Editorials from around New England

Editorials from around New England:

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MASSACHUSETTS

The Boston Globe

April 26

House lawmakers succeeded in gutting what would have been Massachusetts’s first serious attempt to control prescription drug prices, which if successful would save the state tens of millions of Medicaid dollars.

The state Senate, which will take up the budget rider later this spring, simply must do better.

House leaders caved in to a full-court press by the Massachusetts Biotechnology Council during last week’s budget debate on the House floor.

Now MassBio is surely an important part of the local economy, a point made during debate by House Majority Leader Ronald Mariano.

“All you have to do is take a ride through Kendall Square and look at the changes that have happened in the past 10 years,” Mariano said. “We want to make sure we don’t cripple this and allow research to continue without fear of collapsing or triple damage lawsuits.”

But at the end of the day, MassBio is just another special interest - one that certainly does good work - but one that is operating in its own self-interest, not that of the state’s taxpayers.

So here are a few inconvenient facts for lawmakers to consider in the wake of this House sellout:

? The Medicaid program makes up about 40 percent of the more than $42 billion state budget. That crowds out other priorities that are needed to keep the state competitive, like overdue transportation and education investments.

? In the past five years prescription drug prices for patients in that program have nearly doubled - from $1 billion a year to $1.9 billion. The introduction of new and more costly drugs - some costing as much as $1 million a year per patient - threaten to send the Medicaid budget even higher.

Earlier this year, Governor Charlie Baker filed as part of his budget bill a provision that would set up a negotiating process with drug companies with the goal of reducing prices. If in the end negotiations proved unsuccessful, disputes could be appealed to the state’s Health Policy Commission, which would include drug pricing disclosures, public hearings, and possibly a referral to the attorney general’s office under the state’s consumer protection laws.

The Baker administration insisted that only about 10 to 20 drugs would likely be at issue, but that their approach could save as much as $80 million a year.

The House Ways and Means version of the budget originally went for most of Baker’s proposal, cutting only the provision for a referral to the AG, and insisting it would save some $28 million a year. But that was before the campaign of fear of loathing launched by MassBio and its chief executive Bob Coughlin, a former member of the House.

The MassBio-drafted amendment was offered by Rep. Edward Coppinger (D-West Roxbury) and approved 152-3 in the House. It would now prohibit the Health Policy Commission from publishing what it believes the “fair” drug price to be. It also eliminates any explicit reference to authorizing the commission to hold public investigatory hearings or refer cases in which manufacturers do not comply with requests for information to the AG’s office.

In fact, it is a giant step backward - a giant step that puts Massachusetts far behind similar drug price disclosure and cost control efforts in Vermont, California, New York and Connecticut.

And while the industry has been good to and for Massachusetts, let’s not forget the state has also been generous to the industry. Lawmakers approved a 10-year, $1 billion investment in life sciences to be used for grants and tax breaks for the industry in 2008. It was renewed last year and signed into law by Baker, offering up another half a billion dollars over five years.

The real question now is whether the Senate is also inclined to roll over and play dead for MassBio lobbyists or whether President Karen Spilka meant what she said earlier this year about pursuing a new level of transparency in drug pricing.

It would be shameful for this state, which remains a trailblazer in fostering a thriving biotechnology industry, to remain a backwater in holding that same industry to account for its pricing policies.

Online: https://bit.ly/2V1EvnZ

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CONNECTICUT

The Day

April 24

Do we even need to say that housing and transportation must go together when planning for Connecticut’s future workforce?

Of course we do. This is a state of two-acre residential zoning that assumes at least one, usually two, maybe more vehicles parked in each driveway. On the other hand, it is a state of small and medium-sized cities with widely spaced bus routes that are useful only to people with no other options at all. Neither arrangement works efficiently for getting to work, job training or college classes, nor for highway congestion or public transit revenues. Too many drivers, but not enough rides and not enough riders.

Transportation is a major need and a major expense for working people. That is already true, no matter whether the state adopts highway tolls or not.

The Day welcomes Gov. Ned Lamont’s economic and jobs initiative to link new housing development in the state with easy access to transportation. His appointment of Stonington resident Lisa Tepper Bates to head it makes sense as well. She served as executive director of Mystic Area Shelter and Hospitality and as chief executive director of the Connecticut Coalition to End Homelessness. During her tenure there the state became one of the first two to effectively end homelessness among veterans and achieved a three-year decline in homeless residents. On the home finance side, Tepper Bates serves on the board of the Connecticut Housing Finance Authority.

A longtime Lamont supporter, she may have gotten the job while knowing less about transit than housing. However, the governor has had time to observe that Tepper Bates has proven herself effective in managing systems for basic human needs, including where to put the resources so they will be used. And there are people lined up to tell her what is needed, including participants in a federally funded regional study about future housing development. The study is in response to hiring at Electric Boat and to more sailors being stationed at the Naval Submarine Base in Groton in the future. Planners include the state Office of Military Affairs and the Southeastern Connecticut Council of Governments.

Tepper Bates told The Day that as senior coordinator for housing and transit-oriented development she will work with municipalities around the state. She said assistance could be technical, financial or of other kinds.

Housing with public transportation access means more options for low- and middle-wage earners, including access to training and to better-paying jobs. This is good for cities. Connecticut absolutely must support and develop its urban centers, which is where the growth is taking place in other states.

The Day urges Lamont, Tepper Bates, and those who work with them to consider these points:

. Define transit broadly: including trains, ferries, car pools, buses that carry bikes, and safe sidewalks. For a truly insightful plan, leave out no options, but be realistic about the numbers of people who can reasonably make use of each one.

. Collaborate with highway planners and port and harbor officials to investigate the potential for river ferries. A ferry run between Electric Boat and Norwich, for example, could meet up with buses to Northeastern Connecticut communities. A cross-river ferry between Groton and New London would lighten the load on the Gold Star Bridge.

. Undertake solutions to buttress or revise bus systems such as SEAT to make them a reasonable option. And it works both ways. If you build it, and make it affordable, they will come.

. Acknowledge the reluctance of many Connecticut drivers to pay tolls by giving them the option of reliable public transit. If the state enacts highway tolls, it will be up to the individual to compare the costs and the convenience, but it will provide a choice.

Lamont sees this initiative as a way to attract workers that will make them want to stay in Connecticut and reverse the much-decried exodus of young and productive people. The concept stands a fair chance of slowly but steadily reversing a downward trend, and who would not welcome that?

Online: https://bit.ly/2ZyY7OH

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MAINE

The Portland Press Herald

April 26

The question before the Legislature is, paper or plastic? And when it comes to the health of our planet, it’s not as simple as you think.

The Environment and Natural Resources Committee this week held a hearing on L.D. 1532. Sponsored by Rep. Holly Stover, D-Boothbay, the bill would ban single-use plastic bags at retailers across the state. It would also add at least a 5-cent fee for paper bags. A similar bill fell just short last year.

California, Hawaii and New York have passed plastic bag bans. Across the country, more than 200 cities and counties have enacted bans or placed fees on plastic bags, including 21 Maine municipalities. (A ban passed in Waterville last year, but the outcome is being disputed.)

Why? Plastic bags are a waste. Americans use about 100 billion of them a year, and though they are recyclable if returned to a retailer, most end up as trash. They fill up landfills, contaminate streams of recyclables and bust recycling machines. They float in our rivers, lakes and oceans. They litter roadsides, clog drains and kill wildlife.

In total, single-use bags make up 12 percent of total plastic waste in the U.S., and getting rid of them would be a boon to the environments and habitats they now soil.

But something would have to take their place - and that’s where it gets tricky.

One study of California’s ban found that it absolutely cut back on the use of plastic bags - the cities analyzed contributed 40 million fewer pounds of plastic to the waste stream.

But the sale of garbage bags - particularly smaller ones similar to grocery bags - increased too, as people looked for replacements to carry their lunch or pick up after their pets. Those bags are thicker than the ones given out in stores, so they add more per bag to the waste stream.

Use of paper bags took off as well, and paper waste went up by 80 million pounds.

If the planet’s health is the concern, then it makes sense to look at the carbon footprint of each bag as well. The answer may surprise you.

First off, reusable cotton tote bags, which take a lot of energy to manufacture, score out the worst; one study in the United Kingdom found you’d have to use a cotton bag 131 times to have it beat out a single-use plastic bag when it comes to carbon footprint.

You’d have to make at least four to 11 trips to the store with a reusable plastic bag and at least three trips with a paper bag before they were better on emissions than a single-use bag, studies have argued.

So while a ban would take single-use plastic bags out of the equation - off our roadsides, and out of our rivers and wildlife - it would not necessarily reduce overall waste or carbon emissions.

The economist behind the U.K. study favors a fee on plastic bags, which she says is enough to encourage the use of reusable bags while allowing others to still use the single-use bags where it makes sense.

Lawmakers should keep that in mind as they debate a ban. Our reliance on single-use plastic is a waste and a travesty, and a ban would get a significant amount of it out of the waste stream.

That would be a victory for the environment. But unless people replace those single-use bags with reusable ones - and actually reuse them - it would be an incomplete one.

Online: https://bit.ly/2IJAyxJ

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RHODE ISLAND

The Providence Journal

April 23

Gov. Gina Raimondo might be able to slide politically without doing anything. But somebody with power ought to care about the kids in Providence schools, and she decided to be the one.

On Tuesday, Ms. Raimondo announced she is calling on the Rhode Island Department of Education to commission a comprehensive review of the Providence Public School District, identifying its key challenges and the ways the state will seek to fix this broken system. She has done this in consultation with Mayor Jorge Elorza and new state Education Commissioner Angelica Infante-Green.

This seems a long-hoped-for sign the state will no longer accept the status quo.

For decades, we have decried the shameful performance of public schools in Rhode Island’s urban core. Young people, many of them members of minorities, have been poorly educated and effectively robbed of the American Dream. Changing this is the civil rights challenge of our time.

Rhode Island Comprehensive Assessment System tests released last fall laid open the disaster. Only 14 percent of Providence students were proficient in English, and only 10 percent in math. The district’s dropout rates are nearly twice the state average, and chronic absenteeism is a serious problem in middle and high school.

With Ms. Infante-Green coming on board and Providence in need of a new superintendent, the time is ripe for change.

“Rhode Island has an urgent need to improve schools and close achievement gaps across the state. Taking this hands-on approach in Providence is a necessary first step in working to improve outcomes and deliver high-quality education for all students in Providence,” Governor Raimondo said.

Students, teachers and staff “have been let down by the system. For Providence schools to see sustainable improvement there must be a new approach.”

Ms. Infante-Green, the daughter of Dominican immigrants, knows much about the American Dream and the potential for rising through education and hard work.

“I have dedicated my career to fighting for better outcomes and more equitable access to opportunities for young people. That’s exactly what the students and families of Providence deserve,” she said Tuesday.

The idea is not for the state to take over operation of the city’s schools. But it appears that it will lean heavily on them, as it should.

Reform will not be easy. Vested interests may be wary of doing things differently. Ms. Infante-Green promised to listen to everyone.

“Improving Providence schools in a meaningful way is going to take all of us working together with the best interests of students at the center of everything we do,” she said.

True enough. Leadership will require a strong vision and the ability to motivate others to share that vision. But courage and persistence will also be essential, and those who love this state will have to support serious reform when the going gets rough.

We know what is possible. Achievement First in Providence, a public charter school championed by former Mayor Angel Taveras, serves many poor, minority and immigrant children. Its students outperformed many of those in the Rhode Island’s wealthiest suburbs in the RICAS tests. Failure is not the only option in Providence.

We are encouraged by Governor Raimondo’s announcement. It is long past time Rhode Island got serious about improving public education, particularly for the capital city’s neglected students.

Online: https://bit.ly/2UTihEv

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VERMONT

The Caledonian Record

April 24

Last week Robin Smith wrote an article highlighting a bill that would provide mental health benefits to treat post-traumatic stress disorder for Vermont social workers dealing with a surge of child abuse, neglect and abandonment.

H.335 was inspired by a case “in the Newport area after a landlord complained repeatedly to DCF, asking a caseworker to remove children from a filthy apartment where a refrigerator had broken down and food was decomposing in the kitchen.

According to the callers, “a DCF person who took their complaints wanted to know if there was feces on the floor of the apartment in question.”

The landlords “were appalled that was the only standard for unacceptable conditions.”

The suffering endured by some of the kids in our midst would blow most of us away. They stay hidden - and very often unprotected - thanks to Vermont’s endless litany of exemptions to open government laws.

We’re reminded of a story we published in 2014 about a longtime Guardian Ad Litem who resigned in disgust over the DCF’s “Horribly Broken System.”

The story was about Kenn Stransky, a Guardian Ad Litem in Vermont for 17 years. Frustrated with the Department of Children and Families, he resigned his position as an independent voice on behalf of children who can’t speak for themselves.

He told readers that Vermont’s Department of Children and Families has become a rogue bureaucratic agency. Stransky said rules regarding confidentiality prevent all parties from receiving essential information and also prevent the public from being aware of how their tax dollars are spent. He said DCF willfully disregards the views of attorneys or guardians ad litem (GAL), and family court judges too frequently work from inadequate information. Because the public - and even other government agencies - are entirely shut out from the system, there is zero oversight and even less accountability.

DCF commissioner Ken Schatz (then and now) said confidentiality rules are intended to protect children from the stigma associated with being abused. We can’t help but wonder if two-year-old Dezirae Sheldon was more worried about her reputation or her life when DCF returned her to her drug-addicted mother a year after Mommy Dearest was convicted of child abuse and shortly after her two tiny little broken legs healed. Shortly thereafter Dezirae died of blunt force trauma to her head when the stepdad, Dennis Duby, smashed her skull.

Would impervious social workers have been in such a yank to get Desirae home and close her case file if the public was aware of the torture she had already endured?

Or what about 15-month-old Peighton Geraw who died in the same year of “trauma to the head and neck.” Her death was ruled a homicide by medical staff at Fletcher Allen Health Care. After that murder, the Burlington Free Press reported that a Department of Child and Families caseworker, who has authority to remove children from dangerous situations, visited Geraw less than one hour before the Winooski toddler died.

“The DCF worker, John Salter, reported he saw Peighton Geraw sleeping in a crib and he observed bruises to the child’s neck,” according to the Free Press. “Salter left after viewing the baby and speaking with the child’s mother, Nytosha LaForce, 28, and her boyfriend, Tyler Chicoine, 24.”

Salter’s visit, “triggered by a call from a medical staffer at Fletcher Allen Health Care two days earlier,” ended at 1 p.m. Geraw was declared dead at 2:06 p.m. An autopsy revealed the child suffered “a closed head injury, multiple contusion on the top of the head and had a healing leg fracture.”

Rep. David Yacovone - then the head of DCF - insisted that his department wasn’t to blame in either death. Sometimes bad things just happen, Yacovone explained.

But Stransky told us that everyone involved in the system hides behind a veil of confidentiality.

That sentiment was echoed by longtime Essex County prosecutor and former state senator Vince Illuzzi. “In an effort to protect the child, we really protect everybody else,” Illuzzi said. “You only find out about it when there is a tragic consequence that makes it public.”

And for every one of those, there are untold dozens that don’t make the news because of confidentiality rules. Even when the system is “working,” we think the public has a right to know when the state forcibly removes a child from a private home. It’s too invasive an action, taken by an agency funded by the people, to be allowed without the public’s knowledge.

In our 2014 report, “Both Stransky and Illuzzi brought up a case involving shaken baby syndrome which resulted in the baby, who is now about six months old, being left comatose. All adults present said they were innocent, and no criminal charges were filed, Stransky said.

“In those cases, if the child lives, even after suffering permanent damage, and parents are not charged with crimes, the public will never know about it, Illuzzi said.

“People who abuse children shouldn’t be able to hide, Stransky said. He suggested working with the media to cover cases to address the parents’ criminality but with the caveat that reporters will not photograph or identify the child.”

But secrecy isn’t just the rule for outsiders trying to look in. The Citizens’ Advisory Report on the DCF found widespread misperceptions from DCF employees on the ground about the need to reunify families “at all costs.”

When asked for the training and education of those same front-line social workers, the Citizens’ Advisory panel was told the information wasn’t available.

The panel also confirmed all of Stransky and Illuzzi’ observations that little - if any - information is shared between DCF workers and others (police, corrections, medical workers, guardian ad litems, attorneys, other caregivers) inside the system. Case notes and follow-up were incomplete, as was supervision and inquiry “by all child protection system players.”

The Citizens’ Advisory panel made pages, upon pages of recommendations, including this one - “Confidentiality issues and barriers to information sharing should be reviewed to ensure that all parties who need to share information regarding child safety may do so. 33VSA4917 should be reviewed to determine whether it adequately addresses balancing confidentiality concerns with the need for members of child protective services agencies to adequately address concerns of child safety through the open exchange of information.”

As far as we know, there’s still zero transparency - ergo accountability - in the system.

With a record number of cases, constant turnover of social workers, and a bureaucratic malaise throughout the system, we’d venture to guess that gruesome cases persist.

We don’t dismiss for a moment the herculean challenges faced by DCF. Nor do we begrudge the front line workers a little emotional support along the way.

But we’d like to think the $2+ billion that Vermonters invest annually in human services also buys the requisite support needed by our thousands of helpless, abused and neglected kids. That hasn’t been the rule.

Meanwhile, PTSD training or not. Until the Legislature opens up the door a crack, to allow for public oversight, the department will remain wholly unaccountable. And the outcomes will remain tragic.

Online: https://bit.ly/2L76wWJ

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NEW HAMPSHIRE

Valley News

April 24

When Marianne Williamson, self-help author and Democratic presidential aspirant, visited Headrest last week, she attributed the nation’s opioid addiction crisis to greed by pharmaceutical companies, health care providers and pharmacies, abetted by lax federal regulation. As staff writer Tim Camerato reported, the substance-abuse recovery experts at the Lebanon-based nonprofit demurred. While the desire for ill-gotten gains are partially to blame, they said, society was also calling for drugs to better manage pain and doctors were often misinformed about the effects of opioids.

It’s certainly true that man-made catastrophes rarely have a single cause, but recent litigation and criminal prosecutions pending in courtrooms across the nation bolster the case that Williamson was arguing: that the addiction crisis is profit-driven.

At the provider end, on the same day that Williamson visited Headrest, federal indictments were unsealed charging 60 people, including 31 doctors, seven pharmacists and eight nurses, with various schemes to illegally peddle pain pills in exchange for cash and, in some cases, sex. According to an assistant U.S. attorney general, the cases involved about 350,000 opioid prescriptions totaling more than 32 million pills. That, he said, is “the equivalent of a dose of opioids for every man, woman and child” in the five states combined where the schemes were operated - Ohio, Kentucky, Tennessee, Alabama and West Virginia.

At the middleman level, The New York Times reported earlier this week that the attorneys general of New York, Washington state and Vermont have brought new civil suits accusing drug distributors of devising schemes to evade federal regulation, helping some pharmacies increase or get around limits on the amount of opioids they were allowed to buy and tipping off others that they were at risk of being reported to the federal Drug Enforcement Administration. The companies deny the allegations.

Consider that combined, the three major players in the field control 90 percent of the distribution market for drugs and medical supplies. One of them, McKesson, reached an agreement in 2017 with the Justice Department to settle allegations that it failed to meet its legal obligation to monitor and report suspicious orders of opioids. If you doubt that the business is lucrative, consider that the $150 million it agreed to pay the government is less than the $159 million retirement package it bestowed on its longtime chief executive when he left in 2013. (After a public outcry, the package was reduced to a tidy $114 million.)

At the producer end, lawsuits filed by the attorneys general of Massachusetts and New York have highlighted the role of the Sackler family and the company it controls, Purdue Pharma. According to the Times, the filings cite documents that allegedly demonstrate that the family continued to push hard to expand the market for its highly lucrative and highly addictive signature drug, OxyContin, and other opioids years after it had pleaded guilty in 2007 to a felony involving fraudulent marketing of OxyContin and paid more than $600 million in criminal and civil penalties. The filings also allege that as the opioid crisis deepened, the family recognized a new business opportunity in developing opioid-addiction treatment drugs to counter the problem the company had helped to create, profiting at both ends of the funnel. Both the Sacklers and the company deny the allegations.

The filings also shed light on the causes of the crisis highlighted by the Headrest staffers in their meeting with Williamson. According to the Times, they detail how the pharmaceutical industry undertook a concerted effort to reshape public perception of pain and to undercut physicians’ reluctance to prescribe opioids by downplaying the risks of addiction and raising the specter of an epidemic of untreated pain affecting 100 million Americans. And sales representatives focused their marketing efforts in part on inexperienced providers and primary care physicians who knew little about pain management, according to the suits.

We do not hold that the love of money is the root of all evil. But 200,000 Americans have died of overdoses related to prescription opioids since OxyContin came on the market in 1996. Much evidence suggests that the pursuit of profit is heavily implicated in that appalling death toll.

Online: https://bit.ly/2UL2q5P