According tothe state, which sent inspectors to Milwaukeein May, the county’s Behavioral Health Division (BHD) failed in the areas ofpatient rights, medical records, pharmacy, infection control, maintenance,physical plant and governing body, meaning that the administration of thehospital hasn’t fulfilled its responsibilities.
BHD hassubmitted a Corrective Action Plan to the state and has promised to make mostof its fixes by June 25, 45 days after the inspection. Other correctionsthoseinvolving construction, for exampleare given a more generous timeline.
“Submissionof this Plan of Correction is not an admission that a deficiency exists or thatone was correctly cited,” the county wrote in response.
Part of theplan is the appointment of a standing Environment of Care Committee to bechaired by BHD’s Assistant Administrator-Environment of Care Compliance. TheEnvironment of Care Committee members will include the infection controlpractitioner and representatives from dietary, engineering, maintenance andcleaning operations. The committee will begin meeting by June 25, the 45-daydeadline, and will meet regularly.
The state iscurrently reviewing BHD’s plan to see if it’s adequate, said Seth Boffeli, aspokesman for the state Department of Health Services’ Division of QualityAssurance (DQA).
TheMilwaukee County BHD is not accredited with the national organization The JointCommission, which requires inspections once every three years.
BHD isinspected by the state once every four and a half years in a recertificationreview on behalf of the Centers for Medicare and Medicaid Services, and alsowhen complaints have been made about the facility. Boffeli said the state hasmade 17 complaint-driven investigations in the past five years; 11 of thosecomplaints were substantiated.
SystemwideFailure
During therecertification inspection, the state turned up violations that affect allpatients, workers and visitors, such as fire safety issues and inspectioncontrol failures. The main areas of concern include:
n Physical Facilities: The facility’s firealarm system and sprinkler system were not up to national standards, andstairwells were used for storage. The smell of sewer gas was coming from floorshower drains.
The countyreported that some problems have already been fixed, while other concerns needto be addressed in the long term.
- Patient Care: BHD was cited for failingto care for its patients properly, such as not documenting a parent orguardian’s consent, not recording when involuntary medication (“chemicalrestraint”) is given, and not ensuring that medical records were complete upondischarge.
Administrationhas sent memos and held meetings to review these policies with staff, thecounty’s Corrective Action Plan notes.
- Oversight and performance of privatecontractors: Inspectors also turned up problems in the oversight andperformance of private contractors responsible for food service, housekeepingand off-site record storage.
A’Viands,which took over the food service last year, “was unaware the contracted servicewas responsible for maintaining the cleaning of the kitchen area.” An A’Viandsrepresentative “confirmed the dish room was not on a cleaning schedule.”
Some patientmedical records are stored off-site. But the inspectors noted that “MedicalRecords Director B confirmed that employees of this contracted service haveaccess to documents within a patient’s medical record. There is nodocumentation that this contract is reviewed to assure patientconfidentiality.”
In its plan,the county said that it would, among other things, “maintain a record for eachcontractor, 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 failedto provide a sanitary environment to avoid the transmission of infections andcommunicable diseases,” the inspectors found, and administrators failed to giveguidance to the hospital staff and private contractors.
“Environmentaltours reflect poor housekeeping, uncleanable work surfaces, mold and unsanitarykitchen and laundry areas,” the report states.
Theinfection control specialist told the investigators that hospitaladministrators had never asked him/her to provide inspection control expertise,guidance or surveillance to any department aside from the in-patient units.
In itsCorrective Action Plan, the county states that the infection control specialist“will have a written House-wide Surveillance Policy and Procedure developed” byJune 25, and has been meeting with hospital departments and CleanPowerthecontracted housekeeping vendorto develop checklists and schedules.
Reactions
BHD Administrator John Chianelli said BHD is a place to heal and be safe. “Patientsafety is our highest priority and DHHS staff began looking at and addressingwhat needed to be improved immediately,” Chianelli said. “BHD will continuetaking the necessary steps within the proposed time frame to comply with stateand federal regulations.”
Candice Owley, president of the Wisconsin Federationof Nurses and Health Professionals, argued that proper management of staffresources and private contract workers is lacking, and staffing shortages fromfurloughs has made a tough situation even more difficult.
“The front-line workers at the County BehavioralHealth complex struggle day and night to provide safe, quality care withoutenough staff and without support from administration,” Owley said. “[MilwaukeeCounty Executive Scott] Walker'sbudget cuts, privatization actions and furloughs have been a disaster for thepatients. The patients and employees deserve better and hopefully the statereport will cause needed changes to be made.”
RichardAbelson, head of AFSCME Local 48, said he wasn’t surprised by theinvestigators’ findings.
“Theresidents’ living conditions are our working conditions,” Abelson said.
He said theperformance of the private contractors was below the standards set by thecounty workers who had once held those jobs.
“There hasbeen a failure to properly oversee these privatization efforts,” Abelson said,saying that Chianelli “has given the privateers a free hand.”
