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Eleanor Slater’s top doc slams state-commissioned report as a whitewash

Target 12

PROVIDENCE, R.I. (WPRI) – The newly departed chief medical officer of Eleanor Slater Hospital is punching back at a state-commissioned report examining the medical facility, claiming it was riddled with falsehoods and caused reputational damage that could lead to legal problems.

Dr. Brian Daly, who resigned as the hospital’s top doctor Saturday, penned a 16-page response to a recent report issued by the Hospital Association of Rhode and Care New England that praised patient care but criticized clinical leaders. Daly sent the response Monday, claiming the HARI-CNE report painted an inaccurate picture of the hospital.

“The HARI-CNE report was a biased report that seems to have been created to provide cover for the state as it moves forward to continue to engage in adverse employment actions so that it can remove those who have raised concerns about many important issues,” Daly wrote in a copy of the response obtained by Target 12.  

Daly is one of a handful of hospital leaders who have repeatedly raised concerns about improper Medicaid billing at the hospital – a claim that so far hasn’t been disproved. In recent months, Gov. Dan McKee’s administration has pushed to overhaul the hospital’s leadership, removing those who have been speaking out publicly, claiming they are largely responsible for most problems.

“The HARI-CNE report happens to criticize the exact people the state has announced it seeks to remove related to the billing and patient care concerns we raised,” Daly wrote.

Daly sent his response to state leaders, HARI CEO Teresa Paiva Weed and CNE president and CEO Dr. James Fanale. And he took aim at the state for hiring the two outside organizations, arguing they have clear conflicts of interest.

Daly explained part of his past responsibilities included tracking patients who couldn’t be discharged from hospitals across the state, and he suggested Eleanor Slater has become a dumping ground for Care New England to keep complicate medical costs off their books.

“I became aware of the fact that CNE has many patients in their hospitals that they are unable to discharge,” Daly said. “Throughout my tenure here, they have pushed to transfer those patients to ESH where the cost of their care would be paid by the taxpayers. HARI leadership has often pushed this agenda.”

Daly also pointed to the fact that Care New England is currently seeking approval from the McKee administration to merge with Lifespan, a blockbuster deal between the state’s two largest hospital groups. If approved by regulators, the combined group’s market share would total nearly 80% in Rhode Island, according to recent estimates. Care New England is the largest member of HARI.

A spokesperson for Fanale said he wasn’t available Monday to discuss Daly’s response. State spokesperson Randy Edgar declined to comment on any of Daly’s specific criticism, but said the HARI-CNE review was “only one source of information out of many” that would be consulted while considering how to reform Eleanor Slater.

Edgar added that state leaders would “need the results of other pending reviews to inform a strategic plan for the hospital.”

Paiva Weed did not immediately respond to request for comment.

The chief medical officer’s memo is the latest salvo in a months-long war of words between Eleanor Slater’s recent leadership team, who argue they are being targeted for trying to make changes inside a long-troubled institution for the vulnerable, and their critics, who say those leaders are exacerbating or even creating the hospital system’s problems.

However, Daly isn’t the only outsider who has expressed skepticism about the ability of HARI and CNE to offer an independent look at the state-run hospital system. Shortly after the McKee administration announced the review, the federally mandated patient advocacy group Disability Rights Rhode Island sent a letter to the governor citing “serious concerns.”

“As you may be already aware, HARI is the trade association and lobbyist for Rhode Island hospitals, and as such, is not a disinterested third party suitable to undertake this comprehensive review,” DRRI executive director Morna Murray wrote in the June 17 letter. “In fact, the notion that HARI is best suited to conduct an ‘evaluation’ of potential wrongdoing by one of its paying members, makes a mockery of those patients, among others, who are entrusting their care to ESH.”

Asked to comment on the HARI-CNE report after it came out on July 16, Murray reiterated that a truly independent expert “is necessary for a comprehensive and objective assessment of the long-standing complex, and very serious problems at Eleanor Slater.”

“We stand by our letter to Governor McKee,” Murray told Target 12.

As part of his new response, Daly offered a side-by-side comparison of the HARI-CNE review and the recent report by The Joint Commission, a national accrediting agency that lambasted the hospital for its dangerous conditions.

The Joint Commission – which provides independent reviews for thousands of health care organizations across the country – has threatened to revoke the accreditation of Eleanor Slater unless state leaders rectify the issues, including five that were described as “immediate threats to life.”

“The HARI-CNE report read like a sanitized version of [The Joint Commission] report in many ways, with the most troubling deficiencies conspicuously absent,” Daly wrote.

Rhode Island still doesn’t know whether the hospital will retain its accreditation, but McKee and other state leaders have expressed confidence that The Joint Commission will look favorably on the ongoing efforts to fix the deteriorating facilities.

Daly criticized HARI-CNE reviewers for not visiting one of the hospital’s most complicated facilities, the Benton unit. The group didn’t offer a clear explanation for why Benton was left out, and Daly described the decision as “unfathomable.”  

“It is where we care for acutely ill psychiatric patients,” he wrote. “It is the site where our addictions treatment is most active. There is no reasonable explanation why this facility would not be included in a clinical review. The only imaginable explanation is that it would be a site that would not support the opinions that the group wanted to make.”

Daly similarly chastised reviewers for failing to examine the hospital’s COVID-19 response efforts. The hospital has reported only one COVID-19 death during the pandemic, a relatively low number for a congregate living facility where many patients have underlying health conditions. He also defended colleagues who were singled out of the HARI-CNE report, including Dr. Andrew Stone and Eileen Dobbing, both of whom have been heavily criticized by union groups in recent months.

The HARI and CNE team criticized Dobbings, Eleanor Slater’s chief nursing officer, for lacking focus during the interview process, suggesting “that it is this lack of focus that may impede progress in the nursing activities” at Eleanor Slater.

“Even if Ms. Dobbing lost focus (which is unlikely given all the rest of the problems with the HARI/CNE report) it is inappropriate to assert that a person’s performance in any one interview or meeting is suggestive of how their overall performance will be in multiple other settings,” Daly wrote. “This seems to be a defamatory statement given that it was a statement designed to impugn one’s work (and thus damage their career) that was not based on facts or evidence.”

Daly also took issue with the reviewers for seeming to discourage an ongoing effort to discharge patients who could be receiving similar levels of care outside of a long-term acute care hospital, saying it goes against federal laws which require that patients receive care in the least restrictive setting possible.

The HARI-CNE report supported an argument that’s been made by union groups for months: that while the Zambarano unit has some patients who could be discharged, most wouldn’t or couldn’t get the same care elsewhere, requiring the hospital to continue to provide care for long-term patients. Currently, Eleanor Slater costs the state more than $500,000 per patient per year to operate.

“Many of the patients are deemed to be ‘medically stable and ready for discharge,’” the HARI-CNE report found. “Where, technically, this may be accurate, our observations raised many potential disposition concerns that make it almost impossible to transfer any of these patients to a different facility.”

HARI-CNE reviewers were later critical of both Daly and Stone for focusing on the issue of discharging patients during interviews for their report.

“My focus on trying to prevent a violation of federal law is something I am proud of,” Daly wrote in his response. “I do not view it as a criticism – at least not a valid criticism.”  

Beyond the criticism, Daly’s response also offered a new window into certain clinical practices at the hospital. The doctor claims he was hired in the wake of a management company being brought on board in 2015 “after a patient here was found to have had things carved into his/her body.”

Daly also detailed a routine practice prior to his arrival that involved placing psychiatric patients into so-called “twice as tough” restraints “for extended periods of time and most of the day every day.”

“One patient still walks with hands at [their] waist even though no longer in a TAT belt because [they] became so used to it,” he wrote. He separately pointed out that Zambarano has a locked unit, which he said shouldn’t be required in a facility licensed for long-term acute care.  

Daly claims patient care has improved since he came aboard, pointing out the HARI-CNE report generally lauded patient care without giving him or other clinical leaders any credit. He also noted that much of the criticism toward him and other leaders came from union members, who have been at odds with leadership because the hospital has been laying off staff in recent years.

“Of course their point of view is important,” he said. “However, to develop an opinion about anyone in management based almost entirely on the reports of union leaders is inappropriate.”

The HARI-CNE report last month was lauded at the time by RI Council 94 president J. Michael Downey, who represents many of the workers in Cranston. The group has voted no confidence in many of the hospital leaders, including Daly and Stone.

“The Care New England/HARI report affirms what we have known all along,” he said in a statement. “Our members at the Eleanor Slater Hospital in Cranston provide excellent and compassionate care to Rhode Islanders with complex medical and/or behavioral diagnoses.”

Daly’s parting criticism comes at a time of extreme uncertainty for the hospital. The facility has been subject to at least six reviews this year, including an ongoing investigation by R.I. Attorney General Peter Neronha, who is investigating patient care and billing practices.

Separately, McKee has hired a team from Care New England-owned Butler Hospital to review billing practices, and those results are slated to come out this month.

As for Daly, the doctor said he wrote the report to “ensure the record is corrected.”

“I felt compelled to provide a detailed response,” he wrote in an email after sending the report. “It is difficult to be one person trying to fight against all the resources the state can bring to bear, but I refuse to be a scapegoat.”

Eli Sherman (esherman@wpri.com) is an investigative reporter for WPRI 12. Connect with him on Twitter and on Facebook.

Copyright 2021 Nexstar Media Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

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