Rhode Island Department of Health

October 17, 2016October 21, 2016

First Neighborhood Health Station breaks ground in Central Falls

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Think of it as the “Deepwater Wind” of health care: Innovation, starting in Rhode Island, that could be a model for the world. That’s how revolutionary the concept of the Neighborhood Health Station could be, and the first one is being rolled out in Central Falls.

Perhaps overshadowed by a visit from actress Viola Davis, the groundbreaking for the new Neighborhood Health Station in Central Falls heralds the beginning of a new paradigm in health care, one meant to serve the needs of the community, not the convenience of the provider. The Blackstone Valley Community Health Care (BVCHC) Neighborhood Health Station will be located at 1000 Broad St in Central Falls, and will offer primary care, walk-in primary care, dental care, a pharmacy, physical therapy, pediatric care, occupational therapy, mental health services, Ob/Gyn services, radiology and more; serving over 14,000 patients and 50,000 visits a year.

Upon completion in 2018, the city of Central Falls will benefit from having “comprehensive services offered under one roof, where clinical professionals can collaborate face-to-face for improved care coordination” and “same-day sick appointments with convenient hours (8 am to 8 pm) on week days and additional weekend hours, enabling individuals and families to access health and medical services close to home, when it is most convenient for them.”

BVCHC hopes to cover 90 percent of Central Falls residents. “Using medical records to identify at-risk patients, we will continue to collaborate using community resources and with the new health building, we are confident that we can improve public outcomes,” said BVCHC Senior Clinical and Population Health Officer Michael Fine, M.D., who now also serves as Health Policy Advisor to the City of Central Falls.

Based on public meetings with residents, three public health priorities were identified: the community wanted their kids to be safe in school, they needed access to a gymnasium and they wanted better access to primary care.

Based on this input, the team designing the center identified five short term goals. Pregnancy prevention: BVCHC partnered with the school system and Brown University’s Residency Program in Family Medicine to create a school-based health clinic at Central Falls High School to bring prevention and same-day clinical care to the adolescents of Central Falls and to reduce the rate of adolescent pregnancy through education and prevention programs. (Central Falls’ high school pregnancy is 4X the state average).
Multidisciplinary management of individual cases: participants in this collaboration come from all facets of the community, including doctors, dentists, substance abuse, mental health, home care, housing, legal, needle exchange, immigration, transportation, social service, insurers and hospitals. Together, they meet bi-weekly to create customized plans to organize care for the people in Central Falls who are at the highest medical and social risk.
Mitigation of EMS use: people who use the Central Falls EMS more than four times a year have been identified, outreach has been made and they have been introduced to BVCHC where they can get help with medical, mental health and substance abuse issues and where referrals can be made for housing that they might need.
Access to exercise opportunities: The mayor now leads city walks to get people moving every two weeks (organized by Parks and Rec, publicized by BVCHC and housing authority and staffed by both parks and rec and BVCHC). A regular schedule of free busing from Central Falls (three pickup sites at Notre Dame and the housing authority) to the Pawtucket YMCA and to the Lincoln YMCA (for access to swimming pools) was introduced.
Identification of needs within public housing: the city’s community health worker in public housing now brings individual situations and stories to the multi-disciplinary team about tenants, primarily the elderly who are most at risk, to the team to find solutions to their needs.

Innovation is desperately needed in health care. When we as a nation inevitably pass some form of “Medicare for All” single payer health care system it will be vitally important to keep costs down and people healthy. Neighborhood Health Stations point the way.

“None of us,” said Dr. Michael Fine, former head of the Rhode Island Department of Health, “have ever lived in a place where it doesn’t matter if you’re rich or poor, black or white, whether you speak English or Spanish or another language, whether you walk, take the bus or drive a car, where it doesn’t matter if you have papers or not, whether you can read or not, whether you walk on two feet, or walk with assistance… we’ve never seen a place in which everyone matters, in which we look out for everyone. Whether they came to the health center this year or not, whether they do what doctors recommend or not, whether they choose to live differently or not, we stand here today with a different vision: A vision of a place in which everyone matters. It’s a vision of what Reverend Doctor Martin Luther King Jr. called ‘a beloved community.’”

Below, watch Dr. Fine, former head of the RI Department of Health, explain the importance of Neighborhood Health Stations.

August 11, 2016August 26, 2016

Department of Health hears testimony on Burrillville power plant

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The Rhode Island Department of Health (RIDOH) held a public comment hearing in Burrillville Tuesday to solicit opinions on the potential health effects of building Invenergy‘s proposed $700 million fracked gas and diesel oil burning power plant. RIDOH has been tasked by the Energy Facility Siting Board (EFSB) to create a non-binding advisory opinion on potential public health concerns relating to the project, including but not limited to biological responses to power frequency, electric, and magnetic fields associated with the operation of the power plant, and the potential impacts on the quality of drinking water associated with the construction and operation of the plant. The final report is due in early September.

RIDOH has released a first draft of their report, which was consumed by Burrillville residents opposed to the plant. Much of the public comment centered around the idea that RIDOH wasn’t taking into account the compounded effects of the gas infrastructure in and around Burrillville but was instead concentrating on the proposed power plant by itself.

Perhaps the most dramatic moment of the evening came when Stephanie Sloman rose to give her testimony.

“I had a whole speech prepared,” said Sloman (see video #20 below), “but I noticed that Invenergy’s sitting over there, and I refuse to speak and read my speech in front of these people. I don’t think they should even be here, frankly.”

The evening’s meeting was made harder on residents of the town because at the same time as this meeting there was a meeting of the Harrisville Fire District and Water Board. This meant that some people (including me) had to run out to the other meeting and then return to the RIDOH hearing, still in progress.

Several Burrillville residents noted that Governor Gina Raimondo, during her visit to Burrillville in July, recommended that residents get involved in and trust the process. That seems awfully hard to do when two important meetings are scheduled at the same time .

Below is all the video from the event.

March 18, 2016May 19, 2016

Community speaks out to defend Memorial Hospital Birthing Center from closing

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At the third and probably last community meeting being held by the Rhode Island Department of Health (RIDOH) to discuss the potential closing of the Memorial Hospital Birthing Center, well over a hundred people turned out to speak. Since the massive protest outside Care New England’s offices last week the movement to keep the birthing center seems to have grown. One speaker at this community meeting drove over an hour to speak her piece about the closing, because the birth of her child at Memorial four years ago was such a positive experience and so important to her.

Care New England announced the closing on March 2, RIDOH Director Dr. Nicole Alexander-Scott scheduled three hearings because under the law, RIDOH must approve any such closing. The process is called a Reverse Certificate of Need and there are procedures connected to the process that Care New England seems to have skipped when announcing the closing of the birthing center. The process is “intended to ensure access to quality health services and healthcare throughout Rhode Island.” Dr. Alexander-Scott has ruled that she must approve or deny the facility’s proposal within 90 days.

Chris Callaci, an attorney representing the nurses who will lose their jobs if the facility closes, pointed out that Care New England has not actually filed a plan for closing the birthing center, as required by law. The public, he says, is being forced to comment on a plan without any of the details of the plan. Further, he says that scheduling the hearings with barely a week’s notice may be a violation of the law. Calico claims that the first meetings must be scheduled no earlier than thirty days after Care New England has submitted a complete plan.

Because of the vagaries of RI public hearing law, the officials in attendance do not comment or answer questions from the public. So Dr. Alexander-Scott, Executive Director Ana Novais and Chief Legal Council Kenny Alston sat silently as patients, medical professionals and community members spoke out against the birthing center’s closure.

Many who live in Pawtucket and surrounding areas object to having their inpatient obstetrics services moved at the 11th hour to Women & Infants or Kent County Memorial Hospital. To interrupt pregnancy care for women who plan to deliver in April and May is a terrible physical and emotional inconvenience for mothers and families, never mind the increased travel time and the last minute loss of a doula.

One woman who is due in early May said that the only information she has received on the closing of the Memorial Hospital Birthing Center has been from those advocating against the closing. Official communication from Care New England has been scant.

Central Falls Mayor James Diossa said he is very concerned about the interruption of services at the birthing center. But he stopped short of calling on Care New England to change their plan. He simply wishes to be involved as a community partner to make the transition as safe as possible for the residents of Central Falls and Pawtucket. This is similar to the position staked out by Governor Gina Raimondo, who has announced no plan to intervene in the closing but who says she understands the pain being caused “as a mother.”

A doula testified that despite Care New England’s promise that all providers would be credentialed at Women & Infants or Kent, there is no process in place for her to be credentialed. In fact, Women & Infants requires an OB/GYN be present during the process. Since Memorial functions as a community service provider, there is no way most people who use Memorial Birthing Center can afford to have two providers present during the birth of their child.

This has the effect of medicalizing birth, something many women who wish to deliver their children object to.

“If Memorial closes,” said a mother planning to deliver in June, “my choices will be to have a home birth, which I do not want, or go to Cambridge. There is no other place offering the options I want.”

February 15, 2016February 14, 2016

Lead poisoning in Rhode Island

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[A version of this article was originally published by The College Hill Independent on February 12, 2016.]

435px-Symptoms_of_lead_poisoning_(raster) Several men huddled around a fire hydrant late on a recent winter night. They were workers with Providence Water, a state-regulated department of the City of Providence that provides the capital with its water supply. They were flushing the main, the large pipe that runs down the center of a street, by releasing a high velocity stream of water from the hydrant. Over time, minerals from the water build up on the walls of the pipe, tightening its aperture and reducing flow and water quality. According to the workers, these flushes have nothing to do with lead.¹ Providence, the workers were quick to point out, has the second best water in the country.

The claim that Providence has the second best water in the country used to appear on the homepage of Providence Water’s website, until it was removed sometime between October 16 and December 16, 2014. This despite the fact that in 2012, 2013, and 2014 the water consumers got from the tap exceeded the Environmental Protection Agency’s (EPA) lead action level, being the level of concern at which remedial measures are triggered under the Safe Drinking Water Act. Under the provisions of the Safe Drinking Water Act, the utility was required to distribute brochures notifying customers of elevated lead levels in all three years.

The most recent legally required notification of high lead levels was issued May 28 of last year. 2015 water quality data has not yet been released, but a spokesperson for Providence Water, Dyana Koelsch, told the Independent that “the latest testing shows that we do meet current regulations.” It is important to note, however, that meeting current regulations does not mean that the lead levels are below the EPA’s level of concern. For example, an excessively high lead level coupled with an informational brochure is fully in compliance with federal regulations without indicating that water lead levels are safe. As of the time of writing, water quality data had yet to be released.

But the tests that produce such data may be intentionally misleading. UK newspaper the Guardian recently exposed several US health departments for giving at-home water-testers instructions that would lead to systematically underreporting the amount of lead in tap water. The Rhode Island Department of Health allegedly instructed residents selected to participate in the testing to run their taps “until cold” before filling the sample bottles, a practice that reduces the amount of lead in the water and does not reflect the lead content of water that has been sitting in the pipes for several hours (like, for example, when you wake up in the morning).

Koelsch called the Guardian’s claim a “misunderstanding” and said that, while the utility would not go “tit-for-tat” with a newspaper, she conceded it would indirectly rebut the accusation by communicating “the truth.” Providence Water has not yet communicated a statement to the Independent, but has updated the section of their website dealing with lead at least three times between February 5 and 10. The old page, “Lead In Your Drinking Water,” has been replaced with “Reducing Lead Levels in Drinking Water,” and the link on the homepage now reads “Lead in Household Plumbing.” Providence Water has not placed dates on their statements. The most recent one (as of February 10) says, in part, “Our water meets or exceeds all Federal and State Safe Drinking Water Act Regulations.”

Despite lead being a highly regulated and tightly monitored neurotoxin, information about one’s personal risk from lead can be surprisingly difficult to get. Some Rhode Island buildings are certified as lead safe, but most aren’t. And some 80 percent of homes are thought to be older than 1978, the year lead paint was outlawed for home use, according to the Rhode Island Department of Health. Providence Water estimates that 20,000 homes in Providence are still serviced with lead pipes that run from the mainline in the center of the street to the sidewalk, where the homeowner’s piping begins. Federal law has required that Providence Water distribute brochures via mail informing residents of excessively high lead concentrations in the city overall, but doesn’t require that the utility distribute information detailing exactly where utility-owned lead service lines are used. Consequently, a system map is not available online. Customers may call the Lead Service Hotline or the Water Quality Hotline and inquire about a specific address, but it’s easy to imagine that many Providence residents do not know that they should be doing this. And information about pipe material isn’t widespread even among utility employees. None of the maintenance employees from that night knew what metal the service lines off the main they were flushing consisted of.And even if someone does know the material of the pipes, both in their service line and in their own plumbing, testing for lead in the water that comes out of the tap is done mostly by conscientious customers that are willing and able to pick up a lead testing kit and pay a $10 processing fee. Koelsch did say, however, “I’m sure if people can’t afford the $10 they’ll give [the test] to them.”

A recent report by the Environmental Justice League of Rhode Island shows that environmental toxins are predominantly concentrated in low-income and minority neighborhoods of Providence. This finding is supported by a 2010 study in the Maternal and Child Health Journal that demonstrates that lead poisoning is concentrated in Providence, Pawtucket, Central Falls, and Woonsocket, and in poorer and less white areas within each of those cities. In some suburban census blocks they found zero cases of lead poisoning between 1993 and 2005, compared to one urban census block where 48.6 percent of children were lead poisoned in that same time period.² But local activists from organizations such as Childhood Lead Action Project and the Environmental Justice League of Rhode Island say the problem goes beyond the presence or absence of environmental health hazards in these neighborhoods. “We don’t live in a city and a state where everyone has the same power to act on the information that they may or may not have about lead hazards and other environmental hazards in their homes,” Laura Brion, Director of Community Organizing and Advocacy at the Childhood Lead Action Project, told the Independent.

Since federal and state legislation began targeting lead in the 1970s, the incidence of lead poisoning has steadily decreased in the United States, a fact that has lead some media outlets to call news coverage of the Flint, Michigan water crisis overdone. In the mid-1970s the Centers for Disease Control and Prevention (CDC) found that the average US child under the age of 5 had a blood lead level of 15 micrograms per deciliter. In context, the on-going crisis in Flint finds 4.9 percent of the city’s children with blood lead levels greater than or equal to 5 micrograms per deciliter, the amount of lead that the CDC defines as lead poisoning.

Rhode Island is one of the country’s worst states when it comes to lead poisoning. According to a 2010 study by Rebecca Renner published in Environmental Health Perspectives, the rate of children with elevated blood lead levels in Rhode Island is three times higher than the national average. Renner attributes this, among other things, to corrosive water that strips traces of metals from the pipes, to the fifth-oldest housing stock in the nation, and to the tens of thousands of Providence homes serviced with lead service lines.

“We also have issues, just like Flint, with lead pipes being used to bring our water to our homes,” Jesus Holguin, Youth Leadership Director at the Environmental Justice League of RI, told the Independent. “There are similarities between Providence and Flint when talking about our Industrial past and the way these industries have all closed down and moved away, leaving a legacy of pollution in our communities. The right to clean air, clean water, and safe places for kids to play is something that wealthy communities take for granted. Many low-income and minority communities don’t get parks, street lights, housing code enforcement, or safe drinking water.” Koelsch, for Providence Water’s part, says that the utility “take[s] concerns from all their customers seriously, no matter what neighborhood they live in.”

Renner believes that the Rhode Island Department of Health downplays the correlation between lead in drinking water and lead poisoning among children, arguing instead that other environmental sources of lead are the prime drivers of lead poisoning. “When we see elevated blood levels, the typical sources are either paint, dust, or soil,” Joseph Wendelken of the Rhode Island Department of Health told the Independent when asked about Renner’s position. (For the record, Laura Brion agrees that paint, dust, and soil are more often the culprits behind elevated blood levels, but worries that the current flawed testing protocol means that we don’t really know what the scope of the lead-in-water problem is.)

Despite this worry, Rhode Island is making progress in the fight against lead poisoning. Data from the Department of Health show the prevalence of lead poisoning has decreased steadily from 34 percent of children in 2002 to 5 percent in 2014. “Rhode Island is still known, nationwide, as a lead poisoning hot spot,” says Brion. “We’re known as a lead poisoning hotspot that has done a lot to make the situation better, but we’re still not ahead of the pack.” The 2014 data indicate that about 1,000 children had elevated blood lead levels that year, according to calculations made by the Independent. And for advocates, that number is still too high.

Every case of lead poisoning is preventable. The sources of lead are well-known and the mechanisms by which it enters the blood stream are non-controversial, even if the relative proportions to be attributed to water versus soil, dust, and paint are debated. That’s a big reason why these 1,000 lead poisoned children in Rhode Island represent a scandalous failure to public health advocates despite the fact that the figure is an improvement on ten years ago. And it’s why the situation in Flint is such an outrage to so many. Part of what is missed by those who call media coverage of Flint overdone is the fact that ‘better’ simply isn’t good enough when it comes to lead.

Critics of lead abatement policies point out that the blood lead level considered to be poisoning has been lowered over time by the CDC—most recently in 2012 it was lowered from ten to five micrograms per deciliter. State Representative Joseph Trillo (R–Warwick), speaking in 2014 against a tax increase on home sales that would have provided $2.3 million for lead paint abatements said, the state’s improvement in the lead poisoning rate “wasn’t enough for the lead paint people. So what did they want to do? We had reduced it from thirteen thousand kids ten years prior down to twelve hundred. Now it was going down so low they said we have to lower the standard of the blood level. And they did that… we’re putting a tax on the property owners to put money towards a problem that’s been solved.”

But there is no known safe concentration of lead in the blood, and negative health effects have been found with as little as two micrograms per deciliter. The dangers of even low levels of lead are well established and include risk of a variety of neurological and other disorders. Inadequate funding or political will behind lead paint abatement programs, home risk assessment programs, or upgrades to water systems, will continue to allow a certain amount of lead poisoning to happen. And since the victims are predominately poor and predominately Black and Latinx, a certain political tolerance for lead poisoning seems likely to persist despite the efforts of generally well-intentioned yet underfunded health departments like Rhode Island’s. “Although Providence has made a lot of good progress around lead,” Holguin says, “we still see disparities in who’s affected in terms of race and income.”

“When I look at Flint I’m just heartbroken on so many levels because I just know how possible it was to stop the disaster from ever happening,” Brion told the Independent. “Every child that has been lead poisoned has experienced a violent attack on their brain. And I don’t think that’s a dramatic way of putting it. It deserves that attention, that horror, and that respect. Our normal should be zero. Because it can be zero and because all children deserve that.”

¹Providence Water officials disagree, and tout the practice as part of their anti-lead efforts.

²The paper does not make it clear whether that census block is in Providence, Pawtucket, Central Falls, Woonsocket, or Newport, which are statistically clustered together as the worst lead poisoning areas.

January 13, 2016

No pressure, House of Reps, but people are dying

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The Good Samaritan Act was passed in the RI Senate last week on the second legislative day of the season and the enthusiastic support the Act has received from Governor Gina Raimondo and Speaker Nicholas Mattiello gave advocates hope that the bill might be on the fast track. Those hopes were dashed last night when the vice chair of the House Judiciary Committee, Representative Doreen M. Costa (R District 31 Exeter, North Kingstown) motioned to hold the bill for further study.

Larry Berman, communications director for the Office of the Speaker, explained that, “It is customary to hold almost all bills of substance after the first hearing. The exceptions are for minor bills such as marriages. This enables the committee members and staff to review the testimony and many times there are changes made after listening to the testimony.”

The bill exempts “from liability any person who administers an opioid antagonist to another person to prevent a drug overdose. It would further provide immunity from certain drug charges and for related violations of probation and/or parole for those persons who in good faith, seek medical assistance for a person experiencing a drug overdose.”

The bill under consideration in the House is identical to the one that passed in the Senate and it seemed all the members of the House Judiciary Committee were on board with the bill, or at least anxious to be seen sitting in support of it. I have never attended a committee meeting where every member was present when role was called. Even Committee Chair Cale P. Keable (D District 47 Burrillville, Glocester) noted that having no absentees at a committee meeting “hasn’t happened in a long time.”

“Overdoses represent a public health crisis,” said Dr. Nicole Alexander-Scott, director of the Rhode Island Department of Health, in her testimony before the committee, “that is as urgent as any crisis we have ever confronted in Rhode Island in the past.” Both Director Alexander-Scott and Maria Montanaro, director of the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals presented evidence that the law saves lives.

Jonathan Goyer, who is in recovery and works as an advocate combating drug addiction and overdose told the committee, “No pressure, but as I’m sitting in the back of the room, there’s a good chance that as we all sat in here, that we just lost another life… and I don’t think we need to wait until next week, I think it needs to pass today.”

But the bill did not pass, and will not pass this week.

Larry Berman told me the Good Samaritan Act, “is tentatively scheduled to be posted for a vote at the next Judiciary Committee meeting, Tuesday, January 19, and then it could be brought to the floor for a potential vote by the full House on Thursday, January 21.”

No pressure, House of Representatives, but people are dying.

You can watch all the testimony in the video below.

And you can watch Jonathan Goyer explain how Narcan helps save lives here:

A lesson in the use of Narcan

January 4, 2016January 4, 2016

While touting health and natural resources, Raimondo challenged on her support for fossil fuel

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2016-01-04 Raimondo FANG BASE 20 — Raimondo signs her executive order

Governor Gina Raimondo today announced the formation of the Rhode Island Outdoor Recreation Council, touting the health benefits of outdoor recreation and the value of pristine open spaces, even as environmental activists challenged her on her continued support of the fossil fuel industry in Burrillville.

Members of Fighting Against Natural Gas (FANG), Burrillville Against Spectra Expansion (BASE) and Fossil Free RI all attended the press conference in the freezing cold Goddard Park Carousel in Warwick, silently holding signs that said, “Save Burrillville.” After Governor Raimondo signed the executive order creating her new council, one member started chanting “No new power plant!” and was escorted from the room.

In a press release, Governor Raimondo said, “All Rhode Islanders should have the chance to enjoy the countless outdoor recreational opportunities in our beautiful state, and take advantage of these resources as they fulfill New Year’s resolutions and lead healthier lifestyles. Rhode Island’s natural assets are unmatched, with amazing beaches, parks, campgrounds, bike paths, the bay and waterways. The State can do more to encourage use of these resources and promote this critical sector of Rhode Island’s economy.”

Raimondo’s staff has not responded to a request to explain how increasing Rhode Island’s dependence on fossil fuels will make for healthy environments in the state.

Raimondo did not engage with the protesters, but exited quickly after the event. One member of FANG waited in line on stage for a chance to speak with the governor but was turned away. Pia told me, “I was very angry I got kicked off the stage and couldn’t talk to my governor even though I was next in line to do so.”

Director Nicole Alexander-Scott, MD, MPH, of the Rhode Island Department of Health and Warwick Mayor Scott Avedisian did briefly engage. Among the protesters were Kathy Martley of Burrillville, who founded BASE, Sister Mary Pendergast and Sally Mendzela, who were arrested on Spectra property in December, Peter Nightingale who was arrested on Spectra property in August, and Nick Katkevich who was arrested on Spectra property in September.

In a statement Peter Nightingale said, “Fossil Free Rhode Island will continue to confront the Raimondo administration with the fact that natural gas is more dangerous for the global climate than coal and oil. Fossil Free Rhode Island will not stand idly by as front line communities and Burrillville in particular are treated as sacrifice zones.”

I’ll have some video on this later today, and will update if the Governor’s office responds.

December 1, 2015December 1, 2015

Ahead of World AIDS Day, RI leaders launched ambitious 90-90-90 Plan

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Dr. Nicole Alexander-Scott, director of the Rhode Island Department of Health, alongside Providence Mayor Jorge Elorza and Governor Gina Raimondo signed the Paris Declaration in a State House ceremony Monday.

In signing the declaration, the three leaders committed to putting Providence and Rhode Island “on the Fast-Track to ending the AIDS epidemic through a set of commitments. Those commitments include achieving the UNAIDS 90–90–90 targets, which will result in 90 percent of people living with HIV knowing their HIV status, 90 percent of people who know their HIV-positive status on antiretroviral treatment and 90 percent of people on treatment with suppressed viral loads, keeping them healthy and reducing the risk of HIV transmission.

“Rhode Island and the Providence partnership that we’re doing together, represents the first city/state group to join this world wide 90-90-90 campaign.” said Dr. Alexander-Scott in announcing the new effort.

2015-11-30 World AIDS Day 001 Kira Manser — Kira Manser

The announcement and signing ceremony came as part of the Rhode Island HIV Prevention Coalition‘s event held ahead of World AIDS Day 2015, which is today. The event was hosted by Kira Manser, the coalition co-chair.

Speaking at the event was Dr. Philip Chan, who works with AIDS patients at Miriam Hospital. Chan said that to curb the spread of HIV we must concentrate on a few areas. First, we must focus on access to care, especially among gay and bisexual and other men who have sex with men. Second, we must “address other STDs like syphilis, which has increased exponentially across the country. Third, we need to perform routine, opt-out HIV testing, to make sure that everyone gets tested at least once in their life. Fourth, we need to get people who are HIV positive on PrEP and lastly we need to need to work together, government and health officials, to end the epidemic.

Richie DeFilippo, the reigning Mr. Gay Rhode Island, explained the importance of PrEP, pre-exposure prophylactic. “PrEP is a preventative measure of HIV negative individuals to take daily to prevent them from contracting the virus.” It’s a pill taken once a day, but it is very expensive without insurance. DeFilippo aspoke of some of the social and economic barriers that prevent the effective use of PrEP.

Stephen Hourahan, executive director of AIDS Project RI, talked about the stigma still attached to the disease. Hourahan talked about the misunderstanding and stigma attached to the Charlie Sheen announcement. Stigma prevents many from getting tested for HIV, and increases transmission as a result.

The most energetic talk was given by Paul Fitzgerald of AIDS Care Ocean State. “Prevention without advocacy is no justice,” said Fitzgerald, before coming out from behind his podium and leading the audience in activist style chants. “We are not silent! We are not silent!” he shouted to applause. “We have activism to reach! We have people to change! We have policy to make! We have initiatives that must come about, to fruition. And it starts with us. It goes beyond these doors. Every place that we are we should be fighting about AIDS. We should be fighting about those people who cannot access services because they are not there, because they are not paid for, because there’s a political issue.”

2015-11-30 World AIDS Day 010 Richie DeFilippo — Richie DeFilippo

2015-11-30 World AIDS Day 009 Paul Fitzgerald — Paul Fitzgerald

2015-11-30 World AIDS Day 008 Stephen Hourahan — Stephen Hourahan

2015-11-30 World AIDS Day 007 Gina Raimondo — Gina Raimondo

2015-11-30 World AIDS Day 006 Jorge Elorza — Jorge Elorza

2015-11-30 World AIDS Day 004 Nicole Alexander-Scott — Nicole Alexander-Scott

2015-11-30 World AIDS Day 003 Philip A Chan — Philip A Chan

2015-11-30 World AIDS Day 002 David Cicilline — David Cicilline

October 29, 2015October 30, 2015

RIDOH Director Alexander-Scott weighs in on LNG in PVD

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Dr. Nicole Alexander-Scott, director of the Rhode Island Department of Health (RIDOH), responded to the Federal Energy Regulatory Commission’s (FERC) request for comments on National Grid’s plans to build a new liquefaction plant at Field’s Point on the south side of Providence.

The project has been the target of sharp criticism by environmental and social justice groups as an example of environmental racism, and much in Dr. Alexander-Scott’s assessment backs up such an assessment.

Though the director does not outright oppose the project, she does recommend that “FERC conduct a robust review of the project that fully incorporates public health perspectives and reviews potential public health concerns” and that RIDOH, “be deemed a cooperating agency, with all the rights and opportunities to participate in FERC’s review of this project preserved thereby.”

“Given the set of potential risk scenarios,” says Dr. Alexander-Scott in her final paragraph, “RIDOH requests that FERC consider requiring a Risk Management Plan for both the proposed liquefaction facility as well as the existing LNG storage facility, which does not currently have a Risk Management Plan.” [Emphasis mine]

“As Director,” says Dr. Alexander-Scott, “my strategic priorities for RIDOH are to address the social and environmental determinants of health, to eliminate health disparities in Rhode Island by promoting health equity, and to ensure access to quality services, especially for vulnerable populations.”

In her letter, Dr. Alexander-Scott outlines quite a few hazards and “risk scenarios” relative to the project.

Examining the proposal from a geographic standpoint, Dr. Alexander-Scott notes that the facility is planned within “an industrial area with a concentration of facilities listed in the EPA’s Toxic Release Inventory (TRI), facilities requiring Risk Management Plans (RMP), and Treatment, Storage, and Disposal Facilities (TSDF) that handle hazardous materials.”

Perhaps more critical “is the concentration of healthcare facilities and critical health system infrastructure within close proximity to the proposed project. Rhode Island’s only Level 1 Trauma Center is located in the Rhode Island Hospital complex, which includes Hasbro Children’s Hospital and is adjacent to Women and Infants Hospital. There are many additional primary care, specialty care, pediatric healthcare, and Federally Qualified Health Centers within this area of interest at varying degrees of proximity to the site location of the proposed facility. Providence Community Health Center’s administrative building and Chafee Health Center are within the half mile radius parcel map…”

Having this much emergency and non-emergency medical care infrastructure in one area, and an area so close to the proposed liquefaction facility requires “that careful attention be paid to any potential impacts to this critical healthcare infrastructure, including both for the cumulative impacts of construction and normal operation of the facility, and for any potential increased risk for accidents or emergency situations,” says the Director.

She sums up some of the potential accidents or emergency situations:

Although the possibility of an emergency or disaster may be low, the combination of multiple hazardous facilities, healthcare infrastructure, and vulnerable communities requires extra care and attention. Potential hazards may include leaks, fires, floods, earthquakes, hurricanes, storm surge, equipment malfunction, accident, terrorism, and the added risk of secondary offsite incidents including chemical incidents or explosions from co-located facilities requiring chemical risk management plans. RIDOH is concerned about the health impacts that would results from a worst-case scenario involving secondary impacts, which might involve amplified chemical reactions with substances such as chlorine, ammonium, and heat from flammable materials stored in co-located facilities. The close proximity to the I-95 highway corridor, and Rhode Island’s level 1 trauma center present an additional risk to the critical infrastructure needed for responding to any potential disaster situation. With a medically-vulnerable population and a relatively high percentage of people who are linguistically-isolated in the adjacent community, considerations around communications in disaster preparedness and response should also be taken into consideration as part of the environmental assessment and/or a broader emergency/risk management review.”

Though she doesn’t use the term “environmental racism,” Dr. Alexander-Scott provides numbers making it impossible not to draw such a conclusion.

“Socioeconomically,” says Dr. Alexander-Scott, “the one mile buffer around the proposed facility is 75 percent minority population…, 56 percent low-income…, 17 percent linguistically isolated… and 31 percent have less than high school education.” (86th percentile for state). The combined socioeconomics for the neighborhoods of Upper and Lower South Providence and Washington Park are 82 percent minority population…, 64 percent low-income…, 24 percent linguistically isolated… and 33 percent have less than high school education.” She notes that “these socioeconomic statistics are of important public health interest as significant social determinants of health.”

“RIDOH,” says the director, “has ample data on poor health outcomes, elevated health risks, and racial and ethnic health disparities within the City of Providence and in particular within the neighborhoods of Upper and Lower South Providence and Washington Park, which are in closest proximity to the proposed project. RIDOH’s 2014 Asthma Claims Data Report used health insurance claims data to produce detailed hot spot maps for asthma prevalence, emergency department visits, and hospitalizations, which all show asthma hot spots and elevated asthma risk in this focus area, at some of the highest levels in the state. Providence has the highest asthma-related pediatric hospitalization rates in the state, and asthma is elevated in low-income individuals and Black/African American and Hispanic/Latino communities.”

It seems that the efforts of National Grid, in building this facility, stand in direct opposition to the Department of Health’s mission to improve health outcomes in at risk neighborhoods.

“RIDOH is funding 11 Rhode Island non-profit organizations and local governments at various levels to support innovative approaches to improving health outcomes,” says the director. “The Department of Health and these grantees have created Health Equity Zones – defined geographic areas where high rates of obesity, illness, injury, chronic disease or other adverse health outcomes will be improved by coordinated strategies to reduce and manage chronic diseases, promote healthy lifestyles, improve birth outcomes, assure healthy child development, and create environments where healthy choices are easier to make. It is the vision of the Department of Health, that communities are engaged in democracy and committed to equality and diversity. Through these Health Equity Zones we will create and maintain sustainable and healthy places for all Rhode Islanders to live, work, and learn. It is imperative that alterations to the community’s landscape by other sectors does not impede the progress being achieved by such initiatives.”

Ironically, the build up of LNG infrastructure in Rhode Island will contribute to climate disaster, yet the location of the proposed liquefaction facility is at risk from sea level rise caused by climate change. Dr. Alexander-Scott doesn’t explicitly touch on this irony, but says, “Other environmental factors that are worth considering in the scope of the review include coastal flooding, both current and future levels given projected sea level rise, as well as potential storm surge and wind impacts. The effects of climate change on this project and therefore long-term population health is a necessary, additional component of the current environmental review.”

You can read the full letter from Dr. Alexander-Scott here.

September 12, 2015

Food on the Move brings healthy produce to underserved RI communities

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Food on the Move is a new program that brings fresh produce into underserved communities and doubles the value of SNAP benefits for fresh produce. Right now this is the only mobile produce program in the country.

The federal government is watching with “keen interest,” says Amy Nunn. She and Gemma Gorham are program directors of this new way to bring good food to poor people.

Senator Jack Reed, who secured the initial $100,000 investment in the program, said it is based on very sophisticated academic research showing that bringing fresh produce into communities increases healthy eating.

Reed too hopes Food on the Move, “will be a model for programs across the country.”

And Rhode Island is the perfect testing ground. “Fifteen percent of Rhode islanders experience food insecurity,” said Nunn. “The highest rate in New England.”

“How long someone lives should not depend on the zip code they come from” said Nicole Alexander-Scott, executive director of Rhode Island Department of Health. She said 85 percent of those making under $50,000 a year do not eat the recommended servings of fruits and vegetables per day. This program is one way “we are going to [impact] social and environmental determinants of health.”

Towards the end of the presentation Dr. Nunn pointed out that many people only get a small amount of money in their SNAP benefits, and that Food on the Move might not reach them until the second or third week of the month. She hopes that many people will be able to hold onto some of their SNAP money until they can reach a Food on the Move location and double the impact of the benefits.

2015-09-11 Food on the Move 015 Amy Nunn — Amy Nunn

February 25, 2015February 26, 2015

Experts agree: Criminalizing HIV transmission a ‘backwards step’

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If freshman legislator Robert Nardolillo accomplished anything with the introduction of legislation that seeks to criminalize the transmission of HIV, it was to demonstrate the hard won strength and unity of the LGBTQ and medical community in resisting a return to the ignorance, fear and stigma attached to the disease in the 1980s.

Though Nardolillo, in presenting his bill to the House Judiciary Committee claims to have done research on the issue, it became immediately obvious that he had not talked to any of the assembled experts in public health policy in the room last night. If anything, it looks like Nardolillo’s research amounted to little more than copying section 44-29-140 of a draconian and unhelpful South Carolina law passed in 1988, at the height of AIDS hysteria in the United States.

Nardolillo, who did not respond to my request to answer questions before the hearings, did speak to Zack Ford at ThinkProgress and when confronted with studies demonstrating the dangers of this kind of legislation, showed himself to be impervious to reason, saying,

‘Have I read the research? I did,’ Nardolillo confirmed, saying that he still felt that HIV was too serious not to prosecute in a distinct way.

Stephen Hourahan, Executive Director of AIDS Project RI strongly disagreed. The legislation’s passage, said Hourahan, “would mark a backwards step” in dealing with HIV. Since the bill criminalizes knowingly transmitting HIV, the bill will, “privilege the ignorance of not knowing your status.” We don’t want the mantra to be, “Take the test and risk arrest,” said Hourhan, adding that such a bill would create a “viral underclass” and should be opposed by all.

Paul Fitzgerald, executive director AIDS Care Ocean State, echoed Hourahan’s comments, adding, “I don’t believe that it’s smart” to pass such a bill.

Anthony Maselli, a healthcare worker and LGBTQ activist, said that transmission of HIV with “malicious intent is improbable and rare.” The law, says Maselli, “adds insult to injury” and is “a slap in the face.” At the conclusion of his excellent testimony, Maselli was greeted with applause from those crowded into the room.

Anthony DeRose, representing the Rhode Island Democratic Party LGBTQ Caucus and the Young Democrats of Rhode Island pointed out that as a country, we are in the process of rolling back similar laws. Laws such as the one Nardolillo introduced, said DeRose, are “outdated.”

Dr. Amy Nunn of Brown University, who I featured in a piece back in December during a State House event held for World AIDS Day, said that passage of such a law would set back decades of work here in Rhode Island. She called Dr. Michael Fine of the Rhode Island Department of Health a visionary for suggesting that Rhode island might be the first state to eliminate HIV transmission through sound public policy.

Rounding out the night’s testimony was Miriam Hospital’s Kristen Pfeiffer, chair of the RI HIV Prevention Coalition and Ben Klein, a Senior Attorney at Gay & Lesbian Advocates & Defenders. Both were vociferous and forceful in firmly opposing the legislation.

In the face of such strong opposition, it seems extremely unlikely that this legislation will advance out of committee.