Leaders react to counsel's report on AG-hospital dispute

St. Peter's Health
Posted at 6:34 PM, Nov 23, 2021
and last updated 2021-11-24 12:00:27-05

HELENA — A new report released Monday lays out more details about the contact Montana Attorney General Austin Knudsen and other public officials had with St. Peter’s Health when they inquired about a patient’s COVID-19 care last month.

However, Republicans and Democrats still have very different interpretations of what it shows. GOP leaders said it made clear Knudsen hadn’t intimidated health care workers, while Democrats said it still appeared officials were putting undue pressure on the hospital.

The report came from Abra Belke, a special counsel appointed by Republican legislative leaders. She was tasked with examining government records to determining what actions Knudsen, his deputy attorney general Kris Hansen and a Montana Highway Patrol trooper took in early October, in response to complaints from the patient’s family that the hospital was violating her rights. The patient died on Oct. 26.

Democratic leaders in the Legislature requested the report after St. Peter’s stated in media reports that health care providers “were harassed and threatened by three public officials.”

According to the report, shortly after the woman was admitted to St. Peter’s, a family friend who was serving as her patient advocate reached out to Hansen by text message. The advocate expressed concern about the woman’s treatment, saying the hospital had failed to provide her a power of attorney document, prevented her from communicating with her family and denied her access to “alternative medication” an outside provider had prescribed for her.

The report says Hansen was the only public official who spoke directly to health care providers, during a phone call when the advocate put her on speakerphone in a room with multiple providers. It says the hospital’s counsel reported Hansen talked about possible legal ramifications of withholding documents and preferred treatment.

It also says Hansen requested an MHP trooper go to the hospital to take statements from the patient’s family. Documents say the Attorney General’s Office said that action was in line with the “community caretaker doctrine,” which requires law enforcement to act promptly to “investigate situations in which a citizen may be in peril or need some type of assistance.”. The report says the trooper never went inside the hospital or spoke to St. Peter’s staff.

The report includes a text message Knudsen himself sent to a lobbyist for the Montana Hospital Association – who is also a member of the St. Peter’s board – asking for a response to the family’s concerns. At that point, he said the woman was being denied her preferred treatment, access to legal counsel, access to her family and other visitors and the ability to leave.

“I’m about to send law enforcement and file unlawful restraint charges,” Knudsen said in the message.

Text message Knudsen sent to a lobbyist for the Montana Hospital Association
Text message Knudsen himself sent to a lobbyist for the Montana Hospital Association

Knudsen eventually participated in a follow-up meeting with the board member, along with St. Peter’s CEO Wade Johnson and the hospital’s chief medical officer. Johnson later sent a direct text message to Knudsen, stating that they had “ensured the appropriate legal documents were indeed in place and that no undue delays were created on our end” and that the patient’s family understood how they could “provide alternative medications to the patient that are not clinically approved for that use or able to be administered by our staff.”

The report says the third public official involved with the case was Jennifer Fielder, a member of the Montana Public Service Commission and former state senator. The counsel included a summary of a three-minute voicemail Fielder left for a St. Peter’s employee. In it, she said the patient had the right to try ivermectin and hydroxychloroquine in search of life-saving care. Fielder also said “if this doesn’t turn out well there will be a suit,” and said the patient – a former Senate staffer – had many friends and that she didn’t “think the Senators will be too happy to hear about what’s going on.”

According to the report, Fielder identified herself as an elected official in the call, but she told the special counsel she had made it as a personal matter.

When Republican legislative leadership released the report, Senate President Mark Blasdel and House Speaker Wylie Galt said in a statement that it showed Knudsen had not acted improperly.

“The special counsel's examination did not produce any evidence to support allegations that the attorney general "harassed," "threatened," or "intimidated" health care workers, as has been reported in the media,” they said. “To the contrary, St. Peter’s CEO explicitly said he did not feel threatened by the attorney general, and the hospital confirmed that Austin Knudsen never spoke to any medical providers. The misleading and outright false political attacks on Montana’s attorney general by Democrats and members of the media must stop.”

A spokesperson for the Attorney General’s Office echoed that in a Tuesday statement to MTN.

“The report confirms what we’ve said since the beginning: No one at the Montana Department of Justice threatened anyone while trying to get to the bottom of allegations reported to us,” they said.

However, Democratic leaders remained critical. At a Tuesday news conference, House Minority Leader Kim Abbott and Senate Minority Leader Jill Cohenour said they still saw the actions as inappropriate.

“From our view, this report clearly shows a pattern of public officials using their power to intimidate people and Montanans doing their jobs,” said Abbott.

They said Knudsen had offered “shifting justifications” for what happened and that they had hoped for additional information from the counsel, including a timeline of events and a breakdown of all the documents requested and which ones were provided. They said they didn’t believe the report was as clear-cut as Republicans were indicating.

“When someone suggests that if they don’t get what they’re asking for, they’re going to deploy law enforcement, file charges or take legal action, I think a lot of Montanans might find that to be threatening,” Abbott said.

Fielder told MTN she made her call on behalf of someone who was a friend from her time in the Legislature.

“I’d been getting frantic calls from witnesses at the hospital who were concerned about the way the hospital was treating this patient,” she said.

Fielder said St. Peter’s should have honored the patient’s wishes. She called their handling of this case part of a larger pattern of hospitals exerting excessive control over patients and their families, and she said she hoped for a broader investigation.

“The real story here is the victim,” she said.

On Wednesday, a spokesperson for St. Peter's Health shared the following statement in response to the counsel's report:

"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. When public officials became involved, a law enforcement response and a lawsuit were threatened.  In addition, there were phone calls, phone messages and/or social media posts to or about our providers that we believe constitute harassment.

Given how difficult the pandemic has been on healthcare workers, our focus will remain on doing everything we can to support them and avoid issues that take time and energy away from patient care. Our administration is accustomed to addressing concerns brought forward by public agencies and officials, and we prefer to handle these without taking care team members away from the bedside. We continue to work through the matter related to the Attorney General’s office, but have been hesitant to single out any individual in that office or any other public officials that may have engaged our providers or our organization during the care of this patient.  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.

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. Any efforts to exert pressure on our providers will not result in deviation from widely accepted clinical treatment protocols or our hospital policy. 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.

It is incredibly unfortunate this situation occurred, especially at a time when our care teams are working selflessly and tirelessly to care for an unprecedented number of very ill patients. St. Peter’s Health has no other agenda than to provide the very best care for members of our community when they need us."

EDITOR'S NOTE: This story has been updated to include a full statement from St. Peter's Health.

Read the full report: