Fall 2017

Fall 2017

Shadow transit agency

Shadow transit agency

When these three transportation policy wonks talk, the MBTA listens

PHOTOGRAPHS BY FRANK CURRAN

LOOKING AT THESE THREE GUYS, you wonder what they have in common. Marc Ebuña is a 30-year-old information technology worker who dresses fashionably, lives in Jamaica Plain, and sports a Fitbit. Ari Ofsevit is a 33-year-old graduate student studying engineering and city planning at MIT; he lives in Cambridge, bicycles nearly everywhere, and seems oblivious to fashion. Andy Monat is the grownup of the group, a 40-year-old software developer from Melrose who owns two cars and at press time was about to become a father.

What unites the three of them is a fascination with data and transportation. They have found a way, in their spare time, to advocate for change at the MBTA in a radically new way. Instead of testifying before the T’s Fiscal and Management Control Board or knocking on doors at the State House, Ofsevit, Monat, Ebuña, and a handful of other like-minded individuals from a group called TransitMatters make their case using analysis, logic, and data—usually the MBTA’s own data.

This loose confederation of self-described nerds, launched initially in 2009, has become almost a shadow transit agency. They don’t just advocate for pet projects and policies; they actually roll up their sleeves and dig into the data. That’s what sets them apart; they know what they’re talking about.

When the MBTA completed the design for a new Auburndale commuter rail station in Newton earlier this year, TransmitMatters gave it a failing grade. In a piece for CommonWealth, Monat wrote that the T was rebuilding the station in the worst possible way, by making it compliant with the Americans with Disabilities Act in a way that would degrade service and hinder the future potential of the Worcester Line. The T ended up scrapping the nearly $1.3 million design and is now trying to figure out what to do next.

The early design for a new North Washington Street Bridge, which runs from Charlestown into the North End, offered nice bike lanes and pedestrian sidewalks. But Ofsevit and others raised the alarm that the bridge also needed a dedicated lane for the buses that carry thousands of people into Boston and often end up being stalled in traffic. A dedicated bus lane is now part of the design and likely to be one of the first of its kind in the state.

The MBTA scrapped a two-year experiment with late-night (until 2 a.m.) service on Friday and Saturday nights in March 2016. It was too little bang for the buck, officials said. But now TransitMatters is pushing a pilot project that would usher in all-night service every day of the week using buses. State transportation officials were initially resistant, but that hesitancy has evaporated in the face of data showing the new service will cater to low-income employees who often have no way of getting to work in the early morning or home late at night when the T is shut down. It hasn’t hurt that Boston, Cambridge, Somerville, Chelsea, and Revere are backing the TransitMatters plan.

Perhaps the most interesting exchange between the T and TransitMatters was the debate a year ago over how the transit system shuts down at night. Ebuña, Ofsevit, and Monat, using T data and some personal sleuthing, discovered that a well-meaning system designed to prevent any passenger from being stranded was wasting a lot of time and money, as much as $3.8 million a year by their estimates. They said the cause of all of this waste was the decision to put subway lines and the buses that connect to them on hold, often for close to a half hour, waiting for the system’s last Green Line train from Heath Street to arrive at Park Street Station.

Jeffrey Gonneville, the T’s chief operating officer and now its deputy general manager, could hardly contain himself when TransitMatters laid out its concerns in an article in CommonWealth. He fired back that the article was full of errors, particularly the assertion about the Green Line train. He also said the cost estimates were way off base. “The shutdown is a deliberate, impressive, and well-synchronized process, which is managed by dispatchers each evening,” he said.

Nearly three months later, however, Gonneville informed the Fiscal and Management Control Board that he was moving up the departure time of that last Green Line train from Heath Street by 10 minutes to “allow for a more prompt release of other connecting trains from the downtown core.” He also acknowledged that the last train from Heath Street typically carried only one passenger on weekdays.

At the T, which rarely admits a mistake, there is a growing sense of respect for TransitMatters. Joseph Aiello, the chairman of the Fiscal and Management Control Board, says he appreciates what the group does. “They are an organization composed of very, very smart people,” he says. “I’m delighted that they’re incredibly public spirited and that they dive into very, very specific technical matters and supplement the good work the T does on a regular basis. I hope they keep at it. We’re a better T because of them.”

James Aloisi, a former secretary of transportation and the senior statesman on the TransitMatters board, says he is amazed at how much time his young colleagues put into what, for them, is a sideline. “That’s the thing I’ve found remarkable,” he says. “It’s a shared passion. It’s indicative of a new generation that thinks very differently about their own personal mobility and the importance of mobility to their lifestyle.”

Ebuña grew up in Queens, New York, went to college at Rensselaer Polytechnic Institute in Troy, New York, and then made his way to the Boston area. He doesn’t own a car and recalls with some pride a three-hour work commute that required him to board the first train of the day at 5 a.m.  “I try to live my life by the things that I advocate,” he says. “I live in a new building built by three nonprofit developers that’s right next to a T station. It’s sort of this romantic lifestyle that I live that I wish other people could have.”

Ofsevit grew up in Newton, attended Macalester College in St. Paul, Minnesota, and then returned to the Boston area, where he worked for the Charles River Transit Management Association before heading back to school at MIT. For the past six years, he’s been tracking every mile he travels, logging distance and mode. The data convinced him it would be more cost-effective to buy a car rather than renting one or using Zipcar for his frequent weekend hiking and skiing trips. “It’s just really nerdy, but it’s kind of cool at the end of the day,” he says.

Monat grew up in Indianapolis, so public transit really didn’t show up on his radar screen until he moved to Boston after attending Rice University in Houston and working at a software development firm in Austin. Now he’s into public transit big time, but like many of his colleagues he’s still a novice when it comes to Boston politics. On a recent visit to the State House to meet with Rep. Kay Khan of Newton about the Auburndale commuter rail station, he discovered he didn’t know how to get into the building.

“That was actually the first time I had ever been to the State House, which is kind of funny,” he says. “You just go around the side entrance. The front is always closed, right?”

I interviewed Ebuña, Ofsevit, and Monat at CommonWealth’s offices. What follows is an edited transcript of our two-hour discussion.

 

COMMONWEALTH: How did you guys meet?

ANDY MONAT: I met Ari first. He was speaking at a Livable Streets Alliance event, talking about the Longfellow Bridge, about how he had done his own bicycle and pedestrian counts because the ones the state had done were not believable.

ARI OFSEVIT: I biked across that bridge every day to work and I was thinking, boy, they’re saying there are 80 bikes going across every hour. But every time I got to the light at the other end of the bridge, there were 15 cyclists there and that light fires 40 times an hour. I did the quick math and said it’s a lot more than 80 bikes, so I decided to sit on the bridge one morning and just count the bikes. It turns out they were using 10-year-old, outdated data.

CW: Andy, how did you come in contact with TransitMatters?

MONAT: Around 2010, the T was coming out with the arrival information for the subways. So I spent a couple of days and put together a fairly basic website (www.mbtainfo.com) that lets you check arrival times on your phone. Bus information was added later. I set up a Twitter account and started communicating with people about various transportation things and I think that’s how I met the TransitMatters people.

Andy Monat

OFSEVIT: The T was one of the first transit agencies to make its information available.  We need to give the T some credit there. We yell at the T a lot but they did the right thing on that. Transit agencies are generally very protective of their data.

CW: Marc, you’re a cofounder and president of Transit-Matters. How did TransitMatters come about?

MARC EBUÑA: I made a name for myself through Twitter when I first moved to Boston because the MBTA at the time didn’t have a Twitter account. I was listening to people complain about the T and I tried to connect frustrated people to articles and newspaper links or whatever to help them understand why their commute is so screwed up but also who to complain to about this stuff. I started a blog in 2009 that was originally called Transit On The Line. Somewhere in the middle of 2010 I changed it to TransitMatters.

CW: TransitMatters, which is a nonprofit, has raised about $8,000 over the last two years. Do you take a salary as president?

EBUÑA: We’re not paying any wages. I work on TransitMatters unpaid full-time and work part-time on the side for my personal expenses. I do put my IT skills to use at TransitMatters, but I see my work here as a transition out of IT—a critical part of my career pivot into public policy.

CW: What makes you guys do this kind of work in your spare time?

EBUÑA: My natural personality is wanting to fix things. I get angry and then my coping mechanism is to try to fix the problem to get over the anger. For me, simply knowing that there are places that do it better has made me make the leap beyond simply being angry and frustrated and wanting to bring that external expertise and knowledge to the public.

OFSEVIT: I see something that’s not working and my first inclination is not to be angry but to think, why isn’t this working and how can we make this work better? I call it constructive frustration.

MONAT: You look at all the benefits we get from public transportation. It’s hugely important to the economy and education. You get access to jobs. It’s a big deal for people in poverty. If we did a better job at this, think about the additional benefits we could get.

OFSEVIT: We’re all at relatively young places in our lives so it comes down to what is our vision for the next 10, 20, or 30 years. The road system served Boston relatively well for 50 years, and the Big Dig bought us some time and definitely made the city better and more livable. But we’re getting to the point where rush hour is five hours in the morning and five hours in the evening. Boston is one of the best places to live. You have natural amenities, cultural amenities, and a really strong economy. But if the traffic gets worse and the roads continue to be overburdened, none of that is going to be accessible.

CW: How would you describe what you do?

MONAT: People have used the term technical advocacy.

EBUÑA: The big thing we do is look at the small things. We sweat the small stuff and try to make a difference. I also have an issue with the way the T presents itself. It’s often not willing to talk transparently and honestly and clearly about its challenges. These guys have been focused on the T’s operations, but in my view you can make all the operational changes that you want but if you can’t communicate them to the rider then what difference does it make?

OFSEVIT: I would say it’s real politick.

CW: Give me an example.

OFSEVIT: The North Washington Bridge is falling apart and needs to be replaced. This is a city of Boston project. They came out with their design that said it’s going to be a multimodal bridge. It had a nice, wide sidewalk with a view of the city and they had a separated bicycle facility—a 7-foot cycle track, which is fantastic. And they showed a bus in free-flowing traffic. I happen to know that a bus in free-flowing traffic on that bridge going into the city is the exception rather than the rule. Roughly 50 percent of the people who use the bridge ride buses. And they were going to continue to have them stuck in traffic. So I’m looking at this bridge and saying, it’s bicycle and pedestrian friendly, but it’s going to be terrible for transit users. So when they had a public meeting, we got six people to show up and press for bus lanes. It turns out nobody from the city had thought to talk to the MBTA. Nobody from the MBTA had talked to the city.

CW: So they ended up putting in a bus lane?

OFSEVIT: Yeah. And once we got across the kernel of the idea, people were able to jump on it. The T wanted the bus lane to go back as far as possible so buses coming from Route 1 would have a clear path into the city. The Boston Transportation Department looked at it and said we can take out the 12 parking spaces here and give the buses a clear path all the way into Haymarket Square. So now the buses will come across the Tobin Bridge and have a straight shot into Haymarket. Instead of sitting in traffic, they can move into downtown quickly. This does two things. One, it will provide a much better experience for riders. The other thing this will do is, if this works, and I don’t see any reason it won’t work, is allow us to point to this as a concrete example of what can be done. So the second and third time we do bus lanes it will be easier.

CW: Is a lot of your motivation driven by anger with the T?

EBUÑA: I didn’t grow up to be angry at the T and to assume malevolence. I come from the world of information technology, which has a lot of parallels with transportation. They’re both sort of a back-end infrastructure service. Nobody cares what you do as long as it’s not broken. The moment that it’s broken everybody is wondering why you haven’t been doing that thing you were supposed to be doing. So I empathize a lot with not just the T as an organization but with everybody who works there because I know what it’s like to work in a department that is an after-thought for most people.

Marc Ebuña

OFSEVIT: There is malevolence and there is incompetence in the current state administration, but I think this goes way back. If the T doesn’t want to do something, they will make it cost so much that they can say that it’s not worthwhile. As far as the competence of the organization goes, I think there are a lot of really good people working at the T. But I think there are some internal structural issues and management issues. And there are some people who work for MassDOT and the T itself who really could [pauses]. How do I put this?

EBUÑA: Accept a retirement package?

MONAT: Benefit from following some new ways of thinking?

OFSEVIT: Yeah, following some new ways of thinking. One of my favorite things to say about transit agencies is what [sports columnist] Bill Simmons wrote, that every sports team should have a vice president of common sense. This would be someone who would say for any decision, like trading our most popular player or raising the price of beer $3, what are you, nuts? I think that could be brought to transit agencies, where you have someone, internal or external or a group of rider advocates, someone who could come in and say this is going in the wrong direction.

CW: Do you feel like the T is resistant to change?

EBUÑA: The underlying reason the T puts up a lot of resistance is the fear that there’s going to be a backlash from stakeholders. If we shut down the system minutes earlier, the fear is we’re going to be leaving people out in the cold, which is why our proposal on how they shut down the system dovetailed into our overnight service proposal. What if we could save some of that money spent extending rail service for a few extra minutes at X millions of dollars? Why not put that money into running an overnight service network for the people who are out and trying to get home. But the pushback, again not necessarily malevolence, but the T pushes back on different types of equipment and pilots because there is an uncertainty about where the money is going to come from. There’s this operational thinking that’s not only siloed by line and by district but heavily focused on cost-cutting. There is anxiety about using the money we have today in a way that is strategic and efficient because there is always the concern that the budget may not be as liberal next year.

CW: On late-night service, it seemed like your biggest achievement was changing the terms of the debate. Instead of talking about college kids, you talked about the people who work at the airport, restaurants, bars, and other businesses that are open at night.

OFSEVIT: Overnight service, when it ran with trains, the T said no one used it. But it was wildly popular.  If you got on a train at 1:30 in the morning at Park Street, there were 50 other people in the car. It was used by a lot of people, but it was serving the wrong population. It was serving drunk college kids. It wasn’t serving people working at restaurants washing dishes.

MONAT: It was like 25 percent of the workers who live in Chelsea leave for work before 5:30 in the morning, which is a crazy statistic. A quarter of all the workers in Chelsea go to jobs too early to be able to use most of the existing transit.

OFSEVIT: Most other cities have some sort of skeletal late night service, but Boston doesn’t. I think it’s Boston, Houston, and Atlanta that don’t have that kind of service. What we’re saying is this shouldn’t be about Friday and Saturday nights. This should be 24 hours a day.

CW: Do you think the T needs more money?

EBUÑA: Yes. What underscores all of this is equity and resiliency and all of the other issues that are going to be challenging for us in the latter half of the century. You cannot reform your way to a water-resilient subway system.

OFSEVIT: That’s what the Big Dig was all about. If we still had the elevated artery, a lot of what we see in South Boston and the Financial District would not be happening because traffic would be so bad and it would be a lot less desirable. We’re getting close to a half-century beyond the [start of the] Big Dig now and we really need to be thinking about the next 20 to 30 years. At least for the first few years of this decade, Massachusetts has grown at the same rate as the rest of the country for the first time in 100 years. A lot of what TransitMatters does is look at those small operational pieces, but we also have that larger-scale view of what we want to do in the long term. How is the region going to look in 10 to 20 years?

EBUÑA: That was the chief argument with Auburndale and why we intervened to try to change the conversation about the way they were redeveloping that station. What is service going to look like on the Worcester Line  in 20, 30, 50 years? If we do build regional rail, the station we were designing was not going to work.

MONAT: In my mind, good transit produces economic development. Do we want to buy more economic development or don’t we? And that’s what investing in regional rail is.

CW: Does the T ever say thanks—like with the Auburndale station?

MONAT: I am naïve in the ways of government, I guess. I thought that some day not too long after that the T would make some announcement that we’ve looked it over and that project plan was mistaken and we’re going to reorient it this way. I’m not sure to this day there’s been any public acknowledgment of that.

CW: You’re right. I had to chase after them to find out the original design was being scrapped.

 OFSEVIT: This was not malevolence. This was incompetence. We went to a public meeting on the station and asked the designers whether they had talked to rail ops. After a bit of back and forth, it turned out they hadn’t talked to rail operations. They went and talked to rail operations and rail operations took one look at it and said there’s no way we can run this. I don’t know if they’ve said so publicly, but it’s now going in the right direction.

CW: Do you think part of the problem with the T is that the folks there just don’t have enough bandwidth to deal with everything?

MONAT: Absolutely. There are departments in the T that are drowning in the amount of work they have to do and ridiculously understaffed. So, yeah, when someone comes to them and says you should do something that looks like more work, even if it better accomplishes your mission, they say why are you bothering me.

OFSEVIT: It’s sort of a spend money to make money thing. Right now, if there’s an old way of doing something that works but is inefficient, if you start doing that more it just makes it more inefficient. That’s one of the problems with the South Station expansion that the state is advocating for. It takes the current operating structure of North and South stations, which are the chief constraint on capacity on the commuter rail, and it just makes it worse. It means that every train you run has to pull into North Station and then pull out. It’s time consuming. What it really means is that that train can make only one trip during rush hour.

CW: Are you saying the folks at the T are lazy?

OFSEVIT: I don’t really blame people at the T who are overworked and probably under-compensated and have seen budgets cut. The T is really in a place where they are trying to put the service on the road every day. In their defense, that’s something that’s hard to do, especially with the political process here and the aging fleet. There needs to be someone saying, what’s this going to look like in 5 to 10 years, and 10 to 20 years? There probably needs to be better strategic planning at the agency. That’s an area where we need to be more active.

CW: Do people at the T view you guys as pains in the ass?

EBUÑA: I think that depends on the person and the department.

Ari Ofsevit

OFSEVIT: When we’re making work for someone, they probably don’t like us.

CW: But when the T puts all of its data out on the table, isn’t that an invitation for people like you to use it?

MONAT: Auburndale was a good example of that. You get the data, but we’re not in a position to just call up and get a meeting with the transportation secretary or the T’s general manager to listen to our ideas. Sometimes that means you put it out in a public forum where people can think about it. The T is a large organization. Different people at different times see things differently. Our goals are in general alignment with theirs. Our goal is to get better service for riders and improve the region.

OFSEVIT: And, if possible, save money while doing it. I don’t think any of us are averse to saving money, but we’re also not averse to spending money in the long run. We look at the most efficient use of funds.

CW: Isn’t it easy to whack the T?

OFSEVIT: It is really easy to go on Twitter and to say something either mean, angry, or snarky at the T. I’ve done it myself.

EBUÑA: We all continue to do that.

OFSEVIT: Yeah, we all continue to do that. It’s pretty easy to write a blog post about something you see on the T. It’s hard to write a blog post that actually has good data behind it. There are places for everything, but we don’t want to be making snarky comments on Twitter. Hopefully, we’ve sort of graduated from that to the more analytical stuff.

EBUÑA: The snark does have its use, and that’s getting people to recognize in your Twitter post that it validates an experience they have. It’s a level of humanity that allows us to relate to other people. That’s something the T could learn. Other agencies do have a level of humility that relates well to their customers.

OFSEVIT: Look at BART. [Bay Area Regional Transit]

EBUÑA: BART, LA Metro, Chicago Transit Authority. It’s a level of humility, saying we are not an infallible agency. We do make mistakes and we recognize that there are citizens out there who are trying to make a difference and we appreciate it. That would be a nice response.

OFSEVIT: LA and San Francisco wrote transit haikus at each other on their Twitter accounts and it was informative, it was funny, and I think it humanized them. It made people realize that there are people behind this big machine that gets you to work.

EBUÑA: That’s the problem. We recognize that there are people who work at the agency, but a lot of people don’t and that makes it easier to vilify them as an incompetent, malevolent, monolith.

CW: Jim Aloisi, the former secretary of transportation, is on the board of TransitMatters. What role does he play?

EBUÑA: He’s been an asset to TransitMatters because of his past relationships and familiarity with the MBTA staff and being able to get us in a room to have some conversations. There is a respectful but somewhat tense relationship with some of the T staff. We’ll casually crack jokes but it feels like you have to cut the tension with a steak knife in some of the rooms in which we have meetings.

CW: Aloisi is also someone who is familiar with Beacon Hill and the political process. He must know the backchannels.

EBUÑA: In many ways he is the backchannel.

OFSEVIT: Part of politics is knowing when to push and where to push, and where to lay off. That can be hard for us.

Trading gangs and guns for a future

Trading gangs and guns for a future

Can we get young men to give up the dead-end life of the streets?

PHOTOGRAPHS BY MARK OSTOW

HAKEEM JACKSON DOESN’T mince words. “Just a couple of years ago I was shooting at people,” he says.

A wiry 20-year-old with an affable bearing, Jackson is sitting at the Boston offices of Roca Inc., a nonprofit that works with young people who have been in and out of jail and run the streets with gangs. He was put on probation two years ago for selling marijuana on the condition that he enroll in school or find a job. A youth worker from Roca reached out and Jackson has been part of the organization’s program to help gang members and other young people at the margins turn their lives around. He’s now part of a work crew at the agency that does landscaping and other projects and is working on getting his high school equivalency diploma—he dropped out of South Boston High School in 10th grade.


He’s doing well, but the Roca youth workers and Jackson himself know that one small slip could change that. “If I fall back with them and go to jail again, I’m starting over,” Jackson says of the crew he ran with in his Dorchester neighborhood near Franklin Park. “I’m not looking to start over again.”

Plenty of programs target “at-risk” youth in tough neighborhoods. These efforts focus on keeping young people who could be tempted by the lure of gang life or the fast money of drug dealing from starting down that road. Roca and a set of other programs operating in Boston and other Massachusetts cities are taking on a much steeper challenge: getting those already involved with gangs and guns to shift onto a more productive—and peaceful—path.

The logic behind focusing on this population is straightforward. To make a meaningful dent in the havoc of urban gun violence, programs have to deal with those doing the shooting, not just those who could be drawn into that world. But getting this group to make sustained change is not easy. These are young people who already failed to respond to any earlier interventions that may have been tried.

Hakeem Jackson

When it comes to gun and gang violence in Boston, the situation today is a far cry from the bloody 1990s, when the city’s streets were overrun by gang wars fueled by the crack epidemic. In 1992, the city witnessed 152 homicides. Last year there were 46. But that number was up from 2015, when the city recorded a 10-year low with 40 homicides. And through mid-September of this year, homicides were up 40 percent over the same period last year, and total shootings, fatal and nonfatal, were up 18 percent, with 186 compared to 158 for the same period in 2016.

An array of programs like Roca are now in place to work with those who have been part of the gang-driven “noise,” which is believed to account for as much as half of the gun violence in Boston. They are employing a range of strategies that go beyond Band-Aid solutions, with lots of careful thinking and research evidence behind their programs. With palpable concern about an increase in gun violence, the stakes for these efforts seem particularly high.

Rev. Jeffrey Brown, who was part of the clergy effort in the 1990s that helped drive down gun violence in Boston, says today’s far lower homicide rate is little consolation to those in the swath of poor, largely minority areas where violence is heavily concentrated. “It may continue now in smaller circles than it did 20 years ago,” he says. “But it still continues, and you have families torn apart by it. It does not bode well for the health of neighborhoods and the health of the city.”

CHANGING NORMS

Growing up in the Lenox Street public housing development in Roxbury in the 1990s, Matt Jackson says drugs were a mainstay of neighborhood life. “If somebody wasn’t doing them, they was selling them,” he says. “Drugs was the norm.”

For Jackson, the norm was selling. He started dealing when he was 13. When he was 17, Jackson (who is not related to Hakeem Jackson) was arrested with a handgun and enough crack cocaine to trigger a serious trafficking charge. He served five-and-a-half years in state prison.

Listen to an interview with Matt Jackson.

“When I got out, of course I tried to work, but drugs was the norm,” he says. “I didn’t learn my lesson.” Jackson, who is now 34, worked various entry-level jobs, but was often dealing drugs at the same time. That changed three years ago when his girlfriend—the mother of his three-year-old daughter—was killed by gang crossfire while sitting in a car in the Lenox Street projects.

“From that point on, I just knew I couldn’t do anything to go back to prison,” says Jackson, who is raising his daughter as a single father. “I never cared for nothing the way I care for my daughter.” He stayed out of the drug business, but a series of low-paying jobs were not always convincing him he made the right call. That changed when he learned about an unusual program at a Dorchester organization.

Mark Culliton, a veteran nonprofit leader, says he was frustrated by what he saw as half-measures in many programs that aim to get former gang members and high-risk young men on track. Help often meant getting them into minimum wage jobs, but with inadequate support to gain the skills or education credentials to move up and earn a family-sustaining income. “We kept trying to give them low-level jobs that they fail out of and then keep the cycle going,” says Culliton.

The organization Culliton leads, College Bound Dorchester, launched a program last year with an audacious goal. Combining extensive support and high expectations, it aims to get young men like Matt Jackson through a two-year community college program. The program hires former gang members—it calls them “college readiness advisers”—to provide intensive mentoring and support. And it makes use of research on what works and doesn’t work with community college students, who are often the first person in their family to attend college.

Matt Jackson says “drugs was the norm” in his neighborhood growing up. He spent five-and-a-half years in prison, but now is a student at Bunker Hill Community College.

Community college students who arrive needing to take non-credit-bearing remedial education courses often never graduate. So College Bound Dorchester provides remedial courses to those who need them at its offices, with lots of support and tutoring, and only lets students enroll at community college when they’re ready for credit-earning courses. There is also a wealth of research showing students are much more likely to graduate from community college if they attend full-time, rather than mix part-time studies with work. That led to the program’s boldest element: requiring that all the students go to community college full-time—and paying them a weekly $400 stipend while they do.

The organization calls its program “Boston Uncornered.” The name refers to its literal goal of getting young men off the street corners where nothing good takes place, but it’s also a nod to the idea that these people often feel cornered by the choices they’ve made and circumstances they’ve grown up in.

Jackson is now one of about 40 students in the program; the organization hopes to ramp up and get 250 former gang members through a two-year college program. Jackson, who got his high school GED while in prison, finished his second semester at Bunker Hill Community College over the summer.

“I want to do some type of social work, targeting in my mind Department of Youth Services,” he says. “I could work with kids I could really relate with and they could relate to me and just keep them off a path of picking up a gun or thinking drugs are cool or any of that. Because I’m telling you, man, it’s a dead end. And it takes somebody real to really tell you that.”

The ambitious goal for participants reflects the organization’s belief that those causing the chaos in violence-plagued neighborhoods need a real ladder of opportunity in order to make lasting change. But it’s also about lifting up whole neighborhoods. The organization has dubbed the trouble-prone young men they work with “core influencers.” Though they may be small in number—the organization says about 400 to 600 hardcore players among the city’s 2,600 gang members cause most of the trouble in Boston—they have an outsized influence on the trajectory of entire neighborhoods.

Their turnaround, says Culliton, will have ripple effects that extend to everything from property values to economic development, to say nothing of relieving the psychic toll of fear they inject in neighborhoods. “It’s a small group of individuals that nobody ever effectively deals with that hold back whole communities,” he says. “This is, for me, the way to end intergenerational urban poverty.”

The program’s success will be evaluated by researchers from MIT and Northeastern University. Of the 40 who have enrolled since Boston Uncornered started in January 2016, 85 percent have not been arrested and 78 percent have remained with the program.

Matt Jackson

Jackson’s fall course schedule includes a statistics class, college writing, and an introduction to human services. A lot of the fieldwork for the human services class is going to involve visiting various programs around Dudley Square, not far from where he grew up. “I’m going to see a lot of people that I know that watched me grow up,” he says. “It’s going to feel really cool to be out there and people see me doing something different,” he says of the turn he has taken.  “To this day, people that know me, they don’t believe it.”

COOLING DOWN HOTHEADS

For Hakeem Jackson, the Roca program has provided the first glimmer of stability and support in what has been an untethered life of repeated trauma. Gang violence claimed his father, a member of the city’s notorious H Block gang, when Hakeem was three, and an older brother was gunned down in the house where he still lives when he was nine. His mother has a drug problem and he had lots of contact with state social service agencies as a child. “My mom never put us first. She was getting high,” he says. “I come in here, I have a peace of mind that I never had my whole life.”

Roca’s model for the hardcore population it targets is a four-year program that starts with “relentless outreach.” The organization looks to pull in gang members even before the young men are necessarily committed to trying to change. And once someone enters the Roca fold, the youth workers pull them back in if they fall off, something Jackson has done repeatedly, once disappearing for four months.

Now he’s a “team leader” on his work crew and talks about starting a landscaping business with the skills he’s acquired. “It took him forever to finally get on track,” says Shannon McAuliffe, the director of Roca’s Boston program. For most of those the organization works with, she says, “relapse is required.”

Roca has also incorporated extensive use of cognitive behavioral therapy into its work. The approach involves getting participants—nearly all of whom have experienced lots of trauma—to change patterns of behavior that are often driven by distorted thoughts. Cognitive behavioral therapy is based on the idea that thoughts, emotions, and actions are interconnected and that positive behavioral change often requires helping individuals develop healthier, more balanced thinking and emotional regulation. Research with criminal offenders has shown it is one of the most effective approaches to reducing recidivism.

“I really was a hothead. I was a wild boy—knives, guns, shot at people and all that,” says Jackson. “Some of them—they really do work,” he says of the set of 10 cognitive behavior skills Roca has put at the center of its program. “Like ‘flex your thinking’—how to turn a bad situation into a good situation,” says Jackson. “Don’t let your emotions take control of it.”

One of the most daunting obstacles to the work done by Roca and other organizations is that those they engage with are often living in two worlds—the new one they’re trying to form and the one they come from, filled with all the influences that have led to so much trouble. “They are still in their environment while you’re trying to help them with the tools to move past it, essentially,” says Luciana Sousa, the Roca youth worker assigned to Jackson.

“I’m not going to lie—sometimes I do chill with the old crowd,” says Jackson, whose girlfriend had a baby six months ago. “But every time I find myself getting pulled back in by my collar, I separate myself for a little while and come back to work every day. I work my full week. Probably go chill with them for the weekend, don’t get me wrong. Drink a bottle, smoke a couple of joints. You feel me? As far as them being like, ‘Oh, it’s time to go shoot somebody,’ I’ll be like, oh, no, that’s not for me. I’ll be like, I got a job, I got a daughter now. I got too much to lose.”

Roca’s approach, which uses two years of intensive contact followed by two years of gradually reduced follow-up, is now the subject of a massive study being underwritten by an innovative social service funding model. Under the country’s largest “pay for success” experiment to date, public safety officials are directing to Roca about 1,000 young men like Hakeem Jackson, who are already connected to the state’s criminal justice system. Their recidivism rates and employment status over time will be compared with those of 1,000 control subjects with similar backgrounds. A set of philanthropic and for-profit investors are funding the 8-year, $28 million project, which started in 2014. The investors will be repaid—and receive added payments—based on the program’s success on its two key outcome measures.

In preliminary data, the program has an annual retention rate of about 80 percent, so two-thirds of those initially enrolled are still taking part after two years. More than 90 percent of them have not had a new arrest, and 85 percent of those placed in jobs have held them for at least six months.

“Our hope is we can demonstrate what it takes to do it,” says Molly Baldwin, Roca’s founder and CEO.

Boston Mayor Marty Walsh, who has emphasized that gang and gun violence ultimately can’t be curbed by law enforcement alone, says programs such as Roca and College Bound Dorchester are exactly the right long-term approach. For Walsh, the idea of second chances and redemption isn’t just something he believes in; he has lived it. Walsh has been very public about his battle with alcoholism and the years in recovery during which he rose from Dorchester labor official to state representative and then mayor of Boston.

He’s put his own stamp on the growing set of programs to help gang members make a positive turn with Operation Exit, an initiative Walsh launched soon after taking office that works to pull young Bostonians with gang backgrounds and criminal records into apprenticeships leading to skilled, union jobs in the building trades. There is also a component that trains young people for work in the technology sector.

Operation Exit has graduated four classes of nearly 80 people. “There’s no question that people can turn around their lives,” says Walsh, emphasizing the middle-class wages that the program can lead to. “I’ve seen too many success stories. We have to believe that every person can get on that path in life.”

SUMMER SHOOTING SPREE 

The roster of well-thought-out programs in Boston shows some early promise of offering more than just stopgap approaches to gang and gun violence. But the programs don’t intervene directly in the ongoing conflicts on the city streets.

This summer, following a spate of shootings over the long Fourth of July weekend, Walsh convened a group of community leaders and law enforcement officials to consider ways to respond. After the closed-door meeting, which drew several dozen people to the mayor’s City Hall office, the participants emerged for a press briefing.

William Evans, the city’s police commissioner, said saturating known “hot spot” areas with added officers had failed to prevent a bloody weekend. “We had a lot of extra officers out there. Obviously that didn’t do the trick,” he said. Walsh spoke of a range of ideas aired in the meeting, including assigning a police car to city community centers at night to ensure safety there and other efforts targeting younger teenagers.

The fresh worries about violence raised the question of whether police were doing all they could to head off gang violence before it occurs. “My biggest concern is we seem to show up after the shootings,” Mattapan state Rep. Russell Holmes told the Boston Herald at the time. “We do peace walks after it happens. We really need to be addressing the tip of spear, addressing gang members in advance.”

In the 1990s, when the city was reeling from the crack-fueled gang battles and Boston regularly recorded more than 100 homicides annually, police and criminal justice researchers devised a novel approach to suppressing gun violence. Operation Ceasefire involved a targeted message and carrots and sticks directed at those driving the gun violence. Gang members were brought in for “call in” sessions with police, prosecutors, clergy, and various social service providers. They were told that police had them squarely in their sights and would use every tool and pursue every possible charge against gang members if anyone in their crew was caught using a gun. Clergy and service providers offered the carrots, vowing help with school or jobs for those ready to give up gang-banging.

Operation Ceasefire was credited with helping to drive a steep decline in homicides after its introduction in 1996. In its first year alone, the city saw a 40 percent decrease in homicides, from 96 in 1995 to 59 in 1996. By 1999, homicides in Boston bottomed out at just 31.

Ceasefire went on to gain national acclaim and has been used in a number of cities. In a review last year of research evidence on reducing urban violence, Christopher Winship and Thomas Abt of the Harvard Kennedy School concluded that “focused deterrence”—the law enforcement approach used by Operation Ceasefire—“has the largest direct impact on crime and violence, by far, of any intervention in this report.”

Rev. Ray Hammond, chairman of the clergy-led Ten Point Coalition that formed in the 1990s to help address gang violence, was at the July summit at City Hall. He said Ceasefire, which the city has shown an on-and-off attachment to, came up in the meeting, with a particular focus on how it might be updated for the social media age, where gang beefs sometimes now play out first on Snapchat and groups are less geographically rooted than in the past.

“I think people have moved more to the carrot side, so you have things like Operation Exit—really focused on getting kids out of gang life, into unions, into jobs,” Hammond said following the meeting. “We also could do more on the soft-stick side,” he said, referring to the Ceasefire message about the swift and certain law enforcement consequences of gun violence.

Dan Mulhern, a former prosecutor who led the gang unit in the Suffolk County district attorney’s office, now directs the mayor’s Office of Public Safety. Mulhern took part in Ceasefire “call ins” as a prosecutor and says he always felt the lack of well-developed paths out of gang life was a downside of the effort.

Not only are things like Operation Exit now in place, Mulhern says the program really represents “the evolution of Operation Ceasefire.” Twice a year, he says, the city convenes “call in” meetings in which those who have been involved in gang activity are told about the opportunity to get into a union apprenticeship. With police quietly standing in the back of the sessions, he says, the alternative for those not interested in a more positive path is clear.

“We didn’t get away from that,” Evans says of the Ceasefire message. “Maybe the tactic isn’t calling them into a room, but that dialogue’s going on every day on the street between our gang officers and kids.”

Boston Police Commissioner William Evans on one of his regular “peace walks” in Roxbury’s Dudley Square. “We’ve had an uptick in shootings, but we’ll get a hold on that. It’s not like the city is out of control,” he says. (Photograph by Michael Jonas)

Evans, who has made outreach to the heavily-minority neighborhoods most impacted by gun violence a top priority, says he’s reluctant to employ Ceasefire’s tactic of an explicitly delivered threat in formal sessions. “We don’t want to ruin the trust and respect we have with the kids,” he says. “I don’t think we have to be going to drastic means to terrorize kids in these neighborhoods.”

Police command staff convene a weekly meeting to review current intelligence on gang activity, and Mulhern’s public safety office holds a monthly session with representatives of roughly 30 nonprofit agencies and public safety offices to review recent trends.

“We’ve had an uptick in shootings, but we’ll get a hold on that,” says Evans. “It’s not like the city’s out of control.”

Gerard Bailey, the deputy superintendent who oversees the police department’s 70-member gang unit, says this summer’s spate of shootings prompted some worry, but he also thinks it’s important not to view everything through the lens of dry statistics. “We’re always concerned. There’s victims’ families that are affected by this and the people that are committing these crimes—their families are affected by this,” says Bailey. He echoes Evans’ view that violence in the city isn’t on a sudden upward spike. But when it comes to the toll of gun violence, Bailey says, “zero’s the goal and one is too many.”

A QUESTION OF STAYING POWER 

After 20 years on the streets, Matt Jackson says he’s lost track of the number of people he knows whose lives have been lost to gang gunfire. “Too many to count,” he says, lamenting the fact that funeral directors in the city’s black community know the various gangs because they are so often handling burial arrangements for their members. Even more dispiriting, says Jackson, is the fact that lots of those caught up in the violence don’t want to be.

“A lot of these kids don’t want to do this stuff,” he says. “It’s all about leadership and who younger guys have to look up to as role models. We’re basically destroying our communities out here.”

Despite the brutal toll taken by gang and youth violence in urban areas, the commitment to comprehensive efforts to deal with it isn’t always clear. In 2012, the state launched a program directed at those young people most likely to be involved as perpetrators or victims of gun violence. The Safe and Successful Youth Initiative (SSYI) funds outreach programs in 12 Massachusetts cities targeting “proven risk” young residents, aged 17 to 24. College Bound Dorchester and Roca programs in Chelsea and Springfield are among the recipients of SSYI funding.

An early evaluation by outside researchers in 2014 showed that those engaged in an SSYI-funded program were 58 percent less likely to face incarceration than those with similar backgrounds who were not reached by one of the programs. The analysis also said each $1 spent on the program in Boston and Springfield yielded about $7 in crime-related savings in police, court system, and other costs.

In the 2018 budget passed this summer, however, the Legislature cut the program by 35 percent, reducing its funding to $4.25 million.

Gov. Charlie Baker, who has been a strong supporter of SSYI, filed a supplemental budget proposal in August that would restore its budget and even increase it slightly over the 2017 appropriation with an additional $3 million.  The cut by the Legislature “was disappointing,” says Marylou Sudders, Baker’s secretary of health and human services, who oversees the program. But she chalked it up to the tough budget climate and said she did not view it as a “philosophical questioning of the importance of the program” by lawmakers. Sudders says the administration is hopeful that legislators will restore the funding. In the meantime, she says, she is holding off on executing cuts to the programs that rely on the funding.

Culliton, the College Bound Dorchester director, says when people question the idea of paying gang members to go to college, “The first thing I say is, we’re already paying more than we’ll ever pay” through our program. Culliton says that between the cycling in out of prison—at a cost of more than $50,000 per year—and demands on public safety, courts, and the probation and parole systems, research shows that the young men his organization is targeting cost the state about $100,000 a year. “And the outcome of that is that they’re a gang-involved youth the next year and the next year and the next year,” he says.

“We’re spending money on these kids,” says Culliton. “The question is how do we want to spend it?” He says College Bound Dorchester had identified 65 “currently active guys” in Boston gangs who it could have brought into the Boston Uncornered program this summer, but only had funding to add 10 new students.

“These guys are ready to choose a different way and start giving to the Commonwealth instead of taking,” he says. “Even if you don’t care about them,” he says of those who have often been the cause of considerable mayhem, “if you care about the grandmother or the kid growing up in their neighborhood, we have to deal with this population. Whether you believe they are deserving or not, if you care about the other people that they are impacting in the community, you have to do something to engage them.”

“I’m not going to say everyone is going to stop what they’re doing and just run to the program,” Matt Jackson says about College Bound Dorchester. “But I know there’s kids who want out,” he says of the dead-end life of the streets. “Trust me. I’m here, but there’s hundreds of me out there.”

 

Democracy isn’t working in Massachusetts

Democracy isn’t working in Massachusetts

Crowded winner-take-all primaries, incumbency, and special elections subvert will of voters

ON SEPTEMBER 15, 1998, David Nangle, then a State House aide, was effectively elected to the Massachusetts Legislature even though 76 percent of the voters in the district where he ran chose someone else that day. Nangle won the Democratic primary for an open Lowell-based seat in the House of Representatives by garnering just 24 percent of the vote in a field of six candidates. Two months later, Nangle easily defeated his Republican opponent in the November general election to become the state representative for the district—seemingly for life, if he so chooses.

Nangle is hardly alone in claiming a seat in the Legislature with something less than a clear mandate from voters. Last fall, William Driscoll won a seven-way Democratic primary for an open House seat representing Milton and part of Randolph with only 21 percent of the vote. He was unopposed in the general election. And last April, Joseph Boncore won a special election Democratic primary for a state Senate seat by capturing 26 percent of the vote in a seven-person field. The victory sealed his election to the Senate, as he faced no opposition the following month in the general election for the seat representing his hometown of Winthrop along with Revere and parts of Boston and Cambridge.

These elections all failed a basic test of democracy: respecting the will of the majority. But that shortcoming is only the last in what is often a series of cascading steps that contribute to an election system that has atrophied badly and is not serving our democracy well.

Each of these elected officials won primaries with far less than majority support and then cruised in the general election and incumbency. Going top down and then left to right, Rep. Daniel Donahue, Sen. Joseph Boncore, Sen. Sal DiDomenico, Rep. Jeffrey Sanchez, Rep. Michael Moran, Rep. Rady Mom, Sen. Patricia Jehlen, Rep. Robert Koczera, Sen. William Brownsberger, Sen. Michael Barrett, Rep. David Nangle, Rep. Theodore Speliotis, and Rep. Thomas Golden.

The Lowell-based district that Nangle represents, like most Massachusetts legislative districts, rarely sees primary challengers to an incumbent officeholder and is not competitive in general elections. By 1998, the year Nangle won the seat, it had been held by Democrats for 24 years in a row. In the nearly 20 years since then, Nangle has sought reelection nine times, but has faced no significant opponent. He has been unopposed in every primary but one, when he faced a token challenger, and he had a Republican opponent in just three of nine general elections, with none of them winning more than 23 percent of the vote.

Incumbency carries such outsized advantages that sitting legislators are almost never defeated. Indeed, as Nangle’s election history underscores, they often don’t face opposition at all, or only nominal challengers.

The only real opportunity for voters to weigh in on who represents them on Beacon Hill often comes with elections for open seats with no incumbent running. Because most districts in Massachusetts have a clear partisan tilt (the overwhelming share of them toward Democrats), most races for open seats are effectively decided in party primaries, which draw a lower turnout of voters. As in the three examples above, candidates often win with far less than majority support as votes are split among a crowded field.

What’s more, a sizeable number of open-seat legislative races over the last two decades have been decided in special elections prompted by the mid-term resignation of a lawmaker. These contests tend to draw fewer voters than regularly scheduled elections and their timing tends to favor political insiders who can quickly assemble a campaign operation for the short sprint to a special election date set by legislative leaders. That further distorts an already compromised electoral structure.

It all adds up to a dispiriting reality: We have a system for electing members of the Massachusetts Legislature that has strayed far from democratic principles.

Not surprisingly, the problem isn’t something on the radar screens of incumbent lawmakers on Beacon Hill. But some activists are starting to push for change (see “Pushing ranked choice with beer (and pie)”). No reforms will necessarily convince more candidates to run for office or compel more voters to go to the polls, but some of the proposals being floated hold the promise of encouraging more political competition and strengthening the principle of majority rule. Isn’t that what elections are supposed to be about?

INCUMBENT PROTECTION 

David Nangle’s electoral success in the years since he won his House seat is typical for Massachusetts legislators. Once in office, there is little likelihood a challenger will push them out. When incumbent state representatives run for reelection, they win 96 percent of the time. Incumbent state senators have an even better track record, with a 99 percent reelection rate.

Massachusetts needs more candidates in order to have elections that are worthy of the name. Yet when an incumbent is running, there is only one name on the ballot in 62 percent of general elections and 91 percent of primaries. Massachusetts ranked dead last in Ballotpedia’s measure of 2016 state election competitiveness based on percentage of open seats, incumbents facing primary opposition, and general elections with major party competition.

The state’s lack of political competition was the focus of a 2009 feature in CommonWealth, which attributed the dominance of incumbents on Beacon Hill to the entrenched power structure there, the view of legislating as a profession (something strengthened earlier this year with a much higher pay structure), and the general acceptance by voters of a Legislature where turnover is rare. One line in the article stands out: “Without elections, we’re not a democracy. But without candidates, we’re not much of a democracy either.”

To appear on the ballot in Massachusetts, candidates must collect 150 signatures for state representative and 300 for state senator. Although this may seem to be a small barrier, tight deadlines and hyper-technical rules sometimes keep legitimate candidates off the ballot. In 2016, 96 percent of legislative races in Minnesota and 100 percent in Michigan included both Republican and Democratic candidates. In those states, major party candidates are allowed to pay a $100 filing fee in lieu of collecting signatures.

In the relatively rare cases in Massachusetts where there is a choice between an incumbent and a challenger, usually it is only token opposition. In 86 percent of House races and 90 percent of Senate elections with incumbents between 1998 and 2016, the election was non-competitive, with the winning margin of victory greater than 20 percentage points. When there is an open seat, by contrast, only 20 percent of elections are non-competitive and only a handful have only one candidate.

Despite the long odds, about 50 challengers managed to defeat incumbent state representatives over the course of 1,453 elections since 1998, or about 4 percent of the time. Only two incumbent state senators were defeated in 362 attempts.

ELECTORAL FREE-FOR-ALL

Potential challengers know that the most realistic chance of being elected to the Massachusetts Legislature is to wait for an open seat—when an incumbent takes another job, retires, or dies. But open seats are a rarity: Only one out of eight legislative races in Massachusetts is incumbent-free. Thus, the typical voter gets a realistic chance to pick his or her legislator only once every 16 years.

When legislative seats do open up, the elections to fill them often defy the principle of majority-rule. The winner fails to win majority support in 40 percent of open-seat contests, most often in the primary but sometimes in the general election. (See Table 3.)

Of course, most winners of legislative races do claim a majority of the votes, but that’s only because any competition at all is so rare. In general elections, even when there is an open seat, there is almost always a majority winner because typically there are only two candidates on the ballot. Not only are the Democratic and Republican parties usually the only game in town, in most districts one of the two parties is dominant, so all of the meaningful competition occurs within the party primary.

Although primaries are often the more important election for legislative races, primary turnout is much lower than general election turnout, and it has been declining. In recent presidential elections, 60 to 70 percent of those eligible to vote in Massachusetts cast ballots. However, state legislative primary election turnout is low even in presidential years, because the presidential primary is not held at the same time as the state primary. In November 2016, general election turnout was the highest in decades, but fewer than 8 percent of eligible voters turned out two months earlier for the September primary, the lowest yet recorded.

General election turnout in recent gubernatorial elections has rarely exceeded half of those eligible. As in presidential years, primary turnout is far lower, and hit a new low of 15 percent in 2014. Even in 1982 and 1990, when there were close races in both the Democratic and Republican primaries for governor, primary turnout was still barely more than one third of those eligible, lower than any general election.

ISN’T THAT SPECIAL

In 2010, Christopher Speranzo, the state representative for the Third Berkshire District, decided to run for reelection despite the knowledge that he was likely to be offered a better-paying, lifetime appointment as a court clerk magistrate. After newspaper coverage of the Pittsfield politician’s less-than-full commitment to serving out a new term, Speranzo’s only opponent on the November ballot, a Green-Rainbow Party challenger, drew 45 percent of the vote in the general election. Speranzo won with 55 percent of the vote, but resigned his seat half a year into the new term after being tapped by then-Gov. Deval Patrick for the court post, triggering a special election in the fall of 2011 to fill the seat. (Speranzo himself had first been elected to the Legislature in a special election in 2005 when the previous incumbent also resigned for a better job.)

In the 2011 special election to succeed Speranzo, Tricia Farley-Bouvier won the Democratic primary with 37 percent of the vote in a three-way race. She then defeated three opponents (Republican, Green-Rainbow, and United Independent) to win the general election—but with only 33 percent of the vote. Despite having been nominated by a minority of Democratic voters in a low turnout special election primary and then elected by a minority of voters in a low-turnout general election, Farley-Bouvier faced no primary or general election opponents in her first two reelection races.

Fifty of the 199 open-seat elections for state representative over the past two decades, or 25 percent, and 18 of the 56 open-seat elections for state senator, or 32 percent, occurred in special elections—held other than at the usual dates of September and November of even-numbered years. Special elections often draw less media coverage, and many voters are not even aware that an election is occurring. On average, special elections have 20 percent fewer primary voters and 73 percent fewer general election voters than other open seat contests, as shown in Table 4.

Special elections are called by the leaders of the House or Senate when a vacancy occurs sufficiently in advance of the next regular election. A compressed calendar to collect signatures, raise funds, and run a campaign favors candidates closely tied to the political establishment. A total of 70 House and Senate special elections were called between 1997 and 2016, spread out over 49 different dates. In 1999 alone, there were nine special election dates, all but one of which involved only a single electoral district. The extremely low turnout in special elections, and primary elections generally, further facilitates this insider game.

RESTORING DEMOCRACY 

Since they appear to value democracy highly, why aren’t more Massachusetts citizens speaking out about its failures in their own backyard? Voters may not be aware of the pervasiveness of the lack of competition and incumbent advantage, thinking that the lack of competition may be peculiar to their own district, rather than a general feature of the system. They also may not be aware that there are solutions.

In an election that only requires that the winner receive the most votes (a plurality), not necessarily a majority of votes, the number and mix of candidates can significantly affect the outcome. For example, if there are two or more candidates who appeal to the same group of voters, splitting their vote, the preferences of this group may be effectively ignored, even if it constitutes a majority of those voting. In plurality-rule elections, voters are often afraid to express their true choice lest it mean that their least favorite candidate gets elected. This dynamic—the spoiler problem—has certainly held back support for third-party and independent candidates in general elections and it can hurt primary candidates who aren’t considered to be in the top tier of contenders

In recent years, four states have sought to address the plurality-rule problem by abandoning party primaries in favor of a two-round system of elections. In these states, all candidates are listed together on the same ballot in the first round (rather than having separate party ballots). In California, Nebraska, and Washington, the top two finishers in the first round, which is held months earlier, advance to the November general election. In Louisiana, all candidates appear on the November ballot, and anyone who wins an outright majority is elected; if no candidate has a majority, the top two compete in a December run-off. Although two-round systems reduce the spoiler effect, there is often a huge turnout difference between the two rounds. The 2016 gap in percentage points was 28 in California, 38 in Louisiana, and 44 in both Washington and Nebraska. California’s was less because it holds its state and presidential primaries on the same day. Still, this is a major difference in the size of the electorate.

When there are many candidates in a race, however, a two-round run-off system does not entirely address the problem of plurality-rule or spoiler candidates, and limiting the final choice to the top two finishers can distort the preferences of the overall electorate. A two-round system has been used in nonpartisan Massachusetts municipal elections for decades. In the 2013 open race for mayor in Boston, which drew 12 candidates, 65 percent of voters in the September preliminary did not choose either Marty Walsh or John Connolly, the top two finishers who advanced to the final election.

An alternative to run-off systems is ranked-choice voting, which was first proposed by MIT Professor William Robert Ware in 1870 and has been used in Ireland and Australia for decades. Ranked-choice voting eliminates the spoiler problem, but without the problems of a two-round system seen in the 2013 Boston mayor’s race.

As in the four states that have adopted two-round systems, party primaries are not needed under ranked-choice voting. All candidates appear on a single ballot, and instead of being limited to a single choice as they are today, voters can select multiple backups in case their first choice does not receive enough support.

Voters rank candidates from first to last. If there are four candidates, for example, voters rank the candidates 1-4 in order of their preference for them. The ballots are counted by computer as a series of run-off elections. At each stage, a majority is required to declare a winner. If a majority threshold is not reached, the lowest-ranked candidates are removed, one at a time, and their ballots are redistributed to that voter’s next-place choice. That process continues until a winner emerges with the support of more than half the voters. Had this system been in place for the 2013 Boston election, a candidate who did not finish in the top two among first preferences might have emerged as the winner after the rounds of candidate eliminations and vote transfers.

With ranked-choice voting there is also no need for a low-turnout first round; all the balloting takes place in a single election. Voter participation would likely jump from the 10 to 15 percent seen in today’s primaries to the 50 to 65 percent range typical of recent general elections.  Having one election instead of two also means that the cost of running elections would drop significantly.

Voter participation could be further improved by finding alternatives to special elections. Currently, half the states do not use special elections to fill legislative vacancies. In these states, typically the political party that last held the seat either selects a candidate or provides a list of possible candidates to the governor or other public officials charged with appointing someone to fill a vacancy.

Another option is simply to hold some empty seats vacant longer. Since 1997, almost 39 percent of special elections for the Legislature have been held in even-numbered general election years, one as late as June. Instead, the election could be delayed to the regular November election, particularly since the Legislature does not hold regular sessions after July of an election year.

Massachusetts has a venerable tradition of democracy and self-government, and we proudly claim the world’s oldest functioning Constitution. But today the state’s voters frequently face Soviet-style, single-candidate elections. When they do have a choice, it is often a decision settled in a primary or special election by a small fraction of the eligible voters. Against that backdrop, adopting rank-choice voting, easing access to the ballot, and rethinking special elections may not be radical disruptions as much as necessary first steps to renew the participatory, democratic spirit the Commonwealth was founded with.

Paul Schimek is a data scientist and researcher living in Boston with a longstanding interest in voting and democracy. He is a member of Voter Choice for Massachusetts.

All quiet for Baker on the DC front 

All quiet for Baker on the DC front 

Democrats in congressional delegation give him high marks

FOR RICHARD NEAL, the 15-term congressman from Springfield, the reopening in June of the city’s Union Station was a deeply moving moment. Neal, in 1977, had launched his first campaign for a seat on the Springfield City Council there and had at the same time promised to rehabilitate the decaying landmark.

It took a while, but years of scraping for funds, both in Washington and on Beacon Hill, had finally paid off. So it meant a lot to Neal, a Democrat, when Gov. Charlie Baker, a Republican, showed up for the reopening and lavished him with praise. “I wanted to be here to have an opportunity to congratulate all of you, especially the congressman,” Baker said.

Baker, Neal says, played a key role in securing state funds for improvements to the train station to make it accessible for people with disabilities. Neal keeps a coffee table book in his Washington office with photos of the reopening, including one of him and Baker admiring the new space.

Neal also applauds Baker’s efforts to extend broadband internet service to western Massachusetts. “When I call him, he calls back,” Neal says. “He is mindful that he can’t be just Boston-centric.”

At a time when leading Democrats in the state might be expected to pummel the governor to weaken him for next year’s gubernatorial race, the 11 Democrats representing Massachusetts in Washington are instead noting how well Baker has worked with them and at the same time maintained a rapport with the Republicans who actually run things in Congress and the White House.

No one would argue that Baker has particular cachet in Washington—he says he did not vote for Donald Trump and is far to the left of the GOP majority in Congress—but he has also approached the new administration diplomatically.

Trump, as a result, hasn’t cut off a fellow Republican with whom he doesn’t see eye to eye. “I think the Trump administration has to be careful, too,” in order to set Baker up for re-election, says Jim McGovern, the US representative from Worcester. “They would prefer a Republican governor over a Democratic governor, so I think there is still an open line of communication.”

There’s no better evidence of that than Trump’s decision in May to appoint Baker to a White House commission that’s seeking ways to combat the opioid epidemic. If the commission yields more funding for Massachusetts, it’ll help the state, which ranks fifth among all states in its death rate from opioid overdoses, according to a Kaiser Family Foundation analysis of Centers for Disease Control and Prevention data.

Having a Republican to advocate for the state, considering that Massachusetts’s all-Democratic congressional delegation has little sway with Trump or Republican leaders in Congress, is a useful thing so far as the state’s representatives and senators are concerned. “I’m hopeful that he can influence Donald Trump,” says Ed Markey, the US senator who has served in Congress since his 1976 election to the house.

It’s a reversal of fortunes that Markey hopes will work as well with a Republican president as it did when a Democrat, Barack Obama, was in the White House. Then, it was Baker who needed entrée to the administration to secure federal funds to cover costs from the state’s brutal winter of 2015. Markey and Neal set up a meeting for Baker with then-Vice President Joe Biden at which Baker requested federal emergency funds and received more than $120 million.

Baker has already helped some, says McGovern. The GOP effort to repeal and replace the Affordable Care Act, vehemently opposed by every member of the Massachusetts congressional delegation and Baker, fell, in part, because Republican senators balked at slashing federal funds used to expand the Medicaid insurance program for the poor.

McGovern gives Baker credit for joining governors such as John Kasich in Ohio and Brian Sandoval in Nevada in opposing the GOP health care bill. “I think it sends a signal to people all across the country that thoughtful Republicans think this is a bad idea,” he says. Baker’s position as vice chair of the National Governors Association’s Health and Human Services Committee has also offered him a platform to influence and motivate other state chief executives.

The failure of the health care bill, which would also have cut funding for the traditional Medicaid program that preceded the 2010 law, also preserves the arrangement Baker reached with the Centers for Medicare and Medicaid Services last year, before Trump took office, to change the way the state manages the care of Medicaid enrollees. Billions of dollars were at stake.

With big budget cuts on the GOP drawing board, Markey says now is not the time to pick unnecessary fights with the governor. “We as a state are advocating at a time when a lot of what we stand for is under assault,” he says.

Baker also enjoys a better rapport with the Massachusetts Democrats in Washington than some past Republican governors, such as Mitt Romney, because he’s approached the job differently.

“I think he has been extraordinarily non-political,” says Frank Micciche, who ran Romney’s Washington office. “It seems to me he does everything he can to avoid taking shots, political shots, and it’s not all out of the goodness of his heart. It makes sense. It’s not to his advantage to snipe at Democrats, either nationally or locally.”

Micciche points out that Baker has perhaps learned from Romney’s failed 2004 effort, dubbed “Team Reform,” to increase GOP representation in the state Legislature. (The Republicans lost seats that year despite Romney’s efforts.)

“Romney was running against the system. Baker hasn’t done that,” says Micciche. “He’s made himself part of the system. He’s working with [House Speaker Robert] DeLeo and [Senate President Stan] Rosenberg. His idea is to improve the brand for the party by getting results and not being super political.”

One area where there could be friction between Baker and the Washington delegation is over the MBTA. The T’s machinists union has enlisted the congressional delegation in its fight to stave off privatization of their jobs. At one event in Jamaica Plain in August, union officials specifically blamed Baker for the privatization effort. But US Rep. Michael Capuano, who appeared at the event, avoided mentioning Baker during his remarks. Asked about the omission after the event, Capuano acknowledged he wasn’t interested in bashing Baker, saying sometimes more can be gained with honey than vinegar.

Part of the reason Democrats are holding their fire is self-preservation. Baker, like state GOP governors past, has demonstrated a strong appeal to the more-than-half of the state electorate that is not affiliated with a political party, and he’s shown crossover appeal to Democrats, particularly urban Catholics.

“That independent voter he appeals to, they hate the hyper-partisanship,” says Neal.

And the reluctance of high profile state Democrats to jump into the gubernatorial race—US Reps. Katherine Clark, Seth Moulton, and Joe Kennedy, as well as Attorney General Maura Healey have ruled out runs—indicates the widespread view that Baker’s prospects for another term look good. “It looks like it would be a losing battle,” says Peter Ubertaccio, a political science professor at Stonehill College. “You risk losing your seat to wage battle against a fairly popular governor. It could be the end of your career. They are thinking they will try four years hence when it’s probably an open seat.”

There’s also no recent history of a Massachusetts lawmaker in Washington going on to the governorship. You have to go all the way back to Democrat Foster Furcolo, who won the governor’s race in 1956, to find someone who served in Congress ascending to the position. And Furcolo didn’t do so directly, having served as state treasurer in between. His predecessor, Republican Christian Herter, was the last to make the leap directly, having served in the House before his election as governor.

Baker declined an interview request. His spokeswoman, Elizabeth Guyton, provided a list of Baker’s efforts to defend the state’s health care system and to win federal funds for opioid treatment. Those efforts have borne some fruit, in the form of a $12 million grant from the federal Substance Abuse and Mental Health Services Administration this year to help treat people addicted to opioids.

But that’s a modest accomplishment, so when Baker starts campaigning, he might look to the Democratic congressional delegation for character references.

“He’s really an independent in the manner in which he’s administered the state,” says Neal.

“His work with our office has been very strong,” adds Kennedy, citing back and forth between his office and Baker’s on legislation that came out of the Energy and Commerce Committee establishing clear lines of authority between the states and federal government on regulation of self-driving cars. “He has been helpful and we expect he will continue to be,” says the Brookline lawmaker.

The coming year, of course, will bring a renewed focus on politics. As the days tick down to the election, and especially after Democrats select a candidate to take Baker on, the niceties may well give way. But that time has not come yet.

“I’m not averse to criticizing people when we’re at odds,” says McGovern. “But on a lot of the stuff very important to me—economic development issues, transportation issues—where we need to have a close working relationship, we do. I’m a Democrat, but look, there is a time for elections and there’s a time for governing.”

Islands face special pot challenges

Islands face special pot challenges

Nantucket, Vineyard hemmed in by fed regulations

LIVING ON AN island brings with it challenges many on the mainland don’t grasp, from being locked in during storms to being overrun by tourists during the summer season.

But those on Nantucket and Martha’s Vineyard are now facing a new question that their fellow Bay Staters won’t encounter: What about pot?

Massachusetts voters, like the other states that have approved legal marijuana, gave the green light to retail sales despite the fact it remains illegal to sell or possess it under federal law. As long as marijuana stays within state borders—and as long as the Trump administration doesn’t change the leave-states-alone approach adopted by the Obama administration—many believe there is little to worry about.

Not so for the islands off the state’s coast. Because the sea and air are under the jurisdiction of the federal government, carrying even a bud of weed between Nantucket or the Vineyard and the mainland is technically a violation of the federal controlled substance laws. That means all marijuana there has to be grown, manufactured, tested, sold, and consumed on the islands.

Many think federal officials will look the other way when it comes to legal marijuana shuttling over on the ferries, but the Coast Guard warns that is a risk people may not want to take.

“Since marijuana is still federally illegal, we enforce federal law,” says Petty Officer Andrew Baressi, a spokesman for the Coast Guard’s Boston station. “We don’t pick and choose what laws we enforce.”

Given the cost of land on both vacation destinations—Nantucket, at $2 million an acre, is the second most expensive place to buy land in Massachusetts—it will be a real test to find suitable sites for the full seed-to-sale process.

“It’s a really kind of a fascinating issue in trying to allow the islands to have access to marijuana—and these are islands that voted overwhelmingly in favor of legalization,” says freshman state Rep. Dylan Fernandes of Falmouth, whose district includes the Vineyard and Nantucket.

Year-round residents on both islands sent a strong message that they don’t want to be left out when the smoking lamp is lit. Nantucket voters approved the ballot question last year by a 64-36 margin, while the six small towns on the Vineyard all resoundingly said yes. In three of the Vineyard communities, the ballot measure won approval from 70 percent or more of voters.

Fernandes, along with state Sen. Julian Cyr of Truro, who also represents the islands, successfully amended the state’s recreational marijuana law to require the Cannabis Control Commission to come up with regulations to address the special issues facing the two islands by the time retail pot goes on the market.

Testing and supply are the two biggest concerns. While the regulations have yet to be worked out, testing will be required on all pot grown and products manufactured for contaminants and potency. There are currently two certified testing labs in Massachusetts on the mainland and a few more may open up. Cultivators and manufacturers can truck their wares to the labs for testing with the cost being kept relatively low because of the number of outlets that will be using the centrally located facilities.

On the islands, however, growers and manufacturers will have to pay for their own independent labs and that cost will inevitably be borne by consumers. Geoffrey Rose of Oak Bluffs, whose nonprofit has been approved by the state to open a medical marijuana dispensary in West Tisbury and who is considering a retail operation as well, said part of his permit requires him to pay for testing on-island. Between testing and finding suitable sites for cultivation and manufacturing, Rose says the price he charges for pot is likely to be high.

“It all goes into the cost of operation,” says Rose. “Every-thing costs more here.”

Fernandes, the Woods Hole representative, is pushing to get the state to subsidize pot testing on Nantucket and Martha’s Vineyard because of the hurdles stemming from the federal laws.

“How do you bring your marijuana to a testing facility if that testing facility is off-island?” Fernandes asks. “Are there ways for the state to subsidize testing facilities to come on island to shoulder some of the burden? I think we’re going to have some creative piece around testing.”

Another amendment to the law allows craft marijuana cultivators to produce marijuana for sale to retailers. The craft cultivators, similar to beer microbrewers, would be able to band together to grow marijuana plants and sell them wholesale, though not directly to consumers. How much marijuana craft cultivators could grow hasn’t been determined yet because regulations haven’t been written, but some on the islands hope local farmers would set aside some of their land for pot. “I think they’re probably going to have a lot, if not all, of their marijuana, homegrown on the island,” Fernandes says.

Many of the concerns percolating on Nantucket and Martha’s Vineyard arose on the islands of Puget Sound in the state of Washington, which legalized adult use of marijuana in 2012. Washington addressed the concerns by largely ignoring them. No testing facilities exist on the islands and no arrests have been made for transporting marijuana on state-operated ferries.

“We had a lot of growing pains and a lot of talk about what to do initially, but it hasn’t had a big impact on us,” says Ian Sterling, a spokesman for the Washington State Ferries. “If you have a box truck with a whole bunch of obvious markings about carrying marijuana, our people have to report it to the Coast Guard. But if people aren’t flagrant about it, I don’t think it’s something that gets noticed. We’re in the business of moving people, not moving pot. “

In Massachusetts, the Steamship Authority, a quasi-independent state authority that operates ferry service between Cape Cod and the islands, will be under some scrutiny once the sale of pot begins. Robert Davis, the authority’s general manager, says he and his crews have little leeway. “The guidance that the Coast Guard has issued is what we’d be adhering to,” says Davis. “Any vehicles coming on the property are subject to searches.”

At Hy-Line, which operates passenger-only ferries to the two islands out of Hyannis, officials toe the same line as the Coast Guard when it comes to what they’ll allow on board. But Richard Bigelow, head of security for Hy-Line, says pot is not at the top of his priority list.

“Today, in this climate, I’m probably less concerned about someone who has a small amount of medical marijuana than I am somebody carrying on explosives or weapons,” Bigelow says.

Colleges can't be bystanders on opioids

Colleges can’t be bystanders on opioids

Campuses need to step up to avoid overdose tragedies 

THE OPIOID CRISIS, rooted in the overprescribing of painkillers, has seized the attention of public officials from Beacon Hill to Capitol Hill. So, too, has the inadequacy of mental health services on college campuses become well documented. But so far, neither policymakers nor college administrators have connected the dots between the painkiller epidemic and the crisis of young people on campus with more access to narcotics than to care, although the connections are right before their eyes.

The dots were connected for me and my husband Larry a decade ago, in the most horrible way possible.

Our son Jeremy was 21 years old and a junior at Indiana University in 2007 when he fatally overdosed. Jeremy was found in his apartment, rushed to the hospital, and pronounced dead. The coroner’s report claimed cardiac arrest due to an overdose. Toxicology studies found high levels of hydrocodone and cannabis. Where did the drugs come from? How long had Jeremy been taking them?

Jeremy Kritzman at his Brookline High School graduation in 2005.

It would be 13 months before Larry and I knew how unmonitored pain medication, following a back injury at school a year earlier and complicated by alcohol use ignored by the clinicians treating him, led to his death.

Getting answers was not easy. We started at the university, meeting with two deans and the newly appointed associate provost. Jeremy’s professors reported he had been showing up to class and keeping up with assignments and quizzes, though it was only a month into the term. As that was all the information these administrators had, the meeting was short. Jeremy lived off campus—less than a mile from school—which made investigating his death a matter for the local police. That was a relief to the university, I suspect.

That same afternoon, we met with the chief of the Bloomington Police Department and a detective. The chief let loose with a mini-tirade about drug addicts, and the detective asked about hydrocodone, which confused us. We had not yet seen the coroner’s toxicology report, but in retrospect, it was clear that he had. We were urged to keep in close contact, and the detective said that he would do the same.

Yet, for weeks, we heard nothing. The police department ignored phone calls and emails. Just before Thanksgiving, we FedExed letters to the university, the police, and the mayor of Bloomington. Our complaints got the case assigned to a new detective, but she made little headway. She interviewed some of Jeremy’s friends and focused in on a young man who had spent time with Jeremy before he died, but she could not track him down. She tried to locate him on campus, but the dean of students refused to provide information as to his whereabouts and couldn’t say why. Neither could the associate provost. We asked the detective why a university official wouldn’t cooperate. “Sometimes they do, and sometimes they don’t,” she said.

Access to information about college students is covered by the federal Family Education Rights and Privacy Act of 1984, or FERPA. The FERPA law, which applies to institutions of higher education receiving federal funding (they all do), protects students’ educational and personal information from disclosure without prior consent. It also guarantees confidentiality of student medical records, as most university health services neither maintain electronic records nor rely upon third party payments, and therefore are not governed by the Health Insurance Portability and Accountability Act, or HIPAA.

In the event of health emergencies and campus drug and alcohol violations, which may be considered matters of public safety, the law permits institutions of higher education to contact parents of a student until he or she is 21 years of age and/or if he or she is claimed as a dependent on parental income tax. Universities vary, however, in how they interpret the law, and integrate federal and state law into school policy. Some schools telephone parents as soon as there is any violation or health emergency. Others call only if, beforehand, parents and students sign a waiver requesting notification. To do nothing and/or just wait is also not unusual.

LEARNING WHAT HAPPENED

It was more than a year before we gained access to Jeremy’s medical records. In October 2006, while at school, Jeremy was diagnosed with a herniated disk. Hanging out with friends, he had fallen off a barstool—which should have been a bright red flag. As a teenager, Jeremy had had a problem with alcohol, but he and we thought that was behind him. In his Brookline High School graduation speech in 2005, he spoke proudly of having overcome his “inner demons.”

Jeremy’s back injury was followed by numbing down his left leg. He called home worried and we urged him to see a doctor, which he did, readily granting us permission to consult with health care providers. No surgery was necessary, we were told, by a doctor there. Outpatient treatment would include epidurals, massages, and some medication.

When I asked a nurse for additional details about the injury, she was evasive. She never mentioned he might have blacked out, which I only learned afterward from his medical records. These same documents confirmed that Jeremy told his doctors about the alcohol he consumed at college, including that night, in addition to Adderall, prescribed for attention deficit disorder since he was in middle school. There was ample reason for a cautious approach to treatment, and close monitoring. But that is not what Jeremy got.

Indiana University, where Jeremy Kritzman was a student. (Via Creative Commons/flickr by jdfrens)

During the first 12 days of treatment, the Indiana University Health Service prescribed 70 doses of narcotic painkillers, including hydrocodone and propoxyphene, in addition to 30 prednisone (steroid), 20 Skelaxin (muscle relaxant), and 20 Naproxen (anti-inflammatory)—a total of 140 pills in less than two weeks. Within a month, the campus health service referred Jeremy to a physiatrist at Indiana Rehabilitation Associates in Bloomington, where the narcotic regimen continued for seven months. All prescriptions were filled at the Indiana University pharmacy.

Jeremy returned home in May 2007. The year had not been easy. It showed. Irritable and frustrated because his grades had dropped, he worried about getting himself back on track academically. MRI in hand, he consulted a specialist in spinal and back injury at Brigham and Women’s Hospital in Boston. The doctor prescribed anti-inflammatory medication and muscle relaxants, but no narcotic painkillers.

The summer went well. Jeremy was invigorated, calmer, and eager to return to school, which he did on August 20. He was supposed to join us in New York City on October 6 to celebrate Larry’s 60th birthday. But in mid-September, he telephoned, asking to come home sooner, insisting it was important. We made an airline reservation at once. But on the morning of September 19 Jeremy overslept and missed his flight—in retrospect, another red flag. That week he missed two doctors’ appointments. Eight days later he overdosed and died. He should have told us about all the narcotics prescriptions; it cost him his life.

A CAMPUS CRISIS 

Drug overdoses are the leading cause of accidental death in the United States. Since 1999, fatal overdoses have in-creased 167 percent for the population at large and 224 percent among young adults aged 18 to 24. These appalling rates are traceable to the opioid epidemic, fueled by the overprescribing of opioid analgesics and the recent availability of cheaper heroin and illegally produced fentanyl, according to the Centers for Disease Control and Prevention.

According to the federal Substance Abuse and Mental Health Services Administration (SAMSHA), in 2014 18-to-25 year-olds used more prescription medications—psychotherapeutics, pain relievers, sedatives, tranquilizers and stimulants—than other cohorts, older or younger. For every overdose death in this age group, there were 119 emergency room visits and 22 treatment admissions associated with these medications. SAMSHA also found 18-to-25 year-olds were less compliant with doctor’s instructions than other age groups, misusing medication for pain relief, relaxation, sleep improvement and enhanced concentration.

The situation appears worse on residential college campuses. Research comparing college-enrolled 18-to-24 year-olds to peers not in college has found rates of binge drinking, intoxication, and misuse of stimulants significantly higher among those in college. Stimulants such as Vyanese, Adderall, and Ritalin—sometimes referred to as “study drugs”—are passed around freely, with ample supplies due to overprescribing. (Overdose deaths caused by stimulants, prescription and non-prescription, have doubled since 2010.) The chemical culture of alcohol, drugs, and prescription medication on campus and in the doctor’s office are colliding, leaving in their wake a trail of pain and undue harm.

In the midst of this growing crisis, colleges and universities do almost nothing. The federal Clery Act requires campuses to log alleged crimes. The Safe and Drug Free Schools and Communities Act of 1997 targets unlawful possession, use, or distribution of drugs and alcohol. Good Samaritan laws encourage students to call 911 in the case of a medical emergency by granting immunity for illegal possession. But none of these legal measures requires, or even inspires, these institutions to keep track of, let alone act on, the deadly mix of chemicals in circulation among their students.

Institutions of higher education provide little education and guidance to families and young adults about public health and health care services at their institutions for students living either on or off campus. Families are kept in the dark about overdose deaths, ER visits, and prescribing laws and practices in the states where institutions are located. They’re also often given no details about the availability of medical professionals for students, access to pharmacies and standards of care, and university laws and policies, including waivers of federal privacy rules under FERPA so that parents can be informed about what happens to their child.

In the years following Jeremy’s death, I spoke with students, faculty, and administrators at numerous high schools and colleges, including Boston University, Dartmouth, Harvard, Stanford, and George Washington University. College administrators were willing to discuss efforts to curb binge drinking on their campuses. But when it came to health and mortality data, they were defensive.

“Families don’t need to be informed, they know about this troubling state of affairs already, it’s all in the newspapers,” one counselor remarked. A campus medical director said sharing data about student deaths from alcohol poisoning and overdoses, and emergency room visits to campus infirmaries and hospitals off-campus would scare parents away.

When I told a prominent college president that a Yale sophomore had recently died from prescription painkillers obtained from an athlete being treated for a sports injury on his floor, his naïve response was “that doesn’t happen here.” He pronounced alcohol the designer drug of choice among college students. Afterwards, the mother of the young man who died at Yale reminded me tragedies like his are often portrayed as random, convincing us that prevention strategies can’t work.

In the midst of this studied ignorance, institutions of higher learning take little responsibility for health and mental health services. The death of seven students in five months from suicide or overdose at Columbia University led senior Jacqueline Basulto last February to initiate a petition calling for improved mental health services at Columbia and 20 other schools. Within two and half months, close to 1,000 signatures were collected across these campuses. The Columbia administration set up a task force to expand services, the only one of the nearly two dozen schools to respond so far.

A recent survey of 50 colleges by STAT found long delays in obtaining initial counseling appointments. Jacqueline Basulto herself was told to wait two weeks at Columbia counseling when she was suicidal, claiming it was the support of her parents nearby and expensive therapy outside the institution that got her through. She attributes student stress to academic pressure and competitiveness and the stigma of needing help. At Indiana University, where Jeremy attended, as well as several other large schools, STAT found one counselor employed for every 1,500 undergraduates.

The National Survey of College Counseling Centers found in a sample of 275 institutions of higher education that just 58 percent have access to on-campus psychiatrists, despite sharp increases in students arriving on campus on medication already and an increase in medication referrals initiated by counseling departments at those schools. Roughly one in four college students who seek mental health services are on medications that need a psychiatrist’s supervision.

Without enough providers, parents may be forced to mail psychiatric medication to their sons and daughters since out-of-state prescriptions for controlled substances such as stimulants are often difficult to fill. Pill shipments contribute to an unmonitored glut of medications which may be shared, bought, and sold on campuses.

A BETTER WAY FORWARD 

It was during my generation in the 1960s that student protests for free speech and civil rights challenged university authority and the presumption that colleges would act in loco parentis. What followed in its place, according to Peter Lake, who directs the Center for Excellence in Higher Education at Stetson University College of Law in Florida, was the “bystander” era, in which universities felt “no duty to respond” to the risks present on their campuses, including the unsupervised use of alcohol and prescription medications.

Lake calls this a broken system, where administrators often feel powerless, young people feel unprotected, and families feel ignored. He thinks we need to steer a different course, using cooperation, compromise, and strategies based upon science (and hopefully neuroscience). That won’t be easy. But certainly American universities have the technological capacity to collect data regarding student deaths, hospitalizations and injuries, analyze the results, and come up with new ideas for better programs and policies.

Today’s students arrive on campuses from all over the country, filled with excitement and enthusiasm about their future, but with no one to monitor medications they may be taking already and with inadequate access to counseling and mental health services. Young scholars who turn their ankles, sprain their wrists, or tear their ACLs find themselves with a bottle of narcotics that turn them into addicts or suppliers of dorm-room drug swaps. Aspiring doctors, lawyers, and entrepreneurs have their lives turned upside down—if not lost forever—by the smorgasbord of drugs in their midst.

A friend once told me that someday I would wake up and my early morning thoughts would not be of Jeremy. I know that will never happen. But I do hope that someday I will awaken and know that young people like Jeremy are having their health, including mental health, nurtured along with their intellects at those ivy-covered institutions their families entrust them to.

In loving memory of Jeremy and all the others. Janie L. Kritzman is a clinical psychologist living in Brookline.

Drugs are best treatment for opioid abuse

Drugs are best treatment for opioid abuse

Relying on medication is not a morally compromised approach

THE OPIOID ADDICTION crisis in the United States has prompted leaders at the state and federal level to promise more money, new laws, and greater focus on the problem. That focus is needed but so far the policy goals lack clear definition. Even as attention on the problem has ramped up, we have continued to treat addiction in ways that have historically not worked well. Doing more of something that’s not working will not correct the problem. If the policy goal is to create treatment interventions that reduce abuse, lower the rate of remission, and restore patients as much as possible to normal living, there is extensive medical research and practical clinical experience suggesting medication-assisted treatment, or MAT, is the way to go.

Aside from emergencies, traditional addiction treatment in the United States is often not medical in nature but guided by the principles derived from 12-step programs. The goal of these programs, which are characterized by admirable spiritual and moral ideals, is complete abstinence driven by self-discipline and support from peer groups. This approach does not work well for people with opioid dependence. As long ago as 1997, National Institutes of Health experts concluded that “opioid addiction is a treatable medical disorder and explicitly rejected notions that addiction is self-induced or a failure of willpower.” The approach recommended by the National Institutes of Health and virtually all other medical and scientific sources is medication-assisted treatment.

Medication-assisted treatment means using one or more pharmacological agents to relieve the symptoms and risks of addiction, enabling patients to begin returning to normal life and to benefit from other behavioral therapies. The treatment is not a magic bullet and medication-assisted treatment does not guarantee success, but it has a substantially higher rate of positive outcomes than traditional non-medical treatment programs. A team of physicians writing in the New England Journal of Medicine likened medication-assisted treatment to the care needed for “other chronic diseases such as diabetes and hypertension,” where “effective treatment and functional recovery are possible.”

Edward M. Murphy

Because of the stigma associated with drug abuse and the traditional stereotype of the addict, some people find it counter-intuitive to use medication to treat addiction. But when scientists explain how the brain responds to the excessive use of heroin or pain pills, the logic of addressing the pathology with an appropriate medication is persuasive. Opioids attach themselves to receptors in the brain and artificially generate excessive quantities of the neurotransmitter dopamine, producing feelings of euphoria. Addiction is the result of the brain “learning” this new behavior through excessive repetition until it becomes dependent on the artificial effect and craves more.

The argument that experts make for medication-assisted treatment is that managing the brain’s new habit and mitigating the effects of withdrawal will not happen just because a person wants to stop abusing opioids. The process requires a kind of neurological reverse-engineering that can relieve the brain’s urgent need for more drugs. In the absence of appropriate medication, a significant majority of addicts who go through short-term detox will relapse, often multiple times.

There are three medications used in treating opioid addiction. The best known is methadone, which was initially developed in the 1940s as a pain reliever. Because it works by changing the way the brain perceives physical and psychological pain, methadone was soon used to provide people dependent on heroin with a way to manage their withdrawal and to stabilize their lives. Methadone is a synthetic opioid although it does not produce the same high as abused opioids. It is effective but often poorly perceived in the wider community because of its long association with heroin and because people suffering from an addiction disorder normally must go to a registered clinic daily to receive their dosage.

A second medication, buprenorphine, is now gaining wider acceptance among experts. Buprenorphine is called a “partial agonist,” which means that it activates the same receptors as abused opioids but produces a much weaker effect. Essentially the brain is fooled into believing that its opioid craving is met but this happens without the pattern of withdrawal and euphoria that is typical of addiction. The medication is delivered via a daily pill or a strip placed under the tongue and can be prescribed by physicians who have special authorization and training. Patients normally have a month’s supply to take at home. The most common form of this medication, sold under the trade name Suboxone, has a second element that causes unpleasant symptoms in a patient who relapses and takes another opioid.

The third current option is called naltrexone, sold under the trade name Vivitrol. This is an “antagonist” medication that works in a different way than buprenorphine. Instead of fooling the brain receptors, it blocks them so that a patient who relapses cannot trigger those receptors and experience a high. It is administered by monthly injection and can only be given to patients who are already completely detoxed. Vivitrol is increasingly used in criminal justice settings, particularly for previously addicted inmates who will shortly return to their communities.

Each medication has various dosages, side-effects, advantages, and disadvantages depending on the condition of the patient and the arc of his or her addiction history. Only a physician who fully understands the patient’s needs, matches them to the characteristics of the medications, and carefully monitors the ongoing results should make the decision about how best to exploit medication-assisted treatment for the benefit of individuals who need it. Many patients also need to receive psychosocial counseling to help them build on the opportunity provided by the medication.

The National Institute on Drug Abuse summarizes the available research by concluding that medication-assisted treatment has multiple advantages over other forms of treatment and “decreases opioid use, opioid-related overdose deaths, criminal activity, and infectious disease transmission.” Further, MAT “increases social functioning and retention in treatment.” One important study, a randomized, controlled trial published in 2015 by a researcher associated with Harvard Medical School and McLean Hospital, demonstrated that MAT “at least doubles rates of opioid-abstinence” compared with other forms of treatment.

Unfortunately, the treatment endorsed by experts as offering the highest probability of success in moderating the impact of the opioid crisis is not widely available. A health care system normally driven by evidence of clinical efficacy has not organized itself to deliver the care needed by the millions of Americans who suffer from opioid-use disorder. A report issued by the Pew Charitable Trust found a “treatment gap” in which only 23 percent of publicly funded addiction treatment programs and less than half of private sector programs offer MAT. This lack of availability was attributed to inadequate funding and a dearth of qualified providers.

There are additional reasons for the gap. One is the persistent opinion that relying on medication to treat addiction is a morally compromised approach. A psychologist writing last year in Psychology Today articulated this view by saying that “recovery should be about breaking free from all substances.” He also raised the so-called crutch argument, asking if MAT isn’t simply “transferring from one drug to another.” According to this line of thinking, using any drug to aid in treatment is simply switching dependency from one substance to another and is a sign of weakness. This perspective rejects the analogy that using medication to treat addiction is like using insulin to treat diabetes.

It is a sad commentary on our approach to opioids that addicts have easy access to quality medical care when they overdose but not before. According to the Centers for Disease Control and Prevention, more than 1,000 people are treated in US emergency rooms every day for misuse of prescription opioids. Many more are treated in emergency rooms for the use of such drugs as heroin and fentanyl. The trend is strong in Massachusetts, which ranks at the top among states when measured by opioid-related emergency room visits. Approximately 64,000 Americans, including 1,933 in Massachusetts, died from overdoses in 2016. Hundreds of thousands more were saved by the intervention of clinical professionals. Our health care system is improving at helping people dependent on opioids to survive emergencies, but it is still weak in helping them to recover and live normal lives.

As important as it is to save people’s lives, we will not have a successful policy responding to the opioid crisis until we mitigate the psychological, economic, and societal consequences suffered by living victims of opioid use disorders, their families, and their communities. That requires a highly organized system for quick and comprehensive delivery of the best clinical interventions available. Some people receiving medication-assisted treatment will fail to comply with the recommendations of their physicians, just as some diabetics do when they consume too much sugar or neglect to take their insulin. The correct response is not to punish them by denying medication and thereby subjecting them to the torment of their disease. The best antidote is sustained availability of high-quality care designed to bring each patient as close as possible to normalcy.

Edward M. Murphy was head of three state agencies between 1979 and 1995—the Department of Youth Services, the Department of Mental Health, and the Health and Educational Facilities Authority. He subsequently ran several health care companies in the private sector before retiring.  

Diversity data gaps

Diversity data gaps

Surprisingly, some state agencies don't track their minority hiring

EVERY YEAR, THE governor’s Office of Diversity and Equal Opportunity publishes a detailed report on the diversity of the workforce at each of the executive branch secretariats, now numbering nine. But many other parts of state government —the constitutional officers, the Legislature, the judiciary, and the various state authorities—rarely, if ever, release any diversity data on their employees.

So we decided to ask them for the information.

What we found is that many of these government agencies don’t appear to track diversity data as a matter of course. Some assembled the information in response to our request; others had no interest in gathering the data.

Count the Legislature, Secretary of State William Galvin, Inspector General Glenn Cunha, the Pension Reserves Investment Management Board, and the Massachusetts State College Building Authority in the latter category.

“We have no real reason to collect the data,” says Edward Adelman, executive director of the college building authority. “We hire the most highly qualified people to do the work without regard to what we would call, you know, sort of non-merit factors.”

Galvin and Cunha both declined comment on why their offices don’t gather diversity data.

Some of the diversity data provided by the government agencies wasn’t very detailed. For example, some agencies listed the number of minority employees but failed to provide a breakdown by race, ethnicity, or job category. The absence of a breakdown by job category made it impossible to assess whether minorities were employed throughout the organization or concentrated in low-level positions.

Rep. Byron Rushing, the House assistant majority leader and a member of the Legislature’s Black and Latino Caucus, says he was surprised agencies didn’t collect the data or only collected if asked for it. “You can’t take diversity seriously and not collect the data,” says Rushing. “Statistics are important.”

Unlike his predecessors going back to at least Mitt Romney, Gov. Charlie Baker doesn’t include diversity information on his own office in the report he issues on the workforce of the state secretariats. In response to CommonWealth’s request, however, Baker reported that his 69-member staff is 21.6 percent minority, with 10.1 percent Hispanic, 7.2 percent black, and 4.3 percent Asian. The governor’s office provided no breakdown of minorities by job category.

Baker’s overall minority number was slightly better than the 20.7 percent target he set for the nine secretariats and 1.3 percentage points higher than his predecessor, Deval Patrick. Patrick, the state’s first black governor, who was well known for his strong emphasis on a diversified workforce, increased minority representation in his office by 15.1 percentage points compared to his predecessor, Romney.

Among current constitutional officers, Treasurer Deborah Goldberg’s office had the highest minority representation at 29.6 percent, followed by Baker at 21.6 percent, Auditor Suzanne Bump at 19.5 percent, and Attorney General Maura Healey at 17.5 percent.

Healey offered no breakdown of her employees by race, but she did analyze where minorities are located in the job hierarchy. Of the 272 lawyers working in Healey’s office, 12.5 percent are minorities. Of  the 61 supervisory lawyers, 13.1 percent are minorities.  She also reports that minorities make up 21.6 percent of the 315 non-lawyers and 13.3 percent of the 45 supervisory non-lawyers.

The judiciary declined to provide diversity data on its employees, but some limited information has surfaced as a result of a lawsuit filed in 2016 by the Lawyers’ Committee for Civil Rights and Economic Justice. In response to the lawsuit, the Trial Court turned over data on court officers that suggested wide disparities among individual courts within Suffolk County. Minority representation among court officers ranged from a low of zero percent at the John Adams Courthouse to a high of 67 percent at the Boston Housing Court. For all 11 courthouses, the minority average was 34 percent.

We surveyed more than 40 quasi-public state agencies, 15 regional transit authorities, the State Ethics Commission, the Massachusetts Gaming Commission, and the Inspector General. All of the data provided by the agencies is available (quasi-public agencies here, regional transportation agencies here, and independent agencies here.)

The most comprehensive diversity data from any state authority—and for that matter from all the entities contacted—came from the MBTA, which agreed to revamp its employment practices in an anti-bias agreement with the federal government in 2014.

The data indicate 44.8 percent of the T’s 6,369 employees are minorities—more than double the target used by the state in its diversity report on the secretariats.  The top employment category at the T, consisting of 1,203 workers, is 32.3 percent minority, with 21.6 percent blacks, 4.6 percent Hispanics, and 3.7 percent Asians.

The Massachusetts Housing Finance Agency reports 30.3 percent of its 333-member workforce are minorities. The minority percentages at the Massachusetts Water Resources Authority, the Massachusetts Port Authority, the Convention Center, and the Steamship Authority are 21 percent, 21.2 percent, 22.2 percent, and 10.6 percent, respectively.

The Massachusetts Life Science Center says 40 percent of its workers are minorities. It is also the only quasi-public state agency with a minority official in the top job.

The 15 regional transit authorities employ relatively few workers directly, but four of them (Cape Ann, Franklin, Merrimack Valley, and Worcester) have no minorities. The largest regional authority, located on Martha’s Vineyard, says 7.4 percent of its 109 workers are a minority.

Rep. Russell Holmes, a member of the Black and Latino Caucus on Beacon Hill, says all areas of state government should be a role model for diversity.

“Otherwise, how can we go to folks like our state vendors and insist in our contracts with them that they need to have a diverse workforce?  How can we can go and ask someone to do something that we’re not willing to do ourselves?” Holmes asks. “If diversity were a priority in state government, it would get measured. And what gets measured gets done.”

Nurses, hospitals tangle over staffing levels

Nurses, hospitals tangle over staffing levels

Union skirmishes foreshadow ballot campaign over who makes the call

MARK BRODEUR, a nurse at Berkshire Medical Center in Pittsfield, says his unit, which serves patients recovering from anesthesia post-surgery, is usually staffed pretty well. But not long ago he says he found himself struggling to care simultaneously for three patients all requiring critical care.

“I had one incoming patient, so I’m hearing the report on that one at the same time I’m holding another patient’s airway open, at the same time my third patient is having an allergic reaction to the anesthesia and throwing up all over the floor,” Brodeur says. It was a nightmarish situation, he says, because he couldn’t attend to the vomiting patient without leaving the patient whose airway he was keeping open. “Nobody can be in more than one place at one time,” he says.

While every workplace has its pinch points, Brodeur says that nurses have a unique and critical role in the high-stakes hospital environment.  When nurses are not available to monitor vital signs of a critically ill patient who takes a turn for the worse, or provide care instructions to those being discharged, or assist frail patients getting in and out of bed, their absence puts the recovery, safety, and welfare of those patients at risk.

Amber Van Bramer, one of Brodeur’s colleagues at Berkshire, says nurses have a duty to take care of and protect their patients. “We need the resources to do that to the best of our abilities,” she says. “We’re not flipping hamburgers here.” (The spelling of Van Bramer’s name was corrected.)

Brodeur and Van Bramer are among hundreds of unionized nurses who are pushing for increased staffing levels in their contracts with hospital administrators at Berkshire, Baystate Franklin Medical Center in Greenfield, Baystate Noble Hospital in Westfield, and Tufts Medical Center in Boston. Some of the nurses have called one-day strikes, which were followed by management lockouts that hospital officials say were necessary to accommodate the contract terms of replacement nurses.

All of the nurses at these facilities are members of the Massachusetts Nurses Association, the largest nurses union in the state and an organization that has been pushing for higher staffing levels for more than 15 years. The union nearly took the issue to the ballot in 2014, but backed off when it agreed to a last-minute legislative compromise that established minimum staffing levels in intensive care units. Now it’s gearing up for another ballot fight next year that would extend minimum nursing staffing levels to all units of every hospital in Massachusetts.

Hospital officials say nurses are not walking picket lines and preparing for an expensive ballot question fight to protect their patients; instead, they are looking out for their own self-interest. The hospital officials say claims of unsafe staffing are inaccurate, unfair, and misleading and that the reports are invented as a way to engage the public and legislators in what has become an ongoing labor dispute over money. While the staffing issue is currently part of MNA contract negotiations, that would all change if voters approve the question being readied for the 2018 ballot.

Mary Havlicek, an operating room nurse at Tufts Medical Center. (Photo by Michael Manning)

The ballot initiative in several key ways takes staffing authority away from hospital administrators and gives it to nurses. The question would establish limits on how many patients a nurse can take on in every unit of the hospital. In many of the units, that number would vary depending on the status of the patient. For example, the number of patient assignments in the emergency department would vary from one to five per nurse, depending upon the patient’s status (critical, non-stable, non-urgent, and stable). The law gives nurses power in assessing where patients fall along this continuum.

More than anything else, this shift in management control envisioned by the nurses and their ballot question is what drives passions on both sides of the debate. David Schildmeier, a spokesman for the Massachusetts Nurses Association, says administrators at many hospitals across the state shave their operating costs by staffing at a “bare bones” level.

“This is why we need a law to hold hospital administrators accountable,” he says. “Otherwise they are going to cut costs by trimming the patient care budget in ways that an ever-growing body of evidence shows will hurt patients.”

Michael Wagner, the CEO of Tufts Medical Center, scoffs at any suggestion that his hospital is skimping on patient care. “We have spent a lot of time developing an evidence-based practice in patient care,” he says. “Nurses are in the middle of all that, but to say that quality of care is dependent on the number of nurses is so monochromatic, so incorrect. Patient care quality has nothing to do with the number of nurses. To connect the two is moronic.”

TWO VIEWS AT TUFTS

In mid-July, Wagner looked out his office window onto a scene that was arguably a hospital administrator’s worst nightmare—at least one of them.  Hundreds of Tufts nurses walked in a picket line outside the front entrance of the hospital wearing sandwich boards and talking to reporters, patients, and anyone who would listen about why the facility was unsafe for patients.

Wagner says the claim that more nurses would equal better patient care is a false argument.  He says the ballot initiative to mandate minimum staffing levels is based on nonscientific thinking, would cost hundreds of millions of dollars, and accomplish little beyond swelling the ranks of the MNA. “It’s a lot easier for them to talk about patient safety out there than it is for them to say that they want higher salaries and more benefits,” Wagner says.

Terry Hudson-Jinks, the chief nursing officer at Tufts, says that if the ballot initiative becomes law the quality of care in the hospital would actually suffer. She says the law establishes a rigid staffing model with a fixed number of patients per nurse, an approach that does not take into account all the different variables that occur in the everyday operation of a hospital. The acuity and number of patient needs is constantly changing, and to meet those needs a staffing model needs to be flexible, not fixed, she says.

The administration at Baystate’s two hospitals and Berkshire Medical Center share the same philosophy. They say flexible staffing works well by allowing them to adjust in nearly real-time to subtle changes in patient numbers and needs.

Mary Havlicek, an operating room nurse at Tufts who was walking the picket line that day in July, says the stress of too many short-staffed shifts has lowered morale at Tufts. While the hospital says it hired more than 150 nurses in recent years to account for attrition and higher patient needs, Havlicek says nurses are leaving faster than new ones are coming on board. “Many of the younger nurses get trained here, then they leave for better paying jobs across town,” she says.

When a nurse calls in sick or goes out on leave, Havlicek says, managers send out “blast texts” to nursing staff looking for help filling the gaps. But Havlicek says many of these efforts are in vain, as the per diem nurses who ordinarily would be the ones to fill gaps are already working in the hospital when the texts go out.

Terry Hudson-Jinks, chief nursing officer at Tufts Medical Center.(Photo by Michael Manning)

”It makes me want to burst into tears when I think of what is going on. We are the ones who have to look the patients in the eyes when we can’t be there to help them,” she says.

Schildmeier, the MNA spokesman, says nurses and doctors are also the ones on the hook legally if something goes wrong.

“We are not asking for that much,” says Havlicek, her voice cracking with emotion. “Imagine if you’re an ICU nurse and you’re getting all these texts from your manager as you’re driving in, saying, ‘We need help. Can anyone cover ICU?’ It’s terrifying. You’re thinking what situation am I going to be walking into.”

To illustrate what sort of situations might occur, Havlicek recounted an incident in what she described as an understaffed Tufts intensive care unit, which is already regulated by a state law requiring set nurse-patient staffing ratios. More patients were hooked up to a high-tech filtration machine than could be monitored by the available staff, she says, so one of the nurses was asked by her supervisor to call the doctor to ask if one of the patients could take be temporarily withdrawn from the machine.

“That question should never have been asked,” Havlicek says.

On that point, Wagner, the Tufts CEO, is in full agreement. “That didn’t happen in this institution,” he says incredulously. “We don’t withdraw patients from the resources they need because we don’t have staff to monitor them.”

If the incident did in fact take place, he says, the nurse involved should have reported the incident through the process that all staff are trained to follow if patient safety is threatened. “That she was talking to a reporter instead is disgraceful. That nurse takes an oath,” he says.

BACK AND FORTH ON STAFFING

Nurses and hospital administrators argue endlessly over staffing issues, with neither side willing to concede any ground. This dug-in mentality surfaced at Tufts and BayState, but nowhere was it more evident than at Berkshire Medical Center.

Nurses at the Pittsfield facility recently compiled a spreadsheet documenting over 400 instances of unfilled shifts and other staffing concerns. Brodeur, whose unit deals with patients emerging from anesthesia, says the problem has gotten worse since the closing of North Adams Hospital.

Diane Kelly, the chief operating officer at Berkshire, says she doubts the veracity of the situation outlined on the spread sheet. “That data was collected for political purposes,” she says. “If these were real concerns, they would be reported through the quality tracking system.”  She says none of the concerns were reported through the system, even though all employees are trained and tested on the system to ensure that unsafe situations are identified and addressed.

In interviews, six nurses at Berkshire Medical Center say new hires receive training on the quality tracking process, but insist there is no mandatory annual training or testing. The nurses say they have been bringing unsafe staffing concerns up in monthly labor/management meetings for years and filing reports with managers with a copy to the union. But the nurses say administrators have not once suggested these concerns be reported through the quality tracking system. Indeed, one nurse, Jody Stefanik, says she asked administrators during one of the meetings whether she should use the quality tracking system to report staffing concerns and was told no.

Michael Leary, a spokesman for Berkshire Medical, says use of the quality tracking system is mandatory. “Any employee who sees, experiences, or feels there is a risk for a quality incident must report that incident using the form,” he says in an email. “Also, the hospital requires ALL employees to complete mandatory education, which includes the Quality Tracking system. I myself took my mandatory education test last week, and there were multiple questions in regard to the use of the Quality Tracking Form and how and why it is used. If an employee does not pass that mandatory test yearly, they cannot report to work.”

Schildmeier, the spokesman for the Massachusetts Nurses Association, accuses Berkshire Medical Center of “blatantly lying about the nature of the process that is used by nurses to report unsafe situations. BMC management’s response is a cynical ploy to divert attention from the fact that nurses, on hundreds of occasions, have been reporting dangerous situations that jeopardize the safety of their patients, and in the face of those reports, management has refused to address nurses’ concerns.”

The back and forth between Berkshire Medical Center and its nurses is not only confusing but troubling. If the managers are right, the nurses are concocting hundreds of incidents to solicit the sympathies of the public as they buck their managers for a raise. If the nurses are right, the hospital administrators are denying that units are short-staffed in a way that may impact the safety or even the survival of their patients.  Neither scenario is particularly comforting.

LESSONS FROM CALIFORNIA

California in 2003 became the first and only state in the nation to pass a minimum nurse staffing law, which created nearly ideal circumstances to study whether increasing the number of nurses improved patient outcomes or was a waste of hospital resources. Suddenly, one and only one variable had changed in only one state. Once the law was fully implemented, nursing researchers interested in staffing issues found an experimental group (California hospitals), an ample supply of control groups (non-rural states with similar demographics and mix of hospitals), and baseline data for all these groups.

Initially, the research was not conclusive or showed little or no improvement in California. But over time a growing number of peer-reviewed studies have shown a variety of positive outcomes linked to lower patient assignments per nurse. The research suggests Tufts CEO Wagner was wrong when he said “patient care quality has nothing to do with the number of nurses.” A large number of the studies, however, have also suggested that nurse staffing levels alone are not enough to make a difference.

A 2011 study in Medical Care indicated that lowering patient-nurse ratios in hospitals where the nurse work environment is positive had a sizeable effect on patient mortality. But where the work environment was poor, increased nurse staffing levels had no impact.

A 2013 study in BMJ Quality Safety compared hospitals in California, New Jersey, Pennsylvania, and Florida, and found that each additional pediatric patient per nurse was associated with an 11 percent increase in the odds of readmission within 15–30 days after discharge for medical patients and a 48 percent increase in the odds of readmission within 15–30 days after discharge for surgical patients.  

One Massachusetts-based researcher, Judith Shindul-Rothschild of Boston College, has collaborated on a number of studies published in peer-reviewed journals suggesting a correlation between nurse-patient ratios and patient outcomes. A psychiatric nurse, Shindul-Rothschild has come under fire because she is a member of the Massachusetts Nurses Association and a past president of the union. She has also testified on Beacon Hill in favor of minimum nurse staffing levels.

“You have to consider the source,” says Michael Sroczynski, the vice president for government advocacy at the Massachusetts Health & Hospital Association. “That researcher frames things in a way that benefits that organization,” he says, referring to the nurses’ union.

Judith Shindul-Rothschild is a lightening rod in the debate over nurse staffing levels. (Photo by Michael Manning.)

Shindul-Rothschild says she often uses data about Massachusetts hospital staffing and quality measures that is available on the website patientcarelink.org, which is maintained by the Massachusetts Health & Hospital Association.

“It’s their data,” says Shindul-Rothschild. “They can run the reports just as well as anyone else.  I invite them to replicate what I did and tell me what’s wrong with it.  If they want to refute my findings, I have no problem with them writing a letter to the editors of the publication. That’s the professional way to do this.”

A 2016 article by Shindul-Rothschild and others published in the Journal of Nursing Administration compared California to New York and Massachusetts.  “When compared with states that do not have mandated nurse-to-patient ratios, California, which limits the number of patients assigned to RNs, has significantly lower pneumonia readmission rates,” they concluded.

The group’s 2017 study in the Journal of Nursing Care Quality showed that higher patient assignments to nurses as well as poor communication between nurses and patients and a higher incidence of patient falls are all factors associated with a nurse failing to remove catheters in a timely manner, which often leads to urinary infections.

A 2016 study published in the Journal of Emergency Nursing by the same team focused on 67 Massachusetts hospitals and concluded that emergency room wait times increase with each additional patient added to a nurse’s caseload. Shindul-Rothschild, who has met with policymakers in different states, says they all want to know what the “magic number” of nurses is. “I show them the data, and ask them: ‘What do you want [emergency department] wait times to be? 15 minutes? Half an hour?’”

Schindul-Rothschild says that the staffing data posted on the MHA site indicate that Tufts was an outlier in Massachusetts in terms of nurse staffing levels from 2012 to 2016.

In the Tufts medical surgical unit, according to Shindul-Rothschild, Tufts nurses had an average of 4.74 patients, or .67 additional patients compared to nurses at other Massachusetts teaching hospitals. Step-down nurses at Tufts had an average of 3.53 patients, or .47 additional patients, and emergency room nurses had an average of 12.65 patients, an additional 1.71 patients.  Tufts Medical Center says the year-to-date staffing data in 2017 show markedly lower nurse-patient ratios.

Using the same data, Shindul-Rothschild says Berkshire Medical Center had, on average, the second highest number of patients assigned to a nurse in the medical surgical unit (5.27) of all Massachusetts hospitals in 2016. Baystate Medical Center (Baystate Healthcare’s non-unionized hospital in Springfield) had the highest number, an average of 6.24 patients per nurse.

The back-and-forth struggle between hospitals and nurses over staffing levels is already intense. Between now and next fall, when minimum nurse staffing levels may go to the ballot, the battle lines are likely to harden. With hospital control, patient safety, and millions, perhaps hundreds of millions, of dollars at stake, the fight has just begun.

Utilities on both sides of bargaining table

Utilities on both sides of bargaining table

Eversource, National Grid could end up awarding billion-dollar clean energy contracts to themselves

IN MID-MAY,  the MBTA hired a Colorado company to help the agency manage the $2 billion extension of the Green Line into Somerville and Medford. Less than three months later, the Colorado firm was acquired by Jacobs Engineering Group, a key player on one of the three construction teams vying for the Green Line contract.

T officials said it would create the potential for conflict of interest if the project construction manager was affiliated with one of the companies seeking to land the Green Line contract, so they severed ties with the advisor and hired the second-place finisher from the original contracting process.

The circumstances are a bit different, but state officials are taking a very distinct approach in their push for clean energy. Under a measure passed last year by the Legislature and signed by Gov. Charlie Baker, the state’s two major utilities, Eversource Energy and National Grid, are charged with procuring billions of dollars worth of clean energy through two separate contracting processes. But the utilities are also part of groups bidding on the clean energy deals, which means Eversource and National Grid could end up awarding contracts to themselves.

A number of steps have been taken to minimize self-dealing. The utilities adopted standards of conduct that bar company officials on one side of the table from talking to their colleagues on the other side of the table. An independent evaluator is monitoring the contracting process and is charged with making sure everything is on the up and up. And the two utilities are both vying for the contracts, so there is a good chance they will blow the whistle if they witness any self-dealing by the other firm.

Illustration by Richard Mia

 

But the truth is no one knows what’s going to happen as the contracting process moves forward. Billions of dollars are at stake and there are a lot of subjective judgements that will go into picking the winners. Officials at Eversource and National Grid say the procurement process will be fair and impartial, but those assurances haven’t put to rest the concerns among some of the companies vying for the contracts.

Donald Jessome, the CEO of TDI New England, a bidder on one of the clean energy contracts, likes his project’s chances, largely because he has already obtained most of the permits he needs to begin construction. But he knows he is facing a lot of competition, including from affiliates of Eversource and National Grid. Jessome is appreciative of the steps Massachusetts officials have taken to make sure the contracting process is fair, but he admits the situation makes him nervous.

“At the end of the day, I’m being graded by my competitors,” he says. “I can’t help but be concerned. It’s not the best place to be in a competitive process.”

HOW WE GOT HERE

Dan Bosley runs the North Adams SteepleCats baseball team today, but 20 years ago he was a state rep on Beacon Hill pushing through legislation deregulating the electricity industry. Instead of vertically integrated utilities that both generated electricity and distributed it to customers, Bosley’s legislation divided the industry into two parts. Regulated utilities would continue to handle the delivery of electricity to homes and businesses, and power generators would battle against each other in a competitive wholesale market. Competition meant the power generators—and not ratepayers—would be on the hook for any financial losses if a power plant failed or if it produced electricity nobody wanted to buy.

Deregulation worked well. Power generators responded to a falloff in natural gas prices by building plants that produced electricity using natural gas. Plants that relied on coal and oil gradually found themselves being priced out of the market, and forced to shut down. Nuclear plants also fell victim to the market shift toward gas.

Greenhouse gas emissions have declined as the region’s reliance on natural gas has increased. But policymakers are now seeking steeper cuts in emissions to meet ambitious targets for 2030 and 2050. With the competitive wholesale electricity market unlikely to embrace the risk associated with higher-cost forms of renewable energy, policymakers in Massachusetts and across New England began intervening directly, using Eversource and National Grid as proxies to purchase clean energy.

Cape Wind was an early example. National Grid negotiated a long-term, power-supply contract with the offshore wind company in 2010, and Eversource followed suit in 2012. The deal collapsed in 2015 when Cape Wind was unable to complete its financing.

As the state began considering more ambitious clean energy deals, key players on Beacon Hill quietly started discussing what role the state’s utilities should play. According to those familiar with the discussions, there was concern that the utilities might end up on both sides of the negotiating table. Some wanted to create a new authority or designate an existing one to negotiate long-term clean energy contracts on behalf of the state. New York and Texas adopted this approach, and some insiders wanted to try it here.

Ultimately, however, the state decided to stick with Eversource and National Grid. One participant in the discussions said the utility arrangement was the best of several imperfect choices. The utilities offered expertise and institutional memory; they also wielded lots of clout and handed out lots of campaign contributions on Beacon Hill. Benjamin Downing, a former state senator who specialized in energy issues, says he was never totally comfortable with the utilities taking the lead role. “It was and remains a troubling aspect of the entire arrangement,” he says.

The clean energy bill that emerged from the Legislature last year put the utilities in charge of two major procurements—one for clean energy (hydroelectricity, wind, and solar) and one for offshore wind. At the urging of Attorney General Maura Healey, the legislation also called for the appointment of an independent evaluator to monitor the contracting process for any signs of self-dealing.

Both Eversource and National Grid, through nonregulated subsidiaries, are bidding on the state’s clean energy contracts. Eversource’s proposed Northern Pass transmission line would deliver hydroelectricity produced by Hydro-Quebec to southern New England. With partner DONG Energy, Eversource is also one of three likely bidders for the offshore wind contract. National Grid, in partnership with Citizens Energy, is pushing two clean energy projects, one that would bring wind power from Quebec and another that would deliver wind, solar, and hydroelectricity from New York.

Twenty years ago, lawmakers deregulated electricity generation to promote competition and take utility customers off the hook for costly energy projects that don’t pan out. Now, to promote the development of clean energy and meet the state’s emissions targets, ratepayers are being asked to pony up for 20-year contracts negotiated by the utilities.

Bosley never envisioned such a change in the market when he was pushing for deregulation 20 years ago. “The market has changed,” he says.

“We’re gradually moving back toward re-regulation,” says Peter Shattuck, Massachusetts director of the Acadia Center, an environmental advocacy group. “It’s less than ideal.”

Ian Bowles, a former secretary of energy and environmental affairs under Deval Patrick, says putting the utilities in charge of the procurements means the Baker administration has to be vigilant. “The core idea of the 1997 utility restructuring was to require competition and merchant developer risk to drive down power prices,” he says in an emailed statement. “This fact pattern challenges that construct and puts particular pressure on Gov. Baker and his team to ensure fair, merit-based competition and police the natural inclination toward self-dealing.”

Baker administration officials declined interview requests, but a spokesman for the Department of Energy Resources issued a statement suggesting the pressure is on the independent evaluator. “The Department of Energy Resources, along with the attorney general’s office, have fulfilled our legislative requirement to select an independent evaluator to ensure that the solicitation process is open, fair, and transparent and is not unduly influenced by an affiliated company,” says Kevin O’Shea.

HOW IS IT WORKING?

Duncan McKay, the chief compliance officer at Eversource, says he is confident the Massachusetts clean energy procurement process is being run impartially because his company has years of experience guarding against such conflicts.

“This isn’t our first rodeo,” says McKay, pointing to prior instances going back to deregulation when the regulated part of the company was dealing with an unregulated part. “It can be done. We’ve been doing it a long time.”

Eversource and National Grid each identified evaluation and bid teams for both contracts, plus a separate group of subject matter experts who can be called upon for information by either team. Under a standard of conduct the companies signed, information can not be shared between the evaluation and bid teams, and the subject matter experts cannot act as information conduits.

National Grid declined comment on the procurement process other than to say the utility was “complying with all required regulations and statutes.”

McKay says the bid and evaluation teams at Eversource use separate, secure databases and members of the teams wear colored badges to identify themselves—green for the bid team and red for the evaluation team. “If I’m a green badger and you’re a red badger, I can’t be talking to you about confidential information,” McKay says.

Beyond the steps taken by Eversource to guarantee a fair procurement process, McKay says there are a lot of other parties watching, including the independent evaluator and officials from the Department of Energy Resources and the attorney general’s office. He also notes that Eversource and National Grid are competitors on the bidding side, with no interest in seeing a rival get a leg up.

“It is very difficult to conceive of a way you would do something inappropriate because you have so many participants and observers,” McKay says.

The independent evaluator plays the key watchdog role during the procurement process. While the name implies a single individual, the evaluator is actually a team of energy, accounting, and law firms operating under the direction of the Peregrine Energy Group of Boston. According to the firm’s application, two members of the Peregrine team have partnered on eight previous independent evaluator projects. Peregrine’s $749,820 contract with the state runs through the end of 2018.

State officials declined to make officials from Peregrine available, so the only available look inside the contracting process comes from reports issued by Peregrine and proceedings of the Department of Public Utilities, which must approve the final contracts. The procurement for the clean energy contract began in November 2016 and Peregrine started work at the end of December. The offshore wind contracting process is still in its early stages.

A red flag was raised early on with the utilities’ initial request for proposals (RFP) on the clean energy contract. Environmental advocates and several companies participating in the procurement said two provisions in the RFP favored all-hydro projects and would have made it nearly impossible for wind and solar to compete. New Brunswick Power Co. said in a filing with the DPU that the two provisions would “favor one technology (firm hydroelectric generation) over other technologies, are not required by the law, and actually contravene the law’s intent to favor wind and/or solar in conjuction with hydro.”

The dispute was resolved when the RFP was amended to remove the controversial provisions. None of those raising objections singled out Eversource, which at the time was pushing Northern Pass as a hydro-only project. Months later, when bids on the clean energy contract were submitted, Eversource filed both hydro and wind-hydro options.

The DPU rejected two recommendations from the independent evaluator, one that would have allowed the Peregrine team to directly monitor contract negotiations between the utilities and bidders and one that would have disbanded the utility subject matter experts to avoid concerns about information sharing.

The DPU also rejected a suggestion that the utilities should not collect payment of up to 2.75 percent of any contract award if the winning bidder is an affiliate of one of the utilities. Emera Inc., one of the companies vying for the clean energy contract, said in a filing with the DPU that allowing the utilities to collect the annual payments if one of their affiliates is selected would allow the affiliate “to price that remuneration in its bid, providing an unfair competitive advantage.” The DPU said it would make a decision on utility remuneration once the bidding process is completed.

Cynthia Arcate, president and CEO of Power Options, a nonprofit energy-buying consortium, urged the DPU to ignore the wording of the energy diversity law and remove the utilities from the procurement process. “There will be no way of knowing for sure that the winning bidder was chosen based solely on merit,” Arcate said in her filing. “Even with an independent evaluator, there is still the possibility that affiliated companies may have undue influence on the procurement process.” The DPU kept the utilities in charge.

What makes everyone nervous is that the procurement process is not cut and dried. The utilities can’t just open the bids, arrange them in order by price, and award the contract. Most of the projects vying for contracts still face a host of regulatory hurdles. Eversource, for example, has said its Northern Pass project could be completed a year ahead of most of its rivals, but that’s only if it obtains all the necessary permits. It now seems likely the project will not have a key New Hampshire permit in hand when one-on-one contract negotiations are scheduled to start January 25, and there is no guarantee the permit will be awarded by the time the contract is slated to be awarded on March 27.

Dan Dolan, the president of the New England Power Generators Association, is no fan of the way Massachusetts and other states are contracting for energy directly outside of the wholesale markets. But he really dislikes turning the contracting process over to the state’s utilities.

“We simply don’t see a way for it to be an open and truly competitive process when you have that sort of structure in place,” he says. “It’s hard to claim that a company that writes the RFP, bids on the (request for formal proposal), and decides who wins the RFP is unbiased.”