An internal review of the troubled Eleanor Slater Hospital recommends that the state move ahead with plans to close one aging building and reevaluate its leadership to restore trust in the state’s hospital of last resort.

The 10-page report released Wednesday marked the first of a series of steps outlined by a top administrator for Gov. Dan McKee to address the turmoil at Slater, which include allegations by two former high-ranking hospital officials of improper billing practices.

“The current leadership has lost the trust and confidence of staff, community stakeholders and the General Assembly,’’ Womazetta Jones, secretary of the state Executive Office of Health and Human Services (EOHHS), said at a news conference with McKee on Wednesday. 

During a 60-day review of the hospital, Jones said, “I faced resistance and a lack of cooperation and transparency from some of the members of the hospital leadership team.”

The report also described an “entrenched culture” at Slater that includes reports of “threatening behavior, bullying, and retaliation” that need to be addressed.

Jones said she has asked the Human Resources department to conduct a complete review of the leadership team, including job classifications and salaries, and compare those to similar roles in the industry. 

The chief financial officer of the agency that manages Slater, who previously served as the hospital’s interim CEO, was placed by the governor on administrative leave earlier in the week. And the hospital’s chief medical officer is resigning at the end of July. 

The Eleanor Slater Hospital system — four buildings spread over two campuses in Cranston and Burrillville — cares for long-term medical and psychiatric patients. The average length of stay is 14 years, according to state administrators.

In mid-2019, Slater fell out of compliance with federal billing requirements due to its high volume of psychiatric patients and stopped billing for some reimbursements from the federal Centers for Medicare & Medicaid Services (CMS). The move cost the state tens of millions of dollars a year. 

A new plan approved by the CMS in March 2021, “resolved earlier billing concerns,’’ the report said, but billing for federal reimbursement is currently “on hold” since leadership staff raised concerns about whether some items were justified. To address the billing concerns, the EOHHS has “retained an outside, independent third-party” to review all patient billing since the beginning of 2020, the report said. The state has hired a team from Butler Hospital to review its billing records.

The latest report reiterates many of the concerns raised in previous reports about the physical condition of two of Slater’s facilities — the Adolph Meyer building in Cranston and the Zambrano building in Burrillville.

Jones’ report recommends closing the Adolph Meyer building and outfitting new units at the Regan building, also on the Cranston campus, for court-ordered psychiatric and forensic patients. 

Consultants for McKee’s predecessor, Gina Raimondo, also had proposed closing the Adolph Meyer building as well as building a skilled nursing facility on the Zambrano campus in Burrillville, according to a 2020 report. Rhode Island currently has a moratorium on new nursing facility licenses, which state lawmakers would have to repeal before building a new nursing home.

The latest report also calls for developing plans and cost projections for a possible new building on the Burrillville campus, possibly a long-term skilled nursing home. 

The report also highlights other deficiencies, including the lack of any electronic health records system; the Slater hospital system still uses paper records.

The Roosevelt Benton Center, which houses forensic patients who have been charged with misdemeanor crimes, is not large enough to accommodate its average admission census, so patients have been moved into the Adolph Meyer building. Though the state ended civil psychiatric admission to Slater in 2016, the report said, there has been a “significant increase” in these court-ordered admissions in 2021.

The report recommends the state resume admissions to Slater, and require bi-weekly reports on referrals and outcomes.

 Health reporter Lynn Arditi can be reached at Follow her on Twitter @LynnArditi.