Richard Charest, director of the R.I. Department of Behavioral Healthcare, Developmental Disabilities and Hospitals, has been on the job for nearly a year. He replaced former Director Kathryn Powers in May of 2021, coming to the department when the agency was in the spotlight as Eleanor Slater Hospital, a state-run psychiatric hospital, faced financial troubles and resignations within its upper ranks.
Charest, the former CEO and president of Landmark Medical Center, discusses Eleanor Slater, his thoughts on a recent substance-abuse prevention conference and future projects at the department.
PBN: Eleanor Slater Hospital has made headlines over the past year for a range of issues, including staff turnover, Medicaid reimbursements and a plan to create a standalone psychiatric treatment center. What are some of the changes taking place at the hospital now?
CHAREST: Eleanor Slater Hospital has seen tremendous change since my arrival at BHDDH 10 months ago and it will see more as we continue to address long-standing concerns and make sure the hospital has everything it needs to provide the best treatment and care for the Rhode Islanders who need its services.
Some of this work has been driven by inspections by the Joint Commission, the state fire marshal and more recently the Centers for Medicare & Medicaid Services, which identified a long list of issues needing attention. ESH is doing everything it can to address these concerns, and our efforts impact a wide range of areas, including patient care, hospital policies and maintenance of buildings and facilities.
Our response is important, first because we are obligated to do all we can to provide the best patient care and ensure patient safety. And second, because CMS’ concerns could impact the hospital’s ability to seek federal reimbursements that help cover the cost of patient care. A finding by CMS that the hospital no longer meets the conditions for Medicare participation could mean that the hospital would no longer be able to bill Medicaid, which would be a major impact on the state’s budget in the long term.
But I am confident we’re on the right track. We have made major leadership changes at Eleanor Slater, starting with the hiring of Dr. Elinore McCance-Katz to again serve as chief medical officer for the hospital and BHDDH. We are also recruiting for a chief nursing officer and for a CEO to replace me as interim hospital CEO.
While we have a lot to do in the present, we are also planning for the future. The governor’s recommended … [fiscal 2023] budget proposes $170 million in capital investments in the hospital over the next several years. The key pieces of this plan are construction of a new $108 million medical facility on the Zambarano campus in Burrillville, as well as other improvements to the Zambarano campus to support the construction of the new facility, renovations in the Regan Building on the Pastore campus in Cranston, and the procuring of an electronic medical record system for the hospital. Long term, the new facility on the Zambarano Campus would serve as a hospital and skilled nursing facility for medical patients, and the Cranston campus would serve psychiatric patients.
PBN: If a standalone psychiatric facility was created, would that make room for more patients at Eleanor Slater?
CHAREST: No, what this move would do is remove 52 psychiatric patients from the census at Eleanor Slater, ensuring that Eleanor Slater has more medical patients than psychiatric patients. This would prevent the hospital from being considered an institute for mental diseases, which happens when more of the patients are receiving treatment for psychiatric diagnoses rather than other conditions.
Based on recent submissions to Medicaid, our finance staff estimate that Eleanor Slater’s federal reimbursement is about $2.3 million less per month when the hospital is an IMD. This change would also make it easier for the new R.I. psychiatric hospital to be evaluated as a psychiatric hospital, rather than a long-term acute care hospital like Eleanor Slater Hospital is today – an important distinction, because these hospitals are often treated differently in the eyes of regulators.
PBN: What is the most important thing that Eleanor Slater can do for its patients right now?
CHAREST: The most important thing we can do is to ensure the well-being and safety of our patients each day through high-quality care that is observant and attendant to patient needs. To do this, we must have a system in place where we are constantly working to ensure that staff is properly trained to care for patients and where we are constantly ensuring that the hospital has all the resources it needs, including staff, training, policies, equipment and infrastructure. Particularly critical right now is our need to hire more staff. Eleanor Slater is feeling the effects of the national health care worker shortage.
PBN: What points raised during the state’s April 5 substance-abuse prevention conference, titled “Prevention Without Barriers: Applying an Equity-based Lens,” stood out to you?
CHAREST: I had time to speak with just about every regional prevention coordinator at the conference and there were three issues that stood out to me. First, with many high-profile cases of edibles falling into the hands of children, the providers are already embarking on education campaigns and looking toward the future on how to ensure the safety of our children and [youths.]
Second, I was pleased to see that our coalitions are keeping the dangers of tobacco and vaping in the forefront and are very active in providing information to our [youths] on the dangers of these highly addictive substances.
Finally, I was impressed with the work being done to educate adults on Rhode Island’s social host law, which makes it illegal to buy or provide alcohol to underage individuals. These efforts are critical as we take steps to protect young people in Rhode Island.
PBN: The COVID-19 pandemic has monopolized resources for Rhode Island’s health care officials and organizations for nearly two years. Now that the crisis seems to be losing momentum, are there projects at BHDDH that you are looking forward to addressing?
CHAREST: Yes. In addition to the work taking place at Eleanor Slater Hospital, we want to continue to make progress in BHDHH’s Division of Developmental Disabilities by addressing the issues raised in the Consent Decree, which requires the state to take specific steps to improve DD services, including integrated day activities and supported employment services.
In addition, we want to strengthen our community-based behavioral health services by providing varying levels of care for those with serious mental health and substance-use issues. We are also looking to transition from the historical Community Mental Health Center model of care to a Certified Community Behavioral Health Center model, which would enhance our ability to provide behavioral health care in community-based settings by ensuring access to integrated and evidence-based mental health and addiction services. Together, these steps will better serve the people who need help and will reduce the number of people needing state hospital services.
Elizabeth Graham is a PBN contributing writer.
