Second in a two-part series.

Back on April 6, just five of the 12 members of the Health Services Council participated in a vote recommending a change of ownership for CharterCARE Health Partners, the owner of Our Lady of Fatima Hospital in North Providence and Roger Williams Medical Center in Providence.

This vote is sparking concern, as The Public’s Radio reported in part one of this story yesterday. That’s because a major accounting firm flagged questions about the financial stability of CharterCARE’s parent, Los Angeles-based Prospect Medical Holdings.

But there’s another issue -- how fewer than half of the members of the Health Services Council took part in the vote on CharterCARE.

There’s debate about whether the council’s vote was legal.

State law says recommendations by the Health Services Council -- quote -- “shall be by majority vote of the members present at the time of the vote.”

Head of the good government group Common Cause of Rhode Island John Marion said at a minimum, it’s troubling when just a fraction of a board of public appointees makes decisions for the whole group.

“When you write a statute that requires a majority vote,” Marion said, “and then some group smaller than a majority is allowed to make a decision, that really undermines the idea of what we’re doing in sort of having majoritarian rules in place.”

Why did less than half of the Health Services Council take part in the vote on CharterCARE?

There were three recusals: council members Robert Mancini and Jim Riley recused due to financial ties with CharterCARE, and council chairwoman Victoria Almeida recused since she works for the same law firm as Prospect Medical’s local lawyer, Patricia Rocha of Adler Pollock & Sheehan. Two council members abstained and two others were absent. (Almeida referred a request for comment to the Health Department.)

General counsel for United Nurses and Allied Professionals Chris Callaci, whose union represents workers at Fatima Hospital, is a leading opponent of the ownership change for CharterCARE. He questions the legality and the spirit of the vote.

“There should be deliberation, there should be debate,” he said. “And you didn’t see that in this application review, and you haven’t seen in a lot of the more recent reviews. And that’s a disservice to the state, and the council is failing now.”

Health Department spokesman Joseph Wendelken defended the state’s approach.

He said in a place as small as Rhode Island, people with the background and expertise to serve on the Health Services Council sometimes have to recuse due to potential conflicts -- and he called that important for the integrity of votes. Wendelken adds that state Health Director Dr. Nicole Alexander-Scott considers questions of public need and affordability when she makes the ultimate decision on the council’s recommendations.

Wendelken rejected arguments that votes by the Health Services Council were improper. He says recused members are not considered “present” for the purpose of a vote. To do otherwise, Wendelken said, would essentially neutralize the recusals. He says the state’s view is backed by Rhode Island law and Robert’s Rules of Order.

Callaci said he is undecided about pursuing a possible legal appeal of the Health Services Council’s recommendation in support of Prospect Medical.

The Prospect Medical vote earlier this month wasn’t the first time that a fraction of the Health Services Council made a recommendation on a controversial healthcare proposal.

Back in March 2020, the council voted in support of an inpatient rehab center in Johnston proposed by a big Alabama company, Encompass Health. That was despite a finding by a state consultant that the project was not needed, and critics predicted the Encompass proposal will destabilize Rhode Island’s existing inpatient rehab centers.

Just five of the 11 members on the Health Services Council at the time took part in that three-to-two vote, and four members recused themselves.

One member who planned to vote recused himself after Encompass lawyer Patricia Rocha challenged his impartiality, although he disagreed with her argument. Rocha is the same lawyer who represents Prospect Medical before the Health Services Council.

In an unusual twist, Prospect Medical – which operates one of the inpatient rehabs concerned about the Encompass Health proposal – has supported a legal challenge to the state’s approval of the Encompass project, in part by questioning how few members of the Health Services Council took part in the vote on it. An appeal in that case is still pending, after a state hearing officer in February slated a briefing schedule.

State Sen. Louis DiPalma (D-Middletown), who chairs an Oversight committee, is among those concerned by how the council has taken important votes with less than half of its membership.

“I think it’s time to reassess the membership of the Health Services Council to allow them to have a full complement of folks, to the greatest extent possible, being able to participate in each and every meeting, as opposed to the number of recusals that happen on some major issues,” he said.

DiPalma said he’s doing more research on the Health Services Council’s track record on votes, and that he may introduce legislation aimed at preventing votes by just a fraction of the council.

Ian Donnis can be reached at Follow him on Twitter @IanDon. Sign up here for his weekly RI politics and media newsletter.