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PROVIDENCE — For decades, it has been known as the “hospital of last resort.”

Eleanor Slater Hospital, the state-run system with facilities in Cranston and Burrillville, treats people with complex medical and psychiatric needs. It manages patients on ventilators. It cares for people who were found not guilty in court by reason of insanity. It helps people whose long-term injuries are the result of car crashes or gunfire or overdoses. Some patients have been there most of their adult lives.

It provides excellent care, a top state official said Monday night. But it’s also “stuck in the past,” with paper medical records and outdated buildings more reminiscent of 1962 than 2021.


And it needs major changes — including a close look at who it’s caring for, and whether those patients truly need to be institutionalized at a hospital for decades, the director of a state department testified Monday night.

“I always say that no one should live their life in a hospital,” A. Kathryn Power said in written testimony to a Senate oversight committee. “With new medications, care coordination, and group homes, there is absolutely no reason an individual can’t live in the community, as long as they are deemed able through a comprehensive discharge process.”

Power, who is the director of the Department of Behavioral Health, Developmental Disabilities and Hospitals, testified at a lengthy hearing Monday night about Eleanor Slater.

The fate of the state hospital system has become a hot-button political issue. Local elected officials, unions representing hundreds of Eleanor Slater workers, and advocates for people with mental health needs have raised concerns about what’s going on there.

The state last year unveiled plans to build a new skilled nursing facility to replace the facility in Burrillville, which is referred to as the Zambarano unit, for about $65 million. The state would also shutter two buildings at the Pastore complex in Cranston, while keeping the site for “forensic” patients there open. Forensic patients are those who are involved in the court system, including some who are awaiting trial. The plan, developed by New York-based consulting firm Alvarez and Marsal, dates to the Raimondo administration, but Governor Dan McKee included it in his most-recent budget proposal.


What makes the budget situation at Eleanor Slater much more difficult is the fact that the state can’t bill the federal government for some patients because, the state says, it has more psychiatric patients than medical patients. Transitioning to a skilled nursing facility, instead of operating as a hospital, would allow it to bill the federal government for more services, the state said.

Against that backdrop of change, critics of the plan have raised concerns — especially about discharges of patients from Eleanor Slater. One former top doctor there, Normand Decelles, told The Boston Globe that the state was pressuring doctors to discharge patients as quickly as possible, which he said resulted in “unethical, non-compassionate, non-standard care.”

But Power said the discharges, 22 in all since July 2020, were not unusual in number — even though they happened as the state implemented a “more robust” discharge process to make sure people could get into the least-restrictive situation possible.

And she said all patients are discharged only after consulting with them and their families, and only when they had a safe place to go.


Power also said she was “disheartened” by and disagreed with comments from Decelles and another doctor who spoke to The Providence Journal.

Following two hours of testimony and questions for Power and other state officials, about 20 people signed up to testify about Eleanor Slater.

Decelles was among the first. He testified that the only reason more patients weren’t discharged from the Zambarano was because doctors like him refused to discharge them.

“Converting Zambarano to a nursing home would be a major error,” Decelles said, and it would “throw voiceless, vulnerable Rhode Islanders overboard.”

Decelles called the situation, in short, a “debacle” that needed more investigation.

James Cenerini, the lobbyist for Council 94, testified in opposition to the redesign plan. The union represents more than 400 Eleanor Slater workers at the Cranston site, who, he said, have been in the dark about an institution they care deeply about. They were also concerned about their livelihoods, he said.

“There really has been a lack of communication, or a lack of discussion with the employees themselves,” Cenerini said.

Also testifying Monday night: A woman named Pam Costello. She said her son suffered a traumatic brain injury in a 1996 car crash when he was 22. He had been at home and in nursing homes and rehabilitation centers. One nursing home couldn’t handle him, and threatened to send him to a hospital to medicate him, she said.

He’s done well at Zambarano, where he gets good care, she said.


If Zambarano turned into more of a nursing home, “he definitely would not be appropriate for that,” she said. “There has to be staffing and medical professionals.”

Megan Clingham, the state’s mental health advocate, said that some patients at Eleanor Slater who would be able to be treated in the community, in a less-restrictive environment. But there’s nowhere else for them to go in Rhode Island.

“That robust system of services does not exist,” Clingham said. “Any contemplated closing or reorganization of Eleanor Slater Hospital needs to be preceded by a needs assessment and an investment in the community so there are places people can go.”

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