More Troubles at Milwaukee County Mental Health Complex
State finds inadequate patient treatment, record privacy, sanitary conditions and safety
the state, which sent inspectors to Milwaukee
in May, the county’s Behavioral Health Division (BHD) failed in the areas of
patient rights, medical records, pharmacy, infection control, maintenance,
physical plant and governing body, meaning that the administration of the
hospital hasn’t fulfilled its responsibilities.
submitted a Corrective Action Plan to the state and has promised to make most
of its fixes by June 25, 45 days after the inspection. Other corrections—those
involving construction, for example—are given a more generous timeline.
of this Plan of Correction is not an admission that a deficiency exists or that
one was correctly cited,” the county wrote in response.
Part of the
plan is the appointment of a standing Environment of Care Committee to be
chaired by BHD’s Assistant Administrator-Environment of Care Compliance. The
Environment of Care Committee members will include the infection control
practitioner and representatives from dietary, engineering, maintenance and
cleaning operations. The committee will begin meeting by June 25, the 45-day
deadline, and will meet regularly.
The state is
currently reviewing BHD’s plan to see if it’s adequate, said Seth Boffeli, a
spokesman for the state Department of Health Services’ Division of Quality
Milwaukee County BHD is not accredited with the national organization The Joint
Commission, which requires inspections once every three years.
inspected by the state once every four and a half years in a recertification
review on behalf of the Centers for Medicare and Medicaid Services, and also
when complaints have been made about the facility. Boffeli said the state has
made 17 complaint-driven investigations in the past five years; 11 of those
complaints were substantiated.
recertification inspection, the state turned up violations that affect all
patients, workers and visitors, such as fire safety issues and inspection
control failures. The main areas of concern include:
n Physical Facilities: The facility’s fire
alarm system and sprinkler system were not up to national standards, and
stairwells were used for storage. The smell of sewer gas was coming from floor
reported that some problems have already been fixed, while other concerns need
to be addressed in the long term.
- Patient Care: BHD was cited for failing to care for its patients properly, such as not documenting a parent or guardian’s consent, not recording when involuntary medication (“chemical restraint”) is given, and not ensuring that medical records were complete upon discharge.
has sent memos and held meetings to review these policies with staff, the
county’s Corrective Action Plan notes.
- Oversight and performance of private contractors: Inspectors also turned up problems in the oversight and performance of private contractors responsible for food service, housekeeping and off-site record storage.
which took over the food service last year, “was unaware the contracted service
was responsible for maintaining the cleaning of the kitchen area.” An A’Viands
representative “confirmed the dish room was not on a cleaning schedule.”
medical records are stored off-site. But the inspectors noted that “Medical
Records Director B confirmed that employees of this contracted service have
access to documents within a patient’s medical record. There is no
documentation that this contract is reviewed to assure patient
In its plan,
the county said that it would, among other things, “maintain a record for each
contractor, which includes, but is not limited to, infection control plans,
copies of contracts and agreements, contract deliverable plans and audit data”
and develop contractor score cards and reports.
- Infection control: “The hospital failed to provide a sanitary environment to avoid the transmission of infections and communicable diseases,” the inspectors found, and administrators failed to give guidance to the hospital staff and private contractors.
tours reflect poor housekeeping, uncleanable work surfaces, mold and unsanitary
kitchen and laundry areas,” the report states.
infection control specialist told the investigators that hospital
administrators had never asked him/her to provide inspection control expertise,
guidance or surveillance to any department aside from the in-patient units.
Corrective Action Plan, the county states that the infection control specialist
“will have a written House-wide Surveillance Policy and Procedure developed” by
June 25, and has been meeting with hospital departments and CleanPower—the
contracted housekeeping vendor—to develop checklists and schedules.
BHD Administrator John Chianelli said BHD is a place to heal and be safe. “Patient
safety is our highest priority and DHHS staff began looking at and addressing
what needed to be improved immediately,” Chianelli said. “BHD will continue
taking the necessary steps within the proposed time frame to comply with state
and federal regulations.”
Candice Owley, president of the Wisconsin Federation
of Nurses and Health Professionals, argued that proper management of staff
resources and private contract workers is lacking, and staffing shortages from
furloughs has made a tough situation even more difficult.
“The front-line workers at the County Behavioral
Health complex struggle day and night to provide safe, quality care without
enough staff and without support from administration,” Owley said. “[Milwaukee
County Executive Scott] Walker's
budget cuts, privatization actions and furloughs have been a disaster for the
patients. The patients and employees deserve better and hopefully the state
report will cause needed changes to be made.”
Abelson, head of AFSCME Local 48, said he wasn’t surprised by the
residents’ living conditions are our working conditions,” Abelson said.
He said the
performance of the private contractors was below the standards set by the
county workers who had once held those jobs.
“There has been a failure to properly oversee these privatization efforts,” Abelson said, saying that Chianelli “has given the privateers a free hand.”