Mind and Body

Hard of hearing? BHDDH’s Charest and Gov. McKee seem to be tone deaf

Task Force members walk out after BHDDH director refuses to answer a yes or no question, would he support level-funding recovery programs that were cut more than $2 million until more resources could be found

Photo by Richard Asinof

Before the Task Force meeting began on Wednesday, Sept. 8, Jonathan Goyer handed out bracelets, asking: What would Jim Gillen do? On the inside, it was written: Be the change we need.

By Richard Asinof
Posted 9/13/21
Members of the Governor’s Task Force on Overdose Prevention and Intervention staged their own intervention with Richard Charest, director of R.I. BHDDH, before walking out, following his inability to respond to what was asked.
What happened to the $2.7 million in state funds that were supposed to be dedicated to substance use prevention and intervention? Who authored and authorized the funding cuts that BHDDH delivered to recovery programs? What is the status of Medicaid reimbursement for peer recovery coaches? Why did BHDDH decide to hire the controversial Dr. Elinore McCance-Katz as the chief medical officer at Eleanor Slater Hospital and at BHDDH, during of a time of apparent budget shortfalls? Will Gov. McKee own up to the fact that he was given inaccurate information, that the budget cuts delivered to recovery programs were not the result of federal programs sun-setting, as he and BHDDH claimed? Why has the news media in Rhode Island been silent about the budget cuts and the walk out staged by Task Force members?
One of the ongoing messages developed by the late Jim Gillen and his compatriot, Tom Coderre, was that the recovery community in Rhode Island was becoming a constituency of consequence – and that they vote. Given Gov. McKee’s sensitivities around the political equations of the upcoming gubernatorial election, why would he choose to thumb his nose at community recovery advocates and dismiss their concerns about dramatic budget buts to their front line programs? The lack of transparency around the decision to use some $877,000 in federal funds to invest in a new, unproven program, the Imani Recovery project, without it having been vetted by the Task Force, is yet one more empathic break with the community. The truth is, almost everyone in Rhode Island knows a friend, a family member, or a colleague who has suffered from the chronic disease of substance use disorder.
Charest’s expressed desire to meet with recovery community advocates came across as false. He can deceive himself but not recovery community members, because the record is clear: for weeks if not months, Charest had refused meetings with recovery community advocates, never responding to their repeated requests to meet. It may be time for Charest, much like Gov. McKee’s former chief of staff, to resign.

PROVIDENCE – Some 40 members of the Governor’s Task Force on Overdose Prevention and Intervention conducted an intervention, directed at Richard Charest, director of the R.I. Department of Behavioral Healthcare, Developmental Disabilities, and Hospitals on Wednesday morning, Sept. 8. It did not go well.

For more than an hour, in great detail, members told their stories about how the drastic funding cuts planned to take place beginning on Oct. 1 would decimate their recovery programs – heartfelt, honest testimony by those doing the actual work on the ground on the front lines for the last six years.

And yes, these were cuts, despite what Gov. Dan McKee had purported the day before at a news conference, at which the Governor had claimed the shortfall in funding was the result in federal funds being sunset. Someone had apparently been keeping the Governor in the dark about what was going on at R.I. BHDDH and been feeding him lots of manure, which may be good for growing mushrooms but it is not so good for achieving broad support for public policy around health care.

Here is a brief overview of what the Task Force members told Charest, who admitted, remarkably, it was the first time he was learning about this. Why was that?

[Editor's Note: If his agency were still subscribing to ConvergenceRI, Charest would have been able to read the story published on Monday morning, Sept. 6, “BHDDH cuts more than $2 million in funding for recovery programs.” See link below to the story.]

• Linda Hurley, president and CEO of CODAC, the state’s largest nonprofit provider for opioid treatment, told via ZOOM how her agency had been cut more than $1.3 million, including nearly $776,000 to provide medication-assisted treatment “induction” opportunities at BH/Link, on a 24/7 basis. Actual notification had not occurred, unbelievably, until two weeks ago, according to Hurley, because an agency bureaucrat had forgotten to hit send for the email message, leaving it sitting for weeks in the “draft” folder.

• Holly Fitting, Vice President of Recovery and Residential Services at The Providence Center, told how the Anchor ED program had been cut by more than $500,000, despite a promise made in the spring by R.I. BHDDH officials that funding would not be cut. Fighting back tears, she explained what the cuts would mean in personnel and personal terms: “If you check into a hospital after midnight, oh well. No peer support for you.”

• Tommy Joyce, director of Recovery Support Services at The East Bay Recovery Center, told how its funding had been cut by R.I. BHDDH by some 25 percent, $75,000, which was an agency that did not have recovery support before. People will still be overdosing, but will now be without services, Joyce explained.

• Susan Storti, president of the Substance Use and Mental Health Leadership Council of RI, talked about the lack of a strategic plan and a total lack of transparency about how money is spent by R.I. BHDDH. Her points were echoed by John Tassoni, Jr., vice president at SUMHLC, who pointed to the lack of a healthy relationship with BHDDH: providers were seen as vendors, not as partners.

• Colleen Daley Ndoye, executive director of Project Weber/RENEW, told Charest that her community agency also had been hit with big cuts, arguing instead that “investments should be increasing not decreasing,” given the rise in overdoses. She said that funding decisions by BHDDH were never transparent, and urged that the R.I. General Assembly needed to come back into session this fall to meet the emergency funding needs for more Narcan spending and for critical recovery funding.

• Michelle P. Taylor, vice president of Social Health Services at the Community Care Alliance, who serves as director at the Serenity Center, a recovery center in Woonsocket, explained that they had opened a second center during the pandemic, but were barely able to keep pace with the overdose problem. Now, the Woonsocket center had received a $75,000 cut.

• The Parent Support Network's Hope Center had received a $150,000 cut, diminishing their ability to provide services and outreach.

Sen. Josh Miller, who had signed a letter on behalf of the recovery community and served as a moderator for the ad hoc “intervention” that had replaced the regularly scheduled agenda, attempted to write down a running total of all the funding cuts that had been made by R.I. BHDDH, as Task Force members shared them. Miller found it difficult to do so; Charest, in turn, seemed to be learning the extent and damage caused by the cuts for the first time.

Sitting in between Miller and Charest was Dr. Nicole Alexander-Scott, the director of the R.I. Department of Health. Alexander-Scott, after giving a brief introduction to the meeting, and calling the letter sent to the Department of Health and to Charest “important,” stayed quiet for the rest of the meeting, apparently busy listening.

[Also in attendance, sitting in the front row, was Ana Novais, assistant secretary at the R.I. Executive Office of Health and Human Services, while Ryan Erickson, the new chief of staff at R.I. BHDDH, sat in the back of the room, off to the side. On the PR flak side, Linda Reilly, chief community relations officer at R.I. BHDDH, attended, as did Joseph Wendelken, the communications spokesman at the R.I. Department of Health.]

A complete video of the intervention and the walk out was captured by Steve Ahlquist of UpRise RI. [See link below.]

“Choose wisely, sir”
Charest wobbled and vacillated in his response, when Jonathan Goyer, recovery expert and advocate, asked him in direct fashion, would Charest commit to level-funding the programs that had been cut, saying it was a yes or no question, and advising him: “Choose wisely, sir.”

Charest suggested that a smaller group of Task Force members get together to discuss the issue with him, and asked his chief of staff, Ryan Erickson, what was the earliest they could have a response, realizing that the next scheduled monthly Task Force meeting was a month away, on Oct. 13. Erickson suggested a week later, on Sept. 15.

The members, fed up with equivocation by Charest’s inability to give a straight answer, walked out. Here is the blow-by-blow:

CHAREST: Obviously, I can’t have 160 people on this [small group] committee, but I would love to have representatives… [how Charest came up with the 160 figure, obviously a gross exaggeration, is symptomatic of his lack of respect for members of the Task Force, in ConvergenceRI’s opinion.]

GOYER: That’s it [and stands up and begins to walk out, with other Task Force members joining him].

CHAREST: I recognize that you have given me one day’s notice to come up with a solution…

MICHELLE HARTER, manager of the Anchor Recovery programs, on ZOOM [as Task Force members walk out]: “We have been trying to get a meeting with you for the last several weeks and we have been ignored and we have not had any response from the Department of Behavioral Health…”

Translated, when Charest equivocated, saying he could not give a yes or no answer to the question posed, about whether he would commit to level-funding the programs until more resources could be found, members of the Task Force revolted and walked out, a truly remarkable moment for the recovery advocates on the front lines saying no to the tyranny of the bureaucratic elite. They were calling bullshit on Charest.

Six years of hard work by the members of the Task Force in addressing the opioid epidemic on the front lines in Rhode Island had been blown up by Charest’s apparent arrogance and hubris over the last three months – arrogance and hubris apparently supported by Gov. Dan McKee and his administration – stiff-necked behavior on full display at the Sept. 8 Task Force meeting/intervention.

Talk about being tone deaf: At the exact moment that the intervention was occurring, moments before the walk out, when members of the Task Force were sharing how R.I. BHDDH, in tandem with the R.I. Medicaid office, in a major change of policy, were denying reimbursements from Medicaid for the work being done by peer recovery coaches at recovery centers, breaking with six years of policy precedent, the R.I. Executive Office of Health and Human Services was putting out a news release announcing that the agency would now be able to bill Medicaid for services rendered from April 1, 2020, to May 1, 2021, at Eleanor Slater Hospital. To quote WPRO’s Steve Klamkin, “Really?”

If nothing changes, then nothing changes
There were many things that should be considered “shocking” about the walkout.

• First, the only news media covering the meeting were ConvergenceRI and Uprise RI’s Steve Ahlquist. [Ahlquist had been tipped off about the story by ConvergenceRI the day before, at Gov. Dan McKee’s regular weekly news conference.] The question is: Where were the other news media? No WJAR 10, no WPRI, no ABC6, no The Public’s Radio, no Providence Journal, no Boston Globe, no Providence Business News, no WPRO. Why were they all asleep at the wheel? Where were all the so-called health care reporters in the state? Why did both The Public’s Radio’s Ian Donnis and WPRI’s Ted Nesi fail to include the walkout in their weekly political columns? Was it not deemed “political” enough?

Apparently, dead bodies from overdoses are worthy of reporting; live bodies trying to prevent dead Rhode Islanders are not worthy of coverage.

[Editor's Note: Any member of the news media attending the Governor's news conference on Tuesday, Sept. 7, had heard ConvergenceRI's question to the Governor about the cuts, and the follow-up question about a potential revolt at the Task Force meeting the next day. They chose to ignore it.]

As Goyer wrote to ConvergenceRI after the walk out, “The media plays an incredible role in helping to decrease opioids deaths. First and foremost, it is imperative that we read and write stories of recovery and resilience to perpetuate hope for those who are struggling with addiction. Secondly, it is necessary to dig deep to uncover the true reality about how overdose prevention strategies are being handled by government partners. The story that ConvergenceRI published on Sept. 6 took a dark truth and pulled it into the light. It resulted in the largest mobilization of the recovery community that I have ever seen in the Ocean State.”

All of the action, thankfully, was captured live by Steve Ahlquist in his coverage through Uprise RI. [The Providence Journal did run a make-up story on Thursday, the day after the walk out but, as usual, failed to credit either ConvergenceRI or UpriseRI with breaking and covering the story. So it goes.]

• The next most shocking aspect of the walkout was the admission by Director Charest that he had no idea about how state and federal money was being spent by his agency. The flimsy, false excuse, saying  the cuts to the recovery programs and to the medication-assisted treatment programs were the result of the fact that the federal emergency grants had allegedly run out, was exposed as a blatant cover-up for Charest’s policy decisions.

Talk about a lack of transparency. The R.I. General Assembly had never been notified about the pending cuts, according to Sen. Josh Miller, chair of the Senate Committee of Health and Human Services, who began the meeting by pointing out that more people in Rhode Island had died from opioid overdoses than from COVID-19. Overdose deaths hit the perverse high of 384 in 2020 in Rhode Island, a 25 percent increase over 2019.

The trend is worsening. The latest data from the state shows a confirmed 10 percent increase in overdose deaths, when comparing 2021 data for the first months of the year  to 2020 data.

Further, the federal agency SAMHSA, which provided most of  the federal funds to Rhode Island, had apparently also never been notified about the cuts, according to Miller. Charest could not explain why that had happened.

There is apparently plenty of money available to R.I. BHDDH to cover the cuts, as detailed by recovery expert Jonathan Goyer.

• Through a 2019 state law that taxes the manufacturers of opioids, some $5 million a year was supposed to have created a dedicated stream of sustainable funding to combat the opioid overdose crisis, known as the Opioid Stewardship Fund, Goyer, told Charest. Goyer asked Charest: $2.3 million had been spent for this year, but where is the remaining $2.7 million going? Where did the money go last year? Charest seemed to shrug his shoulders and he admitted that he didn’t know. The concept of stewardship appeared to be absent.

Goyer persisted. Where did the money go last year? Who made the decision, without including people in this room? This was a pot of money being underutilized, Goyer claimed.

• Then Goyer asked Charest about the money provided by the federal Substance Abuse and Mental Health Services Administration [SAMHSA] in the last two years, including $23 million in discretionary funds in FY 2020 and $29 million in  FY 2021. Where did that money go? Goyer demanded to know. Charest said he did not know.

What comes next?
Gov. McKee, who had declined to answer questions asked by ConvergenceRI about the cuts on Friday, Sept. 3, and again on Monday, Sept. 6, finally provided an answer to a question from ConvergenceRI, following the walk out by Task Force members on Sept. 8.

ConvergenceRI: The Task Force just staged a walkout after Charest could not give a yes or no answer on level funding [for recovery programs facing cuts as of Oct. 1]. It came after Task Force members staged an intervention, explaining what damages the cuts [would] cause. The actions by BHDDH and by Charest just blew up six years of the Task Force, who demanded to be seen as partners.

GOV. McKEE’s OFFICE: Director Charest was grateful to hear directly from members, advocates and leaders at today’s Overdose Task Force meeting. As he committed in the meeting, he will maintain a more transparent process and work with them and other SUD [substance use disorder] providers to identify possible solutions to the concerns they articulated by mid-September. The Governor is confident that EOHHS, BHDDH, RIDOH, and the Governor’s Office, can reach a long-term solution.

The tone of voice by the Governor’s office is far different than what had been communicated by Gov. McKee at his news conference on Tuesday, Sept. 7, when he dismissed the cuts as merely being the result of a federal funds that were sunsetting.. Further, to say that Charest had committed to a more transparent process in how BHDDH conducts its financial decision-making is not what ConvergenceRI had heard at the meeting. Charest said he wanted to convene a smaller group, “less than 160,” but there was no agreement that he would be open to a more transparent process.

The best way to jump start that overture toward transparency would be to answer the questions that have yet to be answered by BHDDH, by R.I. EOHHS, by Charest, and by the Governor: Who authored these budget cuts? Who then authorized these budgets? Secretary Womazetta Jones? Director Charest? Gov. McKee? What did Gov. McKee know and when did he know it? When was Gov. McKee briefed about the cuts?

The recovery community is united in its goal of leaving no program behind and not giving up the fight until every program is restored to FY 21 funding.

They are willing to give Charest a week, until Sept. 16, to make corrections to the funding cuts and restore level-funding. Further, Task Force members were warned about efforts being undertaken by BHDDH to pursue a divide-and-conquer strategy, playing off recovery centers and programs against each other, which is something they have done in the past, according to recovery community members. Stay tuned.

The Rally4Recovery on Sept. 18 could include lots of fireworks.

Given that it is the recovery community, and they are experts in understanding that recovery is a long-term process that may take a long time to achieve, expect that they will view any future dialogue with Charest as an opportunity for productive learning to take place, with the hope that the relationship with Charest can improve.

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