PROVIDENCE, R.I. (WPRI) — Rhode Island’s largest hospital association on Friday released a report examining the embattled Eleanor Slater Hospital, offering a fairly glowing review of how patients are treated at the state-run facility.
The report by the Hospital Association of Rhode Island and Care New England — commissioned by Gov. Dan McKee’s administration in May — praised the hospital for its “high clinical quality,” while also suggesting that there are some opportunities to improve “as there are in every health care facility.”
“We were very impressed by the high quality of care and the compassionate dedication of the staff overall to a complex and high need population of patients,” wrote HARI president M. Teresa Paiva Weed, a former state Senate president, and CNE president and CEO Dr. James Fanale. “Their work is commendable and merits recognition to reassure all Rhode Islanders that these patients are in good hands.”
The review is by far the most favorable report that’s come out about the state-run hospital over the past two years. And the tone seemed to contradict some findings detailed just last month in a separate report by The Joint Commission, a national agency that described the hospital as a “dangerous environment.”
The HARI-CNE review focused primarily on clinical care at the hospital and relied on site inspections, interviews and information provided by hospital leaders during those visits. But the group didn’t do much fact-finding, disclosing in the final report that “the validity, accuracy and comprehensiveness of the information provided has not been independently verified.”
The group did not visit the hospital’s forensic unit, Benton.
The hospital’s Zambarano unit in Burrillville received the highest praise, with HARI-CNE saying the unit’s staff cares well for patients, medication lists are appropriate and that the skin care of patients — some of whom require two or three staff to get them out of bed — is “truly excellent.”
“When used at Zambarano, restraints were mostly noted for fall prevention and not behavioral indications,” HARI-CNE officials wrote.
The group also 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, it costs the state more than $500,000 per patient per year to operate Eleanor Slater.
“Many of the patients are deemed to be ‘medically stable and ready for discharge,'” officials wrote in the report. “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.”
Some of the reasons cited include patients being undocumented, lacking medical coverage outside of Medicaid or having multiple behavioral issues “making other facilities unwilling to accept them in transfer.”
The report, in turn, was lauded by RI Council 94 president J. Michael Downey, who represents many of the workers in Cranston.
“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.”
HARI-CNE officials estimated a “handful” of the 72 patients could be discharged or transferred, describing their exists as an “inevitability.” Former R.I. Superior Court Judge Steve Erickson, a health-care advocate that follows Eleanor Slater issues closely, expressed dismay by the belief that similar levels of care couldn’t be found outside of an acute-care hospital.
He highlighted that moving patients to the least-restrictive settings possible is mandated by law.
“If we cannot provide a less restrictive environment because we choose not to fund or create the programs that would be less than hospital level care, we are saying that as a society we are OK with higher levels of restrictions on autonomy than we should be comfortable with,” he said.
Overall, Erickson said the report “seems to have little relationship to reality on the ground,” arguing Rhode Islanders should look to the Joint Commission report for better insight into what’s really going on at the hospital.
In certain areas, the two reports paint dramatically different pictures of the hospital. HARI-CNE described staff as having a “profound dedication” to their patients. The Joint Commission detailed a multitude of issues, including an incident in which a nurse told a patient to “go shoot yourself.”
One area where the two reports seemed to agree was on building conditions in certain parts of the hospital. Both reports took issue with the facilities in Cranston, with the HARI-CNE report citing multiple units for having characteristics that make it easier for psychiatric patients to harm themselves.
“The presence of innumerable ligature points presents a significant risk to patient safety,” HARI-CNE officials wrote.
The Joint Commission in 2017 threatened to revoke the hospital’s accreditation over the so-called “ligature risks,” but the hospital remedied the issue by requiring staff to check up on patients every five minutes to make sure they weren’t hurting themselves. The fix, meant to be temporary, remains the status quo nearly four years later.
“The process of room and patient checks every five minutes that was implemented to mitigate the risk of patient self-harm due to the facility’s significant number of ligature risks is inadequate, given the number of patients and size of the unit,” officials wrote.
Notably absent from the HARI-CNE report is any criticism of the building conditions at Zambarano, which Joint Commission officials described as “decrepit.” Earlier this year, the state fire marshal likewise identified more than 100 health and safety violations there.
HARI-CNE did levy some criticism of the hospital’s medical leadership, even while praising overall clinical care at Eleanor Slater. The report cites an interview with outgoing chief medical officer Dr. Brian Daly and chief of medical services Dr. Andrew Stone, saying they “seemed to have clinical strengths,” but their lack of trust in Eleanor Slater and the state agency that runs the hospital “seems to sow a great deal of this discontent throughout the organization.”
“While it is understandable that the physician leadership is frustrated on many fronts, being in a clinical leadership role requires pulling staff and others together with a goal to address the gaps in the provision of care and facilities,” HARI-CNE officials wrote. “It is our opinion that these two leaders, based on our interviews of clinical providers and staff, have not been effective in showing this trait in their execution of the roles.”
Gov. McKee and Health and Human Services secretary Womazetta Jones are currently removing hospital leaders, including Daly, and pointing to the many problems cited in The Joint Commission report as one reason. The leadership shakeup comes after Daly, Stone and others raised concerns about the hospital improperly billing the federal Medicaid program for many years.
McKee has separately hired a team from Butler Hospital to review billing practices at the hospital. Butler is owned by Care New England, the state’s second largest hospital group, which is currently trying to merge with the largest hospital system, Lifespan. The blockbuster deal needs approval from the McKee administration.
R.I. Attorney General is likewise investigating Eleanor Slater, examining patient care and billing practices, and Eleanor Slater is currently fighting to hold onto its accreditation — which The Joint Commission has again threatened to revoke.
In their report, HARI and Care New England provided four recommendations that they said could help the hospital improve clinical care. Those include buying an electronic medical record system, improving facilities, exploring different compensation models and improving technology — such as installing Wi-Fi inside the facilities.
McKee, who tapped the group to do the review, thanked the hospital group and Care New England for their “thoughtful recommendations.”
“I’m proud of and thankful for the frontline staff at Eleanor Slater Hospital who are providing high-quality care to our patients,” he said in a statement. “My team is reviewing the recommendations in the report and will use them as we continue to develop our long-term plan for the hospital.”
The governor, who inherited the many issues at Eleanor Slater from former Gov. Gina Raimondo’s administration, is currently in the process of figuring out what to do next. The hospital has become one of his most complicated problems outside of the coronavirus pandemic, and has dominated headlines for months due to its many problems.
HARI and Care New England officials noted that public attention in the report, describing it as “critical in nature.” The group also expressed concern about the effect of the outside scrutiny on the hospital, saying staff turnover is generally low, but that all the external attention is hurting morale.
“The recent negative media attention challenges their loyalty, and nursing leaders are concerned that they will lose experienced staff as a result,” officials wrote.