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PROVIDENCE — Patients at Eleanor Slater Hospital are receiving excellent care, but the state-run hospital system faces leadership challenges, outdated health records and facilities that are in need of repair, a new report released Friday found.

The report by the Hospital Association of Rhode Island and private hospital system Care New England also found that while some Eleanor Slater patients could be discharged to less restrictive settings, many need the care they get there. That conflicts at least in spirit by assertions made by the state under previous leadership, which emphasized how many patients would do better in other settings. Some patients have been at Eleanor Slater Hospital for decades.

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The state-run Eleanor Slater Hospital system includes campuses in Cranston and Burrillville. Its 200 patients suffer from a range of complex medical and psychiatric conditions, including long-term injuries from car crashes and overdoses. Some have been ordered by the courts for mental health treatment.

The system has been under intense scrutiny for months because of long-running financial problems and a cascade of complaints about conditions there. Gov. Dan McKee put a hold on plans to change the system that were developed under his predecessor, Gina Raimondo.

The report released Friday offered an early detailed view of clinical practices at the hospital system. But a number of entities, including the state attorney general, are scrutinizing Eleanor Slater Hospital. One group, Disability Rights Rhode Island, recently cast doubt on this report’s independence; Eleanor Slater is a member of the Hospital Association of Rhode Island.

The hospital system was preliminarily denied accreditation, though the state says it’s working on getting it back.

Some top officials have said the state has improperly billed Medicaid. Some of them who raised the issues are on their way out. The state, meanwhile, lays much of the blame on hospital leadership.

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The report included criticisms of two physician leaders, Dr. Brian Daly, the chief medical officer, and Dr. Andrew Stone, chief of medical services. Neither actively and routinely cares for patients, the report said.

“While they each seemed to have clinical strengths, the themes throughout the conversations were a lack of trust, poor communications, and frustrated attempts to bring change,” the report said.

Recent layoffs there had left the two full-time physicians on the Burrillville campus discouraged, the report said. Those two lower-level doctors felt physician and nursing leadership had poor communication.

“They felt that their voices were not being heard, and that their leaders, by not being present on the clinical units, lacked the necessary context to make changes with good judgement,” the report said.

Daly, who has resigned but will continue working there until the end of the month, and Stone have been among the most strident internal critics of billing practices at the hospital system. They also told the review team that patients could be better served at locations other than a hospital, even though they acknowledge few other options exist for patients currently in Burrillville.

The system also doesn’t have electronic medical records, which makes everything there, from discharge to quality improvement, more difficult, the report noted. The hospital should invest in an electronic medical records system, the review team found.

The review team looked at every facility on the Eleanor Slater system except the Benton site, whose patients have been ordered for treatment by criminal courts.

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McKee, soon after taking office, halted plans to transform the system. Those earlier plans would have built a new skilled nursing facility in Burrillville to replace the current Zambarano unit, as well as close two buildings on the Cranston campus. The state recently signaled that it would move forward with plans to close one of those buildings in Cranston, but much else, including whether a new building in Burrillville will be constructed, is still undecided.

Among the problems that have been raised at the hospital system: inappropriate discharges from the hospital system. The current leadership has said patients belong in less restrictive settings, but that they’ve only tried to do so responsibly. Some patient advocates have raised the alarm about discharges, and the report underscored those concerns.

“We would be quite concerned with a wholesale transferring of most of these long term patients given the substantial complex, specialty type of care they require,” the report said. “Our clinical team is concerned that this cohort of patients will deteriorate in other facilities who are not skilled nor staffed to care for these patients.”


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