Delivery of Care

Follow the drinking gourd

Attorney General Neronha showcases how the law can be used, with intent, to further the public health when it comes to preventing lead poisoning, holding corporations accountable for their role in the spread of toxic chemicals, and being vigilant in protecting hospitals from the greed of private equity firms

Photo by Richard Asinof

Housing Secretary Stefan Pryor and RI Foundation President and CEO Neil Steinberg engaged in what seemed to be a heated conversation at the ONE|NB 35th birthday party.

Photo by Richard Asinof

A gathering at the entrance at Women & Infants Hospital on Thursday morning, May 25, commemorating the death of George Floyd.

By Richard Asinof
Posted 5/29/23
R.I. Attorney General Peter Neronha has emerged as the state’s North Star, creating a bright light of legal actions with the intent to protect the public health of Rhode Islanders.
Will the General Assembly enact new protections to prevent childhood lead poisoning from occurring in Rhode Island? When will Rhode Island news media stop providing a comfortable platform for Housing Secretary Stefan Pryor to spin his messaging? When will other hospital systems operating in Rhode Island join with Care New England in marking the importance of social justice and racial equity? Will the General Assembly finally take action to raise the low Medicaid reimbursement rates for providers, particularly in the behavioral health sector?
As one top aide to Richard Charest, newly confirmed as the Secretary of the R.I. Executive Office of Health and Human Services, said, allegedly quoting Charest, “I guess I don’t do retirement well.” The problem for Charest is that the problems facing the agency may prove intractable, moving forward. The efforts to renew the state contract for the Medicaid Managed Care Organizations, said to be worth some $7 billion over five years, may implode, if an audit is ever performed looking at how the current MCOs have been spending their money. In particular, the convoluted role that the for-profit Optum is playing, as the manager of behavioral health services for both Neighborhood Health Plan of Rhode Island and UnitedHealthcare, could end up being investigated by the Attorney General’s office. The breakdown of the nursing home industry in Rhode Island as a result of low Medicaid reimbursements may cause further closures. The growing crisis in the lack of state workers employed by government agencies, including DCYF, promises to explode in the coming months. Be careful what you wish for.

PROVIDENCE – It was another big, big week when it came to the intersection of housing, law, racial equity, and politics in Rhode Island.

ONE Neighborhood Builders held its 35th birthday party on Wednesday evening, May 24, at the Graduate Hotel, attended by hundreds, at which Neil Steinberg, outgoing president and CEO of the Rhode Island Foundation, Lt. Gov. Sabina Matos, and Ana Novais, assistant secretary at R.I. Executive Office of Health and Human Services were honored as community catalysts. [See link below to ConvergenceRI story, “A beautiful day in the neighborhood.”]

Conversation and drinks flowed freely. [One advantage to being disabled, not being able to walk, ConvergenceRI mused, is that it renders you invisible to many, free to observe.]

I spy with my little eye
So, it was a heated conversation occurring between Housing Secretary Stefan Pryor and Steinberg that caught ConvergenceRI’s attention, as the ceremonies were about to commence, with ONE|NB Executive Director Jennifer Hawkins talking at the podium.

What were they talking about? Was it Pryor telling Steinberg that the state had been just about to pull the trigger and finally purchase the Dignity Bus, six months after negotiations had first begun, which had provoked Steinberg?

Earlier that afternoon, Pryor had been the guest of WPRI’s Kim Kalunian. But no questions had been asked by Kalunian about plans by the Woonsocket City Council to purchase the Dignity Bus for $150,000, a decision reached at a special meeting on Tuesday, May 23, by a 7-0 vote. [See link below to ConvergenceRI story, “Woonsocket plans to purchase Dignity Bus for $150,000.”]

[Editor’s Note: Neither Steinberg nor Pryor managed to say hello to ConvergenceRI, while Central Falls Mayor Maria Rivera and EOHHS Assistant Secretary Ana Novais did, as did Genesis Center’s President, Shannon Carroll.]

A really big week
The next morning, on Thursday, May 25, Care New England hosted gatherings on all of its campuses [Butler Hospital, Kent Hospital, Women & Infants Hospital,, The Providence Center, and the VNA of Care New England] to observe “tragic death of 46-year-old George Floyd of Minneapolis.” The gatherings, “in remembrance of both his life and as well as all those who have lost their lives to senseless acts of violence related to race,” included silent protests beginning at 9:29 a.m., lasting for nine minutes and 29 seconds, “which was the amount of time that the handcuffed Floyd was pinned to the ground under the knee of Officer Chauvin, while he gasped for breath.”

ConvergenceRI attended the silent protest in front of the entrance to Women & Infants Hospital, the third year in a row attending such a protest. [See second image above.]

The willingness of the state’s second largest hospital system to engage in silent protests, holding signs, “I can’t breathe,” and “Social justice matters,” is a testament to the strength of the willingness of health care workers to speak out for racial equity, particularly during a time when racial issues continue to cleave apart our politics. [Witness the decision by a Florida school district to ban the poem performed by Amanda Gordon at President Biden’s inauguration from being read by students in their classrooms.]

Perhaps next year, Lifespan and South County Hospital will encourage their workers and administrators to participate in similar silent protests targeting violence and racism.

Rhode Island’s bright North Star
Last week, the legal advocacy by R.I. Attorney General Peter Neronha shone like the brightest star in the Rhode Island nighttime sky, serving as our North Star for hope.

Attorney General Neronha and his team illuminated the muddy road toward freedom from slavery – from lead poisoning, from toxic PFAS forever chemicals, and from greedy private equity firms seeking to profit by the process of engulfing and devouring our hospitals.

Through a series of bold legal actions, Attorney General Neronha and his team struck a pose that was brighter than any Mike Cohea portrait of the Independent Man atop the State House, silhouetted by the setting sun.

On Tuesday afternoon, May 23, the Attorney General’s office hosted a gathering at the State House library of a coalition of more than 25 organizations to showcase support for a legislative package that would:

• Increase compliance with the enforcement of the Lead Hazard Mitigation Act to better protect children from the dangers of lead poisoning.

• Establish the Lead Water Supply Replacement Program, which would require the disclosure of the presence of lead service lines to tenants and buyers of real property.

• Expand the protections of the Lead Hazard Mitigation Act to encompass dwellings with two or three units where one unit is owner-occupied.

Deputy Attorney General Adi Goldstein joined State Sen. Dawn Euer at the podium, arguing persuasively that childhood lead poisoning is entirely preventable.

The statistics are hard to argue against: for every $1 spent on prevention efforts, the return on investments is from $17-$221 in benefits from reduced health and education costs and increased earning and tax revenue.

The fact sheet handed out at the session contained some damning data: “Nationally a one microgram per deciliter reduction in the average blood lead levels of preschoolers may result in as many as 116,541 fewer burglaries, 2,499 fewer robberies, 53,905 fewer aggravated assaults, 4,186 fewer rapes, and 717 fewer murders,” according to the National Institutes of Health.

Here in Rhode Island, one out of every 14 kindergarteners has been lead poisoned. Depending on the municipality, between 4 percent [East Greenwich] and 18 percent [Providence] of elementary school students have been lead poisoned, according to the fact sheet.

Childhood lead exposure – even at low levels – damages the brain and nervous system, increases a child’s risk of developing permanent learning disabilities, reduces concentration and attentiveness, slows growth and development, and causes behavioral problems that may extend into adulthood, the fact sheet continued.

Holding corporations accountable
On Thursday, May 25, Attorney General Neronha filed a lawsuit against the manufacturers of per- and polyfluoroalkyl substances, commonly referred to as PFAS.

The lawsuit charged the manufacturers with “causing significant harm to the residents and natural resources of Rhode Island, engaging in a massive and widespread campaign to knowingly deceive the public, moving assets to avoid paying for damages they caused, and continuing to manufacture, market, and sell these hazardous chemicals for decades while knowing the risks, and reaping enormous profits in the process,” according the news release sent out announcing the legal action.

The complaint, filed in Providence County Superior Court, alleges that the defendants, including “major chemical companies such as 3M and DuPont, have violated state environmental and consumer protection laws, leading to the proliferation of these 'forever chemicals.'”

The lawsuit claimed that “ exposure to PFAS has been associated with various significant negative health effects impacting reproductive health, childhood development, and increasing the risk of certain cancers,” according to the news release announcing the legal action.

“We are still uncovering the consequences of exposure to these hazardous chemicals by Rhode Islanders, but the burden of this enormous cost should be borne by the companies who made, marketed, and sold these products at great profit, while hiding their true dangers,” said Attorney General Neronha, as quoted in the news release.

“As alleged, these companies concealed from the public, regulators, and consumers the dangers posed by these chemicals and now their chemicals have infiltrated virtually everywhere from our waterways to our bloodstreams,” Neronha continued. “They have broken the law and harmed the people and natural resources of Rhode Island. We intend to hold them accountable for that.”

Any one who doubts the ability of Attorney General Neronha and his team to hold corporations accountable for their illegal actions should examine how his office was able to hold the manufacturers, distributors, marketers and consultants accountable for their illegal behaviors regarding prescription painkillers, which resulted in a quarter-billion dollars in legal settlements flowing into the state and cities and towns in Rhode Island.

But wait, there’s more
Last week, it was announced that the for-profit private equity owner of Roger Williams Medical Center and Our Lady of Fatima Hospital, Prospect Medical Holdings, was seeking to sell off their financially troubled Rhode Island facilities to the Centurion Foundation, an Atlanta-based nonprofit. As the headline in The Boston Globe aptly put it, “Prospect Medical takes next step to unload R.I.-based hospitals.”

The next step in the Centurion Foundation’s bid to buy Roger Williams and Fatima hospitals requires that state regulators, the R.I. Department of Health and the R.I Attorney General’s office, perform due diligence to make sure that the application is complete.

[Editor's Note: It turned out that the initial submission offered on May 26 by the Centurion Foundation and Prospect Medical Holdings in regard to the proposed  sale of Roberg Williams Medical Center and Our Lady of Fatima Hoapital, did not even meet the criteria of an "Initial Application" under the Hospital Conversions Act requirements, according to a statement  issued on May 31 by the R.I.Department of Health and the R.I. Attorney General's office]

Because of Attorney General Neronha’s previous legal intervention, an $80 million escrow fund was established to keep the two Rhode Island hospitals afloat, at least until 2026, which ConvergenceRI has reported on extensively.

Indeed, Attorney General Neronha’s successful legal interventions have been featured in the reporting by CBS News about the closing of hospitals in Pennsylvania and Texas. As Moe Tkacik, investigations editor at The Prospect, recently tweeted, “The CBS investigative team has done really great work on the hospitals shuttered by private equity strip miners,” calling out the actions of Medical Properties Trust.

Tkacik tweet continued, talking about how CBS News had highlighted “the valiant efforts of @AGNeronha (& virtually zero other elected officials) to stop them.”

In a story published on May 3, 2021, “A wealth extraction system run amok,” ConvergenceRI included, at length, a statement by Attorney General Neronha, regarding the situation, including an overview of the situation:

• Here is a précis about what happened: in 2014, CharterCARE was sold to Prospect Medical Holdings, a for-profit firm in California, one of 17 health systems purchased by Prospect. Now, seven years later, the controlling private equity firm in Prospect Medical, Leonard Green & Partners, was seeking to sell its roughly 60 percent ownership stake back to Prospect’s CEO, Sam Lee, and his partner, having awarded itself tens of millions of dollars in dividend payments in that time. The R.I. Attorney General, having conducted an independent financial analysis of the transaction, as part of due diligence under the Hospital Conversions Act, questioned the financial stability of the health system as a result of the transaction, and was seeking that approval of the sale would be conditioned on the creation of escrow accounts to preserve the future financial viability of the state’s third largest health system.

On Friday, following the calculated moves by CharterCARE to capture the headlines, R.I. Attorney General Peter Neronha issued a statement defending his actions, one worth quoting at length, in part because that part of the story had been lacking in much of the other coverage by the news media:

“As a regulator with the immense responsibility of reviewing business transactions involving hospitals in our state, this office must contemplate outcomes that safeguard the delivery of quality, accessible, and affordable healthcare for all Rhode Islanders. I take that responsibility – and potential impacts on healthcare delivery in our state – seriously.

Assurances from those entrusted with elements of our health care system, upon which Rhode Islanders so critically rely, cannot be taken on faith alone. The ability and commitment to stand behind those assurances must be verified by this office. To do otherwise would be to abandon our mission, and correspondingly the people of this state.

Our robust review of the proposed transaction revealed a national company whose principals and investors extracted hundreds of millions of dollars from the hospitals and services they own. As a result, the company now faces risks to its financial viability which is required to respond to challenges that may arise in a volatile healthcare market, potentially putting every hospital in its system – including our Rhode Island hospitals – at risk of a reduction in services, sale or closure.

The people of Rhode Island deserve the truth. It is a hard truth: that those who claimed to care about health care here in Rhode Island and around the country cared much more – orders of magnitude more – about lining their own pockets than about the people they purported to serve.

Now much is at risk. And the 60 percent majority owner of the hospitals, private equity firm Leonard Green & Partners, L.P., wanted to walk away with $12 million more in its pockets and absolved of billions of dollars in debt. This office, and Rhode Islanders generally, were being asked to rely on the assurances of the current minority owners and would-be new owners that all is well, and all will be well. I am not willing to take the risk that acceptance of such assurances, without more, requires.

The owners have always had a simple choice. They could move forward with the proposed change in ownership with these conditions, which are absolutely necessary to ensure the continued operation of these hospitals. Or they could maintain their current ownership structure. Let us be clear: there is nothing about this latter alternative that puts the hospitals in a worse financial condition. That is simply the status quo.

Ultimately it comes down to this. Under the proposed transaction, majority owner Leonard Green, having made its money at the expense of the financial health of the hospitals, now wants out. So be it. But that choice comes at a price: remedy the malady you have created.

You chose to get into health care. Act like you believe in it.

ConvergenceRI concluded its reporting as follows:

• The battle over the proposed sale of CharterCARE puts on full frontal display the dark side of private equity financing of hospitals, which may prove to be not so much different than private equity financing of other institutions such as newspapers and nursing homes. The private equity firms, it appears, loot the liquidity of the purchased company and then depart, behaving much like a loan shark, leaving the corporate shell at great financial risk, unable to pay the vig, in ConvergenceRI’s opinion.

It also shows the renewed importance of the role that the R.I Attorney General plays in reviewing hospital mergers – and the lengths to which CharterCARE attempted to undercut and sabotage that role.

Editor's Note: The headline,"Follow the drinking gourd," is taken from a folk song about the Underground Railroad, sung the Weavers, and the "drinking gourd"was a reference to the Big Dipper star formation, which points to Polaris, the North Star.

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