AG Neronha on health care, climate change, political power and the Washington Bridge

"We are already in a state of spectacular failure," said Attorney General Peter Neronha. "We just don't see it yet."

Rhode Island Attorney General Peter Neronha gave the keynote speech at the Unitarian Universalist Legislative Ministry of Rhode Island Semi-Annual Legislative Forum in East Greenwich on Sunday. The event was described as “a gathering of Rhode Island's state officers, leading legislators, special interest groups, news media and activist / citizens from across the state.”

The following is an edited transcript of his address:

“Before I became Attorney General. I was the United States Attorney here in Rhode Island during the Obama Administration. I begin there because, from my perspective, nothing has changed. I prosecuted a corruption case as an Assistant, United States Attorney in the early 2000s. The allegations were that a British corporation had conspired to bribe Rhode Island Speaker of the House John Harwood into allowing them to put more video slot machines in what is today known as Twin Rivers.

“It was quite the thing at the time. I mention it because one of the exhibits we introduced at the trial of the British executives that we had charged in federal court was an editorial in the Providence Journal that referenced John Harwood as “Ocean State Emperor” and nothing has changed. I would argue that we are, in this state, subjects of a benevolent dictatorship when it comes to legislation. It's not always benevolent from where I sit. When Nicholas Mattiello was Speaker, I didn't consider him to be benevolent at all. I found him to be difficult. He exercised power for power's sake.

“I think Joseph Shekarchi is a vastly different Speaker. He's willing to listen. He has taken responsibility in this state to move things forward - far more than the Governor. Frankly, he is far more interested than our current Governor [Daniel McKee] in moving the state forward.”

“I'll talk to you about healthcare because healthcare is the crisis on our doorstep that we are not paying enough attention to. For those of us who have an interest in social justice - When your health system fails, it fails for the poor and people of color first, not for those of us sitting in this room, sitting in this town. Healthcare is the number one challenge facing the State of Rhode Island.

“I'm going to give you just a couple of examples of why we've been in court for the last two weeks trying to make the owner of two safety net hospitals live up to their promises. Their promises, very simply, were to pay their bills. The hearings were not covered by any reporter in the state. Not a single reporter covered it. Those hearings this week and last week - do you know that the judge - for whom I have an enormous amount of respect - closed the courtroom?

“It's extraordinary in our democracy when a courtroom is closed. It was closed [to protect] the confidentiality, so-called, of the information of the hospital owner, the same hospital owner who wasn't paying his bills. It's a pretty simple rubric and yet it is incredibly important for this reason: The owner of those two hospitals doesn't care about healthcare. Roger Williams and Fatima Hospitals are social safety net hospitals. They're owned by a company in California that doesn't care about them and wants to close them. I believe, and I don't think anyone could dispute this, that had my office not taken a stand three years ago and forced those owners to put $80 million in an escrow account that we controlled and the owners only get back as they keep the hospitals open, the hospitals would already be closed. That company has closed hospitals all over this nation.

“What does it mean to have two hospitals like that in trouble? Some say that we don't need these hospitals. We have too many hospitals, we have too many beds. I would [counter] that those hospitals have 10% of all of the beds in the State of Rhode Island. They have at least 50 behavioral health beds that cannot be absorbed by Butler. The ward beds cannot be absorbed by Rhode Island Hospital and the Care New England system. I know this because I've spoken to them about it. Who won't get healthcare if those hospitals close? The poorest among us and people of color won't get their healthcare. Yet our motion for a preliminary injunction - to force this company to pay their bills - wasn't covered by a single reporter in the State of Rhode Island and you would know if they covered it because they wouldn't have been allowed in the courtroom and then you would have heard an outcry.

“We need to focus on healthcare now. What is it about those hospitals that has me so concerned? It's not just that they are in immediate danger of closing depending on how this hearing comes out, it's that even if they weren't owned, by at best a negligent owner, they would have a hard time making it right now in Rhode Island because of the way that we pay for healthcare and the mix of our patient population. Rhode Island has a 30% commercial payer patient pool and 70% using Medicare and Medicaid. It is almost impossible to run a healthcare system with that kind of dynamic when your Medicaid reimbursement rates and your commercial reimbursement rates are lower than those of your neighboring states.

“Whether or not these hospitals come out of the situation they're in over the next month or so - even if another owner buys them and the new owner is not investing in those hospitals - the new owner is going to have those hospitals take out debt that they will pay back out of their revenue stream. [But the hospitals] are having a hard time making it as it is. What is it about the current situation that should make us confident that they're going to succeed? There is no reason - unless we take dramatic steps - different from what we've done before. What does that mean?

“We can leverage our state Medicaid dollars to get more federal dollars. If we raise Medicaid reimbursement rates, it's $1.29 to a dollar. Every time we raise Medicaid rates by a dollar, every new dollar brings back $1.29 from the federal government. We're not leveraging our Medicaid reimbursements the way other states do. Why? Because we don't have the vision to do it. We need to do that. We must hold our commercial insurers to their promise to provide you with a doctor when you need one. How many of you need a primary care doctor but are having trouble finding one? Everyone who didn't raise their hand - hang on to your primary care doctor.

“That is the sign of a failing system. Those two hospitals and the current inability of most Rhode Islanders to find a primary care doctor is a sign of a failing system. When Blue Cross sells you an insurance policy, whether directly or through your employer, they are required. It's part of their promise to have a doctor who will see you and when they don't, they're contributing to our healthcare system failure.

“There are things we can do, but we need the leadership to do it. A report in 12 months, folks, is too late and too little. You're going to have some of your Senators and Representatives here this afternoon. They need to talk about healthcare all the time. This is not an insolvable, intractable problem. It's a difficult one, but what I worry about is that in our state government, far too often, difficult problems don't get addressed because they're too difficult.”

“We don't have [a climate change report card] in Rhode Island. My office is preparing one.”

“I could speak as long and with the same directness about climate change. We're going too slow in Rhode Island. The Boston Globe reported several months ago that Massachusetts gave itself a climate change report card for meeting its goals in its version of Act on Climate, [such as] how many heat pumps they had installed in the state and where they were going with electric vehicles. We don't have that in Rhode Island. My office is preparing one. If you're not realistic about what your goals are, if you don't set them, then you don't know whether you're making them or not, and you certainly don't know if you're kicking down the road any kind of accountability as to whether you're reaching them or not. I challenge you to find in state government a real assessment of how we're doing and I will tell you - you can't find one.”

“Somebody asked me about the bridge and I'll share with you that there was a lot of talk in the last few days about going after others for this fiasco.”

“When I was a United States attorney, we brought, on behalf of the people of the United States, an action against Cardi Corporation for failing to build the 195 bridge railing correctly. A woman hit the railing and almost went into the water. Cardi had cut the rebar when there was a mistake in the original construction, and then when they put it back together in a way that did not meet specifications - so the federal government didn't get something that they paid for, which was a railing that worked. That was the basis of the federal claim.

“All of the work according to Cardi, was done according to a sketch signed off on by DOT. Everyone mentioned the sketch. No one could find a copy of the sketch. Nobody remembered cutting the rebar. I thought maybe [the rebar was cut] in the afternoon but it took place over at least 30 days. Nobody remembered, including DOT, cutting the rebar.

“One of the questions about the Washington Bridge is whether anybody's going to sue the state for the damages caused by DOT for shutting this bridge down as opposed to getting it where it needed to be in the first place. Think about it. Some lawyer will eventually figure out that he can represent a class of individuals who have been damaged by this fiasco and sue the state.

“That's the real question we have to keep in the back of our minds as we're thinking about all these federal dollars that are going to come in. I guarantee you that the defense will be that whatever we did, DOT either authorized it or didn't act on something we told them. You can hold me to that. I'll come back in a year if you have another one of these not to speak, but for you to hold me accountable.”

“What I see, and I can talk about this at length, is a lack of leadership in state government to get us to where we need to go. Do you want some advice on how to drive change? Power is held in two principal places, Speaker of the House and Senate President, mostly Speaker of the House. It is not a coincidence that when Senator Mack holds a fundraiser lots of her supporters come out and she has a lot of them - they look a lot like mine when I was still doing them.

“They are more intimate affairs if you will, than the Crown Plaza Lalapalooza that you see when the Speaker has his fundraiser or the Senate President has his fundraiser. That tells you everything you need to know about how power works in Rhode Island.

“I want to make a plan. I have a very strong relationship with both the Senate President and the Speaker. I feel like we can talk about the things that concern one another and I am frankly gratified that the Senate President has raised his level of interest in healthcare, but we in Rhode Island are looking at things within four inches of the front of our face - and we need to do that because when we don't do that, people get hurt - but we also have to be thinking four feet in front of our face because if we don't, we're going to be in big trouble leave.”

“This will be my last thing. Some ER doctors at Brown invited me to speak to them about private equity in healthcare and it is one of the problems in healthcare. That's who we effectively have been fighting with when it comes to Roger Williams and Fatima over the last four or five years. But I shared with them the thoughts that I've shared with you because that's the state of play. What I said to them was that it is going to take spectacular failure. The bridge is a good metaphor for it, frankly. Before anyone pays attention to healthcare the way we need to, it's going to take a hospital closing out of the blue, the way this company closed the hospital outside of Philadelphia six months ago or so. It's going to take that kind of spectacular failure before we realize - a report in 12 months isn't good enough.

“You know what the ER doctors said to me? They said we're in spectacular failure right now.On the day I spoke to them they had 50 patients they were boarding, which meant they needed beds for these patients anywhere in the Lifespan system and they didn't have beds for 50 patients. Imagine your loved one needs to be admitted to the hospital for a stroke or heart attack and instead they're sitting in a bed in a hallway outside some emergency room. We are already in a state of spectacular failure. We just don't see it yet.”