The specially built room at Eleanor Slater Hospital would violate national accreditation standards, according to the hospital's chief executive officer.

01:42 AM EDT on Thursday, July 28, 2005

BY FELICE J. FREYER
Journal Medical Writer

CRANSTON -- A prison-style door and window grates have been installed in a four-bed room at Eleanor Slater Hospital, creating what alarmed staffers are calling a "cage" for Adult Correctional Institutions inmates who need medical care.

The changes have caused a furor at the state-run, long-term-care hospital, where nurses, doctors and even the hospital's CEO were caught by surprise when renovations began the week before last.

Nurses say they fear for their safety because plans call for reducing the number of prison guards when an inmate comes to the hospital, and because up to four prisoners would be grouped together.

Additionally, plans for locking the patient room, which is still vacant, would violate national accreditation standards and the hospital's own policies, according to Richard H. Freeman, the hospital's chief executive officer.

Inmates who are too sick for the prison infirmary have traditionally stayed at Eleanor Slater, one per room, with one guard per prisoner. A.T. Wall, director of the Department of Corrections, said the prison wants to save money on staff by grouping patients together with two guards for up to four inmate-patients. Prisoners would continue to be shackled to the beds and, Wall noted, they are "pretty sick."

Journal photo / Gretchen Ertl

Steel grates are installed on the doors and windows of this hospital room that would house up to four state prison inmates.

But nurses assert that prisoners could easily overcome the guards, and they fear being locked in the room with them.

"I never agreed to work for the ACI," said Deborah Dunning, the nurse coordinator on the sixth floor of the Regan Building, where the ACI room is located. "Why am I going to endanger myself in this way?" Nurses note that the hospital has no security force, not even people greeting visitors in the first-floor lobby.

Kathleen Spangler, acting director of the state Department of Mental Health, Retardation and Hospitals (MHRH), acknowledged that she authorized the renovations at Eleanor Slater without consulting nurses, doctors, the state Health Department, or the national agency that accredits hospitals.

Spangler said she did not talk to doctors or nurses because "it was not a clinical decision. The clinical care for these individuals is not changing."

She said that Health Department regulations permit the planned security arrangements, but she did not confirm her interpretation with the department.

And she said that a staff member at Eleanor Slater, whom she declined to identify, had assured her that the changes would pass muster with the the Joint Commission on Accreditation of Healthcare Organizations.

Yesterday, however, an expert on standards at the Joint Commission, a private agency that accredits hospitals, said that the group's standards require hospitals to conform to the Life Safety Code of the National Fire Protection Association, which prohibits locking patient room doors. Hospitals in Rhode Island must obtain Joint Commission accreditation in order to have a state license.

The Joint Commission expert, Jerry Gervais, associate director of standards and interpretation, was taken aback by the plans to have two guards for four inmates at the hospital. "I've never seen it done that way, and I've been in the business more than 30 years," he said. Common practice calls for one guard per inmate, he said.

Freeman, the hospital CEO, said he participated in discussions on the ACI room, but didn't know that construction was going to start the week before last, nor that a locked steel door would be installed.

"The construction gang got ahead of the clinical gang," he said. "The door and security screens were put in place and it was out of sync with the leadership of the hospital."

Freeman said that the matter was being reviewed. "Inmates are not going to go in there," he said, "unless our doctors and nurses think they're going to be treated appropriately in an environment that meets our standards."

Anne Deal, vice president of the union that represents nurses at the hospital, local 79 of the National Association of Government Employees, said that union leaders met with Spangler only after the work began. "We were informed that it was put on hold," Deal said.

But in an interview yesterday, Spangler said she intended to proceed with the project despite the objections from Freeman and the nurses. Told later that the Joint Commission had informed The Journal that locked doors were not allowed, she said she would "follow up" with that agency.

Wall, the ACI director, said he was "somewhat surprised at the level of uproar that this proposal has created" and insisted that "the security protocols we have in place will ensure the safety of staff."

"We would not pursue a plan that saves money at the expense of proper security," Wall said.

Dunning, the coordinating nurse, said that the prison-style door has been locked, but when the room needed to be entered on Tuesday because of an air-conditioning problem, someone unlocked it with a screwdriver.

Roberta Hawkins, director of the Alliance for Better Long Term Care, a consumer-advocacy group, said relatives of Eleanor Slater patients are upset by the ACI room. "This is a prison room," she said. "It has bars. It has steel sinks and toilets."

The construction started around the same time that a Superior Court judge authorized the ACI to insert a feeding tube in Esteban Carpio, the prisoner accused of killing a Providence detective. Hawkins said that staff and relatives of patients were worried that the state was gearing up to admit more and different types of prisoners to Eleanor Slater.

ACI spokeswoman Ann Fortin said that plans for retrofitting the room were in the works long before Carpio was in the news. She said no decision has been made on whether he will get a feeding tube, never mind where the procedure would be done. And Freeman, the hospital CEO, said there were no plans to change the number of prisoners who go to Eleanor Slater or the reasons why they go there.

Eleanor Slater Hospital cares for ACI inmates who typically were first treated at an acute-care hospital for problems such as strokes or injuries, and then came to Slater for "stepdown" care that can't be provided at the prison infirmary. Spangler said that about 13 prisoners were treated at Eleanor Slater over the past 18 months.

Wall said that the ACI had spent $3,500 for materials for the renovation, but that the labor was being supplied by MHRH. Spangler said she didn't know how much it was costing.

The General Assembly adjourned this year without confirming Spangler's appointment as MHRH director, after she faced unusually strong opposition at her Senate confirmation hearing. Although several people spoke in her favor, representatives of groups that care for disabled people said she was "arrogant" and "unprepared" for the job.

One who spoke in her favor, however, was Wall, who said he was a personal friend. Spangler continues as acting director until the Assembly acts, possibly sometime this summer.

Eleanor Slater Hospital treats patients who don't need the briefer high-intensity care provided at the private acute-care hospitals, but are not ready to return to the community or have behavioral problems. Its long-term patients include people dependent on respirators and people with severe, chronic mental illnesses. But others stay for days or weeks to recover from illnesses, injuries or surgeries.