PROVIDENCE, R.I. (WPRI) – A two-month inspection of the Zambarano hospital found the facility out of compliance with 112 life and safety code violations, ranging from fire prevention issues to an unprotected basement pit that people could fall into “during normal use of the building.”
The R.I. Office of the State Fire Marshal started inspecting the 180-bed medical unit of Eleanor Slater Hospital on March 1, and the effort quickly caught public attention after the state-run facility’s kitchens were shut down due to “unsafe conditions and practices.”
Fast-forward nearly two months and the inspection found more than 100 additional code violations, which overall paint a picture of neglect in a facility where routine upkeep is lacking, according to a report obtained by Target 12.
The fire safety violations are especially problematic in a facility where most of the nearly 80 patients living there cannot walk on their own. The inspection reported at least eight areas not covered by fire sprinklers, including one area inside a kitchen – which were separately cited for having faulty cooking equipment.
“The right side exterior and rear exterior area of the walk-in freezer lacks sprinkler protection,” inspector David Pastore wrote in his report, which contains nearly 100 pages detailing code violations.
State Fire Marshal spokesperson Brian Hodge said several of the violations that needed immediate attention have already been remedied. Others didn’t pose an “immediate threat,” he added.
“Based on the thorough inspection, the Office of the State Fire Marshal believes there is no imminent threat to the patients or employees of the facility at this time,” Hodge said in a statement.
The four-story building, originally built in 1936, spans roughly 142,000 square feet and is located on the edge of Wallum Lake in Burrillville. The code violations are the latest issue tied at the Eleanor Slater system, which includes Zambarano and three more units in Cranston.
For months, questions have swirled around patient discharge protocols and billing practices at the hospital, spurring multiple oversight committee inquiries in the General Assembly. R.I. Attorney General Peter Neronha separately has launched an investigation into the hospital, examining patient care and billing.
“We’re looking into it, we’re taking it very seriously, we’re very concerned about the patient care,” Neronha told Target 12 earlier this month.
Zambarano conditions ‘unacceptable’
Gov. Dan McKee earlier this month tapped his health and human services secretary, Womazetta Jones, to take over as acting director of the R.I. Department of Behavioral Healthcare, Developmental Disabilities and Hospitals, the state agency that oversees Eleanor Slater. (Jones was already overseeing the agency, which falls under the Executive Office of Health and Human Services.)
The governor also tasked Jones with conducting a review of operations, policies and staffing at the hospital, which he said will culminate in a plan to move forward, although it appears he’s also taking a more hands-one approach.
Target 12 has confirmed McKee made an unannounced tour of Zambarano on Wednesday, later telling reporters it was all part of his “due diligence.” The visit was first reported by The Boston Globe.
“As you know, his administration is undertaking a review of BHDDH, which includes the hospital, under the leadership of Secretary Jones,” McKee spokesperson Matt Sheaff wrote in an email. “He wanted to see the hospital firsthand as part of the fact finding mission that is currently underway.”
A spokesperson for Jones told Target 12 earlier this month that the secretary would not be granting any interviews to reporters about Eleanor Slater until after her review is over. Her office did not disclose when that might happen, but McKee on Thursday said he wanted to give the General Assembly a recommendation before the current legislative session ends.
General Treasurer Seth Magaziner, who toured the facilities Thursday, said he wants to see Zambarano remain open, noting that the hospital serves some of the state’s “most vulnerable patients and is an important economic anchor for northwestern Rhode Island.” But he did express concerns with the state of the building.
“There is no doubt that the condition of the facility at Zamabrano is unacceptable and must be addressed,” Magaziner told Target 12 after his tour. “But the problems run deeper than the building itself.”
A potential challenger to McKee in the next year’s Democratic primary for governor, Magaziner has been outspoken about the problems at Eleanor Slater. Many of the issues started under former Gov. Gina Raimondo, but they appear to be coming to a head under McKee, and his decisions about how to move forward could become a political issue down the road.
“There are credible reports of doctors and staff being pressured to discharge patients against their will, staffing and levels of service being unexpectedly cut, and a lack of clear communication from hospital administration regarding the long-term vision for the hospital,” he said. “I am grateful for the Zambarano staff working to care for patients through these challenging conditions and grateful to the media and my colleagues in government who are working to find answers.”
Inside the hospital, safety issues have contributed to a deteriorating and toxic relationship between administrators and staff. Earlier this month, a doctor accused a union leader of threatening him and one of his colleagues over a dispute about whether to relocate patients from Zambarano because of a long-running issue with the facility’s oxygen system. At least one union has since voted no confidence in the hospital’s administrative leaders.
The latest inspection cited multiple leaking oxygen valves, also a fire safety concern. And while some of those issues have since been addressed, Pastore also pointed out “oxygen and vacuum piping are painted and not properly labeled,” which are also violations.
In some cases, the violations didn’t appear too difficult to fix, such as one that cited the hospital for having “coats hanging from sprinkler piping.” But other violations could be more complicated and potentially dangerous, including an exit that has been turned into a closet – resulting in a 75-foot-long, dead-end corridor. (Dead-end corridors cannot exceed 30 feet, according to Rhode Island building safety codes.)
Some violations begged more questions, such as the facility’s life-safety and campus-wide generators both lacking documentation of testing, a requirement every three years. The inspection didn’t make clear whether the generators had been tested or not.
Hodge nonetheless said it’s not “uncommon for a facility of this size to have a correspondingly high number of violations.”
A history of facility issues
The issue of disrepair has come up in the past, including in 2019 when the engineering company EMG conducted a facility condition assessment of Zambarano. The firm concluded the building was in “fair condition” overall, but cited several specific problems.
“Environmental concerns noted include deteriorating finishes with suspected asbestos containing materials, including floor tiles and building piping insulation, as well as paint feeling in stairwells that is suspected of lead,” according to an excerpt of the report provided to state lawmakers last month.
BHDDH former director Kathryn Power — who served as director of BHDDH until she resigned earlier this month for personal reasons — also spoke about some of the facility’s more recent problems during a state Senate hearing on Feb 22.
“We are in buildings that really have not been taken care of for a while,” Power said.
BHDDH and the Division of Capitol Asset Management & Maintenance, which oversee operations and facilities at the hospital, did not respond to multiple questions about the latest inspection. But the results could complicate an impending review by of the facility by the Joint Commission on Accreditation of Healthcare Organizations, also known as JCAHO.
The federal quality-monitoring agency was supposed to review the hospital last September, but the inspection was delayed because of the coronavirus pandemic. Accreditation is widely recognized by the federal government as a condition to receive Medicare and Medicaid reimbursements. And losing it could be catastrophic to the hospital, which has already had federal funding problems dating back to 2019.
Eleanor Slater doesn’t have a great track record with JCAHO in recent years.
During its most recent review of the facility in 2017, the Joint Commission threatened to revoke the hospital’s accreditation, citing life and safety problems with the facilities. Specifically, the facilities had too many “ligature risks,” or areas that would make it easier for patients to commit suicide.
Rhode Island was eventually able to secure the accreditation by requiring staff to check up on patients every five minutes, a practice state officials said continues today.
The Joint Commission does not typically announce when it will show up for a review, but state officials have suggested it could happen sooner rather than later.
“We are anticipating that they will come back imminently,” Power said last month. “We have a sense they will arrive on our doorstep quite soon.”