AUGUSTA — Riverview Psychiatric Center has failed to abide by the terms of a decades-old consent decree by not adequately reducing the risk of injury to clients and staff and by arbitrarily limiting treatment options for patients, according to a report issued by a former court-appointed receiver and consultant.

Elizabeth Jones was asked to report on observations she made during a three-day visit to Riverview, where the state treats its most severe mental illness cases, including patients sent there through the criminal court system.

Jones listed failures in treatment strategies, failure to provide proper interventions following aggressive acts by two patients and continued risk to patients and staff, a “serious misunderstanding of recovery model” that the hospital ascribes to, and lack of treatment and of outdoor time for Lower Saco unit patients, those who have been found not responsible for criminal conduct because of mental illness.

“Treatment options have been arbitrarily limited and, therefore, the provisions of the consent decree have been violated,” she wrote.

She said the use of seclusion and restraint need to follow consent decree requirements.

“At this time, it appeared that the requisite pro-active alternatives to seclusion and restraint have not been explored or provided consistently to the extent needed,” she wrote. “The lack of individualized treatment interventions and the lack of sufficient training and personnel support place both staff and class members at the risk of harm.”

Jones had a number of observations, including concerns that the state is no longer in compliance with the consent decree that requires individualized treatment plans and adequate staffing. The consent decree settled a lawsuit brought two decades ago by mental health advocates that holds the state mental health system to agreed-upon standards of care.

Daniel Wathen, the court master who oversees the consent decree, requested the visit following a series of problems at the hospital in Augusta, including serious attacks by patients on mental health workers and nurses, the use of a stun gun and pepper spray on patients, and a loss of federal funding estimated at $20 million annually because the Centers for Medicare and Medicaid Services had withdrawn the hospital’s certification.

Jones’ report was made public on Wednesday, though Wathen said he and Jones met immediately after the hospital visit with the commissioner of the state Department of Health & Human Services, and the hospital received a copy of the report on Monday.

“The department is in the process of reviewing the report and is not prepared to comment,” department spokesman John Martins said on Wednesday.

Wathen said the hospital already has responded to the report, in part by reuniting the Lower Saco unit with the rest of the hospital.

The hospital administration had set up the 20-bed unit, where the most acutely ill forensic patients are held, as a separate hospital within a hospital, effectively restricting them from interacting with other patients and staff. Patients in that unit could not eat in the cafeteria, work out in the gym or access the treatment mall area, among other things.

“I think things have improved a bit,” Wathen said. “The effects of the decision to reunify the hospital has already had a good effect on the parties. People on Lower Saco are pleased they have improved access to treatment activities and the ability to eat in the cafeteria.”

He said Riverview is asking to be surveyed by federal regulators for certification as a 92-bed hospital.

Jones noted that safety meetings following a series of assaults by one individual did not result in any changes in the person’s treatment plan or privileges. At the time, she noted, there was “no immediate discussion with the class member as to his actions and no discussion with nursing staff regarding ‘individualized coping techniques’ to be taught to reduce the possibility of similar incidents in the future.”

Jones recommends increasing staff at Riverview based on the acuity level of patients rather than the number of patients. Also, she suggested a higher rate of pay for those working on Lower Saco, where most staff assaults have occurred. She recommends against using “floats” to fill in at Lower Saco and commended the hospital for its use of acuity specialists to monitor patient behavior.

She also emphasized the requirement to report patient abuse, neglect and exploitation.

“Regrettably, as widely reported through the media and other investigative actions, there is evidence that two major incidents of abuse (the use of pepper spray and a Taser) were not reported, as required. These are grave violations of the consent decree,” Jones wrote. “During the course of the site visit, voluntary interviews were conducted with both victims. Each described, in unflinching terms, the pain and degradation they experienced during the abusive episodes.”

Wathen anticipates having a conference with Justice Andrew Horton, the judge assigned to the consent decree case.

“What we’ll be looking at and exploring is what is the plan for going forward, then we’ll decide what is the appropriate step for dealing with the fact there has been some violations of the consent decree,” Wathen said. “To some extent, (the report) sharpened my understanding of some of the current difficulties the hospital faces.”