Patient comes forward about sexual relationship with psychiatrist Karl Strelnick 20+ years ago; will testify against him getting his job back following suspension

December 14, 2010

The Journal Sentinel spent six months investigating problems at the Milwaukee County Mental Health Complex. The newspaper found a cascade of problems, including a case where a patient with a history of violence was allowed to roam free, doctors orders were not followed and nurses falsified documents to cover their mistakes.

Another former patient of Karl Strelnick has come forward to say she had a longtime sexual relationship with the fired Milwaukee County Mental Health Complex psychiatrist during therapy sessions more than 20 years ago.

She is offering to testify against Strelnick next month when the county's Personnel Review Board considers his appeal to get his job back.

The woman, now a doctor in New York, also has sent a certified letter to the state's Medical Examining Board claiming that Strelnick violated medical ethics and should have his license revoked. She provided the Journal Sentinel with copies of both letters.

"As a former patient and as a physician and parent, I encourage you in the strongest possible terms to uphold the county's recommendation for dismissal," she wrote to the County Board.

A spokeswoman from the Personnel Review Board said she could not comment about a pending case.

David Carlson, communications officer for the state's Medical Examining Board, said the woman's complaint will be considered by a panel that screens complaints. That panel meets every month or so. If the panel finds merit, he said, the case will proceed to an investigation.

There is no time limit that would make the woman's complaints too old to be considered, he said.

Strelnick surrendered his license for two years in 1987 after admitting to having sex regularly with two other patients. His license was reinstated in 1989 and he was hired three years later by Milwaukee County.

The revelation of the third patient's claims renews questions about Strelnick, who has been working at the county's mental health hospital for 18 years. Last year, he made more than $174,000, records show.

Strelnick was suspended without pay in August after a Journal Sentinel investigation exposed his role in the case of a developmentally disabled patient who got pregnant at the complex in the summer of 2009, even though she was supposed to be given birth control injections.

At the complex, officials placed the woman down the hall from a known sexual offender, who was allowed to freely move around the ward - including leaving it - even as nurses signed forms saying he was being checked every 15 minutes. She was transferred to the ward supervised by Strelnick after it was learned she was pregnant.

The newspaper found officials failed to notify the woman's guardian of the pregnancy for weeks after the woman tested positive, a violation of hospital protocol. During that time, the woman remained on medications that have been found to be harmful to fetuses. Her baby was born in April with signs of life-threatening physical distress.

Four days after the newspaper reported its findings, county administrators removed Strelnick from his post. Strelnick is challenging the removal. His case is scheduled to be heard Jan. 25 by the Personnel Review Board.

Strelnick could not be reached for comment. He does not have a publicly listed telephone number or address. His lawyer, Lawrence Albrecht, did not respond to numerous requests for comment.

The investigation

In January, state and federal investigators found that medical staff at the complex did not have a clear policy on whether to allow sex between patients, including those accused of sexual assault. They declared patients at the Mental Health Complex to be in immediate jeopardy and threatened to cut off federal aid unless immediate improvements were made.

The federal Centers for Medicare and Medicaid Services placed a legal notice of the finding in a weekly community newspaper. The Journal Sentinel obtained copies of the reports through open records laws, after the county refused to release them.

Immediate danger is considered the most serious violation. Strelnick was also involved in an earlier case that prompted the same finding.

In 2006, Cindy Anczak, 33, died of complications of starvation. The state Department of Justice launched an investigation into the death after details were reported in the newspaper.

Strelnick was transferred to the hospital's long-term care units for patients with developmental disabilities, including mental retardation and dementia.

Since then, the county has paid a private lawyer more than $300,000 to defend the county against that investigation and a possible wrongful death lawsuit by Anczak's family.

The lawyer, Mark Cameli, continues to represent the county, though the state closed its investigation and the dead woman's family has not filed a lawsuit. County administrators commissioned an $80,000 report in 2008 on patient safety at the complex but refused to release it, even to the county's own auditor.

Gerald Heer, the auditor, eventually was allowed to see the report on the condition that he describe only the general findings to County Board's Judiciary Committee in a closed session. Details are to remain confidential.

The woman's story

The New York doctor first contacted the Journal Sentinel in October. She said decided to come forward after reading the most recent Journal Sentinel articles about problems at the mental health complex.

Soft-spoken and pensive with wire-rimmed glasses and graying hair, the woman said she first saw Strelnick in 1982. She was 24 years old and enrolled in medical school at the University of Wisconsin-Madison.

"I had been suicidal," she said in a recent interview.

The Student Health Service referred her to Strelnick for treatment, she said. She had been sexually assaulted years earlier and was prone to depression, she said. Strelnick was in private practice in Madison at the time.

"They told me he was good for patients with my condition," she said.

The Journal Sentinel does not name victims of sexual assault. The newspaper verified that the woman is a licensed doctor and attended medical school in Wisconsin in the years she described.

The woman said the relationship began professionally but turned sexual after about a year and a half.

"I was in his office, talking about my problems with intimacy, and he had me sit on his lap," she said. "It just kind of took off from there."

For the next three years, nearly every meeting in his office involved sex with him, she said.

"He told me it was good for me to be wanted in that way," she said.

Strelnick charged her for the sessions.

Her description of the therapy sessions is similar to accounts given by the other women in depositions they gave in preparation for a lawsuit against Strelnick.

In all three cases, the women said they engaged in sex with Strelnick during sessions in his Madison office and were charged for the sessions.

One woman sued, and in 1989 a jury awarded her $1.13 million. That award was reduced on appeal to $750,000.

The other woman dropped her claim. She told the Journal Sentinel earlier this year that she didn't think it was necessary to keep her lawsuit going as long as Strelnick was barred from practicing psychiatry.

All three women said they knew that Strelnick was married, and they felt guilty for having sex with him, but they were confused and did not tell anyone. Strelnick and his wife have since divorced.

The women did not know about each other, they said.

The New York woman's sessions with Strelnick ended in 1987 when Strelnick told her he was losing his license for having sex with two other patients.

"I was devastated," she said.

Starting a new life

Ultimately, she moved out of Wisconsin and started her own medical practice. She is now married with children.

She has not had contact with Strelnick since, she said, though she remains curious about him. She said she goes on the Internet from time to time to check up on him, she said.

She saw the stories in 2006 about Anczak's death from complications of starvation and found them disturbing.

"I felt very sorry for her, but I didn't really relate to her," the woman said.

It was only when she read about the pregnant woman last summer that she decided to come forward.

"It has haunted me," she said. "When I read what happened, the hairs on the back of my neck stood up."

She said she was struck by how vulnerable the pregnant woman was.

"The health care system was supposed to keep her safe," she said. "Instead, it put her at risk in a million different ways."

The case reminded her of what she went through, she said.

"A lot of things did not go well for me in my teens and 20s," the woman said. "There were many opportunities for the system to help me, too, and it didn't. That's a great reason why I went into medicine."

Since reading the articles, the woman said, she felt compelled to come forward.

It was as though she had a complete conversion, she said.

"It crystalized immediately," she said. "For the first time, I saw how wrong all of this was."

Strelnick's past

Strelnick, 61, first got into trouble with his practice in 1984 for failing to provide proof that he completed the required continuing medical education requirements as he had claimed. After the two-year suspension for sexual misconduct, Strelnick's license was reinstated in 1989 with 10 conditions attached.

For instance, he could not treat women. His patients had to be seen in an institutional setting. He could not practice any form of intensive or in-depth psychotherapy. He was not allowed to do psychotherapy of any nature with severely disturbed individuals.

Strelnick was ordered to undergo therapy. He was under the care of a psychiatrist in Madison named Leigh Roberts. Roberts surrendered his license in 1989 after he, too, admitted having sex with a patient, state licensing records show.

Strelnick was hired by Jon Gudeman, then director of the county's Behavioral Health Division, in 1992. Gudeman promised to supervise Strelnick and urged the Medical Examining Board to allow Strelnick to treat women. But the board repeatedly refused.

At the time, two state lawmakers, Barbara Notestein and Jeannette Bell, called the hiring "an outrage."

"The hiring of Dr. Strelnick is absolutely unbelievable," the two wrote in a letter to Gudeman. "His re-licensing is abhorrent."

Gudeman, who retired from the county in 2002 and is in private practice, said he carefully monitored Strelnick.

"They brought him back very slowly and with all kinds of conditions," Gudeman said in an interview last summer. He called Strelnick "a good doctor."

In 1997, after repeated requests by Gudeman, the state examining board removed all restrictes on Strelnick.  He was again able to treat female patients without supervision.

Source: Meg Kissinger, "Psychiatrist faces new sex accusation," Milwaukee Journal-Sentinel, December 12, 2010.


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