Thursday, April 29, 2010

At Last, A Call For Accountability At BHD

From Milwaukee County First:
We are all aware that the Behavior Health Division is a train wreck. There have been numerous problems going on out there for years.

Between Scott Walker using the poor and the vulnerable as his stepping stones in his runs for governor and BHD Director John Chianelli’s poor administration, there have been repeated problems at the complex. These problems have ranged from massive overtime and a higher than acceptable number of injuries that can be directly attributed to a severe shortage of staff. The staff shortage was for “money saving” purposes, but not only did not save any money, but put people in harm’s way needlessly.

More recently, we have seen the story on how a patient was allowed to repeatedly sexually assault a young woman who was also a patient. Instead of self-reporting these critical incidents, they were glossed over until they were discovered in an audit. The county faced losing $60 million in Medicare funding due to Walker’s and Chianelli’s poor leadership.

This was quickly followed by another story showing that Walker’s privatized security was not providing much security at all. Patients and staff in the walk-in clinic were regularly put in harm’s way as patients in a crisis were able to bring weapons, including guns, into the clinic.

And who can forget the privatized food service and their insect-infested food?

I have just learned tonight that our complaints are not falling on deaf ears!

I was just notified that on Thursday (April 29) at 11 am, there will be an event at BHD. Present will be County Supervisors Chris Larson and John Weishan, as well as State Representatives Tamara Grigsby, Jon Richards and Sandy Pasch. They will be calling for “major new accountability over the Milwaukee County Behavioral Health Division.”

We applaud these leaders for showing true leadership in demanding some accountability from Walker and his administration.


  1. Scott Walker doesn't run BHD. Why would you use problems there to slam Walker? That's rediculous. Do all problems in the city of Milwaukee reflect on Barrett? Try to be objective.

    Should there be an audit at BHD? Of course, because there are longstanding problems that should definately be addressed. However, those problems have been going on for years under Ament and every other county exec.

    You really need to abandon your partisan ideology and see things for what they are, and until you do that you will have no credibility.

    The private security at BHD is very good and very responsive and while there should be more overall attention to safety of both patient and staff- the private security is not the issue there. It's more of an administrative system/philosophy regarding balancing patients rights. If you knew anything about BHD, or if you worked there you would appreciate this.

    Ditto for your comments about the food service. So there were no problems when it was run by county workers? Hardly! The food service does a very good job and they are very responsive to critisim and work diligently to correct any problems. There is no great lack of quality or difference AND they do the job at a significant savings.

    You could extend these observations to housekeeping/cleaning as well. The private service, Cleanpower, is every bit as good (I actually think they are much better) then when county workers performed the tasks. Again, if you knew anything about BHD you would realize this.

    We really can't have a serious discussion of the issues until you are better informed-sorry.

  2. What do you mean that Walker doesn't run BHD. That is strictly under his authority. He appoints the administrative staff, which at the present time is the incompetent John Chianelli.

    Walker orders the downsizing and the cut backs. Walker runs it alright, and he has run it into the ground because Walker doesn't know what he is doing.

    The private security company has cost more than $1 million in the last two years than if it stayed public. Furthermore, I would say that they might not be doing such a good job when they're not even monitoring the entry ways and people are bringing in guns.

    The privatized food service as required nurses, psychologists and other professions to leave their duties to assist with meals because the food service has consistently failed to follow the special diets required. And how can you say that insects in the food is a good thing?

    If you worked there, you would know that the cleaning agency does not do nearly the same amount as the public workers did. They don't even go near the day program side of the building. How is that better? Besides, the majority of Cleanpower workers are former county workers. Are you saying they these same people are better than themselves?

    For you to present such ridiculous arguments tells me that either you've never been there, or if you have, you are part of the inept administration trying to cover your butt. If the former is true, you should learn what you are talking about before you shoot off your mouth. If it is the latter, perhaps you should start doing your job a bit better.

  3. I should start doing my job? Pretty snarky. Do you only want comments from people who agree with you or do you truly want to discuss real issues?

    Fact is, Walker does not run every agency in the County and to assert that is silly. Just as Barrett doesn't run the agencies that report to him. Again try at least to appear objective.

    Yes, Mr Chiannelli is but one of the administrators who set policy and run the day to day at the facility. Yes there should be accountability with all the administrators.

    Problems at BHD are longstanding and they reflect the culture of the facility both at the administrative level and the front line staff level. Personally, I would say that the administrators are much more responsible for this negative culture because they are responsible for setting the tone, but you also have entrenched camps of employees that have been there for forevah and I think admin is intimidated. This is not an excuse however. Did this problem exist with past county execs-you bet!

    Opinions aside, let's discuss the heart of your comments. So you say that at BHD, professional staff has to assist with meals becuse the food service isn't following dietican orders? Well, just what is Aviands error rate as compared to the county run food service regarding special diets? Suerly you are not suggesting that the county service never brought the wrong tray to a unit, are you? Now that WOULD be foolish and completely untrue. I think that Aviands has been quite regularly scrutinized because of the controversy over privatization, so there is data to examine. You really should do that-educate yourself on the issues.

    Regarding the cleaning agency, they are just better hands down no questions. Again where do you get your info? I'm not commenting on their integrity as individuals-that's just goofy. I'm commenting on the job they are performing. I appreciate that some are former county workers. Perhaps Cleanpower has higher standards and accountability? They are cheaper too. Its kind of a win win situation.

    Again, we can't have a serious discusiion until you are better informed. I work there I know I see it everyday- you don't. I'm trying to help you because your editorials are so seriously lacking in facts that they are comedic.

  4. Wow, you start out with the insults, and then act as if you're so deeply hurt when you are challenged. How so very hypocritical of you.

    Actually, I was recently in contact with Supervisor Peggy West and was told that the audit of the food privatization, which Walker didn't want, still isn't done. Why is Walker dragging his feet on this? Could it be because he knows that the results are going to be bad.

    And please note, I still haven't even gone into the poor quality of the stuff they serve on a daily basis when they don't think anyone is watching.

    And I would hope that the cleaning service is cheaper, since they aren't doing nearly the same amount of work. If they only clean part of the building, they should only be paid part of the fee. But what about the areas not being cleaned. They will never regain accredited status if they keep operating in such a nonsensical and irresponsible pattern.

    Yes, there have been problems there all along. That goes with working with this population. But to deny that it hasn't become exponentially worse with the budgetary and staffing cut backs is indefensible. Overtime costs are out of control, and people are being hurt needlessly.

    These are people and do not deserve to be treated as second class citizens.

    And I am there enough to see how poorly things are run. Don't criticize unless you know what or whom you are criticizing.

    But maybe we should also ask the legislators and Supervisors to look into whether they should look at what happens to the patients when they are pushed out the door due to the shortage of beds, eh?

  5. I forgot to comment on your responses about the private security.

    You say that the private firm has cost more than $1 million in the last two years as compared to when it was run by county workers. This figure is for BHD alone? That seems surprising. What is your source, please.

    You also comment about security "not watching the entryways" You do realize that throughout the facility entry doors to hospital wards and hallways etc WEREN'T EVEN LOCKED after hours until just a couple of years ago, right?

    Once you digest that get back to me and tell me how this is not a system problem rather than one of privitization. I would also suggest you read the Journal Sentinal article and Dr Sorem's comments about administrators attitudes towards incresed security that is needed at the walk in clinic site.

  6. The source of the numbers is from the county budgets themselves. And yes, it is just for BHD alone. It shouldn't be surprising considering how dangerously short staffed the complex has been under Walker's reign.

    You are talking about locked doors. Do you realize how many people come and go without even seeing a security guard, any time night or day?

    After the gun incident, they actually had guards stationed by the entrances with wands, but that lasted a very short time.

    More often than not, you can walk in without even having to show an ID, and then the only person asking for it is the receptionist.

    Again, how is that better? All it is a clear example of how little Walker and his administration think of this vulnerable population, and why he needs to be called out on it.

  7. Cappy, let's try to discuss the issues at hand to their conclusion please. I was careful to respond to each and every point you raised, please show me the same courtesy.

    Re: Security- Where are the figures for security expenditures at BHD? Can you link to them please?

    Given my previous comments how can you possibly assert that this is an issue of privitization? I would suggest that it is a systems failure rooted in administrative ideology regarding patient rights. If you disagree, please be specific so I can respond.

    There are security guards at the public entrance to the building, at least there were yesterday. How does this factor into privitization? County or private, they don't chose their own assignments, do they? :) They don't get together at the beginning of their shifts and decide what posts to man. Get real

    Re: Dietary There is plenty of info given during county board discussions on Aviands performance. Your comments are greatly exaggerated and you failed to comment on the error rates and problems when the county controled the service. Again please be objective.

    We can talk about staffing and overtime if you want but let's finish this first. You owe it to your readers to present a balanced view.

    There should be accountability I completely agree, but these problems didn't happen overnight. They are longstanding at BHD and they were never addressed by past county execs either. Where is your outrage at Ament? Were you OK with this stuff just so long as there were no furloughs?

    Can you direct to any editorials about patient care/security at BHD that you wrote when Ament was in charge?

    You risk sounding like a partisan hack when you take Walker to task for problems at BHD, but you fail to hold Barett acountable for the agencies that report to him.

  8. I find it rather presumptuous for an anonymous commenter to tell me how I should run my blog.

    But I will let that go and try to explain, again, how this works.

    First, the numbers for the overages by the Security comes from Cory Liebmann's research.

    Now, the security there yesterday actually proves my point. They only were there after their absence was noted. BTW, I do believe I am the only one that has called that out, thank you very much.

    How many guards there are and where they are assigned is determined by their supervisors based on the demands provided by BHD's administration. Obviously, since they are more expensive than advertised, they try to skimp by cutting back on the number, spreading them out and leaving deficiencies such as the doors not being covered.

    If it was with the less expensive public sector, those deficiencies would be lessened if not eliminated.

    As for the food service, I know the Board's been following them closely, for the reasons stated above. If this was a concern before, the Board would have taken action then as well.

    But why are you worried about Ament. Ament has been out of office for eight full years. This is all Walker's mess now. You are starting to sound like someone who is trying valiantly and failing miserably to defend Walker's indefensible willful neglect to this very vulnerable group of people.

    I really hope you don't really work at BHD. It is a scary thought.

  9. I'm sorry if you feel threatened. It was presumptuous of me to think that we could have a discussion of the real issues given my viewpoint is so different from yours, but I had hoped that you might be open to information.

    Should there be an investigation of BHD? Yes, and administrators and Walker should be accountable. Are these problems new? Absolutely not and they existed when Ament was there too.

    Your comments re:security on the link provided. Sorry but this tells the reader nothing. Costs regularly run over bugeted amounts for a variety of reasons. For example, when pharmacy services were privitized a few years ago there was a dramatic increase in bugeting/net due to a change in reimbursement for psych medications with elimination of GAMP funding etc. Someone unfamiliar with this and just looking at the numbers would come to the wrong conclusions thinking the pharmacy is paid much more due to privitization and that is not true. So if you want to say that security firm costs in excess of 1 million more for the SAME coverage/personel (which coverage is not the same BTW) just showing the budgeted vs net without a rationale doesn't accomplish this-sorry.

    About your comments about guards there yesterday. They are there EVERYDAY, same posts. Should there be increased security at the walk in site- yes. Is there now? No. Is it due to "skimpimg" on costs/privitization. No, it's due to the philosophy of the administration and efforts to preserve patient rights etc e.g. "we don't want to run this place like a prison" You should reread the Journal article.

    Re food service. There is lots of information in county board discussions about error rates service etc available in the record. It's not dramatically worse than the county run service and that is just a fact.

    Legacy costs are what make county run services so expensive. You do realize that right?
    My apologies for any typos- I don't have time to check it.

  10. Your argument about the privatization of security vs. pharmacy is a red herring. The change in pharmacy showed an immediate increase, per what you reported. Security did not have that.

    Instead, the privatization of security is the classic delayed bait and switch that has proven time and time again to be the downfall of the privatization argument. They come in claiming to be cheaper, and they are, for the first year or two. Then hidden costs and/or sudden cost increases or whatever the excuse allows the company to raise their rates to levels higher than if they had remained in the public sector.

    Thus the security cost overrun, and the diminishment in services.

    And you are telling a lie if you say that security guards have been at all public entrances. That is not true whatsoever.

    As for your claims about the food service, the only people claiming that there is no change is Walker's administration. Front line workers, Board Supervisors and the facts say otherwise.

    Legacy costs are not really pertinent to this conversation, but since you bring them up: The highest cost is health care which has been going up by double digits almost every year for the past decade plus. The health care costs in WI are higher than anywhere else in the nation, and higher in the MKE area than anywhere else in the state.

    What do you propose that be done to fix this?

    At least Walker's administration has finally figured out that they screwed up by allowing the JCI accrediting to lapse and are trying to get that back.

  11. Oh, and btw, if you really wish to have a conversation, don't try to use Walker's and Chianelli's talking points. Everyone sees through those already.

  12. Let's clarify please- are you saying that security levels (number of guards and cooverage) are now less (you said "diminished") then when it was run by county employees? If so, I can tell you right now that is not the case, but I'll take a look at any info you have. Please reference specifics, years, personnel etc.

    Regarding costs as I mentioned earlier, the "research" in your link only shows bugeting vs net there is no rationale. No explanation of number of guards hours etc for comparision. Do you think the board just approves this stuff with no discussion?

    I'm going to overlook your comment to me about lying because maybe I was too harsh in calling you a partisan hack. If you are truly willing to look at the evidence, then we shall see, if your point of view conforms to the facts.
    I'm willing to change my opinion. Show me I'm wrong :)

    My comment about legacy costs relates to the discusssion about security. Under current levels, with legacy costs what do you think the county would be paying without the private contractor?

    Guards are stationed at the public enterances to the hospital and side enterances are locked or manned and they have been for a few years. I think there are cameras now too. (walk in clinic is an exception) If you have information, that this is incorrect please show me.
    You do remember that public visiting hours for the units were changed a few years ago, right?

  13. Um, yeah, I am not going to take the time or spend the money to do requests on staffing patterns or costs to verify what I have seen with my own eyes in the years that I have been going to the complex.

    I cannot even begin to estimate the number of times I have walked in the main doors and never seen anyone besides the receptionist. And I have yet to see a guard at the door on the third floor, which is not locked.

    As for the Board, I have attended more than enough committee meetings and meetings of the Board as a whole to know that there is much that gets passed with little or no discussion.

    As for the legacy costs, the County is still responsible for any accrued benefits whether the employee is still there or not, so where is the saving? Not to mention the higher costs of privatization which you try to deny.

  14. Thanks that indeed does answer my questions, just as I thought. No need to verify anything, let's just slam folks because it fits our agenda.

    Your readers must be awfully superficial or just content with the third hand info. (and you're acussing me of repeating talking points?)

    Funny you should mention the 3rd floor, because that is where I work. :) It's rather humourous to me that you could miss the guard sitting at the big desk right by the double doors to the parking lot-but OK then

  15. You're always welcome to get the data you are requesting yourself.

    As for my readers, I feel confident that they take my word over an anonymous commenter.

    If there is a security guard at those doors now, he or she was only stationed there since this story broke. As I've said before, I've gone through those doors many times, yet haven't seen anyone there. The same holds true for the main entrance as well. It truly is a shame that the Walker administration only responds when it gets publicly shamed into it.