CRANSTON, R.I. (WPRI) — House Speaker Nicholas Mattiello’s leadership team has once again put $1 million into the state budget for a single Cranston chiropractor, despite the governor’s opposition and a top federal official’s skepticism about his work.
The chiropractor — Victor Pedro — runs an alternative treatment program he calls Cortical Integrative Therapy, or CIT, described on his website as “a revolutionary treatment methodology” for brain injuries and disorders. His 16-year-old practice, incorporated as Rhode Island Integrated Medicine Inc., says it offers “therapeutic rehabilitation, cognitive-behavioral therapy, nutritional counseling, chiropractic care, and visual, auditory, and vestibular therapies.”
Pedro’s website says CIT is “a non-covered service” under group health insurance plans, and patients are required to pay on the first day of treatment with cash or checks only. “We do not accept credit cards,” the website says.
Lawmakers have steered at least $1.88 million in taxpayer money to Pedro’s programs since 2004, even before the newly announced $1 million is added to the total, according to public records obtained and analyzed by Target 12 in recent months. He apparently has powerful patrons in the legislature, who have overruled attempts by both Democratic Gov. Gina Raimondo and former Republican Gov. Don Carcieri to cut off his funding.
Medical experts have repeatedly expressed doubts about CIT. In a 2017 letter refusing to provide federal Medicaid funding for the program, U.S. Centers for Medicare and Medicaid Services Director Seema Verma said there were “very few parameters for cost or quality control” involved. And in 2015, the state’s own Medicaid Medical Care Advisory Committee determined “there wasn’t evidence that the treatment worked.”
A receptionist at Pedro’s office said Wednesday morning he was with a patient and not immediately available, but would be in touch.
Larry Berman, a spokesperson for Mattiello, defended the funding.
“Speaker Mattiello believes the state should be committed to providing appropriate resources to a program offering unique care and treatment in difficult cases and that gives individuals an improved quality of life, enabling them to live outside the confines of medical facilities,” Berman said. “Some established providers would rather warehouse these often neediest of patients rather than offer relief when it is available.”
Berman did not respond to a follow-up question about whether the House has held hearings or taken testimony from Pedro to determine if the CIT money is being used effectively.
Pedro — whose office is near Mattiello’s law office on Park Avenue in Cranston — has been on the speaker’s radar screen for a number of years.
As House majority leader, Mattiello sponsored a resolution in March 2013 congratulating former Rep. Frank Montanaro Jr. for receiving two awards tied to Pedro “for your commitment to advocate on behalf of brain injury survivors and helping to advance Cortical Integrative Therapy.” Montanaro is now one of Mattiello’s most influential advisors as head of the Joint Committee on Legislative Services, which manages the General Assembly’s $51-million annual budget.
Pedro has supported Mattiello’s political career financially, donating $2,000 to the speaker since 2011, according to Board of Elections records. A Victor Pedro is also listed as having served on the Rhode Island Democratic State Committee, which Mattiello controls, as the state committeeman for House District 30.
While Pedro’s state funding has flown under the radar for years, that is quickly changing as critics on both left and right question why Mattiello is continuing to protect a seven-figure line item for CIT while saying there isn’t enough money for other programs.
“How is the public’s money better spent? On unproven medical techniques invented by a Park Avenue chiropractor or on proven, effective programs that actually work in our communities?” Steve Ahlquist asked Wednesday on the progressive news website UpriseRI. In a news release, R.I. Republican Party Chair Sue Cienki urged Mattiello to eliminate the funding for Pedro.
At a briefing with reporters late Friday night, Mattiello defended his decisions on what to fund and what to cut. He insisted House leaders had been “restricted by budget restraints” in a “very difficult” revenue environment, and therefore only included necessary programs in their final plan for the new fiscal year, which starts July 1.
“This is a budget I’m particularly proud of,” he said.
Earned zoology degree at UVM
Pedro, who lives in East Greenwich, bounced between specialties before his arrival in Rhode Island.
He got his education at the University of Vermont, where he earned a degree in zoology in 1981, the school confirmed Wednesday.
Later that year, Pedro enrolled at the Henry Goldman School of Graduate Dentistry at Boston University, according to a résumé posted on The Brain Project, a nonprofit that has highlighted his work. BU has not yet responded to an inquiry about his time there.
From dentistry, Pedro moved on to the New York Chiropractic College, where he graduated in 1985, according to his website. (The college also has not yet responded to an inquiry.) A year later, he became a licensed chiropractor in Rhode Island, a license he still holds today, according to the R.I. Department of Health.
Pedro has since branched his practice out into other states. In 2002, he was granted a chiropractor’s license in Massachusetts, and he received one from New York in 2011, according to state websites.
However, Bay State authorities fined Pedro $200 in 2012 after the state’s licensing division found he had failed to complete required continuing education courses, according to documents obtained by Target 12 through a public-records request. The division also cited Pedro for misrepresenting that he had completed the course on his certification of registration.
Pedro’s résumé describes him as a pioneer of CIT, which first appeared in 2000. He took the treatment on a roadshow, presenting in the Azores and Cambridge, Massachusetts, before conducting a study at Kuss Middle School in Fall River in 2003. The study was not published, according to his website.
In connection with his work with CIT, Pedro has also received a diplomate degree from the American College of Chiropractic Neurology Board, according to his website. A search of his name on the board’s website shows his certification – first issued in 1988 – expired in 2018.
Additionally, Pedro’s online biography says he served as an associate professor at the University of Bridgeport. The school did not immediately return a request for more information.
He also reports receiving a certificate for treating learning disabilities in 2001 from the Carrick Institute for Graduate Studies in Cape Canaveral, Florida.
Montanaro an early Pedro supporter
Pedro first began receiving state funding 15 years ago — but not through the health care budget.
In the spring of 2004, during Governor Carcieri’s first term, the House Finance Committee inserted into the 2004-05 state budget a $150,000 Community Service Grant for an initiative Pedro called the Infinite Potential Program. The grant was sponsored by Montanaro, who at the time represented the Cranston district now held by Mattiello, according to a Providence Journal article at the time.
House leaders routed Pedro’s funding through the Department of Education. House aides said it was “for the treatment of children with developmental and learning disabilities” and “to maximize the performance of each child’s brain over a 12-week period without medication or surgery.”
Carcieri apparently did not agree that it was money well spent: a year later, the governor tried to remove money for Pedro’s program from the budget. But the House Finance Committee restored the $150,000 for 2005-06, setting a pattern of disagreement between the executive and legislative branches over Pedro that has continued to this day.
At the same time, Pedro was also reported to be in touch with other prominent Rhode Island politicians.
Minutes from a June 7, 2005, meeting of Northern Rhode Island Collaborative’s superintendents board show then-Cumberland Superintendent Joseph Nasif Jr. said he had been contacted by Lt. Gov. Dan McKee, who was then between two stints as Cumberland mayor, asking “to enter into an agreement with Dr. Pedro to work with Cumberland students.”
McKee stood by Pedro on Wednesday.
“When the lieutenant governor was mayor, he became familiar with the services that Dr. Pedro provided for individuals living with severe brain injury or head trauma as well as the doctor’s interest in education,” McKee spokesperson Andrea Palagi told Target 12.
“Seeing a value in that work and expertise, the lieutenant governor felt Dr. Pedro could play a role in youth development in Cumberland, particularly in finding new ways to support students struggling with certain learning disabilities,” she continued.
Palagi added, “The lieutenant governor is not familiar with the program currently funded by the state, but he would expect positive results based on his past experience with Dr. Pedro.”
At the time, though, Nasif “expressed mixed reaction to Dr. Pedro’s work,” the minutes say. “Mr. Nasif felt Dr. Pedro was going to use Cumberland students as guinea pigs and expressed concern with his billing methods. Mr. Nasif felt there was no scientific data to support his claims to cure ADHD students and cautioned the Collaborative on getting involved.”
The minutes went on to say that the Northern Rhode Island Collaborative had been designated as the fiscal agent for Pedro’s legislative-directed grant, and that Cumberland officials planned to give the project municipal space. Another staffer at the meeting claimed there was a “possibility” that Pedro would receive a $1.6 million grant from the National Institutes of Health, according to the minutes. (There is no record of such a grant ever being awarded.)
Back at the State House, Carcieri tried again to eliminate Pedro’s state funding in the 2006-07 budget, but was again overruled: House Democrats put $142,500 for Infinite Potential Program into the final tax-and-spending plan. The governor finally succeeded in eliminating the program the following year, when the state faced huge deficits during the Great Recession.
House reversed governor’s funding cutoff
House leaders’ support for Pedro resumed in 2013.
On March 13 of that year, then-Gov. Lincoln Chafee presented Montanaro with an award from the Sarah Jane Brain Foundation, flanked by Pedro and Mattiello, during a ceremony in the State Room. A photo shows the men smiling together at the event. Mattiello sponsored a House resolution later that month congratulating Montanaro on the award.
Not long after, House Finance Committee Chairman Helio Melo added an amendment to the proposed 2013-14 budget that directed the Executive Office of Health and Human Services to “to create a new service entitled Cortical Integrative Therapy.”
Two years later, in 2015, Raimondo was in her first year as governor. Her initial budget proposal for 2015-16 did not include funding for Pedro’s program, but on May 13 her office introduced a budget amendment allocating $496,800 “for cortical integrative therapy services.”
The Executive Office of Health and Human Services was working to win federal approval for a Medicaid waiver that would allow funding to go to Pedro’s program. But at a meeting on June 3, 2015, a panel of physicians that advises the office — the Medicaid Medical Care Advisory Committee — expressed doubts about the idea.
“MCAC members stated that there wasn’t evidence to prove that this treatment worked; it didn’t go through the typical review process for studies, i.e., randomized, double-blind controlled trials or other scientific review process so therefore should not be considered a Medicaid benefit at this time,” the meeting minutes say. “The committee felt that Medicaid should be using and moving towards evidence-based practice.”
In a letter to the Executive Office of Health and Human Services summing up the group’s concerns, its chair said the committee “does not support this pilot, as the proposed treatment is neither evidence-based nor focused on a well-defined disease entity or condition.”
“MCAC typically consults scientific resources such as Centers for Medicare and Medicaid guidance, Center for Evidence Based Policy, or Agency for Healthcare Research and Quality when making recommendations,” the letter continued. “This diagnostic and treatment modality has not been addressed by any such entity.”
Nevertheless, that same month EOHHS submitted its request for a federal Medicaid waiver to support a three-year pilot program to fund Pedro’s CIT program. Two months later, the office withdrew its initial application and resubmitted it under a different category.
It took roughly two years for the answer to arrive from Washington, but when it came it was emphatic: no federal funding for Pedro’s program.
“As proposed, the CIT program is broadly described, with very few parameters for cost or quality control for the specific array of services billed, the intensity of the services, the length of therapy, or the clinical indications for each service,” Seema Verma, President Trump’s Centers for Medicare & Medicaid Services director, wrote in a letter to R.I. Medicaid Director Patrick Tigue on Aug. 25, 2017.
“The state has not provided scientific evidence verifying the efficacy of CIT, nor any indication that CIT was subject to such evaluation,” she continued. She said her agency does not fund “clinical interventions that have not demonstrated clinical safety and efficacy through standard clinical evaluation processes, and ideally through a rigorous randomized controlled trial.” She suggested tapping NIH or private funders.
With federal money officially off the table, the Raimondo administration moved to end state funding for Pedro’s program in November 2017 — only to have House leaders restore the money. The same thing has now happened this year: Raimondo proposed eliminating $1 million in CIT funding from the 2019-20 budget, but when the House Finance Committee approved it on Friday night, the money had been restored.
“The speaker feels that the application for federal coverage was filed by the Executive Office of Health and Human Services with the same level of competency that they created and currently operate the UHIP computer system,” Berman, Mattiello’s spokesperson, told Target 12. “The citizens suffering from head trauma and brain injuries deserve better.”
David Levesque, a spokesperson for the health office, scoffed at the effort to blame the administration.
“EOHHS followed the same statutory requirements with this application as we do with every other proposal for Medicaid funding, and it included supporting materials provided directly by Mr. Pedro. CMS denied Mr. Pedro’s request,” Levesque told Target 12.
“EOHHS has submitted dozens of benefit requests to CMS since 2014, and this is the only one that did not meet federal requirements,” he added. “Given that CIT does not have necessary federal approvals, the governor has repeatedly removed the funding from her budget proposal, and each time it has been restored by the General Assembly.”
Records provided by the Executive Office of Health and Human Services show Pedro billed the state’s Medicaid program for about $1.4 million to treat 418 patients between December 2015 and this month. His payments broke down as $500,000 in the 2015-16 fiscal year; $404,000 in 2016-17; $235,000 in 2017-18; and $302,000 so far in 2018-19.
The full House is scheduled to debate and vote on the budget Friday.
On Twitter, former R.I. Republican Party Chairman Brandon Bell argued the Pedro case was an example of why Rhode Island should give the governor line-item veto power, which would allow her to strike individual spending programs from the budget without vetoing the entire plan.
“Dr. Pedro is the poster child for why we need line-item veto,” Bell wrote.
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Ted Nesi (firstname.lastname@example.org) is WPRI 12’s politics and business editor and a Target 12 investigative reporter. He is a weekly panelist on Newsmakers and hosts Executive Suite. Follow him on Twitter and Facebook
Darren Soens contributed to this report.