AUGUSTA — The court master assigned to make sure patients at the state’s Riverview Psychiatric Center are treated properly is making formal recommendations covering hospital operations after finding the state hospital had failed to address staffing and other problems..

Court Master Daniel Wathen, a former chief justice of the Maine Supreme Judicial Court, laid out the recommendations in a progress report issued Monday covering the past six months that found the hospital had failed to make changes that it had proposed.

He said Monday that the hospital has the funding to address his recommendations.

“The budget is not the problem,” he said. “They have the money to do it.”

The state Department of Health and Human Services has 30 days to challenge the recommendations in court if it does not accept them.

“We just received the final report today – the commissioner is still reviewing,” said department spokeswoman Samantha Edwards in an email.

The 92-bed hospital handles both civil and forensic patients – those committed in connection with criminal charges.

Oversight by Wathen stems from a 1990 consent decree designed to ensure that people treated for mental illness receive appropriate care.

The report issued Monday covers staffing and other deficiencies that have also prevented Riverview from regaining its federal certification, thus jeopardizing $20 million in annual funding.

The certification loss resulted in part from the hospital’s use of corrections officers to handle patients who had proved aggressive and violent to other patients and staff members. The officers have been replaced with acuity specialists hired to help manage patients who are considered dangerous.

Wathen had previewed some of his findings on Jan. 22 before the Legislature’s Government Oversight Committee, which was looking into how staffing affects the safety of patients and workers. Wathen’s report found the hospital had 51 positions vacant on Jan. 19, 47 of them direct care workers.

He noted that 23 of 87 nursing positions were vacant, and that psychiatric providers were “adequate in numbers but lacking in continuity. Out of a total of 11 providers, six are engaged long-term and five are engaged for terms ranging from six weeks to six months.”

Riverview workers told lawmakers on Jan. 19 that forced overtime has crushed morale and driven away good workers. Sen. Roger Katz, R-Augusta, led the public forum to listen to concerns from the workers before the Government Oversight Committee meeting.

In his report, Wathen recommended:

• Not counting acuity specialists as mental health workers when doing staffing ratios.

Wathen says, “Routinely, however, acuity specialists have been assigned to perform as mental health workers in order for the hospital to deal with unit acuity and to maintain the mental health worker/client ratio of 1 to 6 or 1 to 8.”

• Adding a mental health worker to a unit if a client there needs one-to-one staffing. Currently, this doesn’t happen unless a second patient on the same unit requires one-to-one staffing.

• Having mental health workers and, when appropriate, acuity specialists attend treatment team meetings, partially as a way to address a “significant turnover in the psychiatric and nursing staff.”

• Implementing unit-based staffing on a pilot basis in one unit by April 4; implementing it in the three other units by Aug. 1.

• Maintaining an activity log for each unit and reviewing the logs monthly to see whether patients’ access to treatment, services or outdoor areas has been restricted.

• Enforcing penalties if contracting agencies fail to promptly accept Riverview patients found ready to move to outpatient housing. Wathen provides an example from the week of Jan. 18, when 12 civil clients awaited such placement.

“Those 12, one quarter of the hospital’s civil capacity, had been waiting anywhere from 15 to 90 days for placement,” he says. “Collectively, they represent 444 days of unnecessary hospitalization at a time when the hospital is struggling with staffing and has other clients waiting for admission.”

• Having an independent consultant conduct an annual review of the hospital’s restrictive practices and management system.

“The Consent Decree requires a semi-annual examination of restrictive practices by an independent consultant; no such reviews have been conducted in recent years,” Wathen notes, adding that a review done by the hospital in 2015 was “neither complete nor independent.”

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