Report: Helena hospital had ‘systemic’ problems correctly reporting sex abuse allegations

A federal investigation found systemic problems in a Helena hospital that resulted in sexual abuse allegations against employees going undocumented for weeks or months. That's according to new reporting from Montana Free Press on St. Peter's Health.

Montana Public Radio's Austin Amestoy sat down with Montana Free Press Reporter Mara Silvers to learn more. He also spoke with St. Peter's Health CEO Wade Johnson following that conversation.

Austin Amestoy So Montana Free Press has been following this story at St. Peter's Health for more than a year, when a nurse at the hospital was fired after a patient accused him of sexually assaulting her a year earlier. Now, it seems that this federal investigation you guys found uncovered more than just that one case. What did you learn?

Mara Silvers Right, so this document basically describes four cases involving two staff members on different units in different parts of the hospital. And the details of one of those cases matches what we know about the events that led up to the firing of former St. Peter's nurse Aaron Gams in 2024. Gams is now facing a criminal charge of a felony assault against a vulnerable adult in that case, and he's pleaded not guilty to that.

But the federal inspection also linked that same staff member in that case, who they refer to as "staff member A," to another complaint of sexual assault that happened in April of 2024. So that allegation was shared with multiple staff members at the time, but it was not reported higher up the chain until after Montana Free Press reported on Gams' arrest roughly nine months later. There were also two descriptions of assault and inappropriate conduct towards patients by another nurse in the behavioral health unit, and federal inspectors said that those allegations were also never documented in formal complaints.

Austin Amestoy The main point of the federal report, Mara, was that these cases highlight what the report referred to as "systemic failures" within the hospital. What did investigators say those shortfalls were, exactly?

Mara Silvers Yeah, so I think what's important to keep in mind about a report like this from the Centers for Medicare and Medicaid Services is that this agency is responsible for examining hospitals and how those hospitals are functioning. So, it's the hospital that has to meet federal standards in order to be able to bill public health insurance programs. In that way, the report doesn't really litigate each of these accusations against the providers; the providers are kept anonymous. But what it really does is examine how those complaints were handled internally.

And the finding at its core was that the hospital had repeatedly failed to appropriately document these complaints. And I think the most alarming result of that documentation and investigation gap was that this nurse, staff member A, who had been accused by a patient of sexually assaulting her, stayed on staff for about six months until another patient from the year prior came forward to accuse him of assaulting her as well.

Austin Amestoy Has the hospital faced any consequences from this investigation?

Mara Silvers Yeah, so this inspection concluded in January of 2025, and when that happened, federal reviewers found reason to put St. Peter's in what they call "immediate jeopardy" status. And that designation basically put the hospital on the brink of losing the ability to bill public health insurance programs.

But within a couple of days, St. Peter's had submitted a plan for correcting all of its missteps, which basically involved retraining everybody on staff for how to deal with sexual abuse reports, and federal regulators accepted that plan and then dropped the immediate jeopardy status just within a week or so.

We should say that a follow-up inspection about six months after found the hospital was still in compliance with that correction plan.

Austin Amestoy And now this information's being reported by you guys and discussed another six months after that. So, it's been about a year since this investigation concluded. How is St. Peter's Health responding to your reporting?

Mara Silvers So unfortunately the hospital declined to make its administrators available for interviews with us for this reporting, and they didn't answer specific questions that we asked about timeline and when they knew certain things and how they handled certain cases.

But generally, the hospital said that it did take action to address the complaints that it was aware of, even if it didn't document the allegations correctly. A spokesperson for the hospital in a series of emails with us said that the hospital terminated the contract of the behavioral health unit nurse who was a traveling nurse and reported her to the state licensing board, and it said it fully cooperated with law enforcement when necessary, which could refer to the ongoing criminal case against Gams.

And besides that, we haven't heard anything more from the hospital since our story published on Monday.

Austin Amestoy Mara, thank you so much for sharing your reporting with us.

Mara Silvers Thanks for having me.

Wade Johnson Can I just start by saying that this situation is deeply troubling and painful for all of us. When I learned about these concerns that were inconsistent with our values and expectations, I took immediate action as I have always done since I've been here at St. Peter's. And the thought of any patient not being treated with respect is crushing to me and it's crushing to our entire team relative to the allegations.

I think it's important that people understand that we responded immediately when those allegations were made. The principal issue in the CMS report is related to documentation in the event reporting system. So, we have documentation of the investigations that we did. We took immediate action in addressing these situations.

Austin Amestoy Mr. Johnson, the CMS report indicates that on several instances, these allegations were not properly documented after the time they were made for weeks or months afterward within those requisite systems. What happened there?

Wade Johnson Yeah, so it's important to understand that the event reporting system is a system that we maintain internally that tracks information for our organization. When these allegations came forward, the first response was to investigate the issue and ensure that our patients were in the safest environment possible.

So, we investigated them immediately. We took action immediately. And then what we had learned through this is that our documentation into the system — into our event reporting system — lagged too long. And so that was an immediate change, and that's on us. That's something that we needed to fix, but relative to addressing the issue and following through these allegations, we took immediate action.

Austin Amestoy Mr. Johnson, the report indicates that that wasn't always the case at St. Peter's, though. There was a specific instance in reference to a 51-year-old oncology patient at the hospital who had reported an allegation of sexual abuse by a nurse in April of 2024. The report states that that allegation did not make it to high level staff until nine months later. So, why did that patient complaint take nine months to get there?

Wade Johnson Yeah, so that’s actually inaccurate. What took place relative to the patient concern — again, as soon as that patient concern was made, we responded and investigated that and at the time, one of the challenges that we had is that our policy respected patient choice. And in our investigation of that issue, the patient made an initial allegation and then withdrew the allegation. So, they must have been mistaken or confused. And at the time, our policy respected patient choice and we would not pursue an investigation further without a patient's consent in the matter.

And so, we did investigate that issue. We did follow through with that issue. Again, going back to the documentation challenge, that documentation in our event reporting system is actually what didn't make it into or get completed until a few months later, but addressing the issue with the patient in the moment absolutely took place.

Austin Amestoy Mr. Johnson, where was the documentation occurring at that time, if not in your event reporting system?

Wade Johnson So oftentimes, again, historically, when we approach an issue like this, our staff members will keep notes as they're working through things. There may be email communications between staff members or between leaders to address this; we had an additional system that works within our compliance space. So, we have a couple of different locations, and that was honestly — again, that was part of the problem that we have to own as an organization and did own and did correct. And that is, we need a single source of where this information goes in a timely fashion to ensure that we have all of the information in a place where CMS needs that to be.

Austin Amestoy Mr. Johnson, you mentioned that the reason that this wasn't logged in the event reporting system — the case of the 51-year-old oncology patient — was because your primary policy is to respect the patient's choice, basically, in pursuing that sort of action. The CMS report, though, does indicate that a staff member on your staff confirmed that there were no reports, investigations or resolutions made in that April 2024 abuse allegation by the oncology patient. And that seems to be, as the report states, out of line with the hospital's own internal policies. Was that correct?

Wade Johnson So one of the challenges that you have in going through the investigation and even looking through the report — and I'm assuming you've gone through it — is in not all of the staff members, when we review an issue relative to an employee and or relative to a patient, not all staff members are privy to the information relative to that review.

And, as you noted, the patient names and also the employees are coded in the report itself. Some of those employees were not intimately involved in the situation or in the investigation.

And so, you're not always able to capture that through the report that comes out in the end.

Austin Amestoy The employee of the hospital, at the center of this report that the oncology patient made, remained on staff treating patients for months after that report was made. Was there a deliberate decision made by the hospital to not pursue any sort of administrative suspension of that employee while the investigation you mentioned played out?

Wade Johnson As soon as we were made aware of the allegations against that employee, we reacted immediately and removed that employee from patient care when we became–

Austin Amestoy Mr. Johnson, when did that– when did that happen?

Wade Johnson When we became aware of the allegations and the concern, he was removed from the patient care setting.

Austin Amestoy And the report says that that happened in October 2024, but this first allegation was raised in April of that year. Was he removed in April?

Wade Johnson Again, going back to the initial allegation in April, that was the oncology patient to whom you're referring, correct?

Austin Amestoy Yes.

Wade Johnson That investigation — again, the patient withdrew their concern relative to the interaction that they had had with a staff member. So at that time, there was no further investigation that was done relative to the employees in that area.

Austin Amestoy So there was no period of time in April when the employee who was accused of committing sexual abuse was suspended from staff or service?

Wade Johnson Correct. We did not have an official issue that we could investigate at that time. So, we had respected the patient's choice in the matter.

Austin Amestoy Mr. Johnson, has St. Peter's Health since the events of this report were published, contacted any of the patients referenced in this report and asked them if their concerns have been addressed?

Wade Johnson So we have responded to any of the concerns that we have been made aware of through our investigation and through the work that we have done.

Austin Amestoy You guys have contacted the patients?

Wade Johnson Yes, we have.

Austin Amestoy Mr. Johnson, we answered all the questions I had for you today. Is there anything else you want to add on this subject?

Wade Johnson I work with 1,800 people who care deeply, who are all throughout our community, who work hard and who are deeply, deeply devastated by the acts of these two individuals. I think we have the opportunity to continue to demonstrate when we find something, we fix it, we take care of it. And we continue to work together to provide care for our community.