***Article first published by 'The Providence Journal' on Feb. 25, 2015***

CRANSTON, R.I. — The apparent physical abuse of three patients with profound disabilities last year at the state-run Eleanor Slater Hospital triggered investigations by federal and state health officials and has prompted an investigation by state police.

One of the three unidentified patients apparently was abused by the insertion of a foreign object into his rectum, according to documents obtained by The Providence Journal in response to a request made under Rhode Island’s Access to Public Records Act.

All three of the patients are unable to speak, and at least one has severely limited movement, placing them among the ranks of the most fragile people for whom the state is responsible.

Governor Raimondo on Wednesday vowed to determine the facts and take any necessary actions to ensure the safety of all patients at the 495-bed Slater Hospital, which has a main campus in Cranston and a smaller one, Zambarano, in Burrillville.

“I am committed to providing high-quality care to our state’s most vulnerable patients, and these reports have highlighted weaknesses that we must address,” Raimondo said in a statement to The Journal. “The allegation of abuse in the report we’ve received is extremely concerning, and we’re getting to the bottom of what happened.”

According to Elizabeth H. Roberts, new secretary of health and human services, some measures to improve patient safety already have been implemented. Slater is run by the state Department of Behavioral Healthcare, Developmental Disabilities and Hospitals, which reports to Roberts’ office.
“We need to meet the highest standards for these individuals,” Roberts said in an interview.

The roots of the investigations date to an internal report, written by a Slater Hospital employee on June 17, 2014, regarding an individual described in documents as “Patient ID #1.” This patient – a 37-year-old man, The Journal has learned – suffers from cerebral palsy, a seizure disorder, brain injury, and pressure ulcers, or bed sores, and is dependent on staff to keep him alive.

The June 17 report stated that when that patient experienced bowel difficulties several days earlier, an exam at Slater revealed “an irremovable mass in the patient’s rectum.” On June 12, the patient was transferred to Rhode Island Hospital, where he was sent to the operating room and placed under general anesthesia.

A surgeon removed what one doctor described as a “mesh object or sock,” although the pathology report was inconclusive. While the patient had a history of ingesting non-food items, a doctor on the surgical team wrote in the medical record: “I don’t think this could have passed through the stomach ... and suspect this object was inserted via the anus.”

The doctor added: “This finding was suspicious for possible sexual abuse.” The patient’s family then contacted the state police. On discharge, the patient was transferred to a long-term care nursing home instead of to Slater.

Slater did not report the apparent abuse to the state Department of Health, as required by law.

It is unclear how the department eventually learned what had happened, but its first findings were spelled out in a Dec. 17 letter from Raymond Rusin, chief of the department’s office of facilities regulation, to Slater’s chief executive officer, Paul Despres. The letter followed an initial Health Department investigation that ended on Dec. 5.

The December investigation similarly determined that Slater Hospital failed to report to the Health Department the apparent abuse last fall of patients described as “ID #2” and “ID #3.” Staff discovered a scratch on Patient 2′s right upper thigh; on two separate occasions, scratches were found on Patient 3′s right upper thigh and “abdominal area.”

“The scratches on both patients were noted to be in the shape of a cross,” the December investigation concluded. “Although [Slater] suspected abuse, conducted an investigation, and initiated an action plan that included daily skin assessments, they failed to report the suspected abuse to the licensing agency in accordance with State law.”

The December investigation by state health officials triggered a federal review of Slater Hospital by the Centers for Medicare & Medicaid Services. The agency administers financing for institutions, such as Slater Hospital, that are accredited and “deemed” to meet all Medicare requirements.

But on Dec. 15, after receiving the results of the Health Department review, CMS revoked Slater Hospital’s “deemed” status and informed the hospital it would follow up with an unannounced survey of the facility.

If that inspection were to find Slater substantially out of compliance with regulations, the agency warned, the hospital’s Medicare agreement could be terminated.

In response to the investigations, Slater Hospital on Jan. 9 submitted a “plan of correction.” It included a new policy requiring a supervisory registered nurse, when a risk manager is not available, to report suspected abuse within 24 hours directly to the Health Department’s complaint hotline.
On Feb. 6, CMS and Health Department agents jointly conducted the unannounced survey. It found that all of the deficiencies related to the abuse cases had been corrected, prompting CMS to conclude that Slater was again deemed to be in compliance with Medicare requirements.

Meanwhile, the state police probe continues.

Col. Steven G. O’Donnell, superintendent of the state police, confirmed Wednesday that his detectives are involved in investigating the Slater Hospital incidents. No charges have been brought.

“Allegations have been raised about potential patient abuse,” he said. “The allegations are very serious” and, if proven true, he wants to bring the offenders “to justice.”

While “on their face [the allegations] have very much shock value,” he cautioned that when it comes to abuse cases, “sometimes they are true and sometimes they are not.”

“We are in the process of conducting interviews,” he said. “A lot of this has to do with medical records and doctors. Getting those records and interviewing people is where we are at now.”

Roberts said she was not aware of the alleged abuses when she took office at the beginning of the year; they were not included in former Gov. Lincoln D. Chafee’s transition memos, she said. Her first inkling came on Feb. 2, the first day on the job for Maria Montanaro, the new director of Behavioral Healthcare, Developmental Disabilities and Hospitals. Montanaro succeeded Craig S. Stenning, who was not reappointed.

“I have something I need to tell you,” Montanaro said to Roberts.

Since then, Roberts said, her office and Montanaro have begun a review of policies and procedures and made some changes, including improving monitoring of certain doors important for security. In the wake of the December Health Department investigation, Slater already had made other changes, Roberts said. Additionally, Roberts has hired an outside consultant with expertise in health-care facilities, Providence lawyer Raymond A. Marcaccio, to help with the effort.

“What I think it would be fair to say is that the director and I are both seeing this as an opportunity to really focus on improved management and care,” Roberts said. On a visit last week to the hospital, which is a short walk from her office, Roberts said she saw “well-cared-for patients, caring staff. We want to make sure that we have a system that supports them, as well.”

Said Raimondo: “There is new leadership in place both at the executive office of health and human services and the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals. ... We’re going to do everything we can to have systems in place to protect patients’ health and safety.”

Stenning’s tenure as Department of Behavioral Healthcare, Developmental Disabilities and Hospitals chief was tainted by a U.S. Department of Justice investigation that disclosed civil-rights violations in day programs attended by some 3,600 adults with developmental and intellectual disabilities. When the results of that probe were released, in January 2014, Stenning said he would close all “sheltered workshops” by 2017.

When contacted yesterday about the Eleanor Slater investigations, Stenning wrote back: “You would need to talk to Paul Despres, the CEO of ESH.”
Despres did not respond to a request for comment.