PROVIDENCE — The state should move forward with plans to close one Eleanor Slater Hospital building, and also needs a leadership shakeup and potential pay cuts for high-level administrators, a McKee administration review released Wednesday found.
The review represents the first steps in Governor Dan McKee’s efforts to address the crisis that’s roiling the state’s hospital of last resort.
“Change is not easy and will not happen overnight,” McKee said at a news conference on Capitol Hill unveiling the review. “It will take all of us working together on behalf of the patients to improve Eleanor Slater Hospital, and that work begins now.”
Running 10 pages, the review started in early April and was written by Womazetta Jones, the secretary of the Executive Office of Health and Human Services. Jones recommended closing the Adolph Meyer building in Cranston. That’s something the administration of McKee’s predecessor, Gina Raimondo, had also suggested before McKee put a halt to changes when he took office, and came as little surprise. Even a union representing hundreds of workers focused its efforts elsewhere.
But the review largely left unresolved questions about other parts of the sprawling and troubled system, like the Zambarano unit in Burrillville. Raimondo’s administration had proposed building a skilled nursing facility there, which provides a different level of care than a hospital setting. The patients there need a nursing home, not a hospital, state officials had previously argued. Local legislators, though, raised alarms about what they called a “shadow closure” of the Zambarano unit, a major employer in that region.
Jones’ report leaves open the question of whether a new building in Burrillville will be constructed, and whether the current building could still have some use if a new one is built. The state needs to consider what sort of licenses these facilities need to have, Jones wrote. That is ultimately a technical, bureaucratic question, but it’s one that will have a profound effect on the type of care that some of the most vulnerable Rhode Islanders get.
The Adolph Meyer building in Cranston and the Zambarano unit in Burrillville are both in poor condition, with “life safety” work left unaddressed and significant or even extreme ligature risks, the state has said previously.
A number of ongoing reviews, including by the state attorney general, will help guide the McKee administration about the next steps, Jones’ report said. The report lays out recommendations to McKee, rather than formal orders, but they represent the path forward for the state.
The path is similar to the one that Raimondo’s administration had laid out, although there are some differences. For example, the Raimondo administration had also suggested closing the Adolph Meyer building, but had gone a step further and said the Regan building, also on the Cranston campus, should close. The Regan building includes psychiatric and ventilator patients. It has significant ligature risks, or points that could be used for someone to die by suicide. The building also has “life safety” repairs left undone.
Jones’ report suggests the Regan building will be kept open for the forseeable future, something that a union representing hundreds of workers on that campus had pressed for. McKee said the state would address many of the facility problems across the hospital system.
The state also committed keeping open a state-run long-term acute care hospital, which provides a different level of care than a nursing home. That, too, diverges from previous plans, which weren’t explicit on that point, Jones said.
The report also called for a shakeup of leadership running the hospital system. That would go beyond the departures of several high-ranking officials who had raised concerns about operations there, Jones said. Jennifer White, the former interim CEO of Eleanor Slater Hospital and current chief financial officer of its parent agency, was recently placed on administrative leave, and the chief medical officer of the hospital, Dr. Brian Daly, resigned effective July 31. Both had raised concerns about practices there, including billing of Medicaid, but McKee said that’s not why they’re on leave or leaving.
People there tried their best, but in some cases, “the problem was their best wasn’t good enough,” McKee said.
Defenders of White and Daly say privately that they’re being thrown under the bus, at best, or punished for speaking out at worst. McKee denied that was happening.
Jones’ report didn’t name specific people, but said the current leadership team “has lost the trust and confidence of staff, community, stakeholders and the General Assembly.” The current leadership team “lacks cohesion and professionalism amongst one another,” had not been transparent or forthcoming, and had an insular culture, Jones said.
Human resources should also do a salary study, Jones’ report said.
Jones herself has had oversight of the agency that runs Eleanor Slater Hospital, the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals. She has ben the secretary of the Executive Office of Health and Human Services since 2019. In this alphabet soup of agencies, Eleanor Slater falls under BHDDH which falls under EOHHS.
But Jones said she was not responsible for the problems that have occurred and festered while she was serving as the state’s health and human services secretary. McKee backed her up.
“She needed to have the support to do that job,” McKee said. “We all bear responsibility. But we’re addressing the issue.”
The roughly 200 patients at Eleanor Slater Hospital have complex medical or psychiatric conditions. Some are on ventilators or suffer from the effects of drug overdoses or car crashes. The Benton facility in Cranston houses so-called “forensic” patients, or patients who are ordered by a court for mental health treatment. Renovated in 2018, Benton was never on the chopping block, and Jones’ report suggests creating a new license so it can operate independently of Eleanor Slater. The Raimondo administration had done the same.
The hospital system has been embroiled in multiple crises for months. Unions and local lawmakers have raised concerns about plans to reshape the hospital system. Advocates for patients there say there’s nowhere else in Rhode Island to send them, yet doctors have said the state aggressively tried to discharge them anyway to deal with the system’s financial problems.
Those financial problems, meanwhile, are still unresolved because of questions over whether the hospital system has more psychiatric than medical patients, which would threaten its ability to bill Medicaid. The state’s on-again, off-again plans for billing Medicaid have created budgetary confusion and headaches.
Still, one factor remains consistent: Many people who are at Eleanor Slater Hospital might be better served in a different kind of setting. The average length of stay there is 14 years, newly installed BHDDH Director Richard Charest said. The average for a long-term acute care hospital is 25 days.
“It’s our responsibility to make sure they’re in the least restrictive setting that is most appropriate to their level of care needs,” Charest said.
McKee’s plan, though, won early praise from some of the more vocal critics of the Raimondo administration’s plans. Council 94, which represents some 412 Eleanor Slater workers in Cranston, said they appreciated the McKee administration’s emphasis on “rebuilding bridges between management, patients, residents, their families, and front-line direct care workers.”
“As the new plan is fleshed out we hope that it will strengthen the Regan & Benton Hospital Buildings, RICLAS group homes, and allow our members to keep providing critical services as they have done throughout the pandemic,” J. Michael Downey, the Council 94 president, said in an emailed statement.