It’s been more than a year since the Milwaukee County Board directed the county auditor to conduct a five-year follow-up to his 2010 report on patient and staff safety at Milwaukee County’s psychiatric hospital. But work on the report has been halted because hospital administrators won’t turn over the documents needed for the audit.
The 2010 report detailed the hospital’s safety issues, including the failure to protect a female patient from becoming pregnant during her hospital stay. The audit also detailed nurses’ concerns about their own safety as they care for very seriously ill patients.
Even through Milwaukee County Executive Chris Abele signed off on the board’s resolution in April 2015, Behavioral Health Division (BHD) managers haven’t handed over the records Director of Audits Jerome Heer needs to do his work—including the patient incident reports.
BHD has refused to release any records or documents containing a patient’s name, according to a March 22 memo Heer wrote to Scott Manske, the county’s independent comptroller.
BHD managers have obtained a legal opinion stating that it’s up to the discretion of the hospital’s chief medical director, John Schneider, M.D., to release the information to Heer.
Concerns about Media Leaks
Last week, the executive committee of the Mental Health Board, the all-appointee board that oversees the Behavioral Health Division, convened to discuss the stalemate and help Schneider make his decision about releasing the records to Heer.
Heer argued that he has protocols in place to ensure patient and staff confidentiality while conducting his review.
“I’ve been doing this for 35 years. I’ve never had access to records blocked,” Heer said. “Not once. I think I can honestly say I’ve never issued a report that contained information that was in violation of the law.”
Members of the committee—Mental Health Board Chair Duncan Shrout, Vice Chair Thomas Lutzow and Secretary Robert Chayer, M.D.—seemed to offer up reasons to deny Heer access the records, from his expertise with medical records, to the supervisors’ motivation for requesting the audit to the level of detailed information to which he’d have access.
Shrout argued that the 2010 report resulted in a breach of patient confidentiality, with stories and patient photos turning up in the local media without the proper consent.
|
|
Not so, Heer responded. The personal information was revealed in the Journal Sentinel ’s Patients in Peril series, written by Meg Kissinger and Steve Schultze in 2010, not by his office, he said.
“There was patient information released, there were names, there were pictures in the newspaper of your patients,” Heer said. “None of that came out of the audit. Nor would anything like that ever come out of an audit.”
The Patients in Peril series is widely seen as the reason why the state Legislature created the all-appointee Mental Health Board in 2014, and no longer allows county supervisors to make any decisions about mental health or substance abuse services provided by the county. But Heer’s audit cleared up some errors in media reports, including the allegation that staff was falsifying records.
Schneider, at least at the beginning of the meeting, didn’t seem amenable to releasing the information because it would undermine the hospital’s attempt to create a culture of safety.
“As a patient safety issue, and as a staff safety issue, this [releasing the information] would in fact make things worse,” Schneider said.
He said he was also concerned about patient information ultimately being released to the media.
“I have concerns around the fact that the only way to ensure that confidential material remains confidential is to not release it,” Schneider said.
But at the conclusion of the meeting, Schneider said he was open to allowing auditors who have expertise in confidential medical records to conduct the audit, perhaps from the national Joint Commission with Heer as a member of the auditing team. He hasn’t made a final decision yet.
‘I’ve Been Injured’
Chairman Shrout invited the handful of nurses who attended the meeting to comment on the discussion. Jamie Lucas, lead organizer for the Wisconsin Federation of Nurses and Health Professionals, responded for them, because hospital staff had to sign a code of conduct that prevents them from criticizing BHD administration at Mental Health Board meetings or while out in the community.
Since they couldn’t speak freely, a few of the nurses in attendance held signs stating “I’ve been injured.” One wore a neck brace and another had his arm in a sling as a result of injuries they received while caring for patients. Lucas also stated that one nurse not in attendance had her trachea dislodged by a patient, while another patient injured nine staff members over the course of a few days.
“These are matters that are severe,” Lucas said. “They are lives. They are livelihoods. They are the mental and physical well-being of our staff and the people receiving services here.”
Lucas said he was concerned that BHD has released safety data to other outside auditors but balked at releasing information to Heer.
“We need someone to bring these things forward or at least look at them objectively and professionally as the county auditor should,” Lucas said.
