Innovation Ecosystem

An intimate conversation with Dr. Nicole Alexander-Scott

In an hour-long interview conducted by Kerry LaPlante, chair of the Department of Pharmacy Practice at URI, the former director of the R.I. Department of Health shares details about her life

Photo by Richard Asinof/File photo from 2015

Dr. Nicole Alexander-Scott, the former director of the R.I. Department of Health.

By Richard Asinof
Posted 5/2/22
An in-depth interview with Dr. Nicole Alexander-Scott, sharing many personal details about her life, why she became a doctor, the values instilled by her parents and family, the attraction of working in public health, the importance of support from colleagues.
What progress has been made in the recruitment and hiring of a new director for the R.I. Department of Health? Has there been a “great resignation” when it comes to workers at the Department of Health, in response to the stress from the job? What is the schedule for the construction and completion of the new state health laboratory? How are plans proceeding with Providence College and Johnson & Wales University to launch new nursing schools as part of an expanded health care curriculum? What are the prospects that the R.I. General Assembly will consider increasing the Medicaid reimbursement rates as part of the FY 2023 budget deliberations?
The problems with recruiting, training, and retaining a stable health care workforce remains an unsolved crisis in Rhode Island, across hospitals, nursing homes, and community agencies. One of the missing ingredients is accurate workforce data related to nursing professions. What is known that many students who attend college in Rhode Island with majors in health care fields do not stay in Rhode Island – what a consultant from Indiana who presented during a recent health workforce summit described as a brain drain, with Rhode Island serving as the “farm,” from which other states are “harvesting” the crops of talented college students. If the state wanted to create a different approach to its health workforce retention, it might want to consider a communications campaign that talks about Rhode Island as a hotbed of health innovation – from health equity zones to patient-centered medical homes, from advances in robotic orthopedic surgery to new models for primary care delivery – where access to making and implementing new public health place-based policies is possible.

PART One

Editor’s Note: For the third time this week, ConvergenceRI found himself as the sole reporter covering events that somehow seemed to escape the broad sweep of the media scan, reflective of an adage that he used to teach his students when he taught journalism at Hampshire College and when instructing young cub reporters when he was an editor: News is not so much what happens, but what you do not know.

The interview with Dr. Alexander-Scott is broken into two parts, for length purposes It is transcribed from the interview conducted by LaPlante. PART Two will appear in the May 9 edition of ConvergenceRI.

PROVIDENCE – For more than two years, Dr. Nicole Alexander-Scott was seemingly a daily presence in all of our lives, sharing regular updates on the coronavirus pandemic, in a slow, steady, calm voice. As an infectious disease physician, Dr. Alexander-Scott was uniquely positioned to lead the public health response, having to navigate the ever-changing political and health care landscape.

When Dr. Alexander-Scott abruptly resigned in January of this year, it surprised many people inside and outside of government. What really happened may or may not become known, given the political machinations behind the scene that allegedly occurred with Gov. Dan McKee and apparent disagreements about what were the best public health policies and strategies to combat the virus and to protect Rhode Islanders.

Since her departure, Dr. Alexander-Scott has kept a decidedly low profile, after a brief contemplation of running for elected statwide office.

On Wednesday afternoon, April 27, Dr. Alexander-Scott was interviewed by Dr. Kerry LaPlante, the chair of the Department of Pharmacy Practice at the College of Pharmacy at the University of Rhode Island, during which Dr. Alexander-Scott shared many personal details about her early life and her perseverance in choosing to become a doctor.

What follows is an edited transcript of the interview, which was conducted as a way to share Dr. Alexander-Scott’s experiences with members of the URI community. Indeed, the way ConvergenceRI found out about the interview was through the parent of a former URI student, who had been sent information through the URI alumni network.

LaPLANTE: Hello to the URI community! And welcome to my students, faculty, parents, and staff, and members of the URI community. My name is Kerry LaPlante. I am the chair of the Department of Pharmacy Practice at the College of Pharmacy.

It is my pleasure to spend the next hour having an intimate discussion with Dr. Nicole Alexander-Scott, the former director of the R.I. Department of Health, [to talk about] leadership, teamwork, and inspiration, I know that she will be inspirational, as she always is. And, the future of public health as we unpack this global COVID-19 pandemic.

During this time together, I really want to focus on the human side of your experiences. I want to take us through your journey, your past experiences, that brought you to the amazing woman that are you are today.

First question: As a woman leader, a mother, a wife, a sister, a friend, I want to unpack your early years. And then talk about the pandemic, what was it like, day to day. And then, of course, at the end, we will talk about what the future holds for you.

Our student community would love to know, what early experiences did you have as a young person that helped shape the woman that your are today?

ALEXANDER-SCOTT: Well, first, thank you. It is interesting to think about the early years, and how that may have shaped this once-in-a-lifetime moment.

No one ever expected the type of pandemic that we experienced, and I can share a little bit later about how the prior [H1N1] pandemic is part of what drew me into public health.

But before that, let me take some steps back to reflect even further [in my life].

I am proud of the fact that I am a New York native. I grew up in Brooklyn. And, I have a true grounding in family and faith in the way that has really been instrumental to any of my points of success and accomplishments going forward.

I really had an amazing set of parents. I have been intentional about ensuring that my professional name remains hyphenated, although I am honored to be married to an amazing husband, Michael Scott.

That’s my legal name. But professionally, I wanted to ensure that the Alexander of my father was able to continue to be lifted up. I unfortunately lost my dad when I was 11 years old, when he suddenly passed away.

And so, the ability to have my professional recognition as Dr. Alexander-Scott is an important piece to make sure I am constantly reminded about my foundation, and the amazing people that set the stage for me.

I am particularly proud of my mom’s story, which definitely serves as a source of motivation and a source of resilience and persistence, and determination.

My mother was the youngest of six. She unfortunately lost her mom when she was only 11.

Her mom was working in factories in the city of Norfolk, Virginia, and as a woman of color in a factory, where they were not truly caring for the workers, and so she was exposed to what they called consumptive disease. And, at the young age of 36, she suddenly passed away

And my mom and her siblings really carried that with them, knowing that they were on their own. Many of them moved up to New York, where there were other family members who had established themselves.

And, at that young precious age, my mom has quite a number of stories in the 1950s where she was told, because of the color of her skin, that she would not be able to accomplish what she wanted, which, for her, was to be a nurse, or to be teacher. She was told that she was less than; she was told that she was from the country, and she would respond, “What are you talking about? Norfolk is the city.”

She was actually sent to a high school that was only vocational, which would not allow her to go to college. So, she actually went to that high school, completed it, and then began working, and going to high school at night, a different high school, so that she could actually gain the credits needed to attend college.

And, I am proud of the fact that in spite of the lies that she was told, in spite of being on her own, she knew what her truth was. And she was going to expand on that and persevere, in spite of the environment that was around her.

So that, I think, was embedded into my DNA. She ultimately went on to attend college, Pace University, earning her Registered Nurse degree. Then she attended graduate school while working, and obtained a master’s degree in Public Administration, and ultimately became director of Nursing at one of the hospitals in New York City.

So, I grew up, watching her, as you go to your parents’ job, and see her in that administrative role. I truly gained an appreciation for nurses through that experience, which has only been strengthened through my own educational experience.

But also the appreciation for the administrative realm, and how interdisciplinary it needs to be – nurses, physicians, pharmacists, administrators in a hospital, all working together to accomplish what is needed.

That is deeply embedded in the DNA of who I am, gaining not only what I learned from my dad, who was obtaining his Ph.D. in economics, prior to his passing, which I didn't realize, but also from my older brother, who really, as older brothers can do, 11 years older, helped ensure that I understood, to never, ever, ever give up. He would repeat Winston Churchill’s speech.

That [persistence] has oftentimes been put to the test, going through school, being on your own, going through med school, allowing for a steadiness and a persistence to know you need to know to just keeping moving forward.

I would like to say that losing a parent early, you have a different perspective, and it keeps things in perspective. And so, when things are a little bit out there, you remember: you know what, I’m OK, I’m alive, our loved ones are here, and that helps to steady things.

And, knowing that regardless of what is going on around you, staying true to what is important and moving toward that goal, certainly were foundational guides for me during my earlier years as the health director and then during this unprecedented time.

I was honored to serve as director during the pandemic, and making my contribution. It certainly has been a full team effort from the state leadership standpoint.

LaPLANTE: Thank you for sharing that. I have known the story about how you as a little girl lost your father. And, [sharing] what a strong woman your mother is. Thank you for being so open.

As we journey through your career, I guess the next logical question is to ask: why medicine? Why public health? What brought you to that? Your mom was a nurse; your dad was getting his Ph.D. in economics, so why medicine for you?

ALEXANDER-SCOTT: It became a natural path. One of the fun stories was learning, along my way, unbeknownst to me, when I was younger, maybe four or five years old, at family events, my father would tell members of the family: “She’s going to be a doctor some day.”

And it was just sort of a natural instinct. Between what my mom had infused, and knowing the type of encouragement – that you can do anything you put your mind to, the environment that both of my parents set for me, it felt like the best path.

My major in college was human development and family studies.

I really enjoyed understanding human behavior, and what drove that, with the recognition that so much of that is environment that someone is in, where they are living, where they were educated, what food they have access to, and how that informs the outcomes. And, I enjoyed being able to see, from the very young, to the very old, how that contributed to the cycle of life and society overall.

And recognizing that medicine, and, in particular, internal medicine and pediatrics, allowed me to really understand, the impacts on someone’s health, from the very young to the very old.

And infectious disease really had a tremendous overlap. Because, for children and adults, infections are not that dissimilar; it allows for exploring where you are living, and what activities you do, what kind of exposures did you have – all of that directly informed by how we could understand the [best] way to treat an infection. I enjoyed doing that kind of exploratory and investigative work.

It set the stage for public health. I actually had mentors express to me that what I was so passionate about is public health. I was like, “Oh, really?”

When I was at Brown [medical school] for a fellowship, my first year, we had had an infant who came in at just four weeks of age, with a typical fever and a rash. And there is a normal work up that in pediatrics that we do.

We take it very seriously, because an infant is, as you know, so precious, and small, and infections can spread quickly.

And, it turned out that during part of the work up, which included getting some of the specimens from the infant, a nurse accidentally received a needle stick. And so, our normal blood borne pathogen response is to do a work up to see what kind of exposure could have occurred from that.

And, we were surprised to learn that one of tests returned positive for HIV. And so, that meant this young infant, at just four weeks of age, had blood infected with the HIV virus. The nurse ended up being fine.

In my previous residency, there were policies that required us to test for HIV during pregnancy. Because, at this time, we had medication that could have significantly prevented the mom from unknowingly transmitting HIV from her to her child.

And that really sparked in me the opportunity to do something about it [here in Rhode Island]. If we could change the policies, we could make it so no other mom would unknowingly pass on HIV to their child.

That child, by the way, is thriving, and doing great, thanks to medicines, but it really inspired and motivated me, so that working with other valued colleagues in the state, to be able to change our policy, so testing for HIV was easier, and done not only during pregnancy, but in other settings throughout the medical field. And that was exciting to me.

To know that you could work with a team, with folks who knew policy, with folks who knew clinical medicine, with folks who were academics, with folks who were on the front lines in public health, who were out in the community, and together make changes that were not tremendously difficult to do, once you had the backing, that could have a huge impact in a positive way. To my knowledge, we haven’t had the same type of outcome since we made that legislative change, and that is part of why I was drawn to public health.

The second reason is the fact that the H1N1 pandemic occurred, and the health department was looking for infectious disease specialists, recognizing the value of having that type of expertise to help inform public health and policy decision-making going forward.

And, I never looked back.

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