Union says unsafe staffing levels hurt Mental Health Complex in Milwaukee

From The Journal-Sentinel in Milwaukee:

Complaints by nurses over unsafe staffing levels at the Milwaukee County Mental Health Complex have surged this year, suggesting that short staffing could be a factor in a rash of patient assaults, nurses' union officials said May 19.

For the first 4 ½ months of this year, 167 complaints were filed by nurses with administrators at the complex, said Candice Owley, president of the Wisconsin Federation of Nurses and Health Professionals.

That compares with 182 filed for all of 2009.

The complaints generally relate to shortages based on illnesses, staff furloughs and job vacancies, as well as sicker mental patients requiring more intensive care by those on duty, Owley said. An increase in "one-on-one" staffing in which a nurse or nurse's assistant is assigned to monitor one high-need patient can create dangerous situations elsewhere at the Mental Health Complex's acute psychiatric unit, she said.

Owley said a pervasive sense that the complex is dangerous hindered nurse hiring and retention.

"It's very difficult to recruit if nurses feel unsafe," Owley told the County Board's Health and Human Needs Committee.

John Chianelli, the county's administrator for behavioral health, declined to comment, saying he wasn't aware of the increase in unsafe staffing reports from nurses.

"I'll have to look into it," Chianelli said. He acknowledged that a high number of patients requiring "one-on-one" staffing had caused some problems.

Job vacancies
Chianelli told supervisors that progress had been made on nurse hiring since 2007, when a special recruitment effort was launched to fill a large number of vacancies.

He said there were about 30 job vacancies currently on the 350-person staff of the county's Behavioral Health Division. The division's vacancy rate has hovered around 10% to 15%, he said.

Owley said the county's nurse vacancy rate compared unfavorably to other hospitals. The state average nurse vacancy rate is about 9%, and some local hospitals are lower, she said.

The nurses' union lobbied to create two secure wards to house dangerous patients in 2007, when the number of violent incidents was rising. But those wards were estimated to cost $1.3 million each and were not developed.

The county faced financial pressures, and patient advocates also opposed the secure units as too prison-like.

The safety issue came up as the committee Wednesday voted 6-0 to create a community advisory council on patient safety. The move followed reports of multiple sexual assaults at the Mental Health Complex dating to the last half of 2009, which has spawned state, federal and local investigations.

The outside advisory group was recommended by Disability Rights Wisconsin in a report issued Sunday that said vulnerable patients at the complex weren't safe from sexual predators and that staff often appeared indifferent to assaults on patients by other patients.

The advisory group would include patient advocates, law enforcement representatives and former patients, as well as county officials.

The group should be led by an advocacy group such as Disability Rights, said Supervisor Marina Dimitrijevic.

The nonprofit Disability Rights is authorized under state law to advocate for patients and can review patient records and interview medical staff. The group is continuing its probe of patient assaults at the complex.

A second team charged with developing better training for Mental Health Complex staff, as well as the citizen council were endorsed by the County Board panel.

County Executive Scott Walker said Wednesday he backed the citizen advisory council idea and would work with Disability Rights and supervisors on appointees to the panel.

Walker said he wanted to follow a similar collaborative model for addressing problems at the Mental Health Complex to one used three years ago in addressing community housing needs for former mental patients.

A city-county effort to create more housing for people with disabilities was launched in 2007 following reports in the Journal Sentinel on substandard housing for patients with mental illness.

The reports included an article on a man under the county's care whose decomposed body was found in a west side rooming house.

The patient assault issue came to light in February when the Journal Sentinel reported on a federal inspection that found multiple instances of patient sexual assaults at the complex.

The federal Centers for Medicare and Medicaid Services lifted a threatened cutoff of federal funding in April, based on a series of steps the county took to fix problems in training, patient care and patient monitoring.