AUGUSTA — Safety and treatment concerns at Riverview Psychiatric Center are bringing an inspection by the court master who oversees a consent decree governing how the state must treat those with mental illness.
Court Master Daniel Wathen, a former chief justice of the Maine Supreme Judicial Court, laid out plans for the visit in his latest progress report on how the state is complying — or failing to comply — with requirements of that decree.
Additional Images
Wathen's concerns
Court Master Daniel Wathen lists concerns at Riverview Psychiatric Center, the state’s forensic hospital, in a progress report:
• Lack of certification and therefore loss of federal funding
• Operation at 85 percent of capacity or less, but with waiting lists for both forensic and civil beds
• Higher staff turnover rate plus a reorganization in progress under an acting superintendent
• Forensic patients being housed among civil patients
“To be fair, the current operation of Riverview Psychiatric Center can only be characterized as troubling,” Wathen said in the report that was made public Monday.
The 92-bed hospital — the only forensic hospital in the state — lost its certification by the Centers for Medicare and Medicaid Services a year ago and was most recently denied recertification as a 72-bed hospital in late June. The loss of certification will cost the state an estimated $20 million annually although the state has appealed the withdrawal of certification.
Wathen said his visit will be a formal one, and he has requested material in advance.
“It should be a fairly thorough evaluation of the state of the hospital at that time,” Wathen said. “The goal is to see if there’s recommendations that can be made that will assist the department with coming into compliance. It’s not an adversarial type of thing. It’s designed to be helpful to the reorganization process and not antagonistic.”
Wathen said some of the items he intends to look at would be the hospital’s management changes, such as with the superintendent following the March ouster of Mary Louise McEwen, who was replaced by patient advocate Jay Harper. He also wants to examine the response to the Centers for Medicare and Medicaid Services concerns over treatment plans and the effort to restore forensic patients to two units rather than three. Forensic patients are individuals with crime-related charges.
The hospital in Augusta also has been the scene of a number of attacks by patients on staff members. Among the most recent was one on Aug. 16, in which patient Frank Stewart is accused of aggravated assault for allegedly smacking a nurse in the face with a chair, leaving her with serious facial injuries.
Another patient, Charles D. Miles, is accused of destroying property and threatening to kill specific hospital workers and patients in an incident on Aug. 31.
“Although there have been signs of improvement in recent months and plans of correction are in place, the hospital has continued to experience critical incidents involving client and staff safety and from time to time has generated concerns about proper treatment,” Wathen noted.
He also said that the hospital is operating at 85 percent capacity, but has a waiting list for admission.
“It continues to house forensic clients in three of its four units, presumably because of concern about behavior control, even though the two forensic units are not filled to capacity.”
Occasionally one patient is the only occupant of a four-bed unit on the forensic side of the hospital if that patient has proved to be particularly aggressive.
Riverview Psychiatric Center is divided into two forensic and two civil units. However, some forensic patients are being housed in one of the civil units. The forensic side of the hospital is where most of the trouble has been reported.
Wathen also noted that the hospital has had “more staff turnover than usual in certain elements of the workforce since May.”
Wathen said the hospital is in a “critical time of reorganization.” He said he’s planning the site visit next month because “the plans of correction and the management changes should have advanced sufficiently to allow a meaningful review of current operations, to check on progress and to make any recommendation that may be necessary for compliance with the Consent Decree and Consent Decree Plan.”
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.
Helen Bailey, an attorney with the Disability Rights Center of Maine, which represented the patients in the original lawsuit against the state, said she believes the state’s proposed plan of correction for the treatment issues addresses her organization’s concerns as well.
“I do believe that the conditions that gave rise to what was our most serious concern with regard to the abuse and the problem with having correctional officers right on the unit has been dealt with,” Bailey said on Monday. Corrections officers armed with stun guns were brought into the hospital following a particularly vicious attack on March 30, 2013, where a patient bludgeoned a mental health worker in the head and stabbed her repeatedly with a pen, leaving the point embedded in her hand.
The reaction to that attack caught the attention of federal regulators, which eventually led to the certification withdrawal.
Now, the hospital has hired acuity specialists to assist with behavioral and safety concerns.
“There are still little glitches such as when is the appropriate time for calling in Capitol Police and who can call,” Bailey said. “I think there are still some issues over that and who can say what when Capitol Police come in.”
Bailey said one unresolved issue is making provisions for patients who have had head injuries and who are not benefiting from treatment at Riverview.
“They may understand right from wrong, but might have no regulators sometime,” she said. “They may be impulsive.” She said that it appears they’re being forced into the criminal justice system.
A federal report filed June 27 faulted the hospital for a slew of missteps, including unreported medication errors and records-keeping failures, including failures to document assessments, undocumented treatments, too few pharmacy workers, and no time allotted for mental health workers to work one on one with patients.
In response to that report, Harper said previously that the top problem was the hospital’s failure to document when a patient is receiving the treatment called for under an individual patient plan.
He said that was being addressed immediately.
A spokeswoman for the department said late Monday that a response to the progress report likely would not be available until Tuesday.
Betty Adams — 621-5631
Twitter: @betadams
Send questions/comments to the editors.
