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Facing heavy workload, Keene public defender says resources needed to fulfill constitutional duty
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The statewide shortage of criminal defense attorneys threatens to erode constitutional protections for people accused of a crime, Keene’s top public defender is warning.

Alex Parsons, managing attorney at the nonprofit N.H. Public Defender’s local branch, said the heavy burden on defense attorneys — also the result of a swell of court cases delayed from earlier in the COVID-19 pandemic — isn’t as dire in Cheshire County, which his office covers, as some other places. In some urban areas, he said, his peers are handling more than 150 cases at a time.

Still, Parsons called the attorney shortage a crisis that, if it continues, could hurt the quality of representation afforded to in-need, or indigent, defendants.

“Without some substantial relief, I don’t think we will get to something that’s sustainable long term,” he said.

That relief may be forthcoming after a N.H. Supreme Court task force recently released a number of suggestions for reducing the strain on criminal defense attorneys.

Parsons said last week that while some of the recommendations — which include offering financial aid for contract lawyers, resolving cases more quickly and briefly pausing all trials — could help, the state should focus on raising wages for full-time public defenders. Relatively low salaries, especially compared to prosecutors, have made it difficult to hire and retain defense attorneys, he said.

“It’s just not attractive given what people can make as attorneys working outside of criminal defense,” he said.

Founded in 1972, the N.H. Public Defender is contracted by the state to represent criminal defendants who can’t otherwise afford their own attorney — a constitutional obligation since 1963. As part of that contract, staff attorneys with the organization aren’t supposed to work more than 70 cases at a time, according to its executive director, Randy Hawkes.

Four years ago, Hawkes said, NHPD attorneys typically handled around 60 open cases. But in August, the 123 public defenders on staff — spread across offices in each county — had an average of 90 open cases, he said Wednesday.

The steep increase is the result of many attorneys’ having left the organization in recent years as it also took on several thousand more cases, according to Hawkes.

“When we lose experienced attorneys, that office has to absorb the 70, 80 [or] 90 cases that the departing attorney leaves behind,” he said.

Seven attorneys work out of the public defender’s Keene office, which Parsons said is normal for that branch. With the heavy caseload recently, though, and one attorney expected to leave soon, he said it should look to add more.

“It’s extremely difficult,” he said. “It’s putting a huge strain on the attorneys and on the office, more generally.”

New Hampshire public defenders say court closures for more than a year during the pandemic — an attempt to reduce viral transmission — contributed greatly to the current logjam. In just the past 16 months, 32 attorneys have left the N.H. Public Defender, Hawkes said.

Approximately 2,000 cases in the state’s circuit court system still haven’t even been assigned to a defense attorney, while hundreds more need a new attorney, according to the report from the Supreme Court’s criminal defense task force.

Hawkes also blamed the situation on a growing number of client-related responsibilities that defense attorneys have been given in recent years. Whereas an attorney’s duties used to end when a case was no longer active, he said they’re now asked to monitor clients post-conviction, including by developing rehabilitation plans and submitting progress reports to the court — tasks usually assigned to a parole officer in the past.

That means public defenders are taking on new cases faster than they can shed old ones, Hawkes said.

In a job that often exposes attorneys to a great deal of “secondary trauma,” Parsons said, the added stress of an expanding workload can cause many to leave — especially with the prospect of better pay elsewhere.

He noted that efforts are underway to pay New Hampshire’s public defenders — who Hawkes said have a starting salary of $53,000 — the same as prosecutors. Parsons added that contract defense attorneys, who work part-time for the public defender’s office, also need a raise from their current rate, which he said is barely enough to cover the cost of taking a case.

“New Hampshire Public Defender, for a very long time, has had a reputation as one of the top public defenders in the country,” he said. “I certainly fear that we’re at risk of losing that.”

Following a recommendation from the Supreme Court task force, state officials designated $2 million in federal funds last week to hire as many as 10 new, temporary defense attorneys and to pay for additional criminal-defense training.

Funding has already been approved to reimburse contract attorneys for costs associated with their increased caseloads, according to the task force, which comprised judges, prosecutors and criminal-defense advocates.

The group also recommended that courts around the state rely on so-called “early case resolution” programs to hasten the trial process. And the Supreme Court agreed to propose rule changes that would allow attorneys outside of criminal defense to handle administrative work for people accused of a crime.

Parsons said the latter recommendation is surprising, since even well-trained lawyers are often unfamiliar with the specific aspects of criminal-defense work.

“You wouldn’t want a general practitioner to come in and do heart surgery,” he said. “If I were a criminal defendant, I would not be very comfortable with someone who had two hours of training to come in and defend my criminal case.”

Without an influx of new public defenders, Parsons said New Hampshire risks becoming like states where those attorneys are too overworked to provide effective representation, which he called the “legal equivalent of medical malpractice.”

That could allow government prosecutors — in a state with deep libertarian roots — to abuse their legal authority and trample defendants’ rights, he said. And it could put innocent people at risk of wrongful conviction.

Even in Keene, where the public defender’s office has so far avoided the worst of those fears, Parsons said mistakes are “inevitable” under the current working conditions.

“I’m embarrassed to say it, but I am not able to provide the same level of representation that I have in the past [and] that I know I ought to be providing,” he said.

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Local food pantries seeing shortages ahead of Thanksgiving
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With Thanksgiving fast approaching, local food pantries are hard at work prepping free turkey dinners for their neighbors in need.

But, amid the COVID-19 pandemic, organizations continue to face challenges — chiefly, this year, a lack of supplies.

“We are quite literally scrambling to get enough food — non-perishable and fresh produce,” said Phoebe Bray, executive director of The Community Kitchen in Keene. “2021 is proving to be more troublesome than 2020 was, food-wise.”

Rather than a sit-down meal, area food pantries offer donated boxes people can use to make their own dinners. The lack of food availability, though, likely will lead to fewer people being served this year or a slimmer box to bring home, according to some local directors.

Nationwide, supply-chain challenges are affecting food banks and pantries alike, numerous media outlets have reported.

“It’s the problem that the supermarkets are running into — the warehouses have food but they don’t have enough delivery drivers,” Bray said in an email. “We usually buy in bulk from Market Basket but they have stated they cannot accommodate that at the moment.”

The Fall Mountain Food Shelf, at 122 Route 12A in Langdon, typically serves between 800 and 900 people with take-home boxes for Thanksgiving, Director Mary Lou Huffling said. But this year, she said the pantry was able to order enough food for just over 500 meals.

A “couple hundred” people have already signed up for a dinner box, Huffling said, which includes a turkey, stuffing, cranberry sauce, gravy, potatoes, carrots and onions.

“We’re just so thankful we can do it at all,” she said.

The boxes will be packed at Cold River Materials — a company in Swanzey that donated its space to the food shelf — on Nov. 19, she added, and available for pickup Nov. 20.

Anyone interested in receiving a box, or in volunteering their time, can contact Huffling directly at 835-2283.

The Community Kitchen at 37 Mechanic St. in Keene offers food boxes filled with all the fixings (or this year, at least a good portion of them), Bray said. The box is in addition to three-days’ worth of food for an entire household, given through the kitchen’s pantry program.

Bray said the kitchen is planning to distribute about 350 boxes, slightly fewer than in previous years. But, it all depends on what food the organization can get.

“We always plan to add everything that everybody would need for a Thanksgiving dinner, which is still the goal,” she said. “But at this point, we’re not sure if we’re going to meet that goal.”

The Community Kitchen’s boxes will be distributed Nov. 17 and 18.

Anyone interested in receiving one can register at the kitchen Mondays through Fridays, Bray said. Income, residency and age must all be verified during the registration process.

The kitchen is also accepting donations — food or money — throughout the holiday season.

In Troy, Helping Hand Center at 1 Depot St. hasn’t been having issues with getting food for its to-go boxes because the organization gets donations directly from the N.H. Food Bank, according to Managing Director Jeanne Drugg.

Bray, of The Community Kitchen, said pantries can get only four cases of an item from the N.H. Food Bank weekly, so the Keene organization must rely on other donations as well to feed all of its clients.

“Even if the cases have 24 items in them that’s not 100 items in total,” she explained in an email, “when we’re serving 250-300 families a week those 4 cases won’t go very far.”

Helping Hand Center serves a much smaller population, with 50 boxes slated to be given out the week before Thanksgiving.

“That’s a little bit more [than usual],” Drugg said.

The boxes will be distributed Nov. 19, 20 and 22, she added.

Anyone wishing to get one can either drop in to the center Mondays, Fridays or Saturdays beforehand or call it at 603-242-3007.

As for free sit-down dinners, the Monadnock Region’s options this year are limited.

The annual Ralph Rines Memorial Dinner has been canceled for the second year due to the pandemic, according to organizer JoAnn Rines Barnes. This would have been the event’s 47th year of gathering the community for a hot meal.

“A lot of our drivers come from out of town and everywhere,” Barnes said, “so we feel it’s just not safe with COVID. But, we’re hoping for next year.”

Barnes’ father, the late Ralph Rines, a former Swanzey police chief, started the tradition she has kept up for nearly five decades.

The meal usually feeds 100 people at the Community Church of West Swanzey, she said previously.

The Keene Assembly of God at 121 Park Ave. typically offers a sit-down meal inside the church on Thanksgiving. However, Pastor James Stemple said a large portion of the congregation is sick — a combination of COVID-19 and other flu-season ailments — so whether the dinner will occur this year is still up in the air.

About 100 people usually come to the meal, which is available to anyone in the community, according to Stemple.

“It all depends on if we have enough help to do it,” he said.

Why is the world protesting so much? A new study claims to have some answers.

Are we in a historic age of protest? A new study released Thursday that looked at demonstrations between 2006 and 2020 found that the number of protest movements around the world had more than tripled in less than 15 years. Every region saw an increase, the study found, with some of the largest protest movements ever recorded — including the farmers’ protests that began in 2020 in India, the 2019 protests against President Jair Bolsonaro in Brazil and ongoing Black Lives Matter protests since 2013.

Titled “World Protests: A Study of Key Protest Issues in the 21st Century,” the study comes from a team of researchers with German think tank Friedrich-Ebert-Stiftung (FES) and the Initiative for Policy Dialogue, a nonprofit organization based at Columbia University and adds to a growing body of literature about our era of increasing protests. Looking closely at more than 900 protest movements or episodes across 101 countries and territories, the authors came to the conclusion that we are living through a period of history like the years around 1848, 1917 or 1968 “when large numbers of people rebelled against the way things were, demanding change.”

But why? Here, the authors highlight one particular problem: democratic failure. Their research found that a majority of the protest events they recorded — 54 percent — were prompted by a perceived failure of political systems or representation. Roughly 28 percent included demands for what the authors described as “real democracy,” the most of any demand found by the researchers. Other themes included inequality, corruption and the lack of action over climate change. But the study’s authors say policymakers do not respond adequately.

“Too many leaders in government and business are not listening. The vast majority of protests around the world advance reasonable demands already agreed upon by most governments. People protest for good jobs, a clean planet for future generations, and a meaningful say in the decisions that affect their quality of life,” said Sara Burke, senior expert on global economic policy at the FES and an author on the study.

Protests mean different things to different people. The study was released the same week that The Washington Post released a massive, three-part investigation into the Jan. 6 insurrection that began, in part, as a protest about some participants’ concerns, stoked by conspiracy theories, about democratic representation. There will also be significant climate change protests later this week — but some European leaders are concerned that the costs of shifting away from fossil fuels could spark a backlash like the “yellow vest” protest movement in France.

In the United States alone, recent years have seen huge protests from Occupy Wall Street and Black Lives Matter to the Tea Party and Stop the Steal campaigns. But tracking the scale of global protests is a mammoth task. Other projects, such as the Google-backed Global Database of Events, Language, and Tone, have scraped news articles for data about protests. Burke, along with co-authors Isabel Ortiz, Mohamed Berrada and Hernán Saenz Cortés, instead took a more time-consuming method. Researchers worked across news mediums in seven languages to identify protests and protest movements — finding articles “by hand” as Burke put it in response to questions from The Washington Post.

The collection alone represented more than a thousand hours of work before any analysis had even started. But the trends were clear. In 2006, just 73 protest movements were recorded by the study. In 2020, there were 251 — higher even then after the 2008 financial crisis or the Arab Spring revolts of 2011. Europe and Central Asia had seen the largest increase in the number of protest movements and there were more protests in high-income countries than in countries in other income brackets, but a rise in protests was found across all regions and income levels.

(The authors kept records of protest movements across different years, marking them as separate “protest events” when they spanned more than one year for a grand total of 2,809. This does not mean that only 2,809 individual protests occurred; other studies have put the number of Black Lives Matter protests at nearly 12,000 in 2020 alone.)

Other than issues with democracy and political representation, the report identifies rising inequality as another broad theme of protests around the world, contributing to nearly 53 percent of the protests studied. Individual issues raised by protesters included corruption, labor conditions, and reform of public services followed “real democracy” as the most widely cited.

There was also a significant increase in demands for racial or ethnic justice, such as with the Black Lives Matter protests, but there was a small — but growing — number of protests focused on denying the rights of others during the period, with the authors pointing toward Germany’s far-right “Pegida” movement, anti-Chinese movements in Kyrgyzstan and the “yellow vest” movement among them.

The study’s authors acknowledge that their work is inherently political. “There are no neutral numbers in protests,” Burke said, admitting that the vagueness of some numbers, such as crowd size estimates, left items open for interpretation. An Internet-based study is also limited by what is reported. “We can only study what we can see and what we can see is increasingly impacted by where and who we are,” Burke added.

Asked what defines “real democracy,” Burke admitted it was somewhat subjective: “One person’s democracy is another person’s autocracy.” But the study tried to take protesters at their word. In the case of Jan. 6, 2021, in Washington D.C. (which was not included in the study as it was outside of its time frame), Burke said that, too, would have been classified as a demonstration for “real democracy” but also a protest designed to deny rights, among other designations.

Most protests aren’t violent like the Capitol insurrection, the study found, but there has been a slow but steady increase in violence between 2006 and 2020, with just over one-fifth of recorded protests involving some kind of crowd violence, vandalism or looting. In almost half of the protests studied, there were reports of arrests; a little over a quarter saw reports of some form of violence from the police.

Perhaps the key argument from the study is that as protests increase, leaders should take them more seriously. Roughly 42 percent of protests in the study were judged as successful, though that varied significantly by region and the type of protests and included partial successes — a higher figure than some other studies. If our era of protests continues, that suggests many more protesters are going to get at least some of what they want.

“Protests around the world have been getting a dubious reputation lately,” said Michael Bröning, director of the FES New York office. “We need to understand that protests are not a verboten behavior but a core tenet of democracy. What we need is nothing short of a global rehabilitation of protest.”

Heated competition for nurses sparks incentive pay arms race

Last month, hospitals across New Hampshire announced they were raising their wage floors as part of a “market adjustment” to stay competitive amid a labor shortage by offering a minimum $15 to $17 an hour.

But that’s only part of the story. Most registered nurses already get paid roughly twice as much as that, and third-party staffing agencies commissioned by local hospitals are now offering up to $200 an hour for traveling nurse rates.

Hospitals who wish to keep those nurses from working for the competition and fill their own staffing needs are often forced to match those rates, according to Associate Chief Nursing Officer Jennifer Torosian of Catholic Medical Center.

“And the staffers are saying ‘we can’t pass that up,’ ” Torosian said of the traveling nurse rates. “If we don’t fill the current staffing needs ... then the staff is working short-staffed.”

Torosian said nurses are being offered work at hospitals only 30 minutes to an hour drive away.

While a nursing shortage preceded the pandemic, COVID-19 has accelerated the demand, causing a rapid shift in traveling nurse rates, and the frequency of offerings. Torosian said she remembers the pre-pandemic rates ranged from $105 to $125 an hour, and were deployed sparingly by staffing agencies. By 2020, the rates had jumped from $150 to $175, the higher end coming during case spikes in the fall and winter.

“I remember thinking ‘oh my gosh, $150 that’s a lot.’ Little did I know,” Torosian said.

The high rates are only temporary and ad hoc. Nurses who work on a per diem basis have more flexibility to take on those traveling nurse jobs, and fully employed nurses are enticed to pick up the extra hours at another hospital after completing their regular shift.

Steve Ahnen, the President and CEO of the N.H. Hospital Association, said the high rates for traveling nurses are something that deserves more scrutiny from a “market conduct” perspective.

“I have to say the increase in those rates have been alarming,” Ahnen said.

Offering overtime rates, up to double-time and a half, has also become the norm. Torosian said it used to be offered on a case-by-case basis when the patient census went up. Now, she said it’s “pretty much constant.”

Raising the minimum wages in October primarily affected lower skilled workers like licensed nursing assistants, Torosian said. As of May, registered nurses in New Hampshire earn an average $75,970 annually, or $36.52 per hour, according to the Bureau of Labor Statistics. The majority (80 percent) of RNs fall within a pay range of $55,160 to $101,400.

So when a staffing agency puts a traveling nurse rate on the table, hospitals are forced to temporarily give what is essentially about six times their normal pay to keep them. A nurse usually works a full 35-hour weekly shift before overtime and travel rates apply.

Torosian said they try to be proactive and fill shifts ahead of time, but that’s not always possible.

“There’s a point where no amount of money or incentive is going to get someone to work,” Torosian said.

She said hospitals also need to focus on softer incentives besides compensation to keep staff happy and employed. Too many shifts can result in burnout, and hospitals are more acutely aware of the limits of staff “resiliency.”

“What’s interesting, however, is that we’re hearing more and more (and this has been documented across health care) that financial incentives don’t matter like they used to,” Catholic Medical Center spokesperson Lauren Collins-Cline said in an email. “People are losing their resiliency and are looking for relief; from flexible schedules, to added support, and more resources in order to do their jobs.”

Some of that relief is coming in the form of lowering traditional barriers and creating new opportunities. What used to be a more rigid structure, with seniority steps and siloed departments, has become a more fluid and assuasive environment for new and veteran nurses alike, Torosian said.

While new nurses fresh out of school used to be relegated to night shifts and weekends, starting in medical surgical units and moving their way slowly to inpatient units and more favorable hours, they are now, through an accelerated certification program, offered the unit of their preference without being forced to work graveyard shifts, according to Torosian. And seasoned nurses are given the freedom to “float” from unit to unit in a support capacity.

Torosian said she often has to get creative, or just hang out with a staffer to make sure they feel appreciated.

“I’ll buy you Dunkin’ Donuts, I’ll buy you dinner,” she said.

Collins-Cline said Catholic Medical Center also gave its nurses COVID-19 recognition bonuses along with the recent pay raises.

Staff shortages are across the board in all levels and specialties in the healthcare industry, but nurses make up the largest segment of employed staff at Catholic Medical Center, with a plurality of 30 percent.

For Torosian and other nurse administrators, the shortage has changed their daily responsibilities. Staffing issues used to take up about 20 percent of their day, but Torosian said it’s now closer to about 80 percent. And some nurse leaders are taking on the less favorable shifts in order to fill the needs or have better shifts to offer staffers.

“We as leaders, it’s all hands on deck some days,” Torosian said.

The competition means hospitals are keeping a lot of these details close to the vest. Torosian said they couldn’t share what kinds of signing bonuses are being offered for new hires, but said those have increased recently.

Granite State News Collaborative also reached out to Dartmouth-Hitchcock Medical Center to see if they are facing similar decisions, but the hospital declined to comment for the story.

Dawn Fernald, spokesperson for SolutionHealth, which owns Southern New Hampshire Medical Center in Nashua and Elliot Hospital in Manchester said they are dealing with the same health worker shortage and pointed to the minimum pay raise to $17 per hour that went into effect last month.

“We have had to get a bit more creative to fill shifts, move patient care areas and we have worked hard to ensure competitive pay rates for all positions,” Fernald said.

She said they’ve also developed some “retention bonuses” and enhanced benefits for the most critical positions. New benefits include infertility coverage and other benefits to ensure they “remain competitive.”

Fernald declined to comment on the additional burdens placed on nurse administrators to staff shifts daily, or the escalating rates for traveling nurses.

“In many aspects we’re all competing against each other for the staff,” Torosian said.

The competition also extends into the long-term care facilities, which ironically creates a cycle of demand for more nurses at hospitals. Torosian said hospitals like Catholic Medical Center are hiring nurses from long-term care facilities, but because those facilities are often under-staffed, they can’t transfer patients out of the hospital into long-term care. And because the patients stay in the hospitals longer, the hospitals need more nurses to care for them.

Hospitalizations for COVID-19 have ramped up in recent weeks. As of Nov. 2, there were 190 patients hospitalized in the state for COVID. That statistic reached a peak of 220 as recently as Oct. 25, exceeding 200 for the first time since February.

Torosian fears the competition may reach a breaking point.

“We can keep throwing this money at staffing, but for how long?” Torosian said. “I think we need some statewide strategy and planning sessions on how we’re going to address this issue.”

Ahnen said nurses are critical to the work that hospitals do every day and hospitals are taking a multifaceted approach to adapt to the shortage.

“In some respects, it’s kind of the perfect storm,” Ahnen said.

He said hospitals in New Hampshire are reporting about an 11 percent vacancy rate for RNs as of July. That’s closer to 12 to 13 percent for OR and ER nurses, and nearly 16 percent for LNAs.

In the short term, hospitals might get some relief in the form of federal funds. About $25 billion nationwide has been freed up for hospitals (about $17 billion from the Provider Relief Fund of the CARES Act, and $8.5 billion from the American Rescue Plan Act (ARPA)) and hospitals had to apply before last week’s deadline to get that relief.

That will be used for staffing along with other hospital needs such as PPE, COVID testing, and vaccination. But the money for staffing won’t solve the larger problem, he said.

“Long term, there clearly needs to be some steps to help alleviate some of their shortage,” Ahnen said. “We’re gonna need more than just dollars.”

That’s because there’s still a limited pool to recruit from and the state isn’t making new nurses fast enough.

“You can’t wave a magic wand and create a doctor or a nurse overnight,” Ahnen said.

Ahnen said some regulatory changes and college programs with more teachers would speed up that process. New Hampshire hospitals also need to look outward.

In September, the state issued a Request for Proposal to offer a recruitment firm a three-year contract to attract healthcare workers from out of state. Bids are due by Nov. 18.

Torosian said Catholic Medical Center is also starting to recruit international nurses.

For now, hospitals like Catholic Medical Center are throwing lots of money at their workforce needs. Collins-Cline said there isn’t a specific coffer of their operating budget set aside for staffing, but doesn’t believe it can last like this forever. Torosian agrees.

“I do not believe it’s sustainable,” Torosian said. “Although I do not have a specific number. But I don’t see how it could be.”