After a small clinic’s worth of physicians showed up to testify in support of Gov. Dan McKee’s choice for the next director of the Rhode Island Department of Health, the Senate Committee on Health and Human Services affirmed its support for Dr. Jerome “Jerry” Larkin at a hearing Thursday.

The committee voted 5-1 in favor of Larkin’s nomination, with Sen. Elaine Morgan, a Hopkinton Republican, serving the only nay vote. 

Greg Paré, spokesperson for the Rhode Island Senate, said in an email Thursday that Larkin’s appointment will hit the Senate floor on Tuesday, May 19.

The clinicians, many of them colleagues and former protégés of Larkin, came to say nice things about the doctor who serves as medical director of inpatient infectious diseases consultation services at Rhode Island Hospital and teaches clinical medicine as a professor at Brown University. The committee’s mailbox had also been stuffed with written testimonies.    

“We got many, many letters,” said Sen. Joshua Miller, who chairs the committee. “I don’t remember seeing a letter that was not in support.”

But the most memorable affirmation may have been from Dr. Sabina Holland, medical director of the pediatric HIV clinic at Hasbro Children’s Hospital. 

“The highest compliment that a pediatrician can give another pediatrician is to entrust them with the care of their children,” Holland said. “He could have my children.” 

The crowd laughed. Chair Miller offered a playful retort. 

“He can’t have my children,” Miller said.

Jokes aside, Larkin’s competency with children was underlined in several testimonies — including those from members of the Tiverton School Committee, which Larkin has chaired since 2017. Larkin has served on the school committee since 2012 and was most recently reelected in 2020 with 31.1% of the vote.   

The afternoon’s first two testimonies came from school committee members, including Deborah Pallasch.

“I have known Dr. Larkin since he became involved in the anarchy that can be Tiveron politics,” Pallasch said. “In the middle of COVID, as the chair of our school committee — as you can imagine, quite a scary time for us, quite a scary time for our parents, quite a scary time for our children — he led us as a community through that so deftly and so patiently and so respectfully.”

Larkin, in his own words to the Senate, emphasized the at-time martial nature of municipal school politics. “As chair for the last seven years, I am the veteran of 12 hardball budget seasons — some of them scorched earth, some of them merely trench warfare,” Larkin said. “I believe if you can understand the budget of a small-to-medium-sized school district, you have a better-than-even chance of understanding the budget of the Pentagon.”

“The Pentagon might actually be easier, as it seems to be able to spend money unbudgeted, freely, without any apparent consequence.”

Priorities include stabilizing hospitals and nursing homes

The consistency of Larkin’s school board role contrasts the revolving door at the health department, a fixture of the McKee administration. The last permanent director, Dr. Nicole Alexander-Scott, worked under Gina Raimondo’s administration and led the department during the height of the COVID pandemic. Alexander-Scott was reappointed for another five years in 2020, but vacated the position in January 2022, less than a year into McKee’s governorship. 

That vacuum has been plugged by three interim directors since then: Dr. Jim McDonald, Dr. Utpala Bandy, and most recently Dr. Staci Fischer, who took over as acting director when Bandy retired on March 31. Statewide health directors are rare birds nationally, and regional directors are common in larger states. The compensation for such an encompassing job has been criticized for the turnover, although McKee recently and successfully raised the base salary to $250,000.  

Speaking to reporters, Larkin said that, if confirmed by the full Senate, his priorities would likely include the stabilization of hospitals and nursing homes, as well as responding to the opioid overdose crisis.

“But I’m still on the outside looking in,” Larkin said. 

Larkin was so far outside, in fact, that he was unsure how to assess the time demands of his possible new job. Would he continue serving on the school committee?

“I haven’t made a decision,” Larkin told a reporter. “Certainly, you know, the Department of Health is a full-time job but so is being a doctor.”

Judging by the afternoon’s testimonies, Larkin is a good clinician. His 1993 medical degree is from Robert Wood Johnson Medical School at the University of Medicine and Dentistry of New Jersey, and his research specialty is tick-related illnesses and Lyme disease in children and pregnant women.

Dr. Michael Koster pointed out Larkin’s talents as a “med-peds” physician, or someone who “understands pediatric issues as much as he understands adult medical issues.”

“You don’t get a showing of physicians like this,” Koster said, referring to the turnout for the hearing. “You have to earn it. It’s not something you can buy.”

While the public offered no opposition, the senate committee did have a few questions. Miller pointed out the statute that outlines the health director’s qualifications — a prescription which includes “a minimum of five (5) years full time experience in health administration.” Miller was curious how that requirement fit into Larkin’s experience.

“I think it depends,” Larkin began. “So, if you look at how much time do I spend seeing patients — so, everything I do is subsumed under the title of the director of infectious disease consults service. So in many regards, my clinical work is an administrative responsibility. I have to know how those services work.”

Larkin estimated that administrative duties probably comprise half his time currently. 

Sen. Linda Ujifusa, a Portsmouth Democrat, asked Larkin about the state’s shortage of primary care doctors as well as reimbursement rates. Could any initiatives from the health department help shape a more positive environment for Rhode Island’s doctors?

Larkin replied that neighboring Massachusetts and Connecticut are well known to have superior reimbursement rates, but that “rectifying that ultimately is actually a federal issue.”

“Would you mask our kids again?”

Morgan asked Larkin about the state’s handling of the pandemic. Larkin suggested looking at a map, and that Rhode Island ultimately “dodged a bullet” given the severity of the pandemic in nearby Massachusetts and New York. 

Morgan then narrowed her focus. “Closing down the state: Would you do that again?” she asked.

“Do I think the decision was right to shut down in March of 2020 at that time? Yes,” Larkin said.  “Could we have reopened faster? Probably. There was certainly a loss in school districts, and there’s certainly an economic impact on this. So that’s my sort of armchair general retrospective perspective on it.”

“Would you mask our kids again?” Morgan continued.

“Yes. Yes,” Larkin said, and pointed to the measure as effective in reducing transmission, allowing kids to get back in school sooner.

At 4 p.m., bells started ringing.

“It’s not a fire alarm,” Sen. Pam Lauria said. “It’s just the bells for the Senate.”

Miller used the literal sounding of the alarm as a backdrop for one more comment.

“And with that bell from the Senate, I just would like to ask you to be aware of a couple of issues that we have discussed in committee this session,” Miller said, and pointed to recent discussions involving scope of practice. Should committees in the General Assembly be tasked with regulating scopes of practice, or should that be left entirely to medical boards and the health department?

But rather than discuss “going down a very slippery slope of having scope of practice legislated,” Miller filed the question away for another day, and the motion for a vote on Larkin’s advancement began. Sen. Alana DiMario seconded the motion. Only Morgan voted no.  

Larkin’s own words to the committee were punctuated with the occasional cough.

“Excuse my voice. My allergies decided to start today,” Larkin said after he sat down in front of the mic, following odes from his colleagues. “Yeah, I guess that was the easy part. It’s the fondest wish of every Irishman to attend their own wake, and I feel like that’s what I’ve been doing this afternoon.”