Employees at a Sauk City nursing home knew a registered sex offender was living there, but failed to prevent him from abusing three female residents, a state agency has concluded.
The Wisconsin Department of Health Services also determined two administrative officials at the Maplewood of Sauk Prairie nursing home attempted to thwart an investigation into the matter.
Those were just a few of the findings contained in a 110-page report the U.S. Centers for Medicare and Medicaid Services released Tuesday in response to a Freedom of Information Act request.
The DHS investigation identified nine federal violations and determined the nursing home placed its female residents in immediate danger by failing to keep tabs on a registered sex offender who lived there.
Paul Fiscus, Maplewood’s administrator and one of two officials accused of attempting to curtail the DHS investigation, said he couldn’t discuss specifics due to the nature of the situation and confidentiality laws.
“Currently, we have reviewed and responded to the preliminary findings and will continue to work closely with the Department of Health Services to advance our shared goal of protecting the health and wellbeing of our residents,” Fiscus wrote in a prepared statement.
The nursing home has developed a corrective action plan to prevent similar problems in the future. The document also contests several DHS findings, including that administrative staff tried to bully employees in an effort to stifle the probe.
Centers for Medicare and Medicaid Services spokeswoman Elizabeth Schinderle said the next step in the investigative process will be an unannounced revisit at the nursing home.
‘We all knew’
Police were called to Maplewood on May 9, the day after a female resident told staff that 69-year-old Galen J. Malisch entered her room and groped her. Officers removed Malisch from the facility, and a law enforcement investigation has since led to felony sexual assault charges against him.
The abuse allegations prompted DHS to open its own inquiry, which was conducted over 14 days beginning in mid-May. State investigators interviewed staff and reviewed documents.
Multiple employees said they had been aware for months that Malisch was listed on the Wisconsin Sex Offender Registry. One told an investigator that “we all knew.”
A Maplewood social worker said she informed Fiscus and the facility’s nursing director, Joni Blau, that Malisch was a registered sex offender “a few months” before the alleged May assault. She told investigators she assumed the two administrative officials would take action.
But in a separate interview, Blau denied the social worker’s account, saying she did not become aware that a sex offender was living at the nursing home until after the May incident.
The DHS report does not make clear whether investigators asked Fiscus about the social worker’s statement, and he did not respond to a request for comment on that issue.
Staff also were aware of prior incidents involving Malisch and two other female residents, including one in which he reportedly exposed himself to a cognitively impaired patient and “attempted to lure” her. Employees who learned of the alleged crime in February didn’t report it to police, DHS found.
The nursing home — in its correction action plan — takes issue with the finding that it failed to report a suspected crime, noting the female patient was in Malisch’s area and was traveling away from him when the alleged luring occurred.
Based on interviews with multiple employees, DHS determined Fiscus and Blau attempted to intimidate staff and instructed them to limit the information they provided to investigators, “threatening them with their jobs if they said too much.”
The nursing home’s corrective action plan also disputes that finding. “Although no attempted or intentional intimidation of staff, as documented by surveyors, ever occurred in the facility, it appears that surveyors feel this is fact,” the action plan says.
The document says Fiscus and Blau have since received training “to facilitate a supportive, open work environment in which staff feel comfortable coming forward” with concerns.
Blau will participate in additional leadership training and the nursing home will monitor employee comfort levels to alleviate fears of retaliation. A non-management staff liaison will meet regularly with employees to ensure they can provide information in a non-threatening environment.
The report also says Fiscus apologized to employees for their “misconceptions” during an all-staff meeting. His apology was recorded so employees who did not attend the meeting could view it.
Police say an investigation that already has produced felony sexual assault charges against Malisch remains open, and has since been expanded at the request of prosecutors.
In response to a records request related to the felony cases, a Sauk Prairie Police Department representative said documents could not be released because they are part of an ongoing investigation that may produce additional charges.
“While we referred our initial investigation to the (Sauk County) District Attorney’s office for the prosecution of charges, the District Attorney requested that we continue and broaden our investigation,” Administrative Lt. Travis Hilliard wrote in a June 14 letter denying the Baraboo News Republic's request. “As such, the Department continues to conduct interviews.”