Delivery of Care

Choosing family health over a career

Dr. James McDonald, interim director of the R.I. Department of Health, leaves his job to take care of his elderly parents

Photo courtesy of Dr. McDonald/File photo

Dr. Jim McDonald, interim director at the R.I. Department of Health, has resigned his position in order to take care of his aging parents.

By Richard Asinof
Posted 6/27/22
An exit interview with Dr. Jim McDonald, interim director of the R.I. Department of Health, in which he shared his reflections about his work in public health.
Will there ever be an accounting of how the public health work conducted by the R.I. Department of Health was undercut by high-paid business consulting firms whose focus was on economic recovery? How has the COVID pandemic, now being re-labeled as “endemic,” exposed the problems with the business model for hospital-driven health care delivery systems? What are the connections between endocrine disruptors from toxic chemicals from plastics, such as PFAs, and the epidemic of childhood obesity? When will gun violence be recognized as a public health crisis, with full funding for interventions, treatment, and research? How will access to primary health care be disrupted when the state attempts to force some 350,000 Rhode Islanders now receiving Medicaid as their health insurance plan to be re-certified as “eligible,” if and when the federal COVID emergency declaration is rescinded in July?
In one of his pithy answers, Dr. McDonald talked about the nature of the problem of how money gets invested in public health, saying: “We spend far too much money financing ‘all the king’s horses and all the king’s men,’ and too little on preventing an egg-shaped monarch from precariously sitting on a wall.”
McDonald also defined public health, in a similar acerbic manner, “limited resources to achieve optimal outcome.”
There was an awful lot of money spent to keep the health care delivery system in Rhode Island from crashing, supporting the precarious finances of hospital-based health care. Into whose wallets and pocketbooks did that money go? What did it achieve? What were the health outcomes?
An entire echelon of leadership has left and will need to be replaced. Without the ability to look at what happened, it makes the future directions at the R.I. Department of Health that much more tenuous.

PROVIDENCE – The summer solstice, as the Earth tilts toward light in the Northern Hemisphere, has brought with it a host of seasonal changes and shifts. For the R.I. Department of Health, it is a season marking the culmination of wholesale changes in leadership positions.

Dr. James McDonald, the interim director of the R.I. Department of Health, has announced his departure. McDonald had replaced Dr. Nicole Alexander-Scott, who abruptly resigned from her position in January, after more than six years on the job.

Womazetta Jones, the secretary of the R.I. Executive Offices of Health and Human Services, resigned from her position as of May 1, with Ana Novais appointed interim secretary.

If and when there is an accounting of the toll from the coronavirus pandemic – one that looks beyond the numbers of the deaths, hospitalizations, illnesses, the continuing cases of Long COVID and the dramatic surge in mental health and behavioral health demands, the state might consider hiring a consultant [high-priced, no doubt], to analyze the terrible damage done to the state’s public health workforce.

Many would have us believe that we have moved to the “endemic” phase of the pandemic, as Neil Steinberg, president and CEO of the Rhode Island Foundation called it in a recent interview with ConvergenceRI. [See link below to ConvergenceRI story, “The long goodbye.”] Or, that the airplane that was built and flown in mid-air to respond to the crisis has finally been landed, as Dr. McDonald once described the response process in a news conference.

Dr. McDonald recently announced that he was leaving his position in order to prioritize taking care of his elderly parents, the kind of sincere, human-centered response that has marked his career at the R.I. Department of Health. his last day working for the state is July 29.

[Editor's Note: On Thursday, June 23, Gov. Dan McKee appointed Dr. Utpala Bandy as interim director of the R.I. Department of Health. Dr. Bandy joined the agency in 1993 and became director of the agency's Division of Infectious Disease Epidemiology in 2012. Bandy assumed her new role on Sunday, June 26. She was featured in a recent episode of "Public Health Out Loud." See link below, "Outbreaks, epidemics and pandemics, oh my." ]

Here is the ConvergenceRI exit interview with Dr. McDonald, sharing his perspective during a time of transition,

ConvergenceRI: What are you most proud of in terms of your achievements at the R.I. Department of Health?
McDONALD: There are a few things that I consider to be my best achievements at the Department:

•  Spearheading the state’s multi-pronged approach to responding to the opioid epidemic. When I started here, Dr. Michael Fine [then the Department’s director] asked me to get a handle on the opioid prescribing in the state.

This has vastly improved, partly due to many continuing medical education seminars we have given, responsible regulation, and creating the Prescription Drug Monitoring Program.

[Editor’s Note: Dr. Fine’s involvement with the opioid prescription problem in Rhode Island was spurred by reporting done by me, when I worked at the Providence Business News, publishing a story about the research being done by Traci Green, Ph.D., in July of 2011. As a result of that story, Fine decided to change the priorities at the R.I. Department of Health.]

I was also able to lead the team that created regulations for Harm Reduction Centers and optimistic at least one will open in 2022.

•  Incorporating the philosophy of “Just Culture” when reviewing and adjudicating complaints against physicians was transformative for the Board of Medical Licensure and Discipline and our other regulatory boards.

• Being the Medical Director of the R.I. Department of Health’s COVID-19 response. This was a new disease, new threat and new way of life when COVID-19 started. It was surprising [for me] to become a household name, yet I enjoyed our honest conversations about public health.

I was happy that my original way of presenting information resonated with people. It was particularly rewarding to host a weekly Continuing Medical Education series with Dr. Philip Chan, the "Pandemic Update for Providers Call." Together, we were able to really bring the latest and most reliable information about COVID-19 to the health care community.

ConvergenceRI: Do you believe that there is enough momentum to move the safe injection sites from theory into practice in Rhode Island?
McDONALD: I really hope so. We are doing so many other great things, yet this horrible disease really has a hold on people. This is the best way to reduce deaths in Rhode Island and is desperately needed.

We have good people doing great work, and Harm Reduction Centers give people a safe place to use, while they get to a healthier place in their mind, and ideally, get to a point where they will accept treatment and find the joy of recovery.

ConvergenceRI: What would you like to see as improvements with data collection and data transparency at R.I. Department of Health?
McDONALD: Public health can be defined as “limited resources to achieve optimal outcome.” I’d like to see the Department continue to provide the breadth and depth of data that we came to expect during COVID-19 in all of our programs. We are well positioned to take advantage of future federal grant funding for data modernization and optimization in 2022 and beyond. If we can leverage the power of local data, we can optimize local solutions.

ConvergenceRI: What do you think are the most important lessons from the past two years wrestling with the COVID pandemic?
MDONALD: We need to get healthier as a population, less strawberry pop tarts and more fresh strawberries! Our obesity rates lead to increased rates of diabetes, cardiovascular disease and other chronic diseases, this lead to more people dying or being hospitalized due to COVID-19.

If we can take a lesson from Humpty Dumpty, we spend far too much money financing “all the king’s horses and all the king’s men” and too little on preventing an egg-shaped monarch from precariously sitting on a wall.

Prevention is not sexy, nor even, most times, noteworthy, yet it really is the only option we have for a sustainable future.

On a related note, our whole health is important. We all need to get to the beach more often, we need to throw more frisbees, and we all need to see more sunsets. We need to be leaner, happier, and more content. This does not happen scrolling Facebook or binging Netflix.

ConvergenceRI: Do you have any plans to continue your public-facing podcasts on public health, such as your collaboration with Dr. Chan?
MCDONALD: Last week, Dr. Chan and I taped four episodes of "Public Health Out Loud," so there are still a few more episodes in the hopper. I definitely enjoyed doing those podcasts, and would absolutely be open to doing something similar in my future endeavors. But we’ll have to wait and see what happens.

ConvergenceRI: Is Gov. McKee planning to conduct an exit interview with you? What would be the messages you would want to share with him?
McDONALD: The Governor and I are in contact regularly. As I said when I announced my departure, I will continue to be available to Gov. McKee to help where I can. He has my personal cell phone number, and I will always take his call and do what I can to help.

There are so many smart and caring people at the R.I. Department of Health – they need to just keep doing the good work that they do every day.

ConvergenceRI: What questions haven’t I asked, should I have asked, that you would like to talk about?
McDONALD: As I have chatted with many of my colleagues about the need to leave the R.I. Department of Health to be closer to family, I have explained how hard this decision has been for me and my wife.

I have been reflecting on why this decision was so hard for me and found some joy in my painful decision. Although the decision to leave has been the hardest decision of my career, I am thankful it was a hard decision. It was hard because I experienced so much joy in every aspect of my life here.

It really comes down to gratitude. My point is, sometimes when we feel pain – or make hard decisions, it is because we have been experiencing joy. In my case, I recognized there was a higher calling and need to be closer to family in their declining years. There is a lot to be said for celebrating the joy of life and being thankful for the privilege of hard decisions.


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