Lawmakers Urge McKee To Reinstate Patient Admissions At Zambarano

BURRILLVILLE, RI — Two Republican state lawmakers in Rhode Island have asked Gov. Daniel McKee to immediately halt discharges and reinstate patient admissions at the Zambarano Unit of the state-run Eleanor Slater Hospital until an investigation into alleged patient abuse is completed.

In a March 15 letter, Sen. Jessica de la Cruz and Rep. David Place allege that hospital administrators last year quietly hatched a plan to close the Burrillville facility while telling the public its long-term acute care services were not actually needed. The lawmakers charge that hospital administrators fabricated unrealistic criteria for admission and retention, and improperly pressured physicians to discharge patients in an effort to save money.

"It has become clear that administrators endeavor to make 'qualifying for care' at Zambarano impossible for everyone — including current residents," de la Cruz and Place wrote.

The two said there was an "organized effort" by the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals to discharge acute care patients who had no other realistic place to go. They also said there was a plan afoot to downgrade Zambarano's license from an acute care facility to a nursing home. On March 4, the lawmakers released a statement saying a "shadow closure" of the unit was underway.

"We are horrified to learn what is transpiring at Zambarano," de la Cruz and Place wrote to the new governor. "This is a matter of human dignity and moral responsibility."

Last month, Disability Rights Rhode Island informed state officials it was formally investigating discharge practices at Eleanor Slater Hospital.

Patients at Slater are divided into a psychiatric unit at Cranston and a medical unit in Burrillville. The Cranston unit includes forensic patients who have been placed by court order.

Eleanor Slater Hospital stopped accepting new patients last spring. According to WPRI-TV, the state has lost tens of millions of dollars in revenue at the hospital since mid-2019 when the hospital fell out of compliance with federal Medicaid billing requirements.

A spokesman for the BHDDH confirmed Tuesday that there have been five discharges at Zambarano since January 2020, and that Eleanor Slater has not accepted new non-forensic patients who do not need a hospital level of care.

"ESH has not accepted new non-forensic patients, if the applications for admission have come from individuals who do not need a hospital level of care. All applications are reviewed by the Chief Medical Officer and Medical Director for clinical appropriateness. As a licensed hospital, ESH cannot bill for Medicaid reimbursements for patients who do not require a hospital level of care," public information officer Randal Edgar wrote in an email.

He told Patch that hospitals are legally obligated to release patients who do not need a hospital level of care to less restrictive settings.“This is in the best interests of patients, and it is required by federal law and regulation,” Edgar wrote.

Edgar defended the hospital's protocols for admission and discharge. He said that all patients discharged have had a comprehensive discharge plan in place, including wraparound services and support. BHDDH has a contract with the Alliance for Better Long Term Care to assist with transition planning for patients who are heading to nursing homes.Edgar said assisted living facilities, nursing homes, and group homes can encourage continued recovery and greater independence for those who don't need to be hospitalized. He added that as a licensed hospital, ESH cannot bill for Medicaid reimbursements for patients who do not require a hospital level of care.

Edgar did not address the fact that the hospital is not currently able to bill for Medicaid reimbursements due to compliance problems.

Problems at Zambarano are not new, but they came into sharp focus two weeks ago when Dr. Normand Decelles, the facility's retired medical director, took direct aim at hospital administrators. In a scathing four-page letter, Decelles charged that vulnerable patients have been forced out of the facility and new admissions have been blocked because patient costs would no longer be covered by Medicaid.

Decelles in his March 2 letter said the bar for admission and retention was set so high by administrators it became unrealistic for nearly all patients.

"Administrative allegations that Zambarano patients need to leave now because they fail newly-developed hospital 'criteria for admission' is disingenuous and fabricated," Decelles wrote. "Reason: Patients need to leave now because their entire cost is being borne solely by the State of RI, not because they belong in nursing homes."

Patients at Zambarano are difficult to place in other facilities because they face multiple barriers for discharge and acceptance, Decelles said. Those barriers include extreme behavioral problems. Patients suffer from traumatic brain injury, spinal cord injury, multiple sclerosis and Huntington's chorea, quadriplegia, and dementia with aggressive or self-injurious behaviors. Some are sexually aggressive. Others require inserted devices such as tracheotomy tubes and catheters. Patients must be accepted at a new facility before they are discharged, and placing them might not be possible.

"Most patients do not have physical or cognitive capacity to self-preserve or self-advocate," Decelles wrote in his bombshell letter.

For his part, McKee seeks to build a new $65 million long-term care facility at the Zambarano campus. The consolidation plan would eliminate 100 full-time positions, shut two other Eleanor Slater units, and create a new Institute for Mental Disease at the Cranston campus. Budget documents reviewed by WPRI-TV show the reduction could save the state $38.7 million.

The consolidation plan is likely to be met with resistance from organized labor.

“The frontline workers at Zambarano are dedicated to their patients and have been ringing the alarm bell about the troubling changes to patient care at this critically needed state facility for months,” stated Cynthia Lussier, president of the United Nurses and Allied Professionals Local 5019, which represents workers at Zambarano.

Eleanor Slater Hospital is run by interim CEO Jennifer White and Chief Medical Officer Brian Daly, MD.