Thursday, September 23, 2010

Milwaukee Journal-Sentinel investigation reports that county Mental Health Complex ill-equipped to handle violent patients

From The Journal-Sentinel:

A man infected with HIV who routinely bites his cheek and spits blood on nurses remains at the Milwaukee County Mental Health Complex, despite repeated pleas by medical workers to have him transferred to a more appropriate facility.

James Wynos (pictured), 28, diagnosed with mental retardation and schizophrenia, has been charged with 11 crimes since 1999, several related to misbehavior while at the county's psychiatric facility. Charges against him have included battery, disorderly conduct, throwing bodily substances, second-degree recklessly endangering safety, criminal damage to property and lewd, lascivious behavior-exposure.

In addition to spitting at the nurses, Wynos has thrown tables and chairs at them, hit them and threatened to kill them, court records show.

In the most recent case, Wynos was charged July 14 with hitting three nurses, but those cases were dismissed last month at the request of the prosecutor because Wynos was deemed incompetent to stand trial.

One of the nurses Wynos was accused of hitting has been out of work recovering from her injuries for the past seven weeks.

Barbara Barnes, one of the three nurses struck by Wynos, wrote a letter to Milwaukee County Circuit Judge Mary Triggiano this summer asking that he be sent to a more appropriate facility.

"We do not have the capabilities to care for patients who have anti-social personality disorders, which are criminal and not psychopathic," she wrote. "Mr. Wynos brags that he could kill me and get away with it. That shows remarkable insight and anger, not psychosis."

Barnes showed up at court on July 28 and read her letter aloud to the judge. To her horror, Wynos was returned to the Mental Health Complex that same day.

Triggiano said she was not asked to rule on whether Wynos should be transferred back to the hospital or placed elsewhere. The issue at hand, she said, was a doctor's report on his competency. Triggiano said she did not order Wynos released from the jail.

Barnes said she got a call that night from a co-worker saying that Wynos was back at Ward 43-A, one of three units set aside for patients in need of acute care.

Barnes said she called the Milwaukee County Sheriff's Department, and authorities took him back to jail that night. Apparently, there was a paperwork error, Barnes said.

Sheriff's deputies did not return repeated calls Wednesday for comment on the case.

Wynos remained in jail until the case was dismissed Aug. 30 and a few days later was released and taken back to the Mental Health Complex. He is now in Ward 43-C, another acute care ward.

"I feel like I was stabbed in the back," Barnes said in an interview.

Of the 11 charges since 1999, Wynos has pleaded guilty to three of them: battery, disorderly conduct and lewd behavior. The remaining eight were dismissed at the request of the prosecutors, including the July charges.

Each time, prosecutors said they could not make a case against Wynos because doctors had found him incompetent to stand trial. In addition to his mental retardation and mental illness, Wynos suffered a stroke as a teenager, medical records filed in his criminal cases show.

The complex does not have a special unit for patients who are dangerous and awaiting criminal prosecution. Hospital administrators closed that unit in 1997 at the suggestion of the agency that accredited the hospital. That agency viewed such wards as too restrictive.

Patients with mental illness now are on the same wards as those who have mental retardation and other developmental disabilities, some of whom are violent.

A Journal Sentinel investigation last month revealed that one patient was allowed to go off the ward unsupervised, despite a long history of violence, including sexual assaults - even as the nursing staff claimed in their notes that they were checking on him.

The patient, Omowale Atkins, 24, like Wynos has mental retardation and mental illness, and cycled between the court system and the complex. Despite his history, officials placed him down the hall from a woman he now stands accused of sexually assaulting.

Atkins is also believed to have fathered a child with another woman at the complex last summer. That woman also accused him of sexual assault, but charges were not pursued because a doctor considered the sex to be consensual.

In the most recent case, Atkins has been found competent to stand trial - though his attorney is challenging the ruling. He is in state custody while the charges are pending.

The Wynos case underlines the frustration of nurses and others who work at the county's psychiatric hospital.

"Our unit is locked, but Mr. Wynos is free to roam the unit, verbally assaulting staff and peers, throwing items, spitting, hitting and kicking," Barnes, the nurse, wrote in her letter to the judge. "He is smart enough to know that biting his cheek and spitting HIV blood is the most dangerous assault he can do and he does it frequently."

Geri Lyday, interim director of the county department of Health and Human Services, did not answer repeated requests Wednesday for comment on the Wynos case.

Barnes wanted to make it clear Wednesday that she did not furnish the newspaper with Wynos' name, because of federal privacy laws. But she said she and her colleagues do not feel safe with violent patients around.

"They need better, more appropriate care," she said. "It's not fair to them or the other patients who are threatened, too."

Milwaukee County District Attorney John Chisholm said the Wynos case was a perfect example of the difficulty in finding a satisfactory way of dealing with violent patients who are deemed legally incompetent.

"It's an incredibly frustrating feedback loop without any solutions," Chisholm said.

Patients who commit assaults can be prosecuted, but if they can't help in their own defense they often wind up back on the county Mental Health Complex's doorstep, he said.

The complex isn't set up to handle people like Wynos, Chisholm said, agreeing with nurses that it would help to have some version of a secure unit at the complex. Federal law requires placing patients in the least restrictive environment, which Chisholm said was the reason the county abolished secure mental units it once had.

The alternative would be for the county to pay for the costs of more secure care at the state mental hospitals, but the staggering cost of $900 a day is likely to cause policy-makers to avoid that option, he said.

Candice Owley, president of the Wisconsin Federation of Nurses and Health Professionals, told county supervisors Wednesday that a secure unit for dangerous patients was sorely needed. She presented results of a survey the union did of nurses at the Mental Health Complex, which found two-thirds felt the units where they worked were unsafe and one quarter said their units were very unsafe.

More than half of those responding said their morale was low and more than three-fourths reported overall morale among nurses at the complex was low, according to the nurse survey.

Milwaukee County Executive Scott Walker said Wednesday that he supported the concept of adding a secure unit at the complex. But he said he wanted to wait to sign off on that change until he gets reports from a mental health consulting firm hired by the county to root out problems.