The Maine Department of Health and Human Services is requesting money for more than two dozen new positions at Riverview Psychiatric Center in Augusta as the state continues efforts to regain federal certification – and millions of dollars in funding – for the facility.

DHHS Commissioner Mary Mayhew also said she has been told by federal officials that the hospital will not be recertified as long as a significant percentage of its patients have been referred by the criminal court system. About half the patients at the 92-bed hospital fit that description now – the rest are “civil” mental health patients committed either involuntarily or voluntarily.

Mayhew told members of the Legislature’s Appropriations and Financial Affairs Committee during a hearing on the governor’s supplemental budget Wednesday that the situation was “about as clear as mud.” But Mayhew said the federal agencies, after approving the state’s “corrective active plan” to address earlier issues, have since told Maine’s DHHS verbally that they will not recertify Riverview with the number of “forensic” patients from the criminal justice system there now.

The commissioner suggested that the federal government’s stance on Riverview – which had sought to have a separate, distinct unit for forensic patients – differs from its position on other mental health facilities around the country that serve similar functions and are certified.

“That is different from what we are hearing today, which is we won’t certify any of your hospital – civil or otherwise – if you have a certain percentage of your patients that do not require hospital-level care,” Mayhew said.

Gov. Paul LePage is requesting $2.7 million in additional funding to cover hiring the additional staff, improving security and enhancing training. The new positions are included in a DHHS budget that covers the rest of the fiscal year, which ends June 30, and for the next two-year budget cycle, which begins July 1.

LOST CERTIFICATION IN 2013

The U.S. Centers for Medicare and Medicaid Services revoked Riverview’s federal certification – and the $20 million in annual funding that goes with it – in September 2013 after reports of officers using stun guns and handcuffs on patients, along with other problems. Attempts to regain certification failed last year when federal inspectors again found deficiencies, including medication errors and substandard treatment.

The state has since altered policies on patient restraint and seclusion, sought to hire new employees and made other changes as it attempts to regain certification.

Mayhew told lawmakers that she is looking at how other states house forensic patients who do not need full hospital care. Some lawmakers at the hearing suggested housing them in unused space at some of the state’s county jails.

In the meantime, the LePage administration is requesting additional money to fill about 30 new positions at Riverview, partly in response to the issues raised by federal officials.

The positions would include several mental health workers, more than a half-dozen nurses and 12 “acuity specialists” – mental health professionals who are trained to handle agitated or violent patients. The acuity specialists are intended to replace corrections officers or state police who have been called in to deal with violent patients.

‘CONSTANT THREAT OF VIOLENCE’

Riverview staff who spoke at Wednesday’s hearing said that understaffing, inadequate training and mentoring programs, and mandatory overtime are contributing to unsafe working conditions and high employee turnover at the mental health hospital.

“This is probably one of the most dangerous environments I’ve worked in,” Patricia Mason, nurse manager for one of the units at Riverview, told lawmakers. “In my 20 years in the emergency room I was assaulted once. In my seven months at Riverview I’ve been assaulted once, so that should put it in perspective.”

Mason said the staffing and training issues and the “constant threat of violence” are the main reasons that former staffers say they left Riverview. She called it a “self-perpetuating cycle that must be broken” if the hospital is to improve.

Figures provided Wednesday by Riverview staff to the Legislature’s Appropriations and Financial Affairs Committee underscored the safety concerns and what they said is a severe staffing shortage.

There were 199 reported staff injuries at Riverview last year, 103 of which were to mental health workers, said Lisa Cromwell, a mental health worker at the hospital. Cromwell said there are currently 11 mental health workers and two nurses out of work because of assaults or violent patient behavior.

‘WE NEED MORE PEOPLE’

At the same time, Riverview’s mental health staff was required to work more than 18,000 hours of mandatory overtime last year, Cromwell said.

“The extreme number of overtime and mandated hours shows how understaffed we are, and this leads to an unsafe workplace and an unsafe environment for our patients,” said Cromwell, one of several members or leaders of the Maine State Employees Union and the American Federation of State, County and Municipal Employees unions to testify at the budget hearing.

“In the proposed budget for Riverview, there are many positions created but not enough for mental health workers. We need more people on the floor, working with the patients, not in administrative positions,” she said.

DHHS spokesman David Sorensen said in an email that the budget hearing highlighted the need for changes that the LePage administration is seeking at Riverview.

“The employees’ testimony underscores the need for the initiatives put forward by Governor LePage,” he wrote. “Much progress has been made, and the administration is committed to turning Riverview into a model for psychiatric care by improving its outcomes for patients, its safety for staff, and its reputation in the community.”

The Legislature’s Health and Human Services Committee is expected to hold a work session Thursday on the supplemental DHHS budget request, which covers through June 30. The Appropriations Committee is scheduled to hold a work session on the budget proposal Friday.