R.I. report on Eleanor Slater Hospital identifies problems with patient care, leadership

Updated at 4:26 p.m.

WOMAZETTA JONES, the secretary of R.I. Executive Office of Health and Human Services, at far right, Gov. Daniel J. McKee, center, and Richard Charest, at left, the newly named director of the R.I. Department of Behavioral Healthcare, Developmental Disabilities and Hospitals, answer media questions. / PBN PHOTO BY MARY MACDONALD.

PROVIDENCE – State officials on Wednesday said the Eleanor Slater Hospital system will need to be restructured, including its leadership and operations, to become more focused on patient care.

In the first of what is expected to be several reports, Womazetta Jones, secretary of the R.I. Office of Health and Human Services, recommended 70 specific changes to the Eleanor Slater network, which encompasses four state-run hospitals. The changes are designed to address immediate, as well as midrange goals to improve hospital operations.

In a press conference with Gov. Daniel J. McKee, Jones said she encountered “resistance” from leadership personnel over the course of her 60-day review of the hospital operations. She did not name the individuals but said she had referred the matter to state human resources officials.

She said she had asked for all state reports on the hospitals within a five-year scope, but only was alerted to some when other individuals filed requests for public records.

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In recent weeks, multiple leaders at the hospital have resigned or given their notice. Despite the churn, state officials said the hospital is safe. But it needs immediate improvement, according to McKee.

“Eleanor Slater Hospital treats some of the state’s most vulnerable residents,”  McKee said. “Just like any other hospital, patients at Eleanor Slater Hospital deserve the highest levels of care.

“The patients deserve to receive medical care in a facility that is well-maintained, where repairs are addressed in a timely manner,” McKee added.

The state has struggled for several years to address long-standing issues at the Eleanor Slater Hospital system, which includes two campuses, in Cranston and in Burrillville. But in recent months, the management and maintenance of the hospitals have been called into greater question.

A preliminary accreditation report by the Joint Commission, a nonprofit organization that oversees accreditation of 22,000 hospitals in the U.S., found deficiencies with regard to facility maintenance, including stained ceiling tiles, torn pavement that had ensnared a person in a motorized wheelchair and peeling and flaking paint in multiple buildings.

The governor said many of these were being addressed, but he viewed the status of the hospitals as a high priority for his administration. He said an estimate of how much it would cost to replace or repair facilities, under various scenarios, was being assembled and could potentially be brought to the General Assembly this fall.

While it is no secret that Eleanor Slater has had problems, what’s different this time is that the state is going to do something to fix them, McKee said. He said it became apparent soon after he took office that a more in-depth look at the hospitals was warranted.

Additional reports in the coming months released by Jones will address broader areas in the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals.

The department is under the new leadership of former Landmark Medical Center executive Richard Charest.

Among the issues identified in Jones’ report, in addition to maintenance and leadership problems, is the concern that patients are not being treated in the least-restrictive manner possible. For example, the Benton building, which receives court-sent psychiatric patients, including people found ineligible to be tried, has a mix of people who had misdemeanor and felony charges.

The report also notes that the hospitals rely exclusively on paper documentation. There is no electronic records system, she said. The titles, job classes and salaries of the leadership team need to be realigned to match the scope of work. And the billing issues need to be resolved.

Last year, the state lost Medicaid reimbursement for patients at one of the hospitals, Zambarano Hospital, because too many people were admitted with psychiatric diagnoses for its license.

Jones said the entire licensing framework for Eleanor Slater needs to be reevaluated, to determine what licenses are needed for the buildings on both campuses, to accommodate for continuing care for patients, and whether a new facility should be built in Burrillville to replace Zambarano.

A separate psychiatric hospital license for the Benton building is among her recommendations.

“Eleanor Slater Hospital has numerous, complex, intertwined issues that will require our collective efforts to rectify,” Jones said.

The average hospitalization stay for treatment is 14 years for the Eleanor Slater Hospital patients, according to Charest. The patient population is hard to place when discussions are made about discharge, he said, given their circumstances. But the state has to determine if less-restrictive settings exist and if not, can they be created.

(ADDS last 10 paragraphs with additional detail, comment.)

Mary MacDonald is a staff writer for PBN. Contact her at macdonald@pbn.com.

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