CRANSTON, R.I. (WPRI) – On paper, the stories of Adam Pacheco and Anthony Tavares look very different.
A car crash in the 1990s left Pacheco with a traumatic brain injury, unable to move or speak. Tavares was found not guilty of murder by reason of insanity after he stabbed and killed a social worker in 2001.
But the two men have something in common: for decades both have been living at Eleanor Slater Hospital, a state-run facility where it costs a half-million dollars in taxpayer money each year to care for them, according to state budget officials.
The publicly funded medical system is licensed as a long-term acute care hospital. In practice, its campuses serve more like a nursing home for patients with complicated medical needs and a de facto prison for people with mental illnesses who committed crimes.
And while hospitals are typically institutions where people go to be treated and get released after getting better, Eleanor Slater patients often end up living there for years.
“I’ve been here for so long, I don’t know what I’m missing,” said Tavares, whose family has been advocating for several years to have him released to a less restrictive setting, like a group home.
For many Rhode Islanders, the people who live at Eleanor Slater and what happens inside its walls is a mystery. Unlike other publicly funded state operations, the hospital is shielded from some public scrutiny because of laws that state officials say protect information related to patients’ health care.
For example, a Target 12 request to bring a camera into the institution to explore its operations was denied by the state agency that oversees the hospital, the R.I. Department of Healthcare, Developmental Disabilities and Hospitals, or BHDDH. Spokesperson Randal Edgar attributed the denial to the Health Insurance Portability and Accountability Act.
“The HIPAA Privacy Rule bars ESH from inviting or allowing media personnel, including film crews, into treatment or other areas where patients’ Protected Health Information will be accessible in written, electronic, oral, or other visual or audio form,” Edgar said in an email. “We take our patients’ privacy very seriously.”
But state officials have provided some details about who lives at Eleanor Slater, including demographic information and length of stays, offering a glimpse into life at the hospital.
As of July, the average length of stay for the 197 people at Eleanor Slater totaled more than nine years. One patient had been living there for nearly 63 years.
Three of every four patients were men; more than half were over 50 years old. At least 25 patients – about 16% — were older than 70.
For some people — including Adam’s mother, Shirley — the hospital has been a godsend. Adam is in a wheelchair and his ability to communicate using words is limited.
“It’s home, it’s family, it’s his safe place,” Shirley Pacheco said. “Mine too.”
But for other families, Eleanor Slater has been a disappointment.
“At first when we first found out he was going to go a psychiatric facility we said to ourselves, ‘Maybe this is the best thing for him. It was a blessing,’” recalled Tavares’ brother, Justin Votolato. “At this point, there’s no possibility that we could have been more wrong.”
The difference of opinion stems from the differing experiences the families said they’ve had with the hospital over the years.
Shirley Pacheco, who regularly visits her son at the Zambarano unit in Burrillville, said the nursing staff treats Adam like family and does a great job responding to their needs. The campus is tucked away off a roadway in the woods and the building sits alongside the picturesque Wallum Lake.
During a Target 12 interview with Pacheco earlier this year, a nurse interrupted only to ask if Shirley and Adam needed anything, which the mother said is typical.
“At night I can sleep, knowing my son is in good hands,” Pacheco said.
But in Cranston, where Tavares has spent most of his two decades living in the hospital’s Benton facility, a much different situation was described.
“Last week someone hit someone in the head with a jar of shaving cream in a pillowcase,” Tavares told Target 12. “It’s not safe.”
Within the past few months, the Cranston campus – located next door to the state prison – has also seen multiple dangerous incidents.
One patient tried to gauge out their own eye with a spoon. Another was found face-down in a bathroom with string smuggled in from outside the hospital, Target 12 has confirmed.
Earlier in the year, another patient slipped away from nursing staff and was later found walking alone off campus near an intersection of a four-lane roadway, according to a report reviewed by Target 12. Federal regulators have investigated at least two of the incidents.
Tavares and his family argue he’s well enough to be moved out of the hospital and into a less restrictive setting, which is a requirement under the deinstitutionalization policy that’s been in place since the 1960s. Family members said they’ve seen other patients who have done similar things as Tavares discharged in far less time.
And Tavares’ mother, who lives in Providence, believes the reason why he’s left there isn’t because of anything health related, but rather because they cannot afford a lawyer to make the legal case for his discharge.
Tavares was recently moved to another Cranston unit, Adolph Myer, which is supposed to be less restrictive than Benton, he said. But Tavares told Target 12 this week that life remains largely the same and that his requests to live in a group home have gone unanswered.
The widow of the social worker killed by Tavares in 2001 said before her husband died, he told her that Eleanor Slater was “everything you would think a locked psych ward would be and then 20 times worse.”
“It was not a place where people would be getting better,” said the widow, who requested not to be named.
Asked how she felt about the idea of Tavares getting out of Eleanor Slater, she said she wouldn’t advocate for that move because she didn’t think he should be “out and about in society.” But she said she also didn’t think he should be at Eleanor Slater.
“I want him to be safely secure, but I don’t think he needs to suffer unnecessarily in a place that isn’t designed for a person like him,” she said. “There are a lot of deficits in mental health care in this state. There just aren’t enough resources out there.”
The dichotomy between Cranston and Burrillville has led many to wonder why the hospital is set up that way. Rhode Island is the only state in the country without a standalone psychiatric hospital, and state officials for years have been discussing whether to create one at the Benton facility.
“The two shouldn’t be listed as under one umbrella,” Pacheco said. “They are totally different.” Referencing Zambarano, she said, “This is a long-term care facility for people with medical issues.”
The future of Eleanor Slater is still being debated, and Gov. Dan McKee has promised Zambarano will not be shut down – a fear expressed by many of the families of patients living there.
“It would be a sin to take this away,” Pacheco said.
Creating a standalone psychiatric hospital, however, would also create a new funding challenge for the state. The cost of operations is about $1,500 per day per patient.
Currently, the hospital’s funding mechanism allows the state to seek federal reimbursement for the care provided to medical patients at Zambarano, including Pacheco. That money helps offset the cost associated with caring for patients in Cranston, including Tavares, who are ineligible for federally support.
Without that set up, the state would have to cover the entire cost of the psychiatric patients, and the reimbursement rates for the medical patients might be less if the facility wasn’t licensed as a long-term acute care hospital.
And while the past year has come with a lot of public scrutiny on Eleanor Slater — including legislative hearings and an ongoing investigating by Attorney General Peter Neronha into patient care and funding issues — the state hasn’t move quickly toward taking final action.
Rhode Island continues to “evaluate the recommendation to remove Benton forensic facility from the Eleanor Slater hospital license, and create an independent psychiatric hospital,” said spokesperson Kerri White earlier this year.
The idea has been on the table since at least 2019, according to multiple reports issued and reviewed by Target 12 in recent years.