First Neighborhood Health Station breaks ground in Central Falls


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Dr. Michael Fine

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.

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“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.

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Department of Health hears testimony on Burrillville power plant


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Burrillville 45The 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.

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Sierra Club seeks clarification from Elorza on LNG statement


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2016-06-08 NO LNG 003The Rhode Island Sierra Club has responded to Mayor Jorge Elorza‘s statement on National Grid‘s proposed liquefaction project for Field’s Point in the Port of Providence.

“The Rhode Island Sierra Club is glad the Mayor has publicly agreed to not offer any subsidies to National Grid related to the LNG liquefaction project in Fields Point. We would however urge him to clarify whether his definition of subsidy also includes Tax Stabilization Agreements and if it doesn’t, we would would ask him to take the same strong stance against those type of subsidies and end TSA negotiations immediately.

“While Elorza is correct in saying the decision will ultimately be made by FERC, we would argue his assertion, ‘the city will have little input into that decision’ is false. The mayor can’t abdicate his responsibility on this. Local officials can be hugely influential on Federal decisions. An outcry from public officials immensely helped in 2005 when a similar project was ultimately denied.  Not sending in a letter, like the one nine Providence legislators sent to FERC last week, is a statement and a betrayal of his rhetoric on climate change.

“At the absolute minimum, we would ask the mayor to join the thousands of residents, and many businesses, environmental, community and religious organizations in signing the NoLNGinPVD campaign’s petition letter to FERC.

“The mayor also needs to hold the City Council accountable and ask them to follow through on their resolution to provide wide-scale public involvement, on which no action has been taken.   They resolved to host meetings between National Grid, Dept. of Health, DEM, Coastal Resource Management Corporation and city residents, and city residents deserve nothing less.”

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Invenergy power plant facing water problems


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2016-07-19 Burrillville MTBE Site Visit 009Invenergy’s proposed $700 million fracked gas and diesel oil burning power plant in Burrillville is running into some water problems. The Pascoag Utility District, at a special meeting called by board chair Al Palmisciano for August 19, will decide for or against allowing Invenergy to access well 3A, which is closed by court order due to MTBE contamination.

A decision in Invenergy’s favor is by no means certain. In fact, Invenergy already seems to be searching for other options. On August 9 the Harrisville Fire District is taking up Invenergy’s, “inquiry as to whether and under what conditions Harrisville would be willing to consider developing and constructing a well and distribution means to supply water to the power plant at Invenergy’s expense.” Invenergy is also asking Harrisville to “authorize such additional pump and water testing and legal research as is necessary to determine the yield, viability and estimated cost of developing a well on the Victory Highway site and constructing an appropriate means of distribution at Invenergy’s expense.”

The Harrisville meeting is taking place at a time that overlaps with the RI Department of Health (RIDOH)’s public commentary hearing at the Burrillville High School, part of the Energy Facilities Siting Board (EFSB)’s process of determining the fate of the power plant. This will have the effect of dividing the potential audience, but over the last few weeks water has become a very big issue in northern Rhode Island because the area is experiencing a severe drought, with rainfall five inches below average.

Aquifers and wells are feeling the effect of the lack of rainfall. Invenergy plans to use an average of 100,000 gallons of water a day to cool their plant, and almost a million gallons a day when burning oil. This is in addition to the 4 million gallons of water used to cool Burillville’s existing power plant, Ocean State Power. This strain on the area’s water supply may be lead to even more severe water shortages in the area. At the very least, it will forestall the possibility of future growth in the area.

Even if both Harrisville and Pascoag deny Invenergy their water, it doesn’t necessarily put an end to the company’s plans. Water could be imported from over state lines, and of course there is always the option used by Ocean State Power. According to a video by Paul Roselli of the Burrillville Land Trust and Burrillville resident Norman Derjarlais, the company seems to be trucking in the water from Western Sand & Gravel, a nearby superfund site, in leaking trucks. From 1975-1979 about 12 acres of this area was used for the disposal of liquid waste, including chemicals and septic waste.

You can watch the video below.

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Community speaks out to defend Memorial Hospital Birthing Center from closing


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Ana Novais, Nicole Alexander-Scott, Kenny Alston
Ana Novais, Nicole Alexander-Scott, Kenny Alston

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.”

Memorial Birthing Center Public Comment

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Community protests Care New England’s planned closure of Memorial Hospital Birthing Center


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2016-03-10 Memorial Birthing Center 010

Hundreds of people rallied outside Care New England offices in Providence this morning to demand that the Birthing Center at Memorial Hospital in Pawtucket stay open. Organized by the Coalition to Save Memorial Hospital Birthing Center, nurses, community members, mothers and “bucket babies” carried signs and were enthusiastically supported by passing motorists blaring their horns.

I spoke to Rita Brennan, a nurse at the Birthing Center and the president of UNAP Local 5082, representing the nurses there. Brennan says that the loss of the birthing center and the other units at the hospital Care New England plans to shut down will cost the state over 200 jobs.

Implementing the shut down and restructurings has been delayed due to the the intercession of the RI Department of Health (RIDOH), which pointed out that the closing was a breach of contract with the state.

RIDOH Director Nicole Alexander-Scott wrote, “Memorial Hospital is obligated to continue providing all existing services to patients. Memorial Hospital is not permitted, until the process is complete, to make any changes to the primary or emergency services currently offered, including maternal and delivery services.”

Next week there will be three public meetings to allow the public a chance to speak out on Care New England’s plan.

According to the Coalition, the dates, times, and locations of the public meetings organized by the Department of Health are:

March 14th: Goff Junior High School, 974 Newport Avenue, Pawtucket (use the Vine St. entrance); 5:00 PM to 7:00 PM

March 16th: Woodlawn Community Center, 210 West Avenue, Pawtucket; 11:00 AM to 1:00 PM

March 17th: Segue Institute for Learning, 325 Cowden Street, Central Falls (use the Hedley Ave. entrance); 4:00 PM to 6:00 PM

If you are unable to attend one of the public meetings in person, you can email comments to Paula.Pullano@health.ri.gov or mail them to: Rhode Island Department of Health, Center for Health Systems Policy and Regulation, 3 Capital Hill, Providence,RI 02908.

Comments will be accepted through March 25th. Comments can be submitted or shared anonymously. Although all comments from the public will be documented and considered carefully, the Department of Health will not be able to respond directly to any comments that are submitted or voiced.

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Rita Brennan

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


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2015-11-30 World AIDS Day 005 Nicole Alexander-Scott
Dr. Nicole Alexander Scott

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

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RIDOH Director Alexander-Scott weighs in on LNG in PVD


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2015-09-11 Food on the Move 013 Nicole Alexander Scott
Dr. Nicole Alexander-Scott, director of the Rhode Island Department of Health

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.

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Neighborhood Health Stations are better than cutting Medicaid


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NHS01Imagine a plan sitting at the RI Department of Health (RIDOH) that would reduce health care spending in Rhode Island by 15 to 30 percent. A plan with the added benefit of improving health care outcomes “with a cutting edge technology that brings every Rhode Islander into world class care – as they need it, where they need it, when they need it, in a way that builds community instead of building profit for others.”

Neighborhood Health Stations, developed by the RIDOH under the leadership of Dr. Michael Fine, is that plan.

Neighborhood Health Stations are “basically community hospitals without walls,” says Dr. Fine in conversation with Richard Asinof of ConvergenceRI. Dr. Fine planned to build one station for every 12,000 Rhode Islanders, between 75 and 100 such stations in all. The first one was to be built in Central Falls.

NHS02Neighborhood Health Stations would locate pediatricians, internists, family physicians, dentists, nurse practitioners, licensed and registered nurses, advanced practice nurses, physician assistants, mental health and social workers, physical therapists and occupational therapists, pharmacists, emergency medical technicians and paramedics, registered dietitians, home health workers, promotoras, health coaches, navigators and other healthcare workers under one roof, in a facility that would also offer programs such as “nutrition courses, Zumba classes, or group counseling sessions.”

According to Dr. Fine, if we implemented this plan, we could shrink the hospital system in our state. “When you build out the full delivery system of one neighborhood health station for every community of 12,000 people,” says Dr. Fine, “it is very likely that we can reduce the total number of hospital beds by 40 to 45 percent. That means dropping [the number of hospital beds in Rhode Island] by about 900 beds.”

Governor Gina Raimondo’s budget proposes cutting $88 million from Medicaid’s $2.7 billion in spending, a 3 to 6 percent reduction. Since “Reinventing Medicaid” is being presented as an answer to an imminent disaster, improving the quality of health care or paying adequate wages to health care workers is taking a back seat to saving money.

That’s a shame, because a fully realized health care system of the kind imagined by Dr. Fine would attract business and investment to Rhode Island, while draconian cuts in services to our most vulnerable will have the opposite effect. If we could build Neighborhood Health Stations and make them work, “then health care spending becomes a business magnet. People come and locate businesses here, just because of our health care,” says Dr. Fine.

It’s a great idea, but not one that’s likely to happen. Since Dr. Fine’s departure, Neighborhood Health Stations seem in jeopardy. The new head of the RIDOH, Dr. Nicole Alexander-Scott, has yet to comment on the plan. But a more immediate reason for the plan’s quiet demise can be intuited.

“…if I have had one failure [while serving as director of the R.I. Department of Health],” said Dr. Fine, “if I want to be self-critical, [it’s] that I haven’t made it clear enough to people that we don’t have a problem with insurance, the problem is insurance. That thinking, that insurance, as a financial mechanism, can impact health, is a fundamental, categorical mistake.”

Dr. Fine saw his Neighborhood Health Stations as saving money by cutting out for profit insurance companies, and actually reducing the size of hospitals. The Reinventing Medicaid working group is comprised of a diverse group of people, but for-profit insurers and health-care providers have a prominent seat at the table. Timothy Babineau, MD, president and CEO of Lifespan, Peter Andruszkiewicz, president and CEO of Blue Cross Blue Shield of RI and Helena Foulkes, executive vice president of CVS Health and president of CVS/pharmacy will ensure that their corporate, for-profit interests are protected.

To Dr. Fine, Neighborhood Health Stations are the future of health care. “…if we don’t do it, all we’re doing is perpetuating a costly infrastructure that doesn’t work.” An infrastructure that will remain immeasurably profitable to those sitting at the top of certain health care empires.

The “artwork was created by Roger Williams University students, in consultation with students at Rhode Island College School of Nursing, to illustrate how Neighborhood Health Stations could enhance well-being in Rhode Island communities.”

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