Monday, December 9, 2013
By Steve Mistler firstname.lastname@example.org
State House Bureau
AUGUSTA — A special committee charged with assessing a bill to alleviate overcrowding and backlogs at the Riverview Psychiatric Center heard Tuesday that the proposal is only a small fix to a larger problem at the 92-bed facility.
This aerial photo taken on Tuesday April 30, 2013 shows The Riverview Psychiatric Center on banks of Kennebec River in Augusta.
Staff photo by Joe Phelan
The legislative panel also was told that the bill, which would establish a mental health unit at the state prison in Warren where some Riverview patients would be sent, would do little to address a litany of issues at Riverview that threaten to cut off an estimated $20 million in federal funding.
Meanwhile, the Sept. 2 deadline for the funding loss looms. Riverview Superintendent Mary Louise McEwen told the panel that the facility was still working with the federal Centers for Medicare and Medicaid Services to craft a mitigation strategy. However, she also said that a reassessment of conditions at the facility may not occur before Sept. 2.
The federal funding represents more than half of the hospital's operating budget.
McEwen told the Press Herald Aug. 17 that she was confident the federal government would accept the state's remediation plan. A key component of that plan is the federal decertification of 20 beds in Riverview's Lower Saco Unit, where corrections officers have used stun guns and handcuffs to control patients.
The unit segregates forensic patients from the rest of the Riverview population.
Forensic patients are those committed to state custody after being found not responsible for criminal offenses, those who are being examined to determine their competency to stand trial, and those whom a judge has declared incompetent to stand trial and who are being treated to restore their competency.
Decertification would mean the loss of federal reimbursement for patients through Medicaid and Medicare.
Mental health advocates said the bill, L.D. 1515, didn't address the use of stun guns and handcuffs by Kennebec County corrections officers to subdue aggressive patients -- issues highlighted by a federal report that put the facility out of compliance.
Crowding, inadequate staffing and mixing civilian patients with those awaiting competency assessments through the courts were also highlighted in the report.
The audit was prompted by a March 16 assault at Riverview in which 47-year-old Mark Murphy, a patient, allegedly attacked a 26-year-old mental health worker, punching her, striking her with his hands and stabbing her with a pen before another patient intervened.
The attack highlighted growing concerns by law enforcement and mental health advocates that Riverview is struggling to handle a sharp uptick in mental health patients channeled through the corrections system.
In May, a review of data by the Kennebec Journal showed there were 37 injuries at Riverview in 2012, the most since 2009, when there were 53.
J. Harper, with the Augusta-based Disability Rights Center, told the committee that the problems identified in the report stemmed from the loss of staff trained to deal with forensic patients, who may be a risk to other patients or Riverview staff. He said the state had cut staffing levels in half between 2009 and 2012, a move designed to help balance the state budget.
Harper said trained staff members were present during the first work shift at Riverview, but qualified staffing dropped off during the night and early-morning shifts.
Harper said the majority of the documented assaults occurred after the first shift.
Attorney General Janet Mills echoed some of Harper's concerns. She said the bill had been cast as a "silver bullet" when it wasn't. Mills also said she was disappointed that lawmakers weren't made aware of the federal audit earlier.
Even if lawmakers enact L.D. 1515 when the Legislature convenes on Thursday, Mills told the panel that it should stay involved with the problems at Riverview.
Other groups questioned whether L.D. 1515 was appropriate, because it would effectively ship some mental health clients into a correctional facility.
"It should strike us all as strange that we'd send someone to prison to receive health care," said Zachary Heiden, the legal director of the American Civil Liberties Union of Maine.
Rep. Drew Gattine, D-Westbrook, also worried that shipping more mental health patients to Warren would result in a different set of compliance rules.
The Department of Health and Human Services is charged with oversight of Riverview. The proposed ward at the prison would be overseen by the Department of Corrections.
Joseph Fitzpatrick, clinical director of the prison system, also acknowledged that the 32-bed ward at the prison wouldn't meet the hospital compliance standards under which Riverview operates.
Heiden said he was also concerned about provisions in the bill allowing the Department of Corrections to forcibly medicate patients. While such action would require a court order, Heiden said the measure assumed hospital-level care and supervision at the prison.
Nonetheless, some lawmakers appeared inclined to enact L.D. 1515, which carries an estimated cost of $1.5 million in the current fiscal year and $3 million a year thereafter.
Rep. Deborah Sanderson, R-Chelsea, said the bill wouldn't address all the compliance problems cited by the federal government. However, it would provide some measure of additional security at Riverview.
Others were unsure, particularly since the bill didn't address most of the problems outlined in the federal audit. Some on the panel were less certain when McEwen, the Riverview superintendent, said that the federal audit and L.D. 1515 were "two separate issues" with little crossover.
L.D. 1515 was proposed by the LePage administration, but carried over at the request of the Department of Health and Human Services, which anticipated that lawmakers wouldn't be able fund the bill in the biennial budget.
Earlier this month the governor notified Democratic leaders about the funding cutoff through a news release. In the release, LePage blamed the Legislature for not funding his proposal.
According to her written remarks from the May 10 public hearing on L.D. 1515, McEwen did not mention the audit or the pending federal action to the Legislature's Criminal Justice and Public Safety Committee. She did, however, underscore the importance of the bill and increasing safety problems at Riverview.
Democratic lawmakers expressed frustration that they weren't notified of the federal audit.
The bill would add approximately 15 positions for the expanded ward in Warren. The Department of Corrections would have to hire additional staff to handle the new patients. Jody Breton, the deputy commissioner for the Department of Corrections, told lawmakers that it may be difficult to hire psychiatric staff quickly.
Steve Mistler can be contacted at 620-7016 or at: