Departure of three physicians from Zambarano campus of Eleanor Slater renews concerns for patients

BURRILLVILLE — A recent exodus of doctors – and the reliance on a patchwork crew of moonlighting physicians – has renewed concerns among legislators and other patient advocates about what is happening to the 58 patients on Zambarano campus of the state-run Eleanor Slater Hospital.

After a period of apparent calm at the sometimes turbulent state hospital, House Minority Whip David Place has gone public with his concern that "the primary care of the patients is at risk" and the state agency that runs the hospital is "being as elusive as they possibly can be."

"Every one of these patients are there because [their medical conditions] are exceptionally complex and they require day to day primary care. As of right now, based on everything I have been told by reliable sources, that is not taking place," he said.

"The abrupt and unexpected departures of Zambarano’s three remaining long-term care medical physicians over the past several months are a reflection of the administrative support they received," said Dr. Normand Decelles. "Continuity of care, an essential element of quality long-term care, is being lost, and cannot be replaced by a daily rotation of different physicians."

Speaking as the former medical director of the Zambarano hospital (2000-2021) who is still in touch with former colleagues, Decelles told The Journal:

"Patients and staff deserve far better than what is continuing inside Eleanor Slater Hospital today,'' the now retired Decelles said.

Three physicians have left the hospital since July

A spokesman for the state agency that operates the state hospitals in Burrillville and Cranston did not, at first, acknowledge that all three of the full-time doctors at the Burrillville wing of state-run hospital were gone, a concern that prompted the state's long-term care ombudsman, Kathleen Heren, to call the Department of Health last week.

In response to Journal inquiries, Randal Edgar, the spokesman for the state agency that runs the hospital, acknowledged the departure of two of the three full-time medical doctors who provided day-to day "management" of patient care at Zambarano: Drs. Purvi Chokshi and Bette Gillerin.

He said the third, Dr. Somasundaram Panneerselvam, known to colleagues as "Dr. Selvam," is still a state employee, which is true, but does not tell the whole story.

For context on the demanding nature of the job, "Dr. Selvam" was paid $306,313.17 during the year that ended on June 30. That included $79,286.63 in overtime (and a small unidentified, additional payment) on top of his $221,152.10 salary.

His current status?

Dennis Grieco, the lawyer for the union that represents all physicians employed by the Rhode Island Department of Behavioral Healthcare, Developmental Disabilities and Hospitals told The Journal: "The three [State Employed Physicians’ Association] physicians that had been caring for patients in the Zambarano Unit of the Eleanor Slater Hospital until recently are no longer there."

After days of back-and-forth, the Department of Administration on Monday confirmed: Dr. Chokshi's last day of employment was July 13, Dr. Gillerin's was Aug. 15 and Dr. Selvam has been "on leave" since Aug. 9.

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Hospital relying on doctor shuttling back-and-forth between Cranston and Burrillville

Edgar said the hospital has, nonetheless, had a doctor on-site "24/7" at all times at Zambarano, which is licensed as an acute care hospital.

Edgar acknowledged that the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals is relying, in part, on Dr. Susan Ferranti to shuttle back and forth between the Cranston hospital campus, with 85 patients, and Burrillville, with 58. The two campuses are 18-miles apart, a drive that can take upwards of 40 minutes.

Edgar said that is not unusual for Dr. Ferranti, who "as medical director, provides coverage at Zambarano for vacations and sick time. She also covers in Cranston. This is not new."

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To that assertion, Grieco, the union's lawyer, said: "If they are providing round the clock care by having a physician normally assigned to the Cranston campus of ESH cover the patients at Zambarano, I would have to question the physician-to-patient ratios at Zambarano and on the Cranston campus."

Edgar said: there are six full-time physicians, four of whom work on the Cranston campus. The fifth is on leave ("Dr. Selvam") and the sixth is going back-and-forth. They include: "Drs. Selvam" and Ferranti, Katharine Woods, the chief medical officer, Andrew Lekos and contract physicians Heather Abrahams and Chijioke Egbujo.

"As needed, a physician may travel to either campus to provide additional psychiatric and/or medical services," he said. In addition, there are 18 part-time physicians in the rotation. "including a mix of state employees and contracted physicians."

It does not appear any are assigned solely to Zambarano.

Big picture? "BHDDH recognizes the recent changes in physician staffing have exacerbated the already challenging staffing landscape faced by healthcare institutions worldwide. This situation, while manageable, is not ideal, and we are making every effort to recruit more physician support,' Edgar said, adding:

"The safety and well-being of our patients and staff are of paramount importance, and we will do whatever necessary to ensure the success of ESH, its patients, families, and staff."

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Temporary employee's death at the hospital raises concerns

Concerns about the current staffing arrangements bubbled to the surface with the death of a "temporary" employee over the Labor Day weekend.

The death raised red flags for advocates already concerned about the impact of short staffing on the day-to-day care for Zambarano patients, who have life-altering injuries and conditions and, in some cases, have been at Zambarano for decades.

Edgar's account: "An individual who was employed by a staffing agency passed away at the hospital over the holiday weekend. Hospital staff found the individual unresponsive and immediately initiated advanced cardiac resuscitation and contacted emergency services. ..The hospital notified staff of this sad news on Tuesday."

When asked, Edgar said: "Yes, there was a doctor on site."

Grieco did not dispute that, but he said the over-arching problems at the state's Eleanor Slater Hospital are not new.

"For years," he said, "the compensation for ESH physicians has been so significantly below the compensation provided by hospitals in the surrounding area that ESH has been unable to hire and maintain a sufficient number of full time physicians to care for its patients."

"Likewise," he continued. "The facilities and conditions within which the physicians care for patients are extremely outdated, making it more difficult to render that care and thereby, more difficult to attract physicians to provide that care."

His example: The state hospital still "does not have an electronic medical record system ... ESH utilizes the same paper medical records it has used for decades."

This article originally appeared on The Providence Journal: Embattled Eleanor Slater Hospital sees 3 doctors leave Zambarano campus