NAP- Neighborhood Alliance of Pawtucket

Summit Neighborhood Association-in Providence

SNA borders Woodlawn and OakHill

They do some great things that help us and their Summit area of Providence, like Miriam Hospital and Hope and Main Streets, but also are working with us on joint crime, traffic and Joint Signing of the areas. They can be reached by mail at Box 41092 Providence, RI 02940.

They had some Healthy Objections to Expand Miriam Hosp

Sixteen provisions that state that each project shall be evaluated with its effect on the overall cost of health care in Rhode Island and for a good match with state health plans and other comprehensive approaches to the allocation of health care dollars.

These provisions clearly ask you to consider the big picture as it relates to any large capital health care project, and clearly labels you as one of the tools of the State of Rhode Island to hold down the cost of health care.
Given that you are to be among the stalwarts helping keep health care affordable, I would like to make sure that the context of the affordability of health care in Rhode Island is a part of your decision on the application by The Miriam Hospital.

I am going to start with just a few numbers. The first is that by any measure the United States has the most expensive health care system in the world. We spend more total, more per person, and a greater percentage of our Gross Domestic Product (GDP) on health care than any other nation on the planet. Unfortunately the World Health Organization in its most recent rankings rated health care delivery in the United States 37th in the world. We are behind the other western industrial counties in terms of life expectancy, infant mortality, and access to health care. More than 40 million Americans at any one time are uninsured whereas all of the other industrialized countries cover everyone. Costs more, covers less, what a formula.

Right now the percentage of US GDP going to health care is approximately 14%. And health care spending is growing about 3 times as fast as the overall growth in GDP, (8.5% to 3.2% in 2003, growth in health care spending grew more than 10% in each of the previous 3 years)meaning that as a percentage of the economy health care is a growing sector.

That health care takes up more and more of our money is readily apparent to anyone who reads the news. Everyone is struggling with the cost of health care, while the health care industry continues to scream for an ever bigger cut of the pie. One has to conclude that most of the community would not be screaming unless the ever bigger cut of the pie going to the health care industry was damaging large sectors of the economy and /or adversely effecting communities. Clearly the rapid rise in health care costs is a major factor in the troubles we are having with the state budget and every labor negotiation in the country. It is a serious drain on small business.

There is no magic wand to wave that says health care spending will rise 10% this year or that we shall be able to hold costs steady. The rise in costs is the result of a combination of factors such as the development of new technologies and the profit margins of the pharmaceutical companies as well as the actions and individual decisions by health care providers. But one factor clearly is the delivery of new services and the bricks and mortar needed to deliver them. Hospital expansion spending is growing at about 11% per year, pretty much the average for the health care industry as a whole, and any time series of pictures of The Miriam Hospital would show that Miriam has done its share of expanding infrastructure.

To me it is then clear that this expansion request by the Miriam is just the Summit Neighborhood¹s microcosm of the rising cost of health care. The rising costs that are swamping the country are not only swamping the finances of the people of the Summit Neighborhood, but also swamping the neighborhood. Miriam is just one of the thousands of individual decisions that add up to an overall disaster that is playing out in Congress, on Smith Hill, and in every neighborhood adjacent to health care facilities in the country.

You have before you a 20 something million dollar plan, but in reality it is part of a 120 million dollar plan, the plan The Miriam showed the folks in the Summit Neighborhood on March 23 when they had on the screen prices ranging from $114 million to $122 million. Right there is part of the problem. Expansions are presented to the health services council in pieces rather than as a whole. There appears to be no way to take into account the cumulative impact or total cost. No wonder so few proposals get turned down. If everything is looked at in a vacuum almost anything can be justified. Especially when those minding the overall cost store seem to be missing the boat and the map that is needed to get straightened out, the State Health Care Plan, is horribly out of date .

We have also seen how the health industry public relations machine cranks up and adds to the pressure to funnel ever greater amounts of money into the health care industry even as we struggle with the overall costs. Senator Celona is the recent poster boy for how that all works, but mayors and governors are always talking about how the health care industry is one of the industries they want leading our economic revitalization without any recognition that this is exactly what is costing all of us on the other end with rising insurance costs and struggling neighborhoods, even if the outrageous burden of rising costs are the topic of the press conference the day after touting an expanding health care industry.

How could a $120 million dollar expansion not effect the overall health care bill of RI and not contribute to rising costs at a time when we are already struggling with these costs. If Miriam serves the 1 million people in RI, then $120 million prorated over the 40,000 covered by family health care benefits for state workers is at least an extra $5 million dollars the taxpayers have to cover. And I do not care if it is raised through charity, grants, the cost of services, or any government program, it is still directly paid by people and is money that could go elsewhere in the economy except that it is being funneled into a bigger slice of the economic pie for the health care industry and higher health care costs.

Now if we had an open forum and the people of RI voted to increase health care spending 10% every year then those of us in the way of Miriam¹s expansion might have to accede to their wishes, but short of a vote, and short of an open and fair process, there is nothing going on in my community, or any other, that says the people approve of the health care industry sucking in resources at the current rate, especially when one of the results is fewer and fewer people each year having access to services that cost more and more. Somehow it crosses my mind that the current system where parties with a vested interest constantly lobby for more money is why it is harder and harder for the working poor to get access to health care and why neighborhoods are having such a hard time reining in the growth of the institutions on their door steps.

So lets get back to The Miriam. Clearly their expansion is being driven by exactly the same factors driving hospital expansion everywhere, and actually is one of the thousands of individual decisions passed off as rational all over the country that added together create the crisis. The extra $5 million that the expansion of the Miriam will add to the costs of health care for the 15,000 state workers does not break the bank. But it could if we think about the cost of health care for the rest of Rhode Island¹s million people a hundred million here, $50 million there add up to real money. And when it is added to the individually semi rational expansion (despite the overall lack of a plan) at every other health care institution in the state, or the country, it clearly creates a major headache and a huge hole in the pocketbook.

So we are clearly on the horns of a dilemma. Using the very traditional way of looking at this expansion it might make sense. Old facilities, out of date machines, an aging population are the traditional measures. But in an age of skyrocketing health care costs, looking at it as symptomatic of an out of control system eating a bigger and bigger share of the economy, putting stresses on all other parts of the system, makes much more sense. And given the history of the Miriam in our neighborhood is it any wonder that those of us who live nearby look at this as a behemoth about to eat the Summit. History says that all levels of government have traditionally backed the industry and have not protected us from this black hole. We ask you to do your job, but sometimes we think the fix is in.

Recently a number of people in the Summit neighborhood, including our elected officials, have come together around the concept of a right sized hospital. In other words careful study, real planning and actual community dialogue, not the sham process put into place as a reaction to strong community opposition, might help us negotiate the proper role of The Miriam in our neighborhood and end the constant struggle. We believe that strong residential neighborhoods are at least as important to Providence and Rhode Island as expanding health care facilities that have been in the wrong place for 50 years. Can you help us create a real dialogue instead of a sham one? Only if you are willing to reject inappropriate excessive growth.

I have one last concept to bring to you before I wrap up, the concept of personal responsibility. I am a member of the Green party, and we have a list of values that orients our politics. These include democracy, non violence, justice and ecological wisdom. One of the others is personal responsibility, the willingness to take responsibility for doing the right thing. At a recent public meeting I asked Dr Hittner and Mr Alan Gillstein, the chairman of Miriam¹s board, as to whether or not they, and the institution they represent, had any personal responsibility to help hold down the overall cost of health care in Rhode Island. They have to be aware of the budget crunch on Smith Hill, they have to know that more and more Rhode Islanders can not afford access to regular health care, that health care spending is out of control. But both Dr Hittner and Mr Gillstein told me that their only mission is to improve the Miriam, that the rest of what happens in Rhode Island is irrelevant to their fulfilling their mission, that they would take no personal or institutional responsibility for helping hold down the cost of health care. Since they will not, maybe you need to.

So you have in front of you a proposal that comes out of thinking that is antithetical to a part of your mission, to hold down the cost of health care. It may improve the work and bottom line for The Miriam Hospital, but its adverse effects on the the cost of health care, the rest of Rhode Island, and the community surrounding Miriam have not been noted or acknowledged in any way.

Therefore I ask the health services council to take a stand for holding down the cost of health care for Rhode Island, to help our neighborhood maintain its strength, and to start the health care industry on the road to a more rational relationship with the community and the country. Please reject this application.

Their crime watch survey

Neighbors of Hope Crime Watch Survey
In coordination with The Miriam Hospital Security Department, The Summit Neighborhood
Association, The Hope Street Merchants, and The Providence Police Department, residents living
in the Hope (Summit) neighborhood of Providence, RI are in the process of forming a
“Neighbors of Hope Crime Watch”.
This survey outlines the different levels of participation needed for the crime watch, and also
serves as a tool to gather information about what concerns residents of the neighborhood have
about crime in this area. Surveys can be completed and sent to Monica Anderson, Community
Relations at The Miriam Hospital 164 Summit Ave. Providence RI 02906. Surveys can also be
dropped off at the main desk of the hospital. Please complete all surveys by July 1, 2008.
Crime Watch Roles
Block Captain (highest level of participation)

Hosts a Neighborhood Watch Meeting

Visits homes, apartments, and businesses in her/his designated block area announcing the meeting
and encouraging others to participate.

Organizes activities on her/his block and assigns volunteers to assist with activities.

Acts as the “Block” base station captain where neighbors can pick up their volunteer assignments

Distributes crime prevention materials to neighbors on the block

Provides copies of meeting materials, schedules for volunteers, information on special events, etc.

Is familiar with Citizen observer and helps sign up neighbors and promote the program.
______ I am interested in being a Block Captain
Block Watcher (mid-level participation, bi-weekly involvement)

Acts as eyes and ears for their neighbors and reports suspicious activities

Is familiar with the crime prevention materials provided and helps distribute them as necessary

Cooperates and assists the Block Captain

Participates in promoting Citizens Observer

Rotates on the Crime Watch “patrol” if such a patrol is needed.
______ I am interested in being a Block Watcher
Other Volunteer (lower level of participation, approximately once a month)

Helps with fundraising and special events

Participates in any Crime Watch communications (i.e. emergency tree phone, Citizen Observer)

Recruits new volunteers into the program

Is familiar with the Crime Watch prevention materials
______ I am interested in being a volunteer at this level
Name ___________________________________Contact number ________________
Address_______________________________________Email __________________
Question: What do you think are the “crime” issues in the Hope (Summit) neighborhood,
please check any that apply, but circle the one issue that stands out the most?
___Property vandalism ___Break-ins ___Car Theft ___Disorderly conduct
Other: (please specify)_____________________________________________________
_______________________________________________________________________

Email us
sna@sna.providence.ri.us

SNA Website including Traffic Calming Plans

Summitt Neighborhood Association
Miriam Hospital Updates
Summit Crime Reports