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Mercyhealth's Medicare participation threatened after 2016 suicide

JANESVILLE

Jim Brieske’s final hours before his suicide were a mystery to his family for two years.

May 23, 2016, was a Monday. The high temperature was 83 degrees. Skies were clear.

At 11:52 a.m., Brieske checked into Mercyhealth Hospital and Trauma Center, Janesville, according to his medical records.

At about 10:30 p.m., Brieske jumped off the south side of the Centerway Bridge into the Rock River, according to police reports.

Three days later, his body was retrieved downstream near the Center Avenue bridge in downtown Janesville.

Brieske’s family didn’t know he had visited the hospital the day he died until fall 2018 when his brother Brian Brieske was contacted by reporters from WebMD and Georgia Health News who were reporting on emergency room violations across the country.

The Brieske family wonders if Jim’s death could have been prevented had his hospital visit gone differently, Brian said.

A complaint made to the U.S. Centers for Medicare and Medicaid Services shortly after Jim’s death prompted the agency to launch an investigation into Mercyhealth’s compliance with the Emergency Medical Treatment and Labor Act.

Investigators found the hospital had violated multiple requirements and put emergency department patients in “immediate jeopardy,” according to a letter from Gregg Brandush of the Centers for Medicare and Medicaid Services to Mercyhealth.

The federal agency threatened to terminate Mercyhealth’s Medicare participation as a result, according to the letter.

The Gazette obtained documents detailing the investigation from the Center for Medicare and Medicaid Services and from journalists with WebMD and Georgia Health News.

A Mercyhealth official said Friday the hospital disputed and still disputes multiple findings from the Centers for Medicare and Medicaid Service’s investigation.

May 23, 2016

Medical records provided to The Gazette detail Jim’s hospital visit.

James N. Brieske

Jim, 53, told hospital staff he had a “desire to end his life” but did not have a plan in place for suicide. He had experienced suicidal ideations about six months earlier, which landed him at Mercyhealth the week of Thanksgiving 2015, Brian said.

Jim was diagnosed with bipolar disorder in 2006. The disorder caused Jim to experience chaotic episodes. He struggled to maintain stable living situations but never was deemed a danger to himself or others, Brian said.

In November 2015, Jim self-committed at Mercyhealth and was transported to Mendota Mental Health Institute in Madison for a three-day hold, Brian said.

But Jim’s hospital visit in May 2016 went differently, according to his medical records, which detail the following:

Jim was placed under suicide watch at Mercyhealth and was cleared for behavioral health evaluation. While waiting for doctors, Jim walked out of his exam room, removed his underwear and attempted to walk around naked.

Jim struggled to keep his eyes open and mumbled incoherent statements as a social worker tried discussing treatment options with him.

Jim did not respond to the social workers’ questions about his conditions.

Submitted Photo 

Jim Brieske photographed in 1981 in his Marine Corps uniform. He served in the Marines for two years.

The social worker directed staff to call the Rock County Crisis Intervention team to assess Jim for involuntary treatment.

The social worker left the room to consult with the psychiatrist on call. When the social worker returned, Jim had been discharged.

The Centers for Medicare and Medicaid investigation indicates the doctor who discharged Jim did not discuss Jim’s condition with his case manager, the social worker or the crisis team. The doctor believed Jim was stable enough to be discharged and instructed Jim to contact his case manager from Rock County Human Services immediately after leaving the hospital.

Brian has contacted Rock County Human Services to learn if Jim ever visited or called his case manager that day.

A representative from the county told Brian his brother’s records are sealed and the county could not discuss Jim’s history with Brian, he said.

Director of Human Services Kate Luster said she was unaware of Brian’s request and recommended he talk to the county’s HIPAA privacy officer.

Submitted Photo 

Jim Brieske graduated from Parker High School in 1981. He died in 2016 after jumping off the Centerway bridge.

A lawyer told Brian he could petition to become Jim’s special administrator to get the records, but Brian suspects that would be costly and take time, he said.

Mercyhealth investigation

The July 20, 2016, report on the investigation at Mercyhealth indicates problems with Jim’s case and others. According to the report, the hospital failed to:

  • Complete an appropriate medical screening exam for one of six patients with suicidal ideations.
  • Document time of medical screening exam for three of 20 patients.
  • Continuously monitor four of six patients with suicidal ideations.
  • Ensure all patients in the emergency department received stabilizing treatment before being discharged.
  • Post Emergency Medical Treatment and Labor Act signs in five of nine areas likely to be noticed by all individuals entering the emergency department.

Mercyhealth disputes the finding that the hospital did not complete an appropriate medical screening exam for one of six patients with suicidal ideations, said Paul Van Den Heuvel, vice president of legal affairs for the health system.

“Given privacy laws, we cannot comment on specifics as to the patient’s treatment, however, to the extent that any patient consents, generally all patients receive a medical screening exam,” Van Den Heuvel said.

Many suicidal patients receive comprehensive treatment in the emergency department and then are treated in the hospital’s in-patient psychiatric department.

The hospital cannot commit a patient without consent or government intervention, such as from law enforcement or county social services, Van Den Heuvel said.

“What I will tell you is Rock County is very reluctant in circumstances to proceed with a process to admit a patient against his or her will,” Van Den Heuvel said. “It does not have the staffing or resources to staff a night shift relative to crisis intervention.

“It is unfortunate that there are other counties that are more aggressive in their approach to save the patient from themselves and perhaps put other people in harm. There is an apparent philosophy with Rock County is they are kind of reticent in that circumstance.”

A social worker, in Jim’s case, requested Rock County Human Services be called, but Jim was discharged before the call was made, according to investigation records.

The health system also disputes the finding that four of six patients with suicidal ideations were not continually monitored, Van Den Heuvel said.

The patients’ medical records might not have properly identified the environment the patients were in, Van Den Heuvel said.

Patient rooms in the emergency department are glass-fronted and situated in an ovular shape around a large work station where nurses, doctors and staff had a view of patients, Van Den Heuvel said.

The finding that Mercyhealth failed to document actual time of medical screenings for three of 20 patients was correct but should be viewed in context, Van Den Heuvel said.

Mercyhealth’s emergency department is often busy. Physicians had been allowed to document care at a time when it was most convenient to them, which might have been an hour or so after care was given. After the investigation, the health care system changed its policy to require more real-time documentation, Van Den Heuvel said.

The health system provided additional training to emergency staff and reviewed policy as a result of the investigation, Van Den Heuvel said.

A follow-up survey Sept. 7, 2016, by the Centers for Medicare and Medicaid Services found Mercyhealth made corrective action to be in compliance and was no longer at risk of losing its Medicare participation, according to a letter from Tamra Swistowicz of the centers to Mercyhealth.

Van Den Heuvel said incidents with unfortunate results in the emergency department should not diminish the incredible work emergency workers do every day.

The hospital cares for more than 2,000 behavioral health patients in emergency rooms every year. More than 600 of those patients receive inpatient psychiatric care, Van Den Heuvel said.

“Our physicians, our nurses, our other support staff, they’re heroes in the work that they do,” Van Den Heuvel said. “A lot of people can shy away from this work and many do.”

Submitted Photo 

Jim Briekse, left, sits next to his brother David and niece Alisha in a 1990 photo. Jim was diagnosed with bipolar disorder in 2006.

Questions remain

Would Jim be alive if Mercyhealth had called his family to tell them Jim was in the hospital?

Brian thinks so, but there is no way of knowing now.

Van Den Heuvel said he believes the process for calling emergency contacts was the same for physical emergencies, such as injuries sustained in a car accident, and behavioral health emergencies, but he is unfamiliar with the exact policy.

“But I know from interacting with our team in multiple environments, they will search for emergency contacts not even just in your medical records, they will search for if anyone knows if they have a husband, wife, sister, brother,” Van Den Heuvel said.

Brian said none of his family members received a call that day.

Submitted Photo 

Jim Brieske poses for his baseball photo with the UAW Brewers in 1976.

Brian and his family wish they knew more about what drove Jim to jump that day. They speculate the death of Jim’s father, death of Jim’s stepfather and the recent loss of his apartment contributed to him being suicidal, but they will never know for sure.

The question of whether Jim saw his Rock County case manager that day nags at Brian, he said.

Is there something they can do now?

Some of Brian’s family members want to take legal action against Mercyhealth, Brian said.

Brian has been told conflicting opinions from lawyers on whether a sibling or parent could sue for wrongful death. Some have said a spouse or child would have to do so, but Jim had neither.

“It is not about money, but we are trying to find out what happened, what led up to this,” Brian said. “He had all day to think about this.”

Before Jim jumped off the bridge, he stopped and asked a nearby fisherman for a cigarette.

Jim walked around for a while and then returned the cigarette to the fisherman, saying he no longer wanted it, according to police records.

Brian thinks his brother was stalling, hoping to find someone to talk to on the bridge to talk him out of jumping.

But that didn’t happen.

“I am guilty like other people,” Brian said. “When we see people on the street, what do we do? We turn the other way. I am probably just as guilty as the other people, but I am trying.”

Angela Major 

Brian Brieske stands near the Centerway bridge, where his brother committed suicide in 2016. His brother suffered from bipolar disorder for 10 years.


Analysis: The State of the Union is … perhaps outdated?

WASHINGTON

Think of the State of the Union address as the appendix of American government.

It’s been there a while. No one is quite sure exactly what it does. When it’s gone, no one notices.

The standoff over the partial government shutdown and particularly how it led to a fight between President Donald Trump and Speaker Nancy Pelosi over timing, delivery and venue of the State of the Union produced one unexpected side benefit: a refresher civics course.

The speaker can’t, for instance, cancel a State of the Union. The president can’t show up to deliver one whenever he feels like it.

It’s all there in the Constitution, Article II, Section 3: “He shall from time to time give to the Congress Information of the State of the Union, and recommend to their Consideration of such Measures as he shall judge necessary and expedient.”

That’s all, folks.

Setting the time and venue for a joint session of Congress to hear the president deliver the speech requires passing a concurrent resolution. This is where Pelosi flexed her authority, and Trump backed down. Separation of powers for all to see.

Not wanting to let a teachable moment go to waste, it might be worth asking if the State of the Union in its current form is the best we can hope for.

Leaving aside the Trump-Pelosi kerfuffle, is the practice of a president addressing a joint session of Congress during prime-time television, with canned applause lines, human props and hugs and grins aplenty, the ideal way to put on this show?

We are, after all, getting information from a vividly decentralized spectrum.

Last year, an estimated 45.6 million people watched Trump’s SOTU live on Jan. 30 across 12 networks, according to ratings lodestar Nielsen. That roughly tracked with Trump’s first kinda-sorta SOTU in 2017 (technically a joint address to Congress), which clocked in at 47.4 million viewers.

Compare that to Bill Clinton’s first kinda-sorta SOTU on Feb. 17, 1993: 66.9 million over four networks.

One thing Nielsen numbers show is the longer a president is around, the more “meh” the audience.

By 2000, Clinton was at 31.5 million viewers. George W. Bush and Barack Obama saw similar trajectories.

Although it might seem like the State of the Union is set in stone, the president’s tradition of traipsing to the Capitol dates to Woodrow Wilson in 1913, with notable exceptions. Even Wilson skipped it in 1919 and 1920 due to ill health, and “from time to time” his successors have ditched the speech and just sent written messages.

Jimmy Carter was the last one to do that, in 1981, after he lost to Ronald Reagan. In the years they left office, Carter’s successors bailed altogether, providing neither oral nor written messages.

For die-hard fans of hearing something, anything around the beginning of those years, new presidents have addressed joint sessions for a variety of stated reasons, either to talk about “Economic Recovery” (Reagan) or a “budget message” (Bush). In other words, kinda- sorta SOTUs.

Dating to the early republic, George Washington and John Adams delivered SOTUs in person. Thomas Jefferson passed, sending a written message. Other presidents followed his lead. Until Wilson. Sometimes.

It underscores that the State of the Union has been remarkably stable, except, of course, when it isn’t. And when it isn’t, people rarely make a fuss, if they notice at all.

“My slogan would be mend it, don’t end it,” said Jason Grumet, president of the Bipartisan Policy Center. He believes the president coming to “the people’s House” fulfills an important role in a healthy democracy.

But tweaks? For sure.

For one, “No interruptions,” Grumet said. “It’s become like one of those whack-a-mole games,” with each side standing up, clapping, or sitting on their hands. “Let the president give his speech.”

Also: no more acknowledged guests. “Both parties have started to use people as emotional pawns in ways that are not graceful,” Grumet says.

Finally, he said, leave the Joints Chiefs of Staff and the Supreme Court home, taking them out of the political limelight.

Grumet also says Trump deserves credit for not pressing for an alternative venue, seeming to realize “There’s something diminished about the president giving it at a rally or some other partisan venue.”

So can the clapping, punt on the props, remember it’s about the State of the Union, not the State of the Party?

Why not? We can always fall back to what’s familiar.

How’s that working out, by the way?


Obituaries and death notices for Feb. 4, 2019

Arlyn “Butch” Affeldt

Paul L. Jansen

James “Jim” Thomas Mainus

Wallace Roger “Wally” Peterson


Set against a shaky global picture, US economy looks sturdy

WASHINGTON

The U.S. economy, well into its 10th year of growth, still has a spring in its step. And it’s all the more visible when set against a tiring global picture.

A robust January jobs report Friday showed that America’s companies are, for now, brushing off an array of economic perils and still hiring at a brisk pace. The risks that for months had induced hand-wringing among economists about a possible looming recession appear to have had little effect on employers.

Overseas growth is stumbling, led by weakness in China, the world’s second-largest economy. Europe is hamstrung by a recession in Italy and the potential for an unruly Brexit. A trade war between the U.S. and China and higher U.S. mortgage rates, partly engineered by the Federal Reserve, remain threats.

No matter. Employers added 304,000 jobs in January—the healthiest burst of hiring in nearly a year. The unemployment rate ticked up a notch to a still-low 4 percent. But that was mostly because thousands of furloughed federal workers were considered temporarily unemployed because of the partial government shutdown. That quirk should reverse itself this month.

The solid jobs report and a separate survey that showed Friday that U.S. factory growth picked up last month “stood in stark contrast with evidence of slower economic momentum in China and Europe,” said Lydia Boussour, senior U.S. economist at Oxford Economics.

So why is the United States doing so well? And will the sluggish global economy eventually depress U.S. exports and economic growth?

Trends that had looked alarming a month or two ago now appear benign, perhaps even supportive of growth. The stock market, having plunged 16 percent late last year, rose 8 percent in January, its best monthly performance since 2015. Americans who are invested in stocks typically cut spending when market indexes fall steadily. That is now less likely to happen.

And suddenly the Fed under Chairman Jerome Powell looks like an economic ally. The central bank had raised its benchmark short-term interest rate four times last year—action that helped make mortgages and other consumer and business loans costlier. And in December, the Fed’s policymakers said they envisioned raising rates twice more this year.

But this week, the Fed held its benchmark rate steady and sent its strongest signal to date that it saw no need to raise rates in the coming months—perhaps even for the rest of the year. Its message ignited a rally on Wall Street, which cheered the prospect of continued modest borrowing rates for the near future.

Other factors have helped give the U.S. economy an edge over most of its major rivals. Ethan Harris, global economist at Bank of America Merrill Lynch, said the Trump administration’s tax cuts in late 2017 and a sharp increase in government spending last spring helped fuel growth.

“No other major economy in the world did what we did,” Harris said. “The stimulus did a very good job of covering up all the blemishes of the economy, including the risks of the trade war.”

Vigorous U.S. hiring in the past few months partly represents a “lagged effect” from faster growth over the spring and summer, Harris said. Businesses that weren’t able to quickly find and hire all the workers they wanted then have kept adding jobs in subsequent months.

The United States, with its huge domestic market, isn’t as exposed to the vagaries of the global economy as some counterparts overseas. China, for example, expanded last year at its slowest pace in three decades. That slowdown has, in turn, hit German manufacturers who sold much of their industrial machinery to China, and Italian automakers, whose auto exports to China have plunged.

Though earnings at some large U.S. multinationals, such as the heavy equipment maker Caterpillar, have been weak, corporate profits have so far been holding up despite the global slowdown and trade rifts. Of the companies in the S&P 500 that have reported results for the fourth quarter of 2018, 71 percent delivered profit growth that topped Wall Street forecasts, though some have cut expectations for 2019.

And China’s downturn might not last. Megan Greene, chief economist at Manulife, said in a research note Friday that Beijing’s efforts to stimulate growth appear to be having some effect.

Still, many economists, including Harris, think the U.S. economy will slow this year after expanding roughly 3 percent in 2018, the fastest pace in more than a decade. Harris forecasts that annual growth in the October-December quarter of 2018 will be just 2 percent.

He and other economists expect the impact of the tax cuts and extra government spending to fade and for the rate hikes the Fed has already imposed to hold back growth somewhat. Inevitably, too, a prolonged global slump would weaken the U.S. economy as well.

But exactly how the U.S. economy is faring is harder than usual to judge because many data reports, including the quarterly figures on growth, are still delayed from the 35-day government shutdown. The government hasn’t yet said when it will release its first estimate of gross domestic product—the broadest gauge of the economy—for the final three months of 2018.

There are hints that the U.S. economy won’t fare as well in the coming year as it did in 2018. Diane Swonk, chief economist at Grant Thornton, noted that U.S. home and auto sales are declining, a sign that they might have peaked. If so, America’s consumers may not be able to propel the economy as much as they have.


Anthony Wahl 

Rich Swartwout of Richie's Towing, Janesville, loads an abandoned Mazda SUV onto his truck Friday.