Last week, we looked at the history of Zambarano Hospital and briefly discussed why the facility is facing closure. This week, we will look a little deeper into this and how such closure will not only affect the patients but family members and staff as well.
Since our last blog, there has been a flurry of activity from the Statehouse down to local governments. Last week, WPRI reported that in Governor McKee's new budget, he was proposing that a new long-term care facility be built on the grounds of Zambarano, replacing the current hospital.
For the construction to begin on this new hospital, McKee stated that money would be borrowed ($53.6 million) to help pay for the cost of the project, which is projected to be $65 million and take over three years to complete. According to the budget documents, the new building would have "85 beds" and "provide care to patients with complex medical issues such as acquired or traumatic brain injuries and spinal cord traumas."
Great news, but where does that leave the current patients?
Well, according to Kathryn Power, the director of Rhode Island’s Department of Behavioral Health, Developmental Disabilities, and Hospitals (BHDDH), they can “stay in the old units.” Sounds like a plan except for the fact that the state has let it be known that discharge of Zambarano patients based on "new admission criteria and levels of care" is a much more likely scenario than allowing them to "stay in the old units."
The statements coming from the state government about the fate of Zambarano have not gone over well with Rhode Island's long-term care Ombudsman, Kathleen Heren. In a press release to be issued in April, Heren says, "The administration has publicly stated that most residents do not meet the level of care and should go to a nursing home or home to their families. Are you kidding me? Nursing homes cannot deliver the care the hospital can, nor do they have the knowledge to be able to manage behavioral issues. To suggest families can now become caregivers who may themselves be in their late 60’s, is also absurd."
Mismanagement and Neglect
Last week we discussed why we have reached this point. But since then, we have found out that there is more to this story, which highlights mismanagement at the highest levels of state government.
According to an article in the Providence Journal, Eleanor Slater Hospital (Cranston and Burrillville), has been "hemorrhaging tens of millions of dollars" when the state fell out of compliance with the Centers for Medicare and Medicaid Services (CMS) in September of 2019, resulting in Rhode Island's inability to collect reimbursement monies from the federal government. But, the state just did not "fall out of compliance", there is far more to this story.
As we wrote last week, in 2009, the American Recovery and Reinvestment Act was signed into law, requiring that all public and private healthcare providers and other eligible professionals were required to adopt and demonstrate “meaningful use” of electronic medical records (EMR) by January 1, 2014, in order to maintain their existing Medicaid and Medicare reimbursement payments. So the phrase "falling out of compliance" should actually be re-written to say "neglected this CMS mandate for nearly a decade." And there is more.
As someone who worked in the behavioral healthcare field as both a provider and program director at Shattuck Hospital in Boston, one of the biggest drawbacks of implementing the CMS mandate was the cost of the software, training, and technical support. But by 2014, we had this in place, and because we had five years to prepare, we were able to stagger the stages of implementation, making it a somewhat seamless process and budget appropriately for it. Given that, was the cost of this CMS requirement the issue for Rhode Island's non-compliance. Apparently not.
The retired medical director of Zambarano, Dr. Normand L. Decelles, told us that he "was part of a workgroup which evaluated several computerized health information systems/electronic medical records for potential use at ESH. One was the VA Hospital's modular system that we could obtain and use at ESH for $10 (ten dollars!) - the price of the CD. This $15 million hospital computer system was free upon request because it had been developed with Federal taxpayer dollars and was therefore in the 'public domain'. The decision was made not to obtain that system because it would obligate ESH to years of tech support at $250,000 per year."
So here we are, 2021, twelve years later, and the "hemorrhaging" of money is in reality a self-inflicted wound. Budget documents indicated that the state was receiving in the area of $60 million in CMS reimbursement for ESH that has now been cut off. So in order to save $250,000 in tech support annually, they have lost at least $60 million per year in federal reimbursement money. This is your government at work.
As a result of this negligence, then Governor Raimondo assigned senior staff to oversee the issue and the then-director of BHDDH, Rebecca Boss, resigned and was replaced by the current director, Kathryn Power, who had previously led the agency. This was then followed by the resignation of the Eleanor Slater CEO, Cynthia Huether. But this action has done little to address the loss of revenue which has now resulted in the attempt to close Zambarano Hospital.
Staff in Limbo
And what about staff, the life's blood of ESH and Zambarano? Again, there are no clear answers here either. "We don’t have a breakdown at this point in terms of those positions,” said Power. “We are expecting, frankly, that the reduction is going to be achieved through attrition and through some early retirement positions. As we close the Adolf Meyer building and the Regan building [in Cranston], there may be some layoffs going forward.”
Rather than allaying fears, Power's statement about layoffs further muddied the waters and highlighted, at least for staff at the hospital, the concerns they have been expressing about patient treatment since the middle of 2020.
Cynthia Lussier, who is the president of the United Nurses and Allied Professionals Local 5019, who represents employees at Zambarano, issued a statement mid-week that said, “The frontline workers at Zambarano are dedicated to their patients and have been ringing the alarm bell about the troubling changes to patient care at this critically needed state facility for months.”
The closing of Zambarano also carries with it serious implications for the local economy. In the section of Rhode Island where Zambarano is located, there are few employers as large as the hospital. In a statement issued by General Treasurer Seth Magaziner, he was not only concerned about the lack of care should Zambarano be closed, but the economic impact on the area.
“In addition to providing much-needed care for some of Rhode Island’s most vulnerable citizens, Zambarano Hospital is an important economic anchor for Northwest Rhode Island and supports hundreds of jobs. We must ensure it remains fully operational,” said Magaziner.
Caught in the Crossfire
As the battle rages, caught in the crossfire are the families who have loved ones receiving care at Zambarano and professionals who are guardians for many patients. In speaking with them, it became evident that it's not just the medical and behavioral services that the hospital provides, but the caring, compassionate and dedicated staff who provide the emotional support necessary to keep the patients and those who care about them positive and hopeful, even in the darkest times.
“Many of the patients at Zambarano have some pretty significant brain injuries,” said Attorney RJ Connelly III. “But the care and compassion that the staff treats them with are beyond remarkable. And one thing that many people forget, that patient also has a family. His or her injury affects everyone in that family. The staff at Zambarano often becomes a part of that patient’s extended family.”
Shirley Pacheco, whose son is a patient at Zambarano, wholeheartedly agrees with Connelly’s assessment. “…it would be a sin to close Zambarano and displace so many to whom this is the only home they know. My son has been a resident there for 26 years after suffering a traumatic brain injury due to an automobile accident. The care that he receives at Zam is exceptional. I know of no other facility that offers their residents the care given there. It is like one big family, where everyone is treated with respect and love. I don't think my son would have survived if it weren't for the care and attention he has received from the dedicated personnel at Zam.”
Pacheco also had harsh words for the way Rhode Island politicians have treated the hospital and the staff long before this latest controversy. "The question I have asked a few government officials in RI over the years when different issues would arise concerning Zambarano is 'How would you feel if it were a member of your family in this facility - your child or your parent?' None of them ever answered my question, but I'm sure we all know that their reactions/decisions would be much different. It is sad to know that there are heartless, uncaring people running our government, with no concern or respect for those with disabilities."
Kathleen Heren, the State’s long-term care ombudsman and tireless advocate for those in facilities like Zambarano, agrees. In a recent press release, she tells of the stories she has witnessed at “Zam”.
“How did people end up at [Zambarano]? Not all of the people were mentally ill. Some were unwed mothers, a diabetic, an epileptic, or just wayward. Over the years, the hospital has evolved into an outstanding rehabilitative center. The hospital has done remarkable work with head injuries, burns, large bedsores, and any neurological conditions that could not be handled in a nursing home. It has also been a place of last resort for residents who have had anywhere from 3-6 failed nursing home placements. I can attest to referring nursing home residents to the hospital that were in a very sad condition. When I returned to visit them, I was not able to recognize them."
Heren continued, "Being the advocate for the last 22 years I have witnessed many good things and many bad things. There have been many administrative teams that were functioning in positions they were poorly qualified for. I can honestly say the staff who were caring for these most challenging residents never wavered in their care. The staff are devoted and go out of their way to care for their residents.”
According to reports, the state will begin to hold hearings on ESH and the Zambarano unit on March 22, seeking input from hospital administrators, state officials, doctors, and union members. Will this be a kabuki show or can we expect the testimony to have a real impact on the future of Zambarano? Only time will tell.
A patient currently at Zambarano Hospital, Amy D., asked that this video be made.
"During the pandemic, we came to fully appreciate the role that healthcare providers play in our society," said Attorney Connelly. "But long before that, I often and loudly sang the praises of the providers at ESH and Zambarano. Seeing the difference that they make in the lives of patients and their families every day is a feeling that not many other people can feel on a daily basis. They are the professionals that people seek out in their darkest hours, and trust to provide, in many cases, life-saving care to their loved ones."
"I want to emphasize the important role that this hospital plays in the lives of the most vulnerable citizens, both physically and mentally," said Kathleen Heren. "To send these residents out of the environment they thrived in will result in heartache for the residents and their families. We should also praise the physicians who would not waiver in being forced into signing medical referral information they know to be false. The answer to poor management is not to lay the consequences on the residents, workers, physicians, or their families. The old saying 'Render to Caesar the things that are Caesar's', and render to the residents what they so deserve."
"God bless Zambarano and all the wonderful people who have dedicated their lives to caring for the residents there. And shame on those who think that closing Zam is the right thing to do! I intend to keep fighting for my Zam Family and I know that there are many other family members who will do the same," said Shirley Pacheco.
Here at Connelly Law, we will continue to monitor the situation and offer our support to the families, residents, and staff of Zambarano Hospital. On March 29, Connelly Law's Southcoast Seniors Radio Magazine will have a special show on Zambarano Hospital, which will include family members and long-term care ombudsman, Kathleen Heren. And for this week's blog, the final words will belong to Ms. Heren.
"If any family members would like to reach out to me for assistance, I am always available. Your confidentiality will be protected. I can be reached at 401-785-3340 or 1-888-351-3391, or email firstname.lastname@example.org."