The newly departed chief medical officer of Eleanor Slater Hospital says a state-commissioned review of the facility is riddled with errors and suggests “bias or undue influence” on the part of the investigators.
Dr. Brian P. Daly, a forensic psychiatrist who resigned from his job on July 31, released a 16-page letter critiquing a recent report by the Hospital Association of Rhode Island (HARI) and Care New England (CNE), which praised the state-run hospital’s patient care but said it is hampered by leadership discord. Daly, who was interviewed for the report, said the portrayal was inaccurate and damaging to his reputation and that of other hospital leaders who have spoken out about the hospital’s problems.
The Joint Commission, a national organization that accredits hospitals, interviewed many of the same people as those who produced the HARI/CNE report, Daly pointed out in his letter, but reached “dramatically different” conclusions. The Joint Commission found issues with patient care and in June threatened to deny the hospital accreditation.
The July 30 letter from Daly is addressed to Dr. James E. Finale, CEO of Care New England, and M. Teresa Paiva Weed, president of the Hospital Association of Rhode Island.
Daly, 52, who assumed the role of top doctor at Slater hospital in July 2018, is among a handful of employees who have raised alarms about state leaders they say for years have pressured doctors to label psychiatric patients as medical patients. The practice, they said, allowed the hospital to remain eligible for tens of millions of dollars a year in federal Medicaid reimbursements. Some patients also remained unnecessarily confined to the hospital rather than moving them into a less restrictive setting, as required by federal law.
“My focus on trying to prevent a violation of federal law is something that I am proud of,” Daly said.
Gov. Daniel J. McKee and his top administrators have issued their own recommendations for changes at Slater hospital, including removing hospital leaders — in many instances, the leaders who have spoken out publicly against the billing practices.
McKee’s office referred a request for comment to the state Office of Behavioral Healthcare Behavioral Healthcare, Developmental Disabilities, and Hospitals (BHDDH), which oversees Slater hospital.
“The independent CNE/HARI review is only one source of information out of many the Department is consulting to propose how to reform Eleanor Slater and ensure it remains a resource available to vulnerable Rhode Islanders,’’ Randal Edgar, a spokesman for BHDDH said in an email. “As previously stated, Governor McKee, Secretary (Womazetta) Jones, and Director (Richard) Charest will need the results of other pending reviews to inform a strategic plan for the Hospital.”
In his letter, Daly raised questions about the impartiality of the state-commissioned review. Care New England is the largest member of HARI and is currently seeking approval from the state for a merger with Lifespan, the state’s largest hospital system.
Daly said that Care New England also benefits financially from being able to transfer many patients it cannot discharge from their hospitals to Slater hospital, “where the cost of their care would be paid by the taxpayers.”
The review by the CNE-HARI team included four site visits conducted during the week of June 4 to three Eleanor Slater facilities (Zambrano, Adolph Meyer and Regan) on the hospital system’s campuses in Cranston and Burrillville. The team also spoke with hospital staff and reviewed patient charts.
Daly disputed the report’s claim that he and Dr. Andrew C. Stone, chief of medical services, “do not actively and routinely care for patients at the hospital,’’ as evidenced by the lack of any clinical notes in charts with their names on them.
Daly said that about 30-40% of his clinical work was done at the Benton facility, which he said he told the reviewers; and it was the primary site for the clinical work performed by Stone.
The hospital’s Benton facility accounts for at least 25% of the hospital’s census, Daly said, but was “inexplicably” not included in the evaluation. He called this omission “unfathomable,” considering that the facility is where the hospital cares for acutely ill psychiatric patients and provides addiction treatment.
Daly also said the report contained inappropriate and disparaging statements about the hospital’s chief nursing officer, Eileen Dobbing, saying that she lost focus during her interview, which “may impede progress in the nursing activities as ESH.” He said there was no evidence to support this either in her work or in the report.
The CNE-HARI review also omitted mention of what Daly says he told the reviewers about how, prior to his arrival in 2018, psychiatric patients were “routinely” placed in soft wrist and waist restraints known as “twice as tough” or TAT belts, for extended periods. “One patient still walks with hands at his/her waist even though no longer in a TAT belt,” he said, “because s/he became so used to this.”
The review also mentioned that it was appropriate to use restraints for fall prevention, Daly said, though the Centers for Medicare and Medicaid Services (CMS) says that restraints “should not be considered a routine part of a falls prevention program.”
Slater still has a locked unit at the Zambrano facility, which is designated for medical patients, and therefore is not authorized by the state to operate a locked unit. However, Zambrano also cares for patients with dementia, who may be at risk of wandering.
“Given the nature of the report as well as the fact that it is fraught with a multitude of inaccuracies, some of which I feel are purposeful attempts to inflict reputational damage, it is my belief that the report is a biased attempt to fulfill a prescribed agenda,’’ Daly said in an email with his letter. “Accordingly, I felt compelled to provide a detailed response. It is difficult to be one person trying to fight against all the resources the state can bring to bear, but I refuse to be a scapegoat.”
Daly’s critique comes amid uncertainty about whether Slater will retain its accreditation and the findings of an ongoing investigation into billing practices and patient care by Rhode Island Attorney General Peter F. Neronha.
McKee and other state leaders have expressed confidence that the state is making progress in addressing the deficiencies, including its deteriorating facilities, and will be able to relicense the facilities to resume its Medicaid billing.
Health reporter Lynn Arditi can be reached at larditi@thepublicsradio.org. Follow her on Twitter @LynnArditi
