Leaked findings from federal inspection of state hospital expose deficiencies: What we know

PROVIDENCE — Leaked findings of a federal inspection of the state-run Eleanor Slater Hospital reveal a mountain of "deficiencies," including a "failure to ensure" infection control and surveillance and a failure to meet the requirements of Medicare dollars.

The deficiencies cited within the report extend from infection control to patient safety to the condition of the facilities. They include hospital management's failure to start the process to renew its expired operating license until it was called out on the lapse.

Among the other findings of an eight-member team of inspectors from the Centers for Medicare & Medicaid Services:

• "Failure to provide nursing care in accordance with accepted standards of nursing practice."

• "Failure to ensure that the physical plant of the hospital was properly maintained."

• "Failure to ensure all patient medical record entries are legible, complete, dated, timed and authenticated."

• "Failure to meet the 'condition of participation' relative to patient rights and patient safety."

It remains unclear what the repercussions are, if any.

When will the report on Eleanor Slater be released

The arm of the McKee administration that runs the hospital has acknowledged receiving the "survey findings" from the federal agency that holds the purse strings on Medicare and Medicaid dollars on Jan. 14, but thus far has been unwilling to release it.

COVID at Eleanor Slater: Nearly a quarter of Eleanor Slater patients tested positive for COVID in last 10 days

The report reflects the findings of inspectors who visited the hospital in September.

But the state's Department of Behavioral Healthcare, Developmental Disabilities and Hospitals, headed by Richard Charest, the former president and CEO of Landmark Medical Center, has refused to make the report public until Jan 31, the end of a response period.

The Journal has obtained excerpts of the report.

On Monday, in the wake of Journal publication of some of the excerpts, BHDDH spokesman Randal Edgar said: "Some of the issues raised in the report have already been addressed and others are in the process of being addressed."

For example, he said: "critical improvements have [already] been made to the facilities and its operations,'' but more needs to be done, and that "is exactly why the governor’s proposed budget includes over $170M for funding and restructuring of the hospital."

"BHDDH is not refusing to release the report but is planning to release the CMS report on Jan. 31, after the department has had a chance to thoroughly review the report and discuss it with CMS," Edgar said.

Those familiar with the report say it cites more than 50 "deficiencies'' including serious concerns about infection control prior to COVID sweeping through the two-campus hospital earlier this month.

The Eleanor Slater Hospital is not the only health-care facility in Rhode Island that has seen a rise in COVID cases. But it was the only hospital in the state that acknowledged calling in COVID-infected staffers to work over the New Year's weekend to avert a staffing crisis.

COVID in Rhode Island: RI Health Dept. opens door for COVID-infected staff to work at hospitals, nursing homes

On Friday night, BHDDH belatedly disclosed that 60 hospital employees — nearly 10% of the staff — had tested positive for COVID during the seven days beginning Jan. 5, when nearly a quarter of patients were also infected.

Asked how often the hospital was testing during the omicron surge, Edgar, the BHDDH spokesman, told The Journal on Jan. 12:

"The hospital is doing surveillance testing of staff, as recommended by [the Rhode Island Department of Health]. This will happen on a monthly basis.

"The hospital will also test patients and staff when they exhibit symptoms, which is consistent with practice at other hospitals."

What brought inspectors to the hospital: Eye-gouging injury at state hospital sparks federal inquiry

In addition,'' he said, "the hospital is taking precautions that make good sense and allow the hospital to provide clinical care for the illnesses for which its patients are hospitalized."

Why Medicare and Medicaid inspectors visited Eleanor Slater

The inspectors' visit in September followed a lapse in protocol that led to a eye-gouging incident considered serious enough to necessitate verification that the state-run hospital meets Medicare conditions of participation.

Medicare conditions of participation are federal regulations that particular health-care facilities must comply with in order to receive funding from the Medicare and Medicaid programs.

According to the report, a "Medicare recertification survey was performed as authorized by the centers for Medicare and Medicaid Services on September 13 through September 17, 2021 [and] it was determined that the facility was not in compliance..."

A further complication: The hospital's operating license for both the Cranston and Burrillville campuses expired on Dec. 31, 2021, according to the R.I. Department of Health website.

On Friday night, health department spokesman Joseph Wendelken told The Journal, in response to an inquiry: "We received a license renewal package for Eleanor Slater Hospital. All that remains is a transfer of payment for their licensing fee, which is expected very shortly.

"According to statute, if we have received renewal materials from an active license holder, their license is not considered expired (unless the renewal gets denied)."

On Monday, Wendelken acknowledged "the renewal materials were received on 1/19," which was nearly 5 days after the CMS findings were delivered to the hospital.

Edgar said the $44,500 licensing fee has now been paid.

Asked whose responsibility it was to get the renewal application in before it expired, he said: "The failure to submit the application on time was an administrative oversight."

This article originally appeared on The Providence Journal: Eleanor Slater Hospital inspection report by Medicare, Medicaid leaked