The complexhas come under scrutiny since it was reported that a 22-year-old patient hadbecome pregnant while in the county's care and that several female patients hadbeen sexually assaulted by one male patient last year.
According toa preliminary report issued by Disability Rights Wisconsin (DRW), many patientsafety and treatment issues remain.
“Theincidents that led to the investigation were only symptoms of much broader anddeeper problems” at the Mental Health Complex, the report concluded.
Safety Isn't Guaranteed
DRW reviewedthe 11 cases of patients on the Acute Care Unit that raised alarms in theearlier investigation.
DRW found:
- Eight of the 11patients are African American, five have a history of substance abuse, five aresurvivors of sexual assault and/or abuse, and five have a cognitive disability,making culturally sensitive and patient-centered care a priority
- All 11 patients arein their twenties, with the potential to live independently if they couldreceive quality inpatient treatment
- Five of the 11patients alleged that they were sexually assaulted by other patients, but someguardians were not notified of the allegations and physical exams and STDtesting aren't always performed
- The hospital failedto ensure that 10 of the 11 patients were safe from inappropriate sexualcontact while in the Acute Care Unit
- Staff had not beenaware that the hospital had a no-sexual contact policy between patients, andsome administrators suggested that the incidents of sexual contact were all orprimarily consensual
- Inadequate nursingcare or treatment plans, physical exams and discharge planning were common
- Physical restraintswere used on six patients and overmedication was common, prohibiting thosepatients from participating in treatment
- Patients did notreceive treatment for drug or alcohol addiction, trauma or cognitivedisabilities when appropriate
- Ten of the 11patients had multiple hospitalizations and were seen at the county's emergencyroom many times. In spite of these multiple hospitalizations, though, verylittle was done to link these very ill young people with community services andsupport
“Consequently,there was a huge investment of taxpayer funds in expensive and repetitiveinpatient emergency care, with very minimal investment in mental health servicesoutside of the hospital, due to a lack of referral and linkage to theseservices,” the report concluded.
In fact, thecounty doesn't even maintain a waiting list for community services for patientswho cannot access them upon discharge. More than 60% of individuals who needthese services must wait two to three months before receiving them.
BarbaraBeckert, Milwaukeeoffice director of DRW, told the Shepherdthis was one of the biggest take-home messages from the report.
“The waythat 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'thave the appropriate approach in terms of allocating resources. We need moreinvested in the communitysupportive housing, group homes, programs thatprovide targeted case management and community support.”
Safety of Workers Also at Risk
CandiceOwley, 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 yearsthe result,she argues, of inadequate staffing levels.
In FebruaryOwley sent a letter to Milwaukee County Executive Scott Walker detailing someof 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 additionto these incidents, there is a clear increase in reportable exposures toinfectious diseases as a result of bites, spits, etc., with the numberincreasing from 12 in 2007, to 22 in 2008, and 31 in 2009,” the letter states.
Owley'sletter also noted that nurses were “consumed” with keeping patients safe andpreventing deaths and allergic reactions, the result of mistakes made by thecurrent food service vendor.
Owley saidthat Walkerdidn't respond to her concerns but told her he forwarded her letter to anattorney.
She said thehospital is operating with minimum staffing levels, and mandatory furloughs ofsome employees are stretching that staff even thinner. Members of her uniongave up five vacation days this year to address budget cuts, whileAFSCME-represented employeesincluding nursing assistants and socialworkersmust take eight furlough days in 2010.
“I do notknow if alternatives can be found to the furloughs, but you need to know theyare not likely to save any money at BHD and, quite the opposite, cost more inreal dollars and in potential safety violations,” she wrote.
What's more,in response to the safety investigations, some patients are now required toreceive one-on-one monitoring, making staffing even more difficult without anincrease in caregivers.
“It'sextremely irresponsible to furlough any of these workers,” Owley said.
She said thecurrent focus on patient safety and care is an opportunity to take a “longlook” at the right bed capacity and staffing, clinical support, treatment plansand oversight.
Changesin the Works
This isDRW's preliminary report on the Acute Care Unit, and it promises to issue amore comprehensive report in the coming months.
The countyis also working on its own audit on patient safety from 2009 to the present atthe Mental Health Complex, said County Auditor Jerome Heer.
“If thereare issues that indicate there might be a pattern we'll go further back intime,” Heer said. “We may end up talking about things that are historical ifthey are relevant to any issues that we might raise. We may need to talk aboutstaffing patterns or certain protocols that may have been in place orresources.”
Statelawmakersall Democratshave called for a state audit as well, but that wouldneed to be authorized by the Joint Legislative Committee on Audit. That requestwas labeled a “political stunt” by some Republicans, including New Berlin state Sen. Mary Lazich.
MilwaukeeCounty Executive Scott Walker issued this response to the DRW report via hisspokeswoman: “I share their concerns and take this review seriously, andwhile the county is in compliance with state and federal regulations forpatient care, we must go even further to best address the needs of every singleperson seeking care in the Mental Health Complex.”
The reportnoted that some changes have been made to improve patient safety. SinceJanuary, all new patients admitted to the Acute Care Unit must be assessed forhis or her risk for sexual behavior or any type of risk behavior.
Beckert alsosuggested providing some single-gender wards as an alternative to mixed-genderwards for those patients who prefer it.
DRW alsorecommended setting up a Community Advisory Council, improving state oversightand providing a confidential process for family and patients to reportconcerns.
Beckert saidthe county's failure to do long-term, comprehensive, strategic planning formental health care that involves the communityespecially those who use mentalhealth services and their familieshas helped to create the crisis at theMental Health Complex. She said that trying to save individual programs duringthe county's annual budget process isn't addressing the community's broadermental health needs.
“The currentsystem is really broken,” she said.
