AUGUSTA — Staffing and space issues continue to plague the state’s Riverview Psychiatric Center, says a report issued Tuesday by Daniel Wathen, the former chief justice of the Maine Supreme Judicial Court.
Wathen, who was appointed to oversee the consent decree the state entered into over its treatment of mental health patients in its custody, files quarterly updates on conditions at Riverview in Kennebec County Superior Court.
Wathen’s report says that while the Maine Department of Health and Human Services, which operates Riverview, has made significant strides to alleviate staff shortages and improve employee morale, the center still doesn’t have enough nurses on its staff and lacks the bed space needed to treat patients, who are often being held in county jails.
The report comes as Gov. Paul LePage and legislative Democrats negotiate an agreement that would allow a new 21-bed secure facility to be built on the grounds of Riverview in Augusta.
Democrats on the Legislative Council, the governing body for the Legislature, have twice blocked approval of the facility, saying the plans to construct, operate and fund it have never been fully vetted. Under state law the council must approve any new construction on state property within the Capitol Area of Augusta. That includes the Riverview campus on the east side of the Kennebec River.
LePage, in his weekly radio appearance Tuesday on WVOM in Bangor, said he intends to press forward with his administration’s plans to build and privatize the new facility – with or without the Legislature’s consent.
The consent decree, reached in 1990, covers “all persons who on or after January 1, 1988, were patients at the Augusta Mental Health Institute and all persons who will be admitted to the Augusta Mental Health Institute in the future.” Riverview, which opened in 2004, replaced the Augusta Mental Health Institute.
During the three-month period from September to November, Wathen wrote, the waiting list for admission to Riverview averaged nine patients but at one point recently reached a high of 16 patients.
The new facility would be for forensic patients who are undergoing psychological evaluation for the criminal justice system or have been found not criminally responsible by the courts, but who no longer require hospital-level care. The proposal is meant to free up bed space at Riverview and resolve one of the issues that led to the state’s losing its certification with the federal government, along with about $20 million a year in federal support for the hospital.
The federal agency that oversees Riverview’s funding revoked the hospital’s certification in 2013 after regulators found many problems during an audit, including the use of stun guns, pepper spray and handcuffs on patients, improper record-keeping, medication errors and failure to report progress made by patients.
The federal agency, the Centers for Medicare & Medicaid Services, also determined that Riverview was improperly commingling patients who needed intense hospital treatment with those who no longer required hospitalization.
“For quite some time it has been evident that Riverview has insufficient capacity to deal with the number of clients requiring its services,” Wathen wrote. “Although there are waitlists for admission on both the civil and forensic side of the hospital, the most pressing need for additional capacity is presented by the forensic clientele.”
He notes that some forensic patients have been sent to the state’s second secure mental health hospital, the Dorothea Dix Psychiatric Center in Bangor.
He reported that at the start of 2016, Riverview had vacancies in 23 of its 87 nursing positions and that the hospital’s nursing vacancies still average in the mid- to high teens. Wathen also pointed to a dependence on temporary psychiatrists and staff, noting that long-term relationships between doctors and their patients can be critical to successful treatment for the mentally ill.
Wathen’s report acknowledged the ongoing negotiations between legislative leaders and LePage, but he also highlighted the importance of rapid action, saying “the need for increased capacity at Riverview remains evident and urgent.”
He added that if a new facility is built and privatized, it would be held to the same standards of care under the consent decree as Riverview and Dorothea Dix.
The top staffers for Senate President Mike Thibodeau, R-Winterport, and Speaker of the House Sara Gideon, D-Freeport, met Tuesday to discuss the Riverview addition but had not determined the next step.
Last week Gideon said she was hopeful lawmakers would have their questions answered and that there would be movement forward on the new facility before the Christmas holiday.
The Augusta Planning Board approved the new facility during a meeting in October.
Also now in the works is a new bill by Rep. Ellie Espling, R-New Gloucester, the assistant House minority leader, that would remove the requirement in state law that calls for the Legislative Council to approve new construction in the Capitol Area.
Espling said the law change is necessary so that decisions on the construction of new state facilities in Augusta cannot be politicized by the Legislature. Espling said the need for the council’s approval is unnecessary as both local officials and the state’s Capital Planning Commission are required to approve construction projects in the area.
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