PROVIDENCE — The state-run Eleanor Slater Hospital tried to send ventilator patients to an outside facility without informing the patients or their families, according to interviews and state Department of Health records.
The Department of Health surveyed Eleanor Slater in April in response to a complaint and found that it failed to follow its discharge policy earlier this year when it sent documents about a patient to an outside facility without telling the patient. In response, Eleanor Slater strengthened the policy and agreed to report to regulators for six months, according to documents obtained through a records request.
Randal Edgar, a spokesman for the agency that runs Eleanor Slater, noted in an email that this was the only Department of Health survey to identify a deficiency in its discharge policies going back to January 2019. The hospital’s policies on patient records are now even stronger than HIPAA, a federal law that deals with the privacy of patient records, he said. Though HIPAA allows patient information to be shared to assist in the discharge or transfer of another patient, “ESH has now agreed to follow a policy that is stricter than HIPAA by obtaining patient or family consent before sharing such information in this situation,” Edgar said.
But patients’ families and their advocates have raised concerns about the way they were treated. And the episode is also noteworthy because, to critics of the administration at Eleanor Slater, it shows what the state has been trying to do for months now: A “shadow closure” of a hospital of last resort for vulnerable people.
“They were betrayed,” said Melissa Ferrario, the president of NAGE Local 79, a union that represents Eleanor Slater’s registered nurses. “They love the care they get at the hospital. These patients are family to us.”
The hospital is run by the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals. Known as BHDDH, the department is separate from the Department of Health.
Eleanor Slater Hospital has campuses in Cranston and Burrillville. Patients have complex psychiatric or medical conditions. Some have been ordered for mental health treatment by civil or criminal courts; others suffer long-term injuries from car crashes or drug overdoses.
The state had proposed closing some parts of the system, which has sparked backlash from unions, advocates and patients’ families and questions about finances. Peter Neronha, the state attorney general, has launched an investigation, as has Disability Rights Rhode Island.
The issue with ventilator patients came up at the Cranston campus, in a unit called Regan 5, earlier this year. The Regan building is one that the state’s consultants had suggested closing. To Ferrario, the violation of the discharge policies was directly related to efforts to bring down the patient count there so they could justify closing the building. BHDDH, on the other hand, has long denied any such “shadow closure” or underhanded moves.
Ferrario, who is also a nurse and a supervisor in the Regan building, said someone within the state-run hospital system sent the records of five patients to an outside rehabilitation facility in Coventry without telling their families or legal representatives. (The Department of Health survey only concerned the records of one patient being sent to an outside facility, but Ferrario and others said it happened to multiple patients.) There are about eight ventilator patients on Regan 5, Ferrario said.
Ventilators are devices that blow air into people’s airways to help them breathe if they can’t breathe on their own. Because of that, they cannot speak for themselves, literally or figuratively. In many cases, family members also have power of attorney to make decisions for the patients.
“That’s what makes it even more outrageous,” Ferrario said.
The uproar from families and their advocates managed to stop the discharges, according to Ferrario. Those who were concerned included Kathleen Heren, the state long-term care ombudsman.
“This was a trial run they were pulling,” Heren said.
Mary Sicco was one of those affected by the lapse. Her husband, Michael, has been a patient at Eleanor Slater for about five years. He has ALS, a progressive neurodegenerative condition also known as Lou Gehrig’s disease. He cannot breathe or communicate on his own and uses a ventilator. Sicco, a retired school nurse who lives in North Kingstown, became his power of attorney, with the ability to make decisions over his medical care.
But she only learned via an anonymous tip in March, not notification from the hospital administration, that the hospital was considering discharging her husband to a long-term care facility in Coventry, Sicco said. He had been at that facility before and nearly died, she said. Eleanor Slater is the only place he has done well and the only place that can care for him, she said.
Once she learned about the potential plans for his discharge, she called Eleanor Slater and got a bit of a run-around, she said. Several people there wouldn’t answer her questions directly. But a nurse there did eventually acknowledge that they’d sent Michael’s information to the facility in Coventry to inquire about whether he could be discharged there, Sicco said. The facility in Coventry, too, confirmed to Sicco that they’d received information from Eleanor Slater about Michae, she said.
Sicco was stunned. As Michael’s wife of more than 50 years and as his power of attorney, she should have been consulted on such things. She considered it a breach of protocol and a violation of his privacy.
“This, in my mind, is neglect of your responsibility to protect and care for him,” Sicco said.