Rhode Island’s Eleanor Slater Hospital is providing high quality care to patients but is hampered by discord with its leadership and the deterioration of one of its buildings, according to a report of the state-run hospital released Friday by Gov. Dan McKee’s administration. 

The peer review of the state-run hospital was conducted by the Hospital Association of Rhode Island, a trade group that represents Eleanor Slater, and Care New England, the state’s second-largest hospital system. 

The review, conducted at the request of the McKee administration, comes as Eleanor Slater is at risk of losing its accreditation from the Joint Commission, a national accreditation hospital organization, which earlier this year cited more than 100 health and safety violations at the state-run hospital that provides psychiatric and medical care to about 200 patients. The state earlier this week released its plan to correct the deficiencies. 

The management of Slater by both the Raimondo and McKee administrations has been under scrutiny due to a history of financial problems and many rounds of recommended improvements to the hospital.

Unlike the Joint Commission or the state Department of Health, the team that performed the latest evaluation is not a qualified review body and has no regulatory authority.

The report acknowledged concerns raised by hospital leaders who testified at hearings before state lawmakers that “many patients’’ in the Regan 4 and Adolph Meyer buildings did not require hospital level of institutional psychiatric care.

 A handful of hospital employees have raised concerns about some patients who they say have remained unnecessarily confined to the hospital rather than moving them into a less restrictive setting, as required by federal law.

 The report repeatedly states that appropriate alternative community-based care for these patients does not exist in Rhode Island.

 The review by the team of outside hospital administrators and clinicians 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 two campuses in Cranston and Burrillville. The team also spoke with hospital staff and reviewed patient charts. 

The report echoed the Joint Commission’s concerns about the poor condition and safety at the Adolph Meyer facility, especially the risk of strangulation by psychiatric patients. 

The report said that medications administered to Eleanor Slater patients were appropriate, the skin care for patients who are immobile is “excellent” and their clinical care is well documented. However, during interviews with staff the team found that while staff turnover is “generally low,” staff expressed frustration with physician and nursing leadership, citing poor communication and frequent policy and rules changes with “ineffective discussion.”

 The team observed tensions between physicians and other staff, the report said, and were told that “the physicians were not receptive to team input resulting in shutting down these important discussions.” Paraprofessionals also cited severe weekend staffing shortages that, the report said, have led to excessive overtime and burnout. 

During interviews with Dr. Brian P. Daly, the hospital’s chief medical officer, and Dr. Andrew C. Stone, chief of medical services, the report said, the pair expressed a lack of trust in leadership of the hospital and the state agency that oversees it, and expressed frustration with attempts to bring change. (The Department of Behavioral Healthcare Developmental Disabilities and Hospitals oversees Eleanor Slater.) The leadership’s distrust, the report said, “seems to sow a great deal of this distrust throughout the organization.”  

The report noted that Daly and Stone “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, 52, who specializes in forensic psychiatry, is resigning his post at the end of the month. In his resignation letter, he said that he chose to leave his job at the end of July because he felt the hospital was resuming practices that led to “patient abuse” and fears retaliation for speaking out about the problems. Daly 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. 

Rhode Island Attorney General Peter Neronha has launched an investigation into the hospital, as first reported by WPRI/Channel 12, including allegations of possible Medicaid fraud.

correction: a previous version of this story incorrectly reported Brian P. Daly's age.

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