Dr. Devi Nampiaparampil, a Republican candidate for NYC Public Advocate

Devi Nampiaparampil (R)

As Public Advocate, what are the top 3 areas that you will focus on related to increasing work in NYC?

I would align the City’s financial incentives with its goals, address public safety concerns, and remove bureaucratic delays.

ALIGNING FINANCIAL INCENTIVES WITH GOALS:

In the midst of the pandemic, we had a surprise Department of Health inspection on our imaging equipment, which we passed without any citations. Nevertheless, I wondered why the City would conduct surprise inspections on doctors’ offices and hospitals at a time when we were clearly short-staffed, suffering financially, and focused on other areas such as the coronavirus pandemic, the opioid crisis, and trying to make sure patients didn’t suffer and die from other medical problems that were delayed or ignored during the height of the pandemic.

The City has a culture that focuses on fines and penalties without regard to the messaging or the deadly consequences. This is why-- at the start of the vaccine rollout-- healthcare providers opted to throw unused vaccine doses in the trash rather than to inject them into people who didn’t qualify. The penalty for injecting the vaccine into the “wrong” person was exorbitant.

This is also why-- when we desperately needed COVID testing to identify people who were positive for the virus and to limit its spread-- hardly any outpatient medical practices offered the test. Rather than offering resources or PPE, New York offered massive penalties to any medical office who took more than 3 hours to upload a positive COVID result to a website often fraught with technical difficulties. Private doctors’ offices in New York responded as expected. Most decided not to offer COVID tests at all. We saw long lines at urgent care centers and hospitals across the city even though testing kits were available to doctors’ offices for purchase. They did not want to risk penalties that were so high, they could go out of business permanently, on top of risking their own health and their employees’ health to perform the tests. We have the best technology in the world when it comes to both vaccines and testing. Yet we lost lives in New York because our elected officials disincentivized healthcare providers from administering either one. As Public Advocate, I would work on aligning our financial incentives with the goal of economic expansion.

ADDRESSING PUBLIC SAFETY

I often hear “mental illness” cited as the cause of the increased violence in NYC. I’ve treated thousands of people with mental health concerns over my 20 year career. There is a difference between a person who is unwell due to medical or psychiatric illness vs. a person who exploits others and who happens to have a medical condition. I’ve seen people who are delirious, or psychotic from their mental illness, hurt themselves and occasionally others. They may lash out at whoever is near them. It doesn’t usually matter-- to people who are acutely mentally ill-- if the people they challenge are smaller than them. On the other hand, I’ve seen criminals-- pretending to be acutely mentally ill-- make logical decisions to attack people who they perceive to be weaker than them: people who are smaller, those who are often older and frailer and those who are disabled or otherwise unable to fight because they are pregnant or have small children with them. That’s not mental illness. Those are calculated decisions.

Healthcare settings have the highest rates of workplace violence in the entire country. Most of this violence occurs in the Emergency Room, Urgent Care, and Mental Health setting. I have worked in all three. The places I worked used combinations of factors to address violence including:

Visible cameras, ID swipes to manage the flow of people, panic buttons in high-risk areas, a visible police presence in high-risk areas to deter people from acting out, undercover police in waiting areas and Emergency Rooms to intervene quickly should violence break out, and “behavioral code” teams comprised of social workers and psychologists to address threats verbally, psychiatrists who could use chemical restraints such as haldol to stop violent behavior, and police. They also rapidly enacted restrictions against violent patients and visitors and consistently enforced them.

If I were elected Public Advocate, I would develop an algorithm with the NYPD and our healthcare workers to address mental health concerns, patient privacy issues, and healthcare workers’ fears about being assaulted. Prior to the pandemic, social workers and nurses brought a bill to Congress (H.R. 1309) that passed in the House suggesting that violent perpetrators hide behind patient privacy laws-- escaping from police and from prosecution-- by attributing their crimes to medical issues. When I worked at one hospital, I regularly received threats from suspected drug dealers who wanted me to prescribe them large doses of opioids: Oxycontin, fentanyl and methadone. I was a pain management specialist. One male “patient” even said he would wait for me in the women’s bathroom, torture me, kill my kids, and then kill me if I didn’t skip the medical evaluation and FedEx him pain medication every couple weeks.

We should reevaluate the penalties we have for offenses. If they are excessive, then we should change either the penalty or the law entirely. If we agree with our laws, we need to enforce them. Because we don’t punish offenders consistently, people are hesitant to report crimes. There is a loss of confidence that anything meaningful will come of reporting. To some degree, that has contributed to gangs flourishing. I suspect many of these slashings and stabbings and shootings are gang-related. We need to bolster specific divisions in the NYPD such as the Gangs Unit and the Hate Crimes Unit. We need to provide more clerical support to these units for expedited processing. Too many government agencies are slowed down because they lack adequate support staff. I have personally witnessed that when I worked for the federal government treating injured veterans.

REMOVE BUREAUCRATIC DELAYS:

We must attract private investment so we can generate income and tax revenue. I believe it took about 6 months for me to get a medical license in NY in 2008. At that time, other states granted medical licenses in about 2 weeks. Friends and family encouraged me to take a similar job in another state so I wouldn’t lose 6 months’ of a doctor’s salary-- and get 6 months’ more of capitalized student loan and credit card debt instead.

I understand how bureaucratic delays can steer investment and job opportunities away from New York City. If we can attract healthcare providers-- including mental health professionals and social workers-- we can more rapidly and effectively address the consequences of the pandemic. If we can bring engineers, architects, and accountants-- all of whom need professional licenses in New York-- we can facilitate investment and job growth in this city. There are many licenses and permits that could facilitate job growth and economic expansion namely liquor licenses, which contribute to the dining, entertainment, real estate, and tourism industries.

 

How will you support worker rights for gig and other low income workers?

Some people love their jobs and find tremendous meaning in what they do. Other people like their jobs but they have commitments outside of work that need their attention. These commitments could include family, relationships, school, or an illness, for example. Another group of people will do their job but they are mainly just passing the time—watching the clock, so to speak—counting down the hours in the day and counting down the days until retirement or until they can get a new job. A fourth group is composed of people who hate their jobs. I’ve been in all four of these categories at some point in my life.

Individual people may work hard regardless of the compensation system. But for the system to be fair, people who work harder or longer or more efficiently should see some type of reward for their efforts. Otherwise, after some time has passed, they will look at the people who hate their jobs—who don’t achieve as much—and wonder why they’re both compensated the same amount. And after some time, one of two things will happen to that hardworking employee who loved their job. That employee will either leave. Or they will become the employee who hates their job. If we used incentive pay, that might better align workers’ goals and employers’ goals. The worker makes more money when the employer makes more money.

I often see people debating about the minimum wage in the news and whether raising the minimum wage will cost people jobs. The Congressional Budget Office says that raising the minimum wage will help people in the lowest wage groups. That will also cost some people their jobs. Society is asked to make a trade-off between different groups who are struggling to survive in the city.

Which employers offer people minimum wage jobs? In my experience, these jobs are usually offered by small businesses, companies who hire high school and college students, individuals who need help with childcare and home healthcare for dependents, and companies who are doing business in largely minority communities. A convenience store in Jackson Heights probably has a greater percentage of employees earning minimum wage than a hedge fund in midtown Manhattan, for example.

I am in favor of tax incentives—lowering the taxable income—for businesses in the city that include an incentive payment plan and a live-able wage to employees that fall into the lower income category. This would encourage employers to hire employees from lower income groups and to pay them more. It would also reward those employers that are providing jobs to people in those lower income groups. Employers who provide jobs to higher income employees would not be rewarded or punished.

The goal would be to employ more people, kickstart the business with the employee incentive pay, and bring in more tax revenues because people would have more money in their hands.

IMPROVING TRANSPARENCY WITHIN THE MEDICAID PROGRAMS:

Many gig and low income workers must limit their total income just to qualify for Medicaid. As a doctor, I will fight for basic human protections. Throughout my medical career, throughout this pandemic, and throughout my campaign, I have treated patients with various forms of Medicaid insurance. I will fight to improve transparency in the state’s privately run Medicaid program, the largest program in New York State. 2020 was one of the most profitable years in history for CEOs of the private insurance industry. New York paid money to private insurance companies to care for patients. New York taxpayers paid that money for people who had fallen on hard times to receive direct medical care. The administrators of these private programs made money often by *denying* patients medical care. If these workers could have access to more effective medical treatment, they could have a better quality of life overall. The first step is transparency in how money is spent in New York’s Medicaid program. How much is actually going towards patient care? If we can improve low income workers’ health, we can improve their job prospects and quality of life.

What will you do to decrease discrimination and increase diversity of workers throughout NYC?

To increase the diversity of workers, we need to increase diversity among business owners and businesses. I have been so lucky to come in contact with tons of brilliant and capable people in NYC. They have amazing ideas but they hardly ever start their own businesses because it’s too confusing, too risky, and too hard to get start-up money. I learned a lot about how to start my own business from a community college class I took and from asking other business owners questions. If I were elected Public Advocate, I would work on integrating some of the resources of the New York Public Library and the City University of New York (CUNY) system so that people would have free or low cost access to classes that could help them start certain businesses more easily.

New York also has one of the highest rates of business closures in the country making it one of the least conducive places to have a business in the country. We need to support our businesses with more than just words and signs.

If I were elected Public Advocate, I would investigate whether people and businesses are spending money on activities that are not productive-- whether they are being scammed through quasi-legitimate means. When I needed a PPP loan for my small business, I asked my friend-- also a woman from a minority group-- if she had certified as a woman-owned business. She said she had spent thousands of dollars (that she couldn’t really afford) to prove that had a woman-owned business and to prove that she was a minority. She got the certificates but in the end, those certificates didn’t help her at all. The PPP loans didn’t require them. The banks didn’t use them. She just ended up short thousands of dollars. She had also spent time on the application that she could have spent working.

When it comes to discrimination, we cannot tolerate it. Too often, people are unsure whether they are being discriminated against or not. They hesitate to come forward. Then they have to face additional barriers convincing others. I would bring them to our existing City resources. As Public Advocate, I would also work on removing bureaucratic delays in agencies that deal with discrimination. I would push for increased clerical support and increased funding for the Hate Crimes unit of the NYPD.

 

What will you do to ensure that the City is responsive to the needs of new businesses and encourage existing employers to stay in NYC to provide living wage jobs for NYC residents?

Before creating one job, the job creator has to consider what else is necessary. This usually includes other support staff to work in a team, space (industrial, medical, retail), office equipment (computers, furniture, phones), industry specific equipment (freezers, operating room equipment, etc.), perishable or disposable supplies (food or medication, etc.), licenses and permits, insurance coverage (property, slip and fall, cybersecurity, etc.), benefits (health, retirement), payroll taxes (Medicare, Social Security, etc.), and consultants (accounting, legal, advertising, etc), for example. I had to outline and budget these costs before I started my own medical practice in the private sector and before I started an Interventional Pain Management program at the Department of Veterans Affairs in the public sector.

As Public Advocate, I would help employers to overcome these hurdles. Because so many people have been working remotely during the pandemic, and because some offices may have permanently changed their use of office space, New York City has a lot of unused commercial space that we can re-conceive to create new job opportunities.

I have moved about 10 times in about 10 years within New York City. There is no easy way to give away or sell large items. Therefore, furniture and equipment that New Yorkers could either write off as donations-- or that could be bought at low-cost by others for their homes and businesses-- end up in the trash. We need to facilitate the movement of equipment and supplies throughout the city so that reusable items aren’t wasted.

Working as a doctor throughout the pandemic, I saw my costs for PPE and other supplies skyrocket. The cost of the water we kept in the waiting room for patients to drink went up approximately 400% even though the number of patients we saw face-to-face plummeted. The vendor told us this was from a combination of the high congestion taxes and tolls in New York. Because there were often delays in the delivery, I thought there might also be a labor component. People who worked for the vendor might get sick, they might be short-staffed, and they may receive fewer orders and also have a hard time stocking the trucks. For many reasons, it might cost them more to make deliveries into New York City. As Public Advocate, I would reevaluate congestion pricing and tolls for trucks bringing food, medicines, and other valuable supplies into the city. If we can control those costs, we can give businesses and people the break they need to be able to create jobs and to work.

 

How will you increase the public’s knowledge of what City agencies do and how to access these services?

I would regularly interview folks from different City agencies and post the interviews on social media. These would be low-cost low-stress interviews: just friendly discussions so the public could know how their tax dollars are being spent.

The City has several agencies and several programs to help New Yorkers but it’s almost impossible to find them and to figure out what they do. Part of this might be because of a hidden disincentive. When I worked for the Department of Veterans Affairs, for example, there was a rule that doctors must treat every new patient within 7 days or our programs would face massive penalties. On the surface, this seems like it would encourage doctors to see patients more quickly. But in many areas of the hospital, there were doctor shortages. One of the hospitals I worked at was worried that if it received penalties, it would have an even harder time treating patients. The unintended consequence was that administrators refused to post our information on websites and made it more difficult for other healthcare providers to order consultations. That way, the hospital could artificially lower the demand and we could meet the 7 day requirement. It meant patients had very little idea what services were available at the hospital. As Public Advocate, I would look for similarly hidden disincentives within the City and try to reformulate them. Many rules intended for one purpose have unintended consequences.

We saw this with the vaccine rollout as well. The City has a culture that focuses on fines and penalties without regard to the messaging or the deadly consequences. This is why-- at the start of the vaccine rollout-- healthcare providers opted to throw unused vaccine doses in the trash rather than to inject them into people who didn’t qualify. The penalty for injecting the vaccine into the “wrong” person was exorbitant.

Education:  B.A./ M.D., Northwestern University

Background:

  • Physician board-certified in four specialties: Pain Medicine, Sports Medicine, Physical Medicine & Rehabilitation, and Hospice & Palliative Medicine
  • Small business owner with private practice, Metropolis Pain Medicine.
  • Associate Professor at NYU Grossman School of Medicine.

Work Related Proposals (gleaned from Candidate website):

  • In order to bounce back, create a business-friendly environment.
  • Bolster our small businesses and encourage more businesses to come to NYC.
  • To help businesses that closed, took on a tremendous amount of debt, and now have bad credit and can’t benefit from a boom, supports direct cash payments and long-term tax incentives to stimulate the economy in New York City.
  • In favor of tax incentives—lowering the taxable income—for businesses in the city that include an incentive payment plan and a live-able wage for employees.
  • Limit and/or refund the permits and fines that harm small businesses.

To learn more about Devi Nampiaparampil's campaign: https://www.drdevifornyc.com/.