Innovation Ecosystem

Serving as RI’s doctor

Dr. Nicole Alexander-Scott talks about her experiences leading the Department of Health during the COVID pandemic

Photo courtesy of the R.I. Department of Health/File photo

WPRO's Steve Klamkin receives a flu shot from Dr. Nicole Alexander-Scott.

By Richard Asinof
Posted 5/9/22
In the next few weeks, Dr. Nicole Alexander-Scott, the former director of the R.I. Department of Health, will receive an honorary degree from Brown University and a public service award from the Rhode Island Foundation, recognizing her public service.
ConvergenceRI is publishing the second part of an edited transcript of an interview conducted by Kerry LaPlante, chair of the department of Pharmacy Practice at the URI College of pharmacy, In the interview, Dr. Alexander-Scott shared her insights and experiences managing the state’s response to the COVID pandemic.
How much of Dr. Alexander-Scott’s abrupt decision to leave her job in January was tied to policy disagreements with Gov. Dan McKee and his administration over public health strategies? Is Rhode Island ready to have an “uncomfortable conversation” about why two African-American women, Dr. Alexander-Scott and Womazetta Jones, secretary of R.I. EOHHS, left their jobs abruptly in the last few months? With more than one-third of all Rhode Islanders enrolled in Medicaid for their health coverage, when will the General Assembly have the courage to raise the reimbursement rates for Medicaid? Why have the anti-mask advocates resorted to acting as trolls, producing such ugly, vitriolic rhetoric on Twitter? How has the “leaked” memo about the potential decision by the U.S. Supreme Court to overturn Row vs. Wade changed the political landscape in Rhode Island?
The level of vitriol that was directed at Dr. Nicole Alexander-Scott – from inside the McKee administration and on talk radio – cannot be dismissed as mere policy differences. At some point, Rhode Island needs to have what outgoing R.I. EOHHS Secretary Womazetta Jones called some “uncomfortable conversations” about racial equity in government. The deep-seated racial animus that exists in Rhode Island needs to be talked about openly – the apparent fear over what the demographics tell us to be the truth, that minority children in Rhode Island will soon become the majority.
What has yet to fully addressed is the role that high-priced business consultants – including McKinsey & Company and the Boston Consulting Group – played in literally taking over the R.I. Department of Health operations during the pandemic, with the consultants becoming the actual managers and the decision makers.
During the RIPEC forum with the candidates for Governor held last week, the biggest issue not addressed – either in questions or in answers – is the fact that the state’s mental health and behavioral health system is having its 19th nervous breakdown. The facilities are under-resourced, the workers are underpaid, the community-based health centers are struggling to stay open, and the patients – children, teenagers, adults, and seniors – cannot access services. The major cause, the failure to raise Medicaid reimbursement rates, is known. The problem is that the candidates – and the news media are complicit in ignoring the conversation. What happens to a raisin in the sun?

Editor’s Note: Here is PART Two of the interview with Dr. Nicole Alexander-Scott, conducted by Dr. Kerry LaPlante, the chair of the Department of Pharmacy Practice at the College of Pharmacy at URI. The content is an edited transcript of the interview, which took place on Wednesday afternoon, April 27.

The interview picks up with Dr. Alexander-Scott explaining how she became attracted to the practice of public health during her fellowship at the Warren Alpert Medical School at Brown University, working on combating a previous pandemic, the H1N1 flu in 2009.

The interview is published this week by ConvergenceRI, in advance of Dr. Alexander-Scott being honored for her seven years of service as director of the R.I. Department of Health by the Rhode Island Foundation, and by Brown University, which is awarding her an honorary degree.


PROVIDENCE – [interview in progress with Dr. Nicole Alexander-Scott]

ALEXANDER-SCOTT: The director of the Department of Health at the time took me under his wing, mentored and supported me, and I loved every minute of it, really starting with [working with colleagues whom] I considered to be the super heroes, like they literally had capes on at the Health Department, in what they were doing, to really give their all, 24/7, early on, with that pandemic. People were sleeping at the Health Department…

I was so inspired and so in awe, and I just wanted to be a part of that. The type of commitment that people had – and they still have to this day – is something that kept me drawn into public health. And, infectious disease and medicine is a great pathway into that realm.

If I had the opportunity, I would do it all over again, in the same way.

LaPLANTE: I see the joy in your face when you talk about it. You know, when I came here to Rhode Island, Brown and the ID [infectious disease] division were globally known for all of their HIV work, [it was] so fantastic to be able to learn from [such great] mentors.

Let’s move into the present time. The world was thrust into this pandemic in March of 2020. I can’t imagine what it was like as the “doctor” of the state, to be responsible for keeping all of the people of Rhode Island safe and healthy and protected. What were those early days like for you?
ALEXANDER-SCOTT: It was certainly unimaginable – but doable. The thing that is helpful, coming from the world of medicine, [is that] you are familiar with intensity, in terms of pressure, in terms of how precious people’s lives are that you are responsible for.

You don’t anticipate that it was going to be every day; no one certainly imagined that this pandemic would be exponentially more than what we had experienced previously.

The notion of recognizing the importance of being able to communicate – and transparently – what we know, and the fact that the knowledge is expected to evolve and change, to ensure that we can accurately and quickly take on that knowledge, apply it, and then communicate it effectively, that was the focus.

I already had a tremendous appreciation for communications. The R.I. Department of Health has the best communications team that I have ever worked with, or could imagine [working with]. The responsibility and the level of respect for how critical it is to get that right is something that was the necessary piece to guiding so much of the day.

Particularly, that was when we were having press conferences every single day. And the tremendous [work] that would have to go into preparing – and making sure that we had accurate information, and accurate data, really took a significant chunk of the day. And that was aside from learning and then implementing and putting in place the various policies that were in place.

I can honestly say that the only way I was able to get through because my young man, my little guy was less than a year, it was a whole team effort. My personal hero, my husband, and my son, to this day, take it in stride. As long as he [knows] that he is loved, and he knows that he is OK, and we were there [for him].

He understood that the mornings started early. We had an amazing nanny who was like a grandmother, not only for him, but for us as well, making it possible so that we could take on each day the way that we needed to. The ability to get through those kinds of days, with those levels of intensity and pressure, for sure, was based on the family support that I had.

And, it was also based on amazing colleagues; there is nothing like knowing you are surrounded by individuals who are committed. There was so much sacrifice that occurred at the personal levels of my colleagues – in marriages, in their families, in their family members being OK, with the types of hours that everyone was all in for, ensuring that we could do everything that we could to keep Rhode Island at the forefront of the response, in getting what was needed for Rhode Islanders.

That type of energy inspired and motivated [me] to make it through the 20-hour days that occurred seven days a week, with the daily news conferences. It is an honor to have that opportunity be there, to have the type of team that was needed; it had to be everyone stepping up to the plate and bringing their resources, their knowledge, experience and assets to the table, so that we could provide the full government response that was needed.

LaPLANTE: Who would have ever known that it would have lasted this long? I don’t think most people know that you had that young baby at home and you were doing it all. Michael [Dr. Alexander-Scott’s husband] was a supportive guy. It was an honor watching you go through that with grace and dignity and positivity. But clearly, you sit on the shoulders of your team at the Department of Health. I have worked with them for years. They are a great group of people.

LaPLANTE: Changing [focus] a little bit, but also staying with the pandemic, where did you see teamwork at its finest? What kind of unity did you see? What kinds of collaboration? And, what vision of where we could improve?
ALEXANDER-SCOTT: It was that sense of commitment. And accountability. Regardless of the profession, there was recognition that we needed every one, we needed every one at the table in some form or another to help Rhode Island get through the response.

No one thought twice about it. We did it. We had a critical mission that set the stage, making sure what was necessary is in place. And you were privileged to be alongside people who were willing to do what it took.

And so, it was fascinating for me to see, because from the Department of Health standpoint, our Center for Emergency Preparedness and Response, all of the colleagues that work there, across the entire Department, and the colleagues that usually work with us in those types of emergency of the prior pandemic, this was a norm.

But, to be able to have the other players at the table, interdisciplinary folks on the outside of government, the nurses and clinicians, certainly physicians, but everyone, the pharmacists, who were out on the front lines, [with] their students, who were stepping in, contributing to our response. We had so many students early on.

And then, within government, it was across all of the agencies. Many of them received a Public Health 101 [course of] learning, because they didn’t know what case investigation or contact tracing was, even though these are normal, bread-and-butter, tried-and-true interventions, that are [proven] effective for public health for decades if not centuries.

And so, [with] everyone being able to soak that in and understand. And then, so much of the learning was new, you know, wearing masks, and the benefits and necessity of that. Accessing supplies for testing. Being able to scale up to the level that no one could have imagined. Our state health laboratory was amazing. How they pulled together with resources that we know have been limited,

We are getting a new state health lab. And so, imagining what they accomplished in the midst of the type of challenge that had been in place for years. We had been working for so long to accomplish this. Knowing that everyone did what was necessary on behalf of Rhode Islanders and to see the benefits, to see the outcomes and the lives saved, to know that it was hard, and there were many challenges and difficult stories.

But we are also aware of the stories that we prevented because of that work, and it is an honor to stand along side all of the professionals who made a difference across the board in helping to make that happen.

LaPLANTE: That is the tough thing in infectious diseases. You will never really be able to put your finger on how many lives you have saved. You can’t predict that. There is no crystal ball It was amazing work. Thank you.

I am going to turn to, now that the vaccine is out, we are preparing [to distribute it], it is October of 2020, I will speak to my own personal experience, when I asked to serve on Gov. Raimondo’s COVID vaccine subcommittee.

In those early days, I so appreciated the Department of Health leadership, because we would start every single meeting with our guiding principles, and that is a practice that I have now picked up with my teams, [because] that framework was critical in creating and informing our decisions.

We were always clear, from the beginning of every single meeting, safety was paramount. We were steadfast in [our goals] to minimize morbidity and mortality. We wanted effective distribution of the vaccine. We wanted to ensure access to the vaccine for all of Rhode Islanders, particularly for those who had limited options.

For me personally during these days, I found myself in a lot of deep reflection on my own personal values, which is what we turn to when we have to make significant decisions, based on limited information.

I remember consulting with an ethicist, and the ethicist asked me reflective questions, helping me understand my own framework for making these decisions.

I learned that my framework in making these decisions, maybe it was more in line with my Jesuit education, but it was to be not a stakeholder for pharmacy, per se, but for the good of all.

I wanted the decision to be practical, real. I wanted obtain the necessary information to ask the difficult questions, create choices, and anticipate obstacles, so my framework was not to be a stakeholder, like pro-pharmacy, this is what we are going to do. But I needed to vote in a different mindset, which was for the good of all, which was the good of public health.

After sharing my own personal experience on this, I have to ask you: What grounded you? You have this calm, steady approach. To know you personally and professionally, you just own that. You have such strong values, which I admire. And, the “calmness” about you. You have advocated for the health of the public. What kept you grounded? And, what experiences and framework brought you to that place?
ALEXANDER-SCOTT: Wow, that is a great question. And to hear your [story], because it certainly aligns with what I learned and what I have learned to admire and to appreciate.

For me, it is very similar. The sense of being grounded is always an important component. I reflect back on times in the clinical world, in the hospital, and remember a nurse telling me: “The more intense and pressured it gets, the calmer you become.” And I was like, “Really?”

Just being able to ensure that I can hear that inner voice, particularly as things are happening around [me], and stay grounded to what I see as maintaining integrity. And what would be key, what would I want for my mom, to do for a loved one that I have, and how would I want them to be guided in making those decisions.

So, ensuring that with all the data, and the inputs that are coming, that I am able to still understand and proudly tell my son, or tell my family member, or my husband, that regardless who is asking or who is watching or who is not, this is something that I would stand by, in terms of attempting to get to the best outcome possible, for all people.

And, that includes the people who don’t have the voice for themselves, or those who may be overlooked, or who may be marginalized, as well as those who we do see.

So much of public health is making sure that we are doing it for the vulnerable as well as for the broader population, knowing that sometimes, there may not be someone else otherwise able to advocate and make those decisions.

That certainly played out, early on [in the pandemic]. When our vaccines rollout occurred, and we appreciated members of the vaccine committee such as yourself, who stood with us, and said: Let’s do the best we can to ensure that we have that health equity lens in our approach.

We stayed focused on what is going to keep people alive and keep people out of the hospital. And, that meant you had to start with the communities that have been most impacted. It is not because of any genetics or any of their decision-making, but it is the environments that they are in, the conditions and factors that they are living in and dealing with, the jobs access that they have, because they have to get out and be exposed at a time when it was really dangerous.

And then, the co-morbidities, because of all those other determinants of health, set certain populations up for being at higher risk of being hospitalized and of death.

We still needed to do a better job. But that was really a guide for doing the best we could, early on, which meant, going slower, so that we captured those communities, and we were able to see the results.

We had the largest drop in those who were hospitalized, or those who died because of COVID, early on, And then, we were able to very quickly build on that with the mass vaccination sites, which many people saw as well done, and that again, was our whole government approach, with the Rhode Island National Guard, and my hero, [Major] General [Christopher P.] Callahan, and how he led that team so amazingly.

[Everyone] had to partner with us – all of the clinicians out in the community, the schools that were engaged with us, and the parents, everyone understanding that we needed to ensure that the vulnerable were cared for.

Municipalities did a great job – calling seniors, walking them in, helping them to get vaccinated, everyone had their hands on deck. And, knowing that that was the right approach, and doing my part to guide us in that direction, so that I could stand confident, stand with the integrity [that we were] doing the best we could for the people in the best way possible, in the way I would want done for my loved ones, or seniors, or other vulnerable groups.

That was a guide that would help me stay the course – and to be able to explain it, when not everyone agreed with it. But to stand strong in that approach, and it making sense that it was just being the right thing to do.

LaPLANTE: And that’s your job, to protect the public health. I always say: a good community protects the most vulnerable first. How can you not?

As you know so intimately, public health, by definition, promotes and protects the health of people in the whole community. It aims to prevent the spread of disease, to prevent injuries, [such as to] promote smoke-free environments for communities, again, public health.

And that is exactly what the CDC is charged to do, as is the Department of Health.

I try to make this very important distinction when talking to my friends and family, that are more autonomous, that are more individualistic, where they want to emphasize freedom of choice. And, I get that.

But I think that is an important message to share that when you are in charge of the public’s health, [one] that sometimes can be in direct conflict with individual freedom and individual choice.

That is a talking point that I always try to share. That sometimes, there is this conflict of public health versus individual health, for people to understand.

Having said that, if you could share with the URI community some of the observations and learning that you have taken away from this experience.

And, maybe comment on what we see coming in public health and health care delivery nationally and globally, as we move through this pandemic – and hopefully do not have another one.
ALEXANDER-SCOTT: One of the things that COVID really helped expose is that understanding that while there is tension between the individual and the population, everyone is connected, in one way or another.

We experienced it more so, as the state that we are, Rhode Island, perhaps compared to other states. The virus is not taking into account: “Let me not cross that street, because that is where a community is doing better, compared to this community.” And so, the ability to show where there is alignment, between that individual and the community.

You are never an individual that is in isolation when you are making those decisions. And, the ability to understand how independence, which is important, can be connected with those around you, in a way that makes it better, not only for you, but for your loved ones as well.

The notion of caring for your most vulnerable isn’t only just because it is the right thing to do. It does come back to you, in a positive way, when you do that. It is when we ignore that group that is marginalized, or may not seem important, or that may have challenges, that we recognize it ultimately can negatively impact. I am hopeful that this pandemic really showed that.

I know it was hard for that message to come through, because there are so many different voices. The ability to understand how connected we are to community, and to those that who are around us is key to our ability to get through the finishing of this pandemic and being ready for the next one.

When you think about, [asking the question]: “How does this impact the people that I love?” that is a way to really make that connection between the independent individual and others.

When you have someone that you love, who is immune-compromised, in some way or another, and so, regardless of the vaccine, they are still are lacking the actual protection so that they can stay alive, because they are more at risk if they are exposed to COVID, you are more motivated to help ensure that anyone around them, the community around them, is as vaccinated as possible.

Because that means the life of your loved one, who you want to be around, who you want to be able to cherish and enjoy – and that could be for a very young child who is just so precious and you want to help protect [so they can] enjoy the rest of their life. Or, it could be for a senior, who is full of wisdom and still wants to live their full life. So, everyone is connected in one way or another.

For going forward, there is an opportunity not only for that to resonate, but for public health, this is the first time that folks had a slightly better recognition that public health exists. I keep on my public email signature: “Public health saved your life today.”

And, then, [we need to have the] resources and support and value the workforce. I mentioned in the beginning [of the interview] the sacrifice that so many people experienced. We have to compensate for that. We have to show that that is appreciated, what people have done, if we want to continue to have this workforce, so that we can have the clean beaches and the quality food and the clean water and the health care licenses for the nursing homes and hospitals that are safe and have strong quality.

All that connects back to public health [workers] being able to do what they do. But that can only happen with the resources and support for the workforce.


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