Delivery of Care

‘We are punching so far above our weight’

A candid conversation with Miriam Weizenbaum, the outgoing Chief of the Civil Division at the R.I. Attorney General’s office, after four transformative years on the job

Photo by Richard Asinof

Miriam Weizenbaum, outgoing director of the civil division at the R.I. Attorney General's office, shared her views of the changing landscape of public health in Rhode Island.

By Richard Asinof
Posted 3/25/24
An exit interview conducted with Miriam Weizenbaum, Chief of the Civil Division at the R.I. Attorney General’s office.
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PROVIDENCE – Nearly five years ago, in early 2020, ConvergenceRI interviewed Miriam Weizenbaum when she had been hired to serve as Chief of the Civil Division at the R.I. Attorney General’s office.

Her role, as defined by Attorney General Peter Neronha in the news release announcing her appointment, was to serve as “the people’s lawyer [emphasis added], protecting and advancing the interests of all our residents, particularly our most vulnerable.”

In that interview, Weizenbaum told ConvergenceRI that she could not be “risk averse” [emphasis added] in deploying strategies to protect the state’s most vulnerable residents. [See link below to ConvergenceRI story, “You cannot be risk averse.”]

Indeed, during her stint as Chief of the Civil Division, Weizenbaum played a critical role in shaping the legal strategies being pursued under Attorney General Peter Neronha’s leadership in the mission to serve as the state’s public health advocate. Her reach included:

  •   decision-making rejecting the proposed merger between Lifespan and Care New England.
  •   enforcement of regulations governing the sale by the for-profit private equity owners of Roger Williams Medical Center and Our Lady of Fatima hospitals.
  •    enforcement of lead poisoning prevention laws to hold delinquent landlords accountable for their inaction.
  •   winning more than $300 million in legal settlements against opioid drug manufacturers, distributors, consultants and pharmacies.
  •   expanding the Environment Division to include both energy and climate.

Last week, I had the opportunity to conduct an exit interview with Weizenbaum, as she prepared to depart her job at the end of March. The interview focused on how the landscape around public health had changed in the last four years.

Weizenbaum lauded the leadership of Attorney General Peter Neronha. “One of the things that really makes a difference for all of us doing such mission-driven work is good leadership,” she said.  “I think that Peter is transformative [emphasis added]. There is just no other word for it. You know, he’s bold; he’s plain spoken. He’s clear about what matters to him. And, you know, as somebody who is working in his office at his direction, it just makes an enormous difference to know that not only does the boss have your back, but, the boss really wants you to push as far as you can go for the benefit of Rhode Islanders.”

Here is the ConvergenceRI interview with Miriam Weizenbaum, sharing her insights about how the legal advocacy under Attorney General Peter Neronha has broadened the public health mandate for all Rhode Islanders, during a time when the delivery of health care has been in crisis.

ConvergenceRI: The legal team under the Attorney General has really been a driving force in serving as a public advocate, for better health in Rhode Island. Now, that you’re stepping down, you have an opportunity to look back and say, “How have things changed?” for the better, and where are the challenges that still lie ahead. Let’s start with the first part of that question: How have things changed, for the better?  
WEIZENBAUM: It has changed for the better in so many ways. You know, I will take the liberty to define health broadly, to start with, and then kind of narrow down to a more conventional sense of the word.

I think that health, defined broadly, means, and includes, access to the means of a healthy life. That requires work on a bunch of different fronts that have been developed in this office. I think that that is a really important change.

For example, where we had one of the only consumer units run by a non-attorney, we now have a very active consumer unit with an amazing attorney as its unit chief, doing work that puts and keeps money in the pockets of Rhode Islanders that they are entitled to.

And that, you know, translates into health for families and individuals, right. You work hard, you need to retain the fruits of your labor. Our consumer economic justice unit is really important in that regard.

I will also note that that unit and the chief of that unit were very much involved the Lifespan/Care New England [merger] review because of the anti-trust component. That’s an important piece.

Another important piece is the work being done by what used to be the Environmental unit, which is now the Environmental and Energy unit, which basically has swept in not only consumer issues related to energy but climate. [They are] critically related to health. That expansion is new. And, the recognition of the need for this office to squarely put its work on The Act On Climate is, I think, a vast improvement.

I think that this office is in some ways the point of a spear on that, because we have been able to marshal significant resources and work closely with advocates.

And then, there is access to the natural world, which is healthful, and which the Attorney General defends

And, I think, in the civil rights arena, clearly, the anti-lead work, getting lead out of houses, is a huge health issue.

Living without hate. And having the means to recognize and protect against hate crimes. That clearly is really important to the well being of Rhode Islanders, among the things that is now called the Civil and Community Rights unit, has done. So, I would say that those broadly fit within health.

Checking the boxes  
More specifically, to more traditional definitions of health, what we have been able to do is, first of all, take on what one might say are the core regulatory responsibilities of the office.  The obligation to review applications for hospital transactions, that's one regulatory function. Another one is commenting on proposed rate increases in health insurance.

Just taking those two. I think the office did a good job of evaluating the basic regulatory requirements. You can disparage checking the boxes. But it actually matters. And we know that in health care from infection control. Checking the boxes is important.

I think what we have been able to do is to move beyond that. So that, for example, reviewing the Prospect transaction with the exit of the private equity owner, evaluating the Lifespan/Care New England transaction, and the current proposed transaction between Prospect and Centurion, what our health care unit has been able to do, has set as its obligation – and what the Attorney General has set as our obligation – is to include in consideration of the regulatory work what is the impact of the availability of health care on the people who are vulnerable. And that is really all of us, because all of us need health care, but really centered on what people need, and what they are not getting. And then, evaluate the transaction with that in mind.

So, that when we are asking questions, we go beyond, you know, “Is the board properly constructed?” “Is the proper paperwork filed for HCA application?” To go beyond that, to say: “What will really be the impact for people in this community?”

And, that leads us into a very close review of the financial condition of the proposed purchaser, of the hospital itself.

I was looking back at our decision in Lifespan/Care New England in denying that application. You know, we talked about – we pointed to the fact that there wasn’t a concrete plan that we could really evaluate. But we went beyond that to say, “Not only did you not check the box by [not] giving us a plan, but here’s why a plan is important.” Because a merger will affect… [and] we went and identified all of the aspects of the delivery of health care.

I believe that is a huge improvement, because now somebody’s eyes are on that bigger question of: “How is health care being delivered?”  “What are the drivers of success?” And, “What are the drivers of the places where enormous gaps [in the delivery of health care] exist?”

So, I would say, those are big improvements. There are lots of ongoing investigations that I can’t really talk about because they are investigations. But there is just a ton of good work going on.

ConvergenceRI: I attended the first public hearing held on Tuesday, March 19 [about the proposed purchase of Roger Williams Medical Center and Our Lady of Fatima hospitals by the Centurion Foundation].  I came away thinking I had gotten stuck in time, and I was shuttled back some 14 years ago, listening to testimony before the judge in the bankruptcy hearing for Landmark Medical Center and the various stakeholders offering heartfelt testimony.

The workers, the people on the front lines, were rightfully concerned about “What’s going to happen to my job?” And the people who have jobs, jobs that seemed secure, were saying: “I want to keep my job!” But, where does the patient fit into all of this? 

Because the patient is the one who has the hardest time accessing the services in a timely fashion. I’m sorry if I am talking too much here.    
WEIZENBAUM: No, I think I understand what you are saying. I don’t know if there is a question you are asking, so that I can respond.

ConvergenceRI: Where does the value of the patient and what the patient says, and what the patient needs, come into these transactions?  
WEIZENBAUM: I think that is a really, really important question. Let me identify a few pieces that I think I can respond to it.

First of all, with respect to this office, when we began developing what is now the Public Protection Bureau, and there are four units – Health Care, Consumer, Civil Rights, and Environment and Energy – we defined each of those units with a mission that included developing and prioritizing legal work based on the needs of community by engaging with community.

And, so, I say that, because I think that has successfully been worked into the DNA of all of what we call the “public protection” work that the office is now doing.

With respect to health care, our office has lots of relationships with organizations that work with patients. And, that helps to inform our work.

Having said that, from the Attorney General’s perspective, I am confident that we are thinking about the patient. And, I think your question is: Where is the evidence of that?

At this stage for that transaction, in the middle of performing that regulatory function, we really can’t speak to where we are with the regulatory function. Because in fairness to the applicants, we have to complete it. And not to arrive at – you wouldn’t want a jury coming back with a decision, halfway through [hearing] the evidence. That wouldn’t be fair. We need to complete the process.

The other point I’ll make is that I think Rhode Island has a paucity of advocates, with respect to health care. Not that there are none at all; people are working really hard, but there is not a critical mass to show up for a public comment like that.

So, that makes it even more important that this Attorney General centers the patient, and again, I think you can see that in the way that we have done reviews in the past, and our engagement with right now, fighting in court to get Prospect to honor its obligation [under the previous agreement].

ConvergenceRI: When is that hearing?  
WEIZENBAUM: That hearing is on March 26.

ConvergenceRI: What do you expect to happen at that hearing?  
WEIZENBAUM: I expect the judge to hear evidence. The issue is: How much is the hospital in arrears over 90 days with its vendors? And, if so, then we’re asking the court to order them to come up to date on their debt, which is required under the decision, which has the force of law. I don’t know what the outcome will be. But that is what is at issue. And again, it is to make sure that those hospitals have what they need to be able to deliver care to patients. So, I think that the patient gets centered in those ways.

ConvergenceRI: As a reporter, what I have found, is that in the U.S., there are only about three or four excellent reporters, like myself, who have really dug into what’s going on with for-profit private equity enterprises and hospitals. 

There’s Gretchen Morgenson from NBC-TV News; there’s Moe Tkacik from the Prospect; [there’s Hannah Levintova from Mother Jones], but I am hard pressed to name other people, because there is an absence of what I call good journalism.

Here in the Rhode Island, it doesn’t do me any good to call out what I see as the lack of good health care reporting. I’m just one person; I cover the waterfront, as it is. It doesn’t take that much effort to figure out what’s going on. 

I have raised the question with the Attorney General. My question is: What does the news media have to do differently to understand where we are today and the types of reporting that is needed to better publicize what’s going on? Not that you can answer that, but it’s my own self-serving question. Do I clone myself? How do I educate the other people? Are they willing to listen?  
WEIZENBAUM: I don’t know the news media market well enough other than to say that I think more attention must be paid. And, that attention, in my view, means, again, understanding what those drivers are. Whether you want to use the simple direction of “Follow the money.” Or, “Follow the effect on patients.”

Again, centering on people who are vulnerable. I think there are different ways in, but I think it begins with caring enough about the issue that you are paying attention as it evolves.

ConvergenceRI: What are the challenges that still remain? You are passing the mantle on to Kate Sabitini. Where do you think that it needs to go, if you can talk about that?  
WEIZENBAUM: I think we are really, incredibly lucky to have Kate stepping into this position. The Civil Division is staffed with increasingly extraordinary attorneys, what we’ve been talking about the Public Protection side, and on the Defense of the State side.

We’ve been able to attract some really, really good people. And, I think consolidating those gains is critical. We really need to continue to build a workplace that supports the people who work there, that gives them a quality of life/work balance, because good people do good work. And, if you treat good people well, then they want to stay and do the good work.

I think one challenge for everyone in the legal field is recruitment. We are punching so far above our weight. You can’t sustain that forever without expanding. That will be a challenge. People are really jazzed about the work that they are doing. That bodes well.

ConvergenceRI: It is impressive for me to be on the outside and see all the good work that is being done, and to have reporters say to me, “No other Attorney General is doing this kind of work on regulating private equity." That’s the feedback I have gotten from reporters such as Moe Tkacik at The Prospect and NBC’s Gretchen Morgenson. They ask: Why aren’t other Attorneys General doing this work?  
WEIZENBAUM: One of the things that really makes a difference for all of us doing such mission-driven work is good leadership. I think that Peter [Neronha] is just transformative. There is just no other word for it. You know, he’s bold; he’s plain spoken. He’s clear about what matters to him. And, you know, as somebody who is working in his office at his direction, it just makes an enormous difference to know that not only does the boss have your back, but, the boss really wants you to push as far as you can go for the benefit of Rhode Islanders.

It’s really hard to appreciate how transformative that leadership has been. I think, unless you are on the inside, or you’ve been in a big organization.

It is not something I really understood from the outside, but now, having been on the inside of government, it’s very clear to me how important that is.

ConvergenceRI: For you, now, do you have any political ambitions? Do you have any sense of having climbed Mount Kilimanjaro in this car…  
WEIZENBAUM: [laughter]

ConvergenceRI: …are you going to focus on family? Are you going to take some time just to re-evaluate? And, if you don’t want to share any of this, that’s fine.  
WEIZENBAUM: No, I am happy to. There are things that I love about practicing law. So, I’ll continue to do work at my former law firm.  I like litigation. And, I miss it to a certain extent. I look forward to doing some of that. Certainly, not on a full-time basis.

I can say, as far as ambition for political office, that is an absolute and hard no. That’s just not what I will be doing. I have a terrible memory for names.

I think the world is going to have a lot of upheaval, is my guess, over the next few years. And, I think we are all going to have to make decisions about how we keep our shoulders to the wheel. And, I feel a responsibility to do that, too.

The other thing that is very near and dear to me is the Gamm Theater. I am president of the board of the Gamm. And, I believe very, very strongly in the arts. Because, without imagination, we will never know what “good” looks like. If we don’t know, we can’t work for it. And, I have a family. And, they are super happy to have me back.

ConvergenceRI: Here is an invitation. Any time that you would like to write something for ConvergenceRI about the arts and the importance of theater, and what’s going on in terms of theater, you’re more than welcome to share your thoughts about that.

People forget the importance of theater in bringing issues to the forefront where we can have a conversation. Part of the problem that we face now is difficult to have a conversation about anything with anybody because there is so much disinformation and misinformation. And theater is way of bringing that to the surface in a healthy manner.    
WEIZENBAUM: I think that’s right.

ConvergenceRI: What haven’t I talked about, should I have talked about, that you would like to talk about, in terms of how you see the landscape changing?  
WEIZENBAUM: We have covered a lot. You ask good questions. I believe in the work of this office. I think it’s got an extraordinary set of tools that are finally being dusted off and sharpened and put to good use. And that is going to absolutely continue. And, it’s incredibly exciting. It is hard for me to express how appreciative I am for the opportunity to have been here for whatever difference that was able to make.

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