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Hospital stands by statement its employees were 'threatened'

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St. Peter's Health

St. Peter's Health in Helena.

St. Peter’s Health in Helena has again asserted that public officials “threatened” a law enforcement response and lawsuit over the treatment of a COVID-19 patient, adding their side of the story to the growing number of reactions following a recently released special counsel’s examination of the dispute.

"As shared in our previous statement and consistent with the special counsel’s investigative report, St. Peter’s Health maintains that our providers and care team members were threatened and harassed when they refused to administer treatments for COVID-19 that are not authorized, clinically approved or within the guidelines established by the FDA and the CDC," the hospital said Wednesday.

The special counsel was investigating the involvement of state Attorney General Austin Knudsen, his deputy Kris Hansen and state Public Service Commissioner Jennifer Fielder. All three are Republicans, and the patient, who has since died, was well-known in GOP circles.

While the report for the first time made public Fielder's involvement and shed light on further details about the actions of Knudsen and Hansen, by law the special counsel cannot make findings or draw conclusions. Special Counsel Abra Belke in an interview Wednesday said the review had limitations set by law and because of that she had to walk a “super tight rope” in her work.

But conclusions by others have fallen on either side of that line, producing widely varying pronouncements and interpretations of Knudsen, Hansen and Fielder's actions.

In October, Knudsen texted a hospital board member saying he was “about to send law enforcement in and file unlawful restraint charges” and that his "patience" was “almost gone.” He later had a call with the hospital's CEO, Wade Johnson; the chief medical officer; and the board member. During the investigation, the CEO told Belke, through the hospital's lawyer, he was not threatened by the call.

Knudsen's spokesperson late Monday used the counsel's report to say the attorney general's actions didn't amount to threats.

“No one at the Department of Justice threatened anyone while trying to get to the bottom of allegations reported to us,” Kyler Nerison wrote in an email.

But St. Peter’s said Wednesday the special counsel’s report was consistent with their previous statements.

“When public officials became involved, a law enforcement response and a lawsuit were threatened," the hospital said. 

Doctors who were at the hospital during the dispute have told the Montana State News Bureau they were warned of the possibility of a trooper being sent and felt threatened too. The Montana State News Bureau is not identifying medical providers at their request over concerns about retribution. 

State Senate President Mark Blasdel and Speaker of the House Wylie Galt in a statement also interpreted the special counsel’s report as vindicating for the attorney general, though they didn’t address Hansen or Fielder’s actions. They also cited the CEO's statement to Belke.

The special counsel said Wednesday she was not able to talk with the two other hospital employees on the call to learn their reactions. Under law, during the interim between legislative session she only has the ability to review government documents. If the investigation was during the  every-other-year legislative session, she would be able to compel people to speak with her.

Belke said she ended up getting the statement from Johnson, however, because based on documents she reviewed she began to question if the CEO felt threatened or harassed. Initially Belke didn’t said she didn’t plan to ask the question, or numerous others she developed about people’s conduct, that she was not empowered to ask.

“But there just came a point where there wasn't anything written down. There were no written-down threats,” Belke said.

Without further details from the hospital, she said she felt it was essential to ask the CEO the “single question of did the attorney general threaten or harass you on the call that you had with (him)? And they provided that answer after three or four days.”

Belke said she asked the CEO and not the other two on the call because the CEO had already been offered up by the hospital. She also said she didn’t want to take her work beyond the scope allowed by law.

“If I'm suddenly asking deep questions about what was the contents of the call, how long was the call, can I talk to all people on the call, were any notes taken from the call — now suddenly we've gone from a permissible examination of records to a pretty in-depth investigation,” Belke said.

“ ... We're trying to stay on the side of a permissible examination of records and not going to an impermissible investigation. It was a super tight rope to walk. At times it was frustrating to me and I found myself just kind of wishing we were in session so that I could blanket request everything that I would have wanted in a full investigation.”

In their statement, St. Peter's said “out of respect for the Office of the Attorney General and the genuine effort being made by both parties to address the concerns brought forward, we made the decision to respond only to the narrow scope of questions we were explicitly asked during the special counsel’s investigation, and we did not elaborate on any of the conversations or events that took place during the care of the patient.”

Deputy Attorney General Hansen spoke to doctors during a speakerphone call initiated by the patient's advocate where she discussed legal ramifications. She also dispatched a trooper to the hospital to take family members’ statements. The counsel’s report revealed state Public Service Commissioner Fielder left a voicemail at the hospital, also referencing possible legal action.

Knudsen’s text to the board member referenced claims the patient was “being denied her preferred informed treatment” and Fielder’s message named ivermectin and hydroxychloroquine as drugs the patient had requested but was not prescribed. Neither are approved or recommended by the Food and Drug Administration for the treatment of COVID-19.

On Wednesday, St. Peter's said elected officials tried to influence the patient's care, though it did not specify if that statement referenced Knudsen, Hansen and/or Fielder.

“We stand by our assertion that the involvement of public officials in clinical care is inappropriate; that individuals leveraged their official positions in an attempt to influence clinical care; and that some of the exchanges that took place were threatening or harassing,” a hospital spokesperson wrote. “Any efforts to exert pressure on our providers will not result in deviation from widely accepted clinical treatment protocols or our hospital policy."

Knudsen's text message to the CEO also said the patient was being denied access to legal documents and visitors. The hospital again pushed back on that in their Wednesday statement.

"Further, we reviewed all medical and legal records related to this patient’s care and verified that our teams provided care in accordance with clinical best practice, hospital policy and patient rights," the statement read.

Fielder's documents

Another area the special counsel's report was unable to provide definitive information about was Fielder's involvement beyond leaving the voicemail. Doctors that spoke with the Montana State News Bureau have also said Fielder was on the call with Hansen initiated by the patient's advocate.

After the hospital confirmed to Belke that Fielder was involved and shared Fielder's voicemail, Belke reached out to the commissioner.

Fielder in response insisted to Belke that government records related to the incident did not exist.

“She in her capacity as a public service commissioner is representing to me that there are no documents,” Belke said. “I don’t have the power to compel a search for documents. I would have to take her at her word.”

Lee Newspapers has also requested records from Fielder. Following initial coverage of the dispute at the hospital, the Montana State News Bureau has repeatedly tried to contact Fielder about her involvement. She did not return numerous voicemails left on her work and personal cellphones, and hung up on one reporter after saying "Not talking to you."

The PSC has not yet filled the newspaper's request, though it did demand $240 to implement a "legal hold" on Fielder's records, which included emails as well as instant messages. The request was made Oct. 29 and the PSC asked for payment to stop destruction of any records Nov. 3.

The records requested include Fielder's work emails, work text messages, work call records, written communications Fielder created with government property and communications created by PSC staff or commissioners at Fielder's request during the month of October. A lawyer for the PSC called the amount of records "extensive."

Belke said during her investigation she consulted the Legislative Services Division about how she should proceed if she felt there might be government records she was unable to access.

“Because my in-session powers specifically list the ability to compel documents, and my interim powers don't, I am somewhat reliant on the representations of the agencies and the officials that these are all the documents,” Belke said.

Another question her investigation could not clarify was the policies and process involved in dispatching the trooper. Belke said some of those answers were contained in information she could not make public because it is confidential criminal justice information that's part of an ongoing Department of Justice investigation. 

“With the documents I was able to release publicly, it is a little opaque how we get from the text messages between the patient advocate and the deputy AG to the taking of the report from the family, but ... the investigative file — which will be public information eventually — makes that more clear,” Belke said.

She added she hoped the hospital would eventually be able to release their own findings from their own internal investigation.

New position

The special counsel's role was created by the 2021 state Legislature and this is the first time it's been deployed. Belke said the process has shown the challenges of the role. She also said she saw potential for abuse of the position.

“This statute could conceivably allow, if you got an activist partisan special counsel in this position, you could have someone conceivably papering agencies within the government and third parties with requests for information that would be an end-run around the legislative audit process. And that is something I specifically want to avoid,” Belke said. The Legislature has an audit division that is able to review agency actions.

It’s been frustrating to see news reports saying her investigation drew conclusions, Belke said.

“There there are no conclusions. But from a policy perspective, it's what I was asked to do. And I think it's better if the people involved can read the report, look at the same information that I looked at to whatever extent possible, and evaluate for themselves.”

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