The complex
has come under scrutiny since it was reported that a 22-year-old patient had
become pregnant while in the county’s care and that several female patients had
been sexually assaulted by one male patient last year.
According to
a preliminary report issued by Disability Rights Wisconsin (DRW), many patient
safety and treatment issues remain.
“The
incidents that led to the investigation were only symptoms of much broader and
deeper problems” at the Mental Health Complex, the report concluded.
Safety Isn’t Guaranteed
DRW reviewed
the 11 cases of patients on the Acute Care Unit that raised alarms in the
earlier investigation.
DRW found:
- Eight of the 11 patients are African American, five have a history of substance abuse, five are survivors of sexual assault and/or abuse, and five have a cognitive disability, making culturally sensitive and patient-centered care a priority
- All 11 patients are in their twenties, with the potential to live independently if they could receive quality inpatient treatment
- Five of the 11 patients alleged that they were sexually assaulted by other patients, but some guardians were not notified of the allegations and physical exams and STD testing aren’t always performed
- The hospital failed to ensure that 10 of the 11 patients were safe from inappropriate sexual contact while in the Acute Care Unit
- Staff had not been aware that the hospital had a no-sexual contact policy between patients, and some administrators suggested that the incidents of sexual contact were all or primarily consensual
- Inadequate nursing care or treatment plans, physical exams and discharge planning were common
- Physical restraints were used on six patients and overmedication was common, prohibiting those patients from participating in treatment
- Patients did not receive treatment for drug or alcohol addiction, trauma or cognitive disabilities when appropriate
- Ten of the 11
patients had multiple hospitalizations and were seen at the county’s emergency
room many times. In spite of these multiple hospitalizations, though, very
little was done to link these very ill young people with community services and
support
“Consequently,
there was a huge investment of taxpayer funds in expensive and repetitive
inpatient emergency care, with very minimal investment in mental health services
outside of the hospital, due to a lack of referral and linkage to these
services,” the report concluded.
In fact, the
county doesn’t even maintain a waiting list for community services for patients
who cannot access them upon discharge. More than 60% of individuals who need
these services must wait two to three months before receiving them.
Barbara
Beckert, Milwaukee
office director of DRW, told the Shepherd
this was one of the biggest take-home messages from the report.
“The way
that we are currently using our limited funds doesn’t make a lot of sense,”
Beckert said. “There’s a significant human cost and a fiscal cost. We don’t
have the appropriate approach in terms of allocating resources. We need more
invested in the community—supportive housing, group homes, programs that
provide targeted case management and community support.”
Safety of Workers Also at Risk
Candice
Owley, head of the Wisconsin Federation of Nurses and Health Professionals,
said her organization has called for more attention to safety issues for years.
She said the number of assaults on staff has spiked in recent years—the result,
she argues, of inadequate staffing levels.
In February
Owley sent a letter to Milwaukee County Executive Scott Walker detailing some
of the risks to workers: staff had received a broken nose, black eye and bites;
an HIV patient attempted to bite staff and spit into their mouths and eyes;
staff have been punched and kicked; one nurse had his shirt ripped off.
“In addition
to these incidents, there is a clear increase in reportable exposures to
infectious diseases as a result of bites, spits, etc., with the number
increasing from 12 in 2007, to 22 in 2008, and 31 in 2009,” the letter states.
Owley’s
letter also noted that nurses were “consumed” with keeping patients safe and
preventing deaths and allergic reactions, the result of mistakes made by the
current food service vendor.
Owley said
that Walker
didn’t respond to her concerns but told her he forwarded her letter to an
attorney.
She said the
hospital is operating with minimum staffing levels, and mandatory furloughs of
some employees are stretching that staff even thinner. Members of her union
gave up five vacation days this year to address budget cuts, while
AFSCME-represented employees—including nursing assistants and social
workers—must take eight furlough days in 2010.
“I do not
know if alternatives can be found to the furloughs, but you need to know they
are not likely to save any money at BHD and, quite the opposite, cost more in
real dollars and in potential safety violations,” she wrote.
What’s more,
in response to the safety investigations, some patients are now required to
receive one-on-one monitoring, making staffing even more difficult without an
increase in caregivers.
“It’s
extremely irresponsible to furlough any of these workers,” Owley said.
She said the
current focus on patient safety and care is an opportunity to take a “long
look” at the right bed capacity and staffing, clinical support, treatment plans
and oversight.
Changes
in the Works
This is
DRW’s preliminary report on the Acute Care Unit, and it promises to issue a
more comprehensive report in the coming months.
The county
is also working on its own audit on patient safety from 2009 to the present at
the Mental Health Complex, said County Auditor Jerome Heer.
“If there
are issues that indicate there might be a pattern we’ll go further back in
time,” Heer said. “We may end up talking about things that are historical if
they are relevant to any issues that we might raise. We may need to talk about
staffing patterns or certain protocols that may have been in place or
resources.”
State
lawmakers—all Democrats—have called for a state audit as well, but that would
need to be authorized by the Joint Legislative Committee on Audit. That request
was labeled a “political stunt” by some Republicans, including New Berlin state Sen. Mary Lazich.
Milwaukee
County Executive Scott Walker issued this response to the DRW report via his
spokeswoman: “I share their concerns and take this review seriously, and
while the county is in compliance with state and federal regulations for
patient care, we must go even further to best address the needs of every single
person seeking care in the Mental Health Complex.”
The report
noted that some changes have been made to improve patient safety. Since
January, all new patients admitted to the Acute Care Unit must be assessed for
his or her risk for sexual behavior or any type of risk behavior.
Beckert also
suggested providing some single-gender wards as an alternative to mixed-gender
wards for those patients who prefer it.
DRW also
recommended setting up a Community Advisory Council, improving state oversight
and providing a confidential process for family and patients to report
concerns.
Beckert said
the county’s failure to do long-term, comprehensive, strategic planning for
mental health care that involves the community—especially those who use mental
health services and their families—has helped to create the crisis at the
Mental Health Complex. She said that trying to save individual programs during
the county’s annual budget process isn’t addressing the community’s broader
mental health needs.
“The current system is really broken,” she said.
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