A legislative probe into the involvement of public officials over the treatment of a COVID-19 patient at St. Peter’s Health in Helena provided new details into the dispute and identified Public Service Commissioner Jennifer Fielder as one of the officials involved.
The Montana State News Bureau previously reported the primary agency involved was the Attorney General’s Office, including Attorney General Austin Knudsen and his deputy, Kris Hansen.
A summary a probe by the state Legislature's special counsel confirmed Fielder's role. Fielder left a voicemail with the Helena hospital, suggesting it would be subject to litigation if “this doesn’t turn out well” after stating the patient had a right to try ivermectin and hydroxychloroquine, two drugs not approved for the treatment of COVID-19.
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In October St. Peter’s said three public officials “harassed and threatened” its providers who declined to administer treatments that are not authorized, clinically approved or within FDA guidelines to treat COVID-19 to a patient who requested them.
The Attorney General’s Office maintains Knudsen and Hansen did not threaten anyone, and Knudsen called his discussion with hospital executives “cordial.” According to the report from special counsel Abra Belke, Hansen discussed “legal ramifications” with the patient’s health care providers. Belke said in her report the hospital did not provide any specific examples of threatening language, though her powers as counsel are limited to obtaining government records.
Fielder has not returned several messages from the Montana State News Bureau seeking comment on the matter, including a voicemail left Tuesday.
All three officials are Republicans, while the patient, who has since died, was a prominent member of Republican groups in Montana.
The report contains text messages between Knudsen and hospital executives, emails with St. Peter’s attorney and a brief correspondence with Fielder. The document clarifies Montana law does not grant the special counsel the power to make findings of fact or conclusions of law.
House Speaker Wylie Galt and Senate President Mark Blasdel, both Republicans, issued a statement late Monday that addressed the attorney general’s role in the incident, but not Hansen or Fielder.
The GOP lawmakers said the report “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.”
Galt and Blasdel also said the “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 report does not, however, include reactions of the other two hospital officials on the call with Knudsen, including Chief Medical Officer Dr. Shelly Harkins and a hospital board member, nor does it include how the providers who spoke with Hansen interpreted her mention of “legal ramifications.”
Democratic leadership said in a Tuesday morning press conference the report “clearly” showed acts of intimidation by the attorney general and his deputy, as well as Fielder. House Minority Leader Kim Abbott and Senate Minority Leader Jill Cohenour said the information contained in the counsel’s report was more limited than they had requested, with several key items missing, such as any documentation of Hansen’s phone discussion with the patient’s doctors.
“The deputy attorney general threatened those legal ramifications, the attorney general also threatened to get law enforcement involved, former Sen. Fielder also threatened legal action to the hospital,” Cohenour told reporters. “So I don’t believe that there is any insinuation here that the AG has been cleared of any wrongdoing, at all.”
Cohenour also described the attorney general’s explanations for his office’s involvement as “revisionist.”
The Montana Department of Justice and Attorney General’s Office has said it was investigating “serious allegations” of patient mistreatment related to reports from the patient’s family that the hospital had, among other things, refused to allow her to receive certain medications. The family additionally claimed the hospital did not deliver legal documents related to the patient’s power of attorney. The family also reported they were not allowed to see the patient, whose text message communication had also been cut off.
The AG’s Office said late Monday the report confirmed their previous statements.
“No one at the Department of Justice threatened anyone while trying to get to the bottom of allegations reported to us,” Kyler Nerison, a spokesperson for the Attorney General’s Office, wrote in an email.
Nerison declined to answer a follow-up question asking for a distinction between a threat and Hansen discussing “legal ramifications” with a provider, or the attorney general telling the hospital board member in a text that his patience was “almost gone” and he was on the cusp of sending law enforcement to the hospital and filing charges.
Nerison also declined to answer a question seeking the status of the department’s investigation into allegations made by the family. Hansen dispatched a state highway patrol trooper who took the family members' statements at the hospital and relayed their responses to the Lewis and Clark County attorney, who said there was no foundation to pursue an investigation.
As long as the investigation is ongoing, certain materials related to the incident remain sealed as confidential criminal justice information, Belke noted.
The report includes text messages sent by Knudsen to Mark Taylor, a lobbyist for the Montana Hospital Association who sits on the St. Peter’s Board of Directors. The report does not specify the date of the exchange.
Knudsen wrote Taylor that a patient was being “denied her preferred informed treatment.” The attorney general also said the patient was being denied access to visitors and a power of attorney form, as well as the ability to leave.
“I’m about to send law enforcement in and file unlawful restraint charges,” Knudsen texted.
After Taylor said he’d make inquiries, Knudsen said he wanted a fast response.
“This has been going on since yesterday and I was hoping the hospital would do the right thing. But my patience is almost gone,” Knudsen wrote.
Belke’s report says the hospital’s “counsel confirmed a delay” in the delivery of legal documents. However, in a text message to Knudsen included as an appendix to the report, the hospital’s CEO Wade Johnson said he had “ensured the appropriate legal documents were indeed in place and that no undue delays were created on our end.”
The special counsel’s report also says the patient’s advocate expressed concerns to Hansen the hospital had cut off communication and wasn’t providing “alternative medication” prescribed by outside medical providers. Fielder’s letter to Belke, included in the report, identified those medications as ivermectin and hydroxychloroquine.
Johnson’s text to Knudsen said the family was made aware of methods to communicate, as well as “how the family can provide alternative medications to the patient that are not clinically approved for that use or able to be administered by our staff.”
In saying that Knudsen didn't threaten anyone, both GOP leadership and the AG's office pointed to Knudsen’s call with hospital officials. Reverberations of his text message, however, were felt by the hospital’s doctors.
Dr. Dana Osborne, a general and robotic surgeon at St. Peter’s Health, said in an interview Tuesday the fallout from the dispute has harmed her and her colleagues. She was on-call in the emergency room the evening Knudsen sent the text to Taylor.
“If you could pick one thing that was the absolutely 100% most perfect thing to not do, threatening us with arrest for doing our jobs, that was it,” Osborne said, briefly pausing while crying. “My dog in this fight is my colleagues. To see how much wind was taken out of their sails when there wasn't much to start with ... "
That, combined with the year-and-a-half stress of the pandemic and increasing hostile actions toward health care workers over COVID-19, was too much, Osborne said. Still, she said doctors want nothing more than their patients to get better and feel each loss personally.
“It’s like you’re doing everything. You’re staying afloat, you got your head above water, you’re dealing with all these patients who refused to get vaccinated, you have down what you’re going to say to them and how you’re not going to use ivermectin and you’re surviving and you’re surviving this pandemic and then someone throws you a lead balloon and you’re just not able to tread water anymore," Osborne said. " … It was just to the point where we’ve been dealing with this, we’ve been trying to survive it and (then) to be threatened with arrest for doing our job.”
St. Peter’s has not withdrawn their statement that “several providers were contacted by three different public officials ... regarding the treatment of a patient in our care. These conversations were deeply troubling to our physicians and staff because they were threatened and their clinical judgement was called into question by these individuals.”
In response to questions sent to the hospital Tuesday, a spokesperson said “St. Peter’s Health is currently reviewing the report that was released (Monday) night.”
The report states Fielder left a three-minute voicemail with the hospital’s risk management office on Oct. 11.
In the message, Fielder first identified herself as a state senator, but later clarified she's a former legislator. Fielder is now a state public service commissioner.
In a letter to Belke, Fielder said her involvement was not an “agency matter” and therefore she had no government records related to it. Lee Newspapers has also made a request for Fielder’s records.
Fielder, the report states, advised the recipient of her voicemail that she didn’t think “the senators will be too happy to hear about what’s going on with [the patient’s] case at St. Pete’s right now.”
Fielder additionally noted her voicemail should not be erased, because “if this doesn’t turn out well there will be a suit.”
Belke said she had no authority to investigate the matter further and took Fielder at her word that no additional government records exist.
After initial reports of the dispute, Lewis and Clark County Sheriff Leo Dutton told news outlets he had concerns with the attorney general dispatching the highway patrol to the hospital, which lies in his jurisdiction.
Dutton on Tuesday said he and Helena Police Chief Steve Hagen spoke with Knudsen following the incident about their concerns that Knudsen overstepped his authority. Dutton called the meeting “good and productive,” but referred questions about the details of that conversation to Knudsen. Knudsen’s spokesperson declined to answer questions about it.
Dutton added that “sheriffs around the state are extremely interested in that meeting.”
The Department of Justice has made several different claims about its jurisdiction to send a trooper, initially pointing to two different segments of state code and later its Medicaid Fraud Control Unit.
During Belke's investigation, however, the department changed its explanation again to say highway patrol are “duty bound” to investigate claims of patient mistreatment in their role as “community caretakers.”
Belke cites Montana case law in the report that says law enforcement officers have a duty to promptly investigate “situations in which a citizen may be in peril or need some type of assistance.”
In this case, the trooper did not enter the hospital, and only spoke with the patient’s family in the parking lot before leaving the area.