Wisconsin: City Staff Say STD Case Outsourcing Was "Horrible Public Health"

The outsourcing of STD treatment in Racine led to "horrible public health" practices before it was ultimately suspended, according to some city health department officials. From January 2008 to May 29, 2009, the city contracted STD treatment out to the Racine Family Medicine Center, which does not specialize in STDs.

"Some of the doctors just didn't strictly follow the CDC guidelines" for dealing with STDs, said Jeff Schmidt, the epidemiologist who oversees STD treatment in Racine. Some patients did not receive proper screening; others reported being told that HIV and syphilis testing were not available; and some patients and their partners went untreated, city health officials said.

"This is horrible public health," Michele Breheim wrote in a February 2008 e-mail to Janelle Grammer, the city's public health administrator. Grammer faced a termination hearing on Wednesday, during which the e-mails were made public, amid allegations she failed to provide leadership and fostered poor department morale. She was suspended without pay last month.

One female patient reportedly had sexual contact with a person who had gonorrhea but was allegedly told she "looked clean" and left untreated, Breheim said. "Now the partner needs re-treatment," Breheim wrote in another February 2008 e-mail. "I don't know how many people he has re-infected."

Schmidt said he did not think Racine Family Medical Center was at fault, but that "there was a lot of miscommunication in there." It was hard to keep all the center's physicians aware of the guidelines, he said.

Grammer asked Schmidt under cross-examination if he was aware of the department's budget constraints. Outsourcing treatment was not Grammer's first choice, but she faced many competing challenges, she said.

Racine has re-hired its former clinic nurse and given her a raise, and now the city is back to treating STDs again, Schmidt said. "Give us a year and maybe we'll be able to tell" if treatment has improved, he said.

Back to other news for June 2009