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Doctor raises alarms about discharges from state-run Eleanor Slater Hospital

In a scathing open letter, the doctor accuses the R.I. hospital of “unethical, non-compassionate, non-standard care.”

PROVIDENCE — In a scathing open letter, a doctor who recently retired from the state-run hospital for people with complex medical conditions in Burrillville, R.I., said the administration is inflicting “psychological harm” on its patients and their families in its efforts to discharge them.

Dr. Normand Decelles Jr., who retired from the facility after a 20-year tenure, said in an interview that Eleanor Slater Hospital is trying to solve its financial problems on the backs of its most vulnerable people.

In an interview, Decelles called the situation a shadow shutdown of the cash-strapped facility.

“To slow the financial hemorrhaging, the administration has been pressuring the doctors to discharge as many patients as possible as quickly as possible and to curtail as many services as possible, to the point of what I see as an unethical, non-compassionate, non-standard care,” Decelles said.

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Eleanor Slater Hospital has campuses in Cranston for people with psychiatric conditions, and Burrillville, for people with medical conditions. It’s run by the state Department of Behavioral Healthcare, Developmental Disabilities and Hospitals. Decelles worked for 27 years at the Burrillville site, called the Zambarano unit, including 20 years as medical director and physician administrator. He formally retired in February, with his last day in October.

In an emailed statement, the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals said: “Decisions related to discharge are made on a clinical basis according to each patient’s healthcare needs — and not on any other basis. The hospital’s discharge and admission criteria reflect this: decisions about admission and discharge are based on clinical assessment alone. Depending on each patient’s clinical assessment, the hospital may make discharges to healthcare settings that allow people to be in community settings. Again, these decisions are made on a clinical basis alone, consistent with hospital policy, and not for any other reason.”

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Later Thursday, Disability Rights Rhode Island, a federally-mandated independent agency that serves as a legal advocate for people with disabilities, told the Globe it has been formally investigating discharge practices at Eleanor Slater since February.

“We want to make the public aware, in light of recent news reports concerning Eleanor Slater Hospital, that we are a resource for anyone who may have information they want to share,” Executive Director Morna Murray said in an emailed statement, urging people to contact them. “We are reaching out to staff, patients, families and community members.”

Local officials fear that the state is trying to shut down or downsize the Zambarano unit. Mental health advocates also have raised concerns about consolidation plans at the Cranston campus. Former Governor Gina Raimondo’s administration repeatedly denied that the state was trying to shut down Zambarano. Raimondo resigned as governor as she was sworn in as President Joe Biden’s secretary of commerce earlier this week, and former lieutenant governor Dan McKee took over as governor amid uncertainties over the future of Eleanor Slater.

“I’m hoping for a clean slate with Governor McKee,” said state Senator Jessica de la Cruz, a Republican of North Smithfield who represents the area. “We’re advocating for the hospital to remain open, because there is no other place for these people to go.”

She and state Representative David Place of Harrisville had a conversation with McKee last week, de la Cruz said. McKee made no promises, but de la Cruz said she’s hopeful that he’ll support the hospital.

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Behind the scenes, Decelles portrayed an institution trying to discharge its patients even though other facilities had rejected them again and again.

Since February of 2020, Zambarano has stopped accepting new medical patients, Decelles said. All along, the administration said the patients who were already there, sometimes for years, didn’t belong there and didn’t fit the criteria for a place like Zambarano. Those new criteria, Decelles said in his open letter, are “contrived, non-standard, and clinically invalid.”

“Very appropriate candidates for admission are now frozen in Rhode Island’s acute hospital beds with no discharge options,” Decelles said.

Decelles said he’s the one who personally reviewed the admissions for people there, and stands by his work over the last decades. The state, he said, is now trying to justify reducing the population by changing the rules they’ve lived by all along, he said — all to save money.

The patients at Zambarano have “permanently life-altering medical and physical conditions” like traumatic brain injuries from gunshot wounds, spinal cord injuries, end-stage diseases, brain injuries from drug overdoses, and dementia with aggressive behaviors, Decelles said.

It serves as something of a hospital of last resort for people who have been rejected from other facilities or failed to succeed in other settings.

The state had to stop billing the federal government for services at Eleanor Slater, which added to its financial woes. That happened because to get federal funds, facilities have to have more medical patients than psychiatric patients, the state said at the time.

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But according to Decelles, the hospital also faces barriers to federal reimbursement because of its lack of a computerized health information and medical record system.

Advocates for Eleanor Slater patients also are concerned about what’s going on in the Cranston facility, which treats patients with serious, persistent psychiatric illness who haven’t been able to be treated in community settings. Plans released last year by Raimondo’s administration contemplated closing some units of Eleanor Slater in Cranston.

One story that has caught the attention of mental health advocates concerned an arson in Warwick, where a 28-year-old woman who’d spent seven years at Eleanor Slater in Cranston allegedly set fire to an apartment building. Aiyana Milton was discharged from Eleanor Slater in the summer of 2020, but left her community group home, according to her family.

Deborah Masland, Milton’s mother, said her daughter wasn’t able to go back to Eleanor Slater even after she ended up in various community facilities in the last few months. The system has too many gaps, and Milton didn’t have a good intermediate option after her departure from Eleanor Slater, Masland said.

“There’s something broken in this state,” Masland said.

Reached for comment, Meg Clingham, the state mental health advocate, said she also was concerned about some of the discharges from the Cranston facility. Patients are lingering in community hospitals because group homes have not accepted them, and Eleanor Slater has accepted very few admissions outside of those involved in the criminal justice system in years, Clingham said.

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“While I support efforts to place patients in the least-restrictive settings where they can receive the treatment they need, at the current time, Rhode Island lacks the robust array of community settings that are needed to keep the most challenging patients safe,” Clingham said. “Even with a comprehensive system of care in the community, there will always be a need for a small number of long-term psychiatric hospital beds.”


Brian Amaral can be reached at brian.amaral@globe.com. Follow him on Twitter @bamaral44.