A psychiatrist who was fired this year for failing to properly document patient care at the Minnesota Security Hospital had been forced to resign in 2005 for exactly the same violation — yet was later rehired by the state and spent three years treating patients at regional mental health hospitals.
The psychiatrist, Dr. Edward L. Kelly, returned to work for the state in 2009 to practice in the Community Behavioral Health Hospital system, a network of 16-bed mental health facilities dotted across Minnesota.
In an interview Thursday, Kelly denied being forced to resign in 2005 and said the only infraction that led to his firing this year was his failure to promptly enter handwritten notes into the hospital’s electronic records system. “I was thrown under the bus by the Minnesota Department of Human Services,” Kelly said. “I was the scapegoat so the problems at the hospital would be put over on to me.”
A person with direct knowledge of Kelly’s departure in 2005 said he was asked to submit his resignation after high-ranking medical staff at the hospital found that he had not properly documented the condition of his patients.
DHS officials, citing employee privacy laws, declined to discuss the circumstances of Kelly’s departure in 2005 but said that he was not fired. They acknowledged rehiring Kelly in 2009, but said he had the right credentials to treat patients in the state mental health system, including the regional hospitals and the security hospital in St. Peter.
“Our physicians were familiar with Dr. Kelly’s positive clinical reputation, and his training as a forensic psychiatrist was directly relevant to the work he was doing in St. Peter,” Deputy Commissioner Anne Barry said in a statement. “To serve our populations, DHS will continue to seek the most qualified people in a highly competitive field.”
Kelly is one of two psychiatrists who were harshly rebuked last week by a Hennepin County judge for submitting reconstructed medical records to the court, an action the judge described as an attempt to hide the maltreatment of a mentally ill woman who was held for 16 months at the St. Peter facility. The other psychiatrist was the hospital’s medical director, Dr. Steven Pratt, who ordered Kelly to reconstruct his files on more than a dozen patients.
On Wednesday, Barry sent an e-mail to employees in the agency’s State Operated Services (SOS) Division addressing a story in last Sunday’s Star Tribune that recounted the woman’s case.
“The story documented the failure of one of our former medical providers to keep timely patient records, which led, in part, to a patient being held in the program for longer than acceptable,” Barry wrote. “There is no question this was a tragic case that never should have happened.”
The episode was the latest in a series of problems at St. Peter, the state’s largest mental health facility with nearly 400 patients. Several staff psychiatrists resigned or asked for reassignment after a stormy period in 2012, and Human Services Commissioner Lucinda Jesson placed the hospital on conditional licensure.
Roberta Opheim, ombudsman for Mental Health and Developmental Disabilities, said in an interview Friday that the charting issues with Kelly and Pratt are a continuation of violations that were highlighted back in 2011 by DHS licensing investigators.
“At a very minimum we’d expect the state as a provider to be a leader in quality care,” Opheim said. “When doctors don’t chart in a timely matter, it potentially slows down a patient’s ability to leave the program because they can’t get timely treatment without all the information. And at worst it is medically dangerous — what if you change a med but don’t chart it?”
Judge became suspicious
The recent patient-records violations came to light early this year, when Hennepin County District Judge Jay Quam asked Human Services officials to give him an update on a 49-year-old woman who had been committed to the St. Peter hospital after being arrested for spitting on two police officers.
Quam became suspicious of patient records submitted in her case, and discovered that Pratt had directed Kelly to reconstruct three months worth of medical progress notes on the woman’s deteriorating condition, according to court transcripts and interviews. Pratt fired Kelly once the reconstructed files were completed.
In an interview with the Star Tribune, Kelly denied that the woman ever suffered maltreatment and said he had advocated for her release months earlier. But he did say that he approved putting her under a “sleep lockout” order, under which a patient is deliberately locked out of his or her room during the day to allow participation in programs designed to restore mental competency.
Kelly insists that despite falling behind in his record-keeping, he has always put patients first and had advocated for faster release back into the community.
In a letter to the newspaper, he said, “I have always made objective and honest appraisals of my patients’ conditions and have been careful in developing appropriate medication regimens that balance risk and benefits.”
He said that he has always tried to minimize antipsychotic medications for sleep and anxiety because of the severe side effects that can surface.
“There are many people who continue to believe that nearly every patient at MSH-St. Peter requires antipsychotic medications. I insist on utilizing my own professional judgment about diagnosis and treatment, and refuse to simply accept what some other clinician, particularly a one-time evaluator, may report.”
Kelly’s resignation in 2005 and the circumstances behind it were confirmed by a source who has direct, first-hand knowledge of Kelly’s actions at the time.
According to the source, the problem with Kelly’s patient records was discovered while reviewing his files on the eve of a crucial visit by a national accreditation commission sent to survey programs and inspect medical files. As a result, Kelly was ordered to come in over a weekend, before the commission’s arrival, and bring his files up to date. The source said Kelly failed to perform the work as ordered and was forced to resign.
Kelly acknowledged record-keeping problems. He said that at the time, he was working at the St. Peter hospital three days a week, driving down from Fargo, N.D. “There was lateness with my notes,” he said. “My notes needed to get caught up. Notes are supposed to be entered within seven days. This is a common problem for many doctors.”
Kelly said that at the time of his firing in February of this year, Pratt went out of his way, twice, to tell him he was a good doctor. “I was thrown under the bus to appease the judge,” he said.