me, is a pro-active approach in how to take on violent crime.

We have put together a team to do that, by working with Providence police, with Central Falls, Pawtucket, the Department of Corrections, the Alcohol, Tobacco and Firearms forces, and investigators in my office, to identify those individuals and be able to move very quickly, to get guns out of their hands.

ConvergenceRI: And, on the legislative side?
NERONHA: We have had good success, I believe, in making our streets and neighborhoods and schools safer in the last couple of years.

In my mind, there are still a couple of things outstanding; one in particular that I think we really need to address is the issue of high-capacity magazines. Since having a high-capacity magazine is not unlawful in the state, we are trying to point out those instances where shells from high-capacity magazines are recovered. When you can get off 20, 30, 40, 50 rounds without ever changing the magazine, the odds of you causing real damage are significantly higher.

Because it is the high-capacity magazines that we are seeing in the hands of bad guys, literally all the time now, and it is those high capacity magazines that allow them to get a lot of rounds in the air very, very quickly.

ConvergenceRI Another point of debate is how best to reinvest the money won in lawsuit settlements. You won what I think was a great judgment against McKinsey, and you have a fair amount of money coming back to the state, as a result of that. You were able to allocate some $1 million for additional naloxone supplies, even though you can’t target that money for such uses. as Are there opportunities for better types of negotiations about how the money gets spent and how that money is directed, and the types of interventions that you can make when you win a lawsuit?
NERONHA: If you are looking at it solely from my perspective, as attorney general, I’d love to be able direct the money to where I think it should go. Sometimes that has its own headaches. Because there are a million asks, and only so many can be satisfied, but that comes with the responsibility of a job.

But the way our state statute works, there is a state statute that applies to multi-state recovery, which involves almost all the big cases that we bring. The opioid litigation is a good example of that. But, by the statute, I can only keep a very small percentage of that, and the rest has to go to the general assembly for it to be allocated by the General Assembly, as they see fit.

When we went back and looked at the state statute, whether I like it or not, we are pretty comfortable with the fact that those monies need to be appropriated by the General Assembly. We actually got that limit increased, to allow us to actually hire more attorneys to get, I hope, better settlements for Rhode Islanders.

We also want to make sure that we can put as many guardrails around the money when we enter into the settlement, so that we are least going to the subject matter that the settlement is designed to address.

[Editor’s Note: The recent settlement with drug manufacturers, distributors, and consultants advising them for $112 million puts a new process in place for how those funds are distributed.]