Milwaukee's city-run clinic returns to full range of testing for sexually transmitted diseases

Mary Spicuzza | Milwaukee Journal Sentinel

Milwaukee's city-run health clinic is again offering a broad range of testing for sexually transmitted diseases.

The change follows heavy criticism from doctors, nurses and public health advocates, who expressed outrage over limits placed last week on Keenan Health Center, the only city-run clinic that provides free, confidential STD testing and treatment.

"We're very pleased that it is in operation for full exams because there is a need in our city, and we want to do everything we can to meet that need," Milwaukee Mayor Tom Barrett said.

The clinic, at 3200 N. 36th St., returned to providing a full range of STD testing services Thursday, one week after the restrictions took effect.

The clinic's services again include pelvic exams for women, as well as "swab" tests. Both procedures can help quickly diagnose STDs with serious, long-term health consequences. Pelvic exams are especially crucial in diagnosing pelvic inflammatory disease, which can lead to infertility and other complications.

The clinic sees as many as 5,000 individuals annually, with African-Americans representing the majority of clients. The city has been providing STD testing for nearly 30 years.

Milwaukee has some of the worst rates of sexually transmitted diseases in the country. The Milwaukee area ranked first in the nation in gonorrhea rates and fourth in chlamydia; and it has among the highest rates of HIV among men of color under the age of 25.

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The Milwaukee Health Department dramatically scaled back testing for sexually transmitted infections earlier this month following a directive from interim Health Commissioner Patricia McManus.

McManus at the time raised concerns the clinic nurses were conducting tests outside the nursing scope of practice. The clinic closed Aug. 8, then reopened the next day under the scaled-back orders.

But on Monday, the city attorney's office issued a written opinion concluding the procedures performed by nurses at the city's Keenan Health Center "do not endanger or threaten the health of the people."

The opinion, which was signed by City Attorney Grant Langley and Assistant City Attorney Benjamin Roovers, cited the state's Standards of Practice for Registered Nurses and Licensed Practical Nurses, known as Chapter N 6.

It also noted that the city attorney's office had reached its conclusion after consulting with Geof Swain, medical director at the Health Department.

"It would also be reasonable to conclude that the medical procedures RNs were performing at Keenan meet all of the requirements of 'delegated acts' laid out in Chapter N 6, and do not endanger or threaten the health of the people," the opinion read.

That same day, Barrett called on the clinic to again provide a full scope of services.

Ald. Khalif Rainey also called for the clinic to return to its previous practices.

"The clinic’s nurses are most effective in battling the problem when they are allowed to fully perform the pertinent procedures and practices allowed under state code, and I urge Dr. McManus to make sure they are allowed to do so," he said.

Over the last week, there was an outcry from many in the medical community who criticized the limits and warned of dire consequences if they were not reversed.

Kim Litwack, dean of the College of Nursing at the University of Wisconsin-Milwaukee, wrote to aldermen Tuesday criticizing the move to limit STD testing, saying she read the Journal Sentinel article about Milwaukee scaling back services with "horror and anger."

"There is a major problem with the statement involving the nurses working outside their scope of practice. The RNs were working within their legal scope of practice," Litwack wrote.

She added that the limiting STD testing was "not necessary, and more importantly, puts the citizens of Milwaukee at risk unnecessarily."

Sheldon Wasserman, chairman of the Wisconsin Section of the American College of Obstetrics and Gynecologists, warned in a letter to the editor of the Journal Sentinel that placing such limits on clinic nurses as Milwaukee faces some of the worst STD rates in the nation would make the city a "laughingstock."

"By preventing nurses from performing STD testing, it is unknown how many hundreds of cases will go undiagnosed. Such practice would leave women and men in our community at risk of suffering short and long-term consequences, and would result in our crisis situation in Milwaukee in becoming even worse," wrote Wasserman, who is also a Milwaukee County supervisor. "Clinic nurses must be able to properly test for STDs in order to prevent an epidemic situation in Milwaukee from spiraling even further out of control."