Earlier this year, staff at Ascension Columbia St. Mary’s hospital on the East Side heard news that every caretaker fears: a patient had died. According to a nurse familiar with the case, the man, who was elderly and diabetic, had come in for an amputation in the fall of 2022. He showed early signs of dementia and required additional care and attention from hospital staff as he recovered from surgery.
It’s time to pick your Milwaukee favorites for the year!
In the weeks following his amputation, the man developed bedsores. “He would refuse to turn over unless you took the time to explain things to him,” says the nurse, “but no one had the time because we were so understaffed.” The sores got worse and led to a staph infection, an extremely contagious bacteria. That bacteria, in turn, triggered sepsis, a dangerous and extreme response to an infection.
In early 2023, he was still in the hospital. The man, who had long struggled with breathing issues, was diagnosed with lung cancer, but because he was still fighting sepsis, he was not eligible for chemotherapy or radiation treatment. Six months after his amputation, he died in hospice care.
His was a complex case, but the nurse – who, like many sources cited in this story, spoke on condition of anonymity for fear of reprisal – believes Ascension’s staffing policies at the very least left little room for dignity in the patient’s final months. “He died all alone,” says the nurse. “It was devastating.”
LATE LAST YEAR, Milwaukee Magazine published an investigation into Ascension Columbia St. Mary’s hospital, long considered one of the city’s premier health institutions. The report detailed how systemic staffing shortages had led to issues in patient safety causing dozens of doctors, nurses and surgeons to leave the hospital, fearing for their patients and careers.
Three months after MilMag’s digital report and one month after it appeared in the February issue, Ascension Wisconsin saw a sweeping leadership shakeup, including the replacement of Bernie Sherry, a senior vice president who had overseen Ascension Wisconsin since 2016. The hospital system also weathered inquiries from Milwaukee Common Council members and a demand for transparency and answers from U.S. Sen. Tammy Baldwin, who cited MilMag’s report in her inquiries to Ascension CEO Joseph Impicciche.
Most recently, State Sen. Chris Larson, D-Milwaukee, proposed a bill that aims to establish a statewide minimum of nurse-to-patient ratios and limit shift hours in hospitals across Wisconsin.
“We had been working with a number of nurses who had become increasingly frustrated,” says Larson. “The horror they felt, you could see it in their faces. I can’t imagine working in an environment where it’s just a matter of which landmine you’re going to step on that day.”
The problem is a national one, says Larson, who hopes to set a hearing for the bill in coming months. Locally, says Larson, some of the loudest voices raising the alarm came from within the Ascension Wisconsin network. “It’s clear that there’s not enough other workers to actually get the job done,” Larson continues. “These nurses are doing this because they want to help. But that’s very much being taken advantage of by hospital administrators and those who seek to use health care as a huge profit-producing machine.”
MILMAG‘S ORIGINAL INVESTIGATION on the crisis at Ascension Columbia St. Mary’s reported how severe staffing shortages had led to staff concerns around patient safety. In interviews, nearly a dozen current and former employees reported a chaotic work environment where nurses were overworked, safety and sterilization protocols overlooked, and where patients were left in potentially dangerous positions both in the operating room and while recovering from surgery.
“It’s clear that there’s not enough other workers to actually get the job done.”
– State Sen. Chris Larson, D-Milwaukee
In the year since, Ascension nurses, doctors and hospital staff report that little has changed. Nurse shortages, they say, have only gotten worse, though Ascension points to improved recruitment and retention. And while management assured changes in the wake of the investigation, hospital employees across Ascension Wisconsin say those promises now feel empty.
As one former Ascension surgical tech put it: “After last year, I thought we had hit rock bottom, but it turns out there is no bottom.”
ONE FORMER NURSE who worked at Ascension St. Francis Hospital from 2016 to 2021, when she left the health care industry, has remained an Ascension patient and was being treated for a kidney infection last summer at Ascension’s Ozaukee Campus in Mequon. But she became furious when she was told she would need to be transferred to Columbia St. Mary’s. “I absolutely did not want to go,” recalls the woman, who delivered her first child at Columbia St. Mary’s in 2013 and describes the experience as traumatizing. “I had the worst experience of my life at that hospital, and I never wanted to go back.”
As a first-time mother, she says, she craved guidance and explanation while pregnant but received little from her doctor at the time. She left many appointments in tears and fearful of both labor and the birth of her baby. She delivered that son successfully and now receives care at Ascension’s Ozaukee campus, a 45-minute drive from her home. “I make that drive for every appointment because everyone at Columbia St. Mary’s is overworked. No one cares. You’re just another number.”
But last July, when a kidney stone developed into an infection – while she was once again pregnant – the woman ended up back in the hospital she was trying to avoid. The infection put her at high risk for preterm labor, and Columbia St. Mary’s has a Neonatal Intensive Care Unit.
After three days in the hospital, she was sent home and then received a prescription of antibiotics. She returned to Columbia St. Mary’s over a week later, this time with what she was sure was a urinary tract infection, which can raise the risk of high blood pressure for pregnant women. Despite her symptoms, she says, no one diagnosed the infection. “I was begging to be taken seriously,” recalls the woman, who eventually got a proper diagnosis. “It took blood, sweat and tears to get proper treatment. And I’m a nurse. To me, it confirmed that this is a hospital that does not care about its patients.”
Her experience is not an isolated one. The Spring 2023 Leapfrog Hospital Safety Grade report, a national grading system meant to inform patients on facility safety, gave Ascension Columbia St. Mary’s a C rating overall. (The hospital advertises itself as “one of the top 100 hospitals in the country.”) The Leapfrog report, which divides its rating into categories including Infection, Safety Problems and Practices to Prevent Errors, rates the responsiveness of staff to patients as “worse than average.”
“After last year, I thought we had hit rock bottom, but it turns out there is no bottom.”
– Former Ascension Surgical Tech
One reason for that, says one Ascension nurse, is a workload that stretches employees far too thin – an issue raised repeatedly to MilMag more than a year ago. “We’ll work 18-hour shifts with up to eight patients when we’re only supposed to have half that number,” says the nurse. Understaffing has meant that there is often no one to take over patient care at the end of a 16-hour shift, the nurse says. “If we leave without giving a report to the next nurse, that’s patient abandonment.” By contrast, at St. Francis Hospital, where the nursing staff are unionized, nurses can only be kept for a total of 14 hours, which union leaders argue is still too much.
The grueling hours add up. “It completely burns you out, which means you can’t do your job,” says the nurse. “It makes you feel incompetent.”
An Ascension Wisconsin spokesperson says that nurses at Columbia St. Mary’s are never required to work 18-hour shifts and that nursing leaders at the hospital “have been diligently working to overcome the national shortage of caregivers that has impacted health systems across the state and country. These efforts have helped increase our nursing retention rate by 5% the first half of the calendar year – and this continues to improve month over month.”
THE ENVIRONMENT at St. Francis on Milwaukee’s South Side is also dire, says one Ascension nurse. “If I were to describe it in one word,” they say, “it would be horrible.”
Ascension closed the birthing unit at St. Francis in December 2022 – a decision that was met with protests from hospital staff and members of the Milwaukee Common Council, who expressed concern about the lack of access to maternal and neonatal care for South Side communities. But multiple employees have shared concerns about the direction of the broader hospital as well.
According to several Ascension employees, patients who show up at either the Franklin Hospital or St. Francis emergency departments after hours or on weekends may not receive the care they need. “If you walk into St. Francis and you’re having an active [heart attack] and it’s five o’clock on a Friday, you’re getting transferred to Columbia St. Mary’s,” says one employee. That’s because St. Francis no longer keeps its cardiac catheterization lab (cath lab) open after regular business hours, a change that took effect in 2021. “That means you’re at the liberty of how fast an ambulance can arrive. What if there isn’t one available? That’s not safe for patients.”
According to an Ascension spokesperson, this decision is not an uncommon one: “Centralizing complex care – like cardiac surgery and high-acuity [severe or urgent] cath lab services – is a model followed by most advanced heart programs across the country.” The safest action for a patient experiencing a life-threatening medical emergency, the spokesperson says, is still to call 911: “All of our emergency departments are ready to care for emergencies.”
Emergency transfers between Ascension campuses are rare, but the risks are high. Columbia St. Mary’s is 15 minutes away from St. Francis and 25 minutes from Franklin by ambulance with no traffic. And the cumbersome transfer process requires finding an empty hospital bed and a Columbia St. Mary’s doctor who can take care of the patient, a challenge at the East Side hospital where beds are often in short supply. “You’re just waiting for something to go wrong,” says the Ascension employee.
IN RECENT YEARS, many hospitals across the country have trimmed staff due to financial losses, high material costs and a tight labor market. Ascension Wisconsin hospitals are no exception.
But a year after the hospital system first came under fire for staffing shortages, employees say conditions at the East Side hospital have not improved much. “We’ve lost so many good people,” one former Columbia St. Mary’s nurse says of the exodus of medical staff the past few years. “Nobody wants to stay there. We stay for our patients, but everyone has their limits.”
Read MilMag’s first Ascension Columbia St. Mary’s investigation.
