Union-lead coalition urges rejection of constitutional convention
Union-lead coalition urges rejection of constitutional convention
By now you should have received the Rhode Island Secretary of State’s 2024 Voter Information Handbook, as it was mailed to all registered voters before early voting started on Oct. 16. The Handbook includes an “explanation and purpose” of Question 1: Shall there be a convention to amend or revise the Rhode Island Constitution?
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This ballot summary, paid for by taxpayers and written by a government official, is supposed to be objective. But it is biased against calling a convention because instead of merely explaining the question it takes the improper additional step of answering it by implying that a legislature can do anything a convention can at less cost and risk. It mimics three biases that convention opponents routinely make in their anti-convention advertising:
More: Taking sides: Where do RI leaders stand on constitutional convention question?
First, it doesn’t explain the unique democratic function of the periodic constitutional convention referendum in Rhode Island’s Constitution. Twenty-four American state constitutions provide the ballot initiative to allow the people to bypass the legislature. As an alternative legislature bypass mechanism adopted by 14 states, Rhode Island’s framers adopted the periodic constitutional convention referendum.
Accordingly, the ballot summary should have stated that the Rhode Island Constitution’s periodic convention referendum is the only way the people of Rhode Island can break the legislature’s monopoly gatekeeping power over constitutional amendment. The ballot summary also misleadingly implies that a convention’s − but not the legislature’s − constitutional amendment proposal power is unlimited, with the implication that such unlimited power is bad. But if a convention’s agenda could be limited by the legislature, it would be unable to fulfill its democratic function as a legislature bypass institution.
More: Hopes, fears and money go into campaigns for and against constitutional convention
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Second, it lacks a simple explanation of the three public votes that constitute the convention process: 1) whether to call a convention, 2) if called, to elect convention delegates to propose constitutional amendments, and 3) whether to approve or disapprove each of the convention’s proposed amendments. Its focus on the first two votes supports its implicit narrative that a convention is riskier and less democratic than a legislature.
Third, it only attempts to quantify a convention’s potential costs, thus not only excluding its potential benefits but also violating Rhode Island “law.” It is standard practice in public policy analysis to provide a cost-benefit analysis, so only providing costs is clearly biased. In a submission to the secretary of state, I suggested one way to quantify benefits: estimate the break-even point for the percentage of government waste a convention would have to reduce to match its costs. Given the Rhode Island State Government’s $14-billion annual budget and $140-billion budget between convention referendums, a convention that reduced state government waste by only .1% (such as by mandating an independent inspector general, which the legislature has refused to do), would have a payback of 29,200% using the SOS’s highest convention cost estimate, $4.8 million. And this, mind you, when the public thinks that state government wastes 42% of every dollar spent.
I don’t endorse estimating either benefits or costs in a ballot summary because doing so requires heroic assumptions inappropriate for such a summary. But given the SOS’s insistence on providing a cost estimate, he should have balanced it with a benefit estimate. Cutting out the biased cost estimate would also have been consistent with the 2014 legal advice provided to the SOS by a former Rhode Island Supreme Court justice and the SOS’s own legal counsel. They argued that only Rhode Island bond measures should have cost information in their explanation. But no practical mechanism exists to enforce this law, and a law without an effective remedy isn’t really a law.
Surveys indicate that voter information handbooks provide the most used and by implication influential voter information on so-called low-information ballot measures such as the convention referendum. It’s sad, then, to see the SOS so recklessly abuse this power, even if he is not the first Rhode Island SOS to do so.
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J.H. Snider is the editor of The Rhode Island State Constitutional Convention Clearinghouse and author of the video “Question 1 – Constitutional Convention.”
Four Rhode Island hospitals — Newport, Miriam, South County and Westerly — received top marks in the fall report from Leapfrog Group, a nonprofit that grades hospitals on safety.
The Washington, D.C.-based Leapfrog assigns hospitals letter grades based on data from the Centers for Medicare & Medicaid Services (CMS) as well as Leapfrog’s own surveys. Rhode Island’s hospitals didn’t perform much differently than they did in spring 2024 (The Miriam and Newport have consistently earned A’s the past two years), with two notable exceptions. Westerly’s A is its first since 2022. Landmark Medical Center in Woonsocket, which has received nine consecutive A grades, dropped to a B.
Kent Hospital and Rhode Island Hospital also received B grades. The embattled Our Lady of Fatima Hospital and Roger Williams Medical Center both earned C grades.
South County Hospital’s good report card was a boon to Dr. Kevin Charpentier, the vice president and chief medical officer at South County Health, the hospital’s parent company.
“It’s more than a score — it’s a promise to our community of prioritizing the highest level of patient care,” Charpentier wrote in an email.
The score was also a bit of good news amid an ongoing dispute between the hospital’s administration and its staff. A September letter sent by doctors and nurses to the South County Health’s board of trustees detailed escalating tensions between providers and management, with doctor resignations, service cuts and growing patient backlogs among the signatories’ concerns.
Landmark’s B left its CEO Mike Souza disappointed.
“We take quality very seriously and our team has already put plans in place to address the areas needing improvement,” Souza said in an emailed response to Rhode Island Current. “Our community will continue to receive great care and our expectation is that we will return to an ‘A’ grade in the near future.”
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Leapfrog aggregates 30 metrics to assess how well hospitals care for patients as well as prevent bad outcomes, like infections and falls. The grades are given to roughly 3,000 hospitals, not including VA hospitals or children’s hospitals. Hospitals that lack enough data for multiple metrics are also excluded.
Lisa P. Tomasso, senior vice president of the Hospital Association of Rhode Island, said via email that the trade group was pleased with the state’s performance. But she added that the grades, while insightful, are “not comprehensive, as they exclude factors like social determinants of health, community-level health challenges, and systemic issues like Medicaid reimbursement rates.”
But grades still hold value. Robert Hackey, a professor of health sciences at Providence College, said that “hospitals that don’t do well tend to poke holes in whatever rating methodology that’s used.”
“If you look at the hospitals in Rhode Island, for the most part, we’re performing very well,” Hackey said. “Yeah, we obviously have two low performers. It’s Fatima and Roger Williams. And there’s a common thread there. They’re both owned by Prospect and they’re both for-profit institutions, yeah. And they both struggle.”
A representative for CharterCARE Health Partners, the Rhode Island subsidiary for Prospect Medical Holdings, which owns Roger Williams Medical Center and Our Lady of Fatima Hospital, did not respond to requests for comment. Facing growing debt, Prospect has sought to unload many of the hospitals in its portfolio, including the two safety net hospitals in Rhode Island. A proposal to sell Roger Williams and Fatima to a new, nonprofit owner, received conditional approval from state regulators in June, but the status of financing required to complete the transaction is unclear.
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Hackey said it’s a bad sign when hospitals ignore questions on Leapfrog’s survey — something both Fatima and Roger Williams Medical Center did when it came to inquiries about nursing and leadership. Our Lady of Fatima Hospital’s ‘C’ grade is indicative of ongoing quality issues at Prospect Medical Holdings’ hospitals in Rhode Island, says Providence College Professor Robert Hackey. (Michael Salerno/Rhode Island Current)
Meanwhile hospitals owned by the state’s largest health care system — Brown University Health, formerly Lifespan Corporation — all performed well. Rhode Island Hospital, the state’s flagship hospital, received a B grade despite demonstrating below-average prevention rates of blood and urinary tract infections and falls causing broken hips, as well as less-than-stellar marks for hospital leadership and communication about medicines with patients.
Since 2021, Rhode Island Hospital has received C grades more often than not. The B is evidence that things are improving, said Dr. Dean Roye, senior vice president for medical affairs and chief medical officer at the hospital. The Leapfrog grades “help us pinpoint areas” to work on, Roye said. He added that a reorganization of quality and safety departments across Brown Health’s properties was another factor in Rhode Island Hospital’s improved grade.
But Hackey is eyeing another Brown property, the A-graded Miriam, for a surgery he has scheduled for December. He explained with a laugh that checking the Leapfrog ratings was one of the first things he did when deciding where to have his surgery.
“The goal of this is to have a more educated healthcare consumer,” he said.
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Above average results
Leapfrog uses the percentage of A grade hospitals in a state to determine a state’s national ranking. Almost 61% of Utah’s hospitals received A grades, giving it the top slot nationwide. The top 10 states all sported at least 40% A grade hospitals.
An A grade indicates hospitals that prioritize safety, said Alex Campione, program analyst for the Leapfrog Group, who noted that about 32% of hospitals nationwide achieved this grade. Rhode Island was over the national average with 44% of its hospitals receiving an A grade.
“Each year more than 250,000 people will die in hospitals due to preventable errors, injuries, accidents, and infections,” Campione said. “We estimate that, at the very least, 50,000 of those lives could be saved if all hospitals performed like A hospitals.”
Rhode Island placed fourth nationwide in Leapfrog’s spring 2024 scores, also with 44% at an A grade, but it was pushed out of the top five this time around by three states that rose with higher grades: California, North Carolina and Connecticut. Connecticut was the only other New England state to crack the top 10. Vermont fared worst of all, and was ranked 48th nationwide, tying for last place with North Dakota, South Dakota and Iowa. There was not a single A grade hospital in any of these states.
Grading the graders
But a bad report card might not be the final word on a hospital’s quality. A 2019 article in New England Journal of Medicine Catalyst graded the graders, and gave Leapfrog a C-, the second lowest of the four systems reviewed. The study noted that Leapfrog had a detailed framework for measurement, with a unique focus on the hospitals’ “culture of safety.” But it also relied on its proprietary survey for a good chunk of its data — a problem, the authors thought, since Leapfrog grades hospitals the same regardless of whether they complete the survey.
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Dr. Karl Bilimoria of the Indiana University School of Medicine, who chairs the school’s surgery department and leads its Surgical Outcomes and Quality Improvement Center, led the 2019 study. He wrote in an email Tuesday to Rhode Island Current that Leapfrog’s efforts still leave something to be desired.
“Leapfrog has many issues with their methodology and their general approach that persist and they have been the least receptive to improvement suggestions and the least adaptive to changes in the science of quality measurement,” Bilimoria wrote.
Asked about Bilimoria’s idea that Leapfrog is not responsive to suggestions, spokesperson Lula Hailesilassie said by email that the public is regularly invited to submit feedback on proposed changes to its surveys. Comments on the 2025 survey are open through Dec. 13, 2024.
PROVIDENCE — The application period for Rhode Island’s charter schools opened this week, giving families a shot at roughly 3,000 seats projected to be available at charter schools next year.
A blind lottery for available seats will be held on April 1. Charter schools are in high demand in Rhode Island, with roughly 11,000 families submitting 30,000 applications for 2,500 seats lasts year. (Families can apply for more than one school.)
There are about 13,000 Rhode Island public school students currently enrolled in 25 charters, some of which are larger networks with multiple schools.
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Despite the demand, teachers unions and other public school advocates have sought to block the expansion of charter schools, concerned they are financially hurting the traditional public school system. School funding follows each child from their home school district to the charter school.
In this week’s episode of the Rhode Island Report, Chiara Deltito-Sharrott from the Rhode Island League of Charter Schools talks about the future of charter schools in Rhode Island, and provides a rebuttal to comments made by Maribeth Calabro, the head of Rhode Island’s largest teachers union, in an episode earlier this month.
Steph Machado can be reached at steph.machado@globe.com. Follow her @StephMachado.
United Way of Rhode Island accepts initial donations from the Fund’s sponsoring energy companies. (courtesy: United Way of Rhode Island)
PROVIDENCE, R.I. (WLNE) — United Way of Rhode Island announced the Rhode Island Good Neighbor Energy Fund has begun for the 2024 through 2025 season.
The fund helps families that need assistance paying their home heating bills but are not eligible for federal or state assistance.
Since it was founded, the Good Neighbor Energy Fund has aided over 48,250 Rhode Island homes.
United RI says any local households in the state that are in need of funding assistance for energy are encouraged to contact a local Community Action Program agency, or to call the 211 helpline for help locating a CAP agency.
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GNEF eligibility is determined on total income not exceeding 300% of the federal poverty level, and provides up to $825 per household each heating season depending on eligibility, fuel type, and need.
United RI said in addition to sponsors, the fund relies on Rhode Islanders who donate through the “Warm Thy Neighbor” campaign.
Donations can be made through the yellow donation envelope enclosed with monthly energy bills, or by scanning the QR code on the envelope.
Additionally, donations can be given through phone by texting “WARM” to 91999.
For more information, visit United Way of Rhode Island’s website here.
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