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Maine Lawmakers Scramble to Resolve Psychiatric Hospital Crisis
08/21/2013   Reported By: Patty B. Wight

Riverview Psychiatric Hospital is slated to lose $20 million in federal funding beginning Sept. 2. The Centers for Medicare and Medicaid Services says the hospital does not meet quality standards, citing, among other things, correction's officers use of weapons to subdue forensic patients. Though Riverview has submitted proposed remedies in hopes of avoiding the loss of funding, those plans have been rejected. Now state lawmakers are scrambling to figure out what to do next. Patty Wight reports.

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The concerns at Riverview (right) center around its forensic units. These house patients who have come to the hospital through the court system. They mave been found unfit for trial, or not guilty of a crime due to mental illness.

It was one particular event in March - when a patient attacked a mental health worker, hitting her and stabbing her with a pen - that sparked two inspections last spring. Inspectors found what they called serious deficiencies at Riverview, deficiencies so substantial that they were found to limit the hospital's ability to provide adequate, safe care.

Among the problems cited: low staffing levels, lack of documentation of restraints, and the role of corrections officers who sometimes use tasers and handcuffs.

"It's a very rare occurrence," says Mary Louise McEwen, the superintendent of Riverview. She says she was surprised that the Centers for Medicare and Medicaid Services, or CMS, deemed the use of corrections officers as unacceptable.

"Prior to having corrections officers on site, if there were situations where there was concern of life or limb threat to someone's safety, we would call for law enforcement to respond to our facility," McEwen says. "And by having correction officers on site, it allowed that response to be faster to prevent injuries."

Still, after the inspections, McEwen says she immediately took action to fix the problems, and submitted plans detailing the strategy. But the federal government rejected two different plans for being too vague. McEwen submitted another plan last Friday, but there is no guarantee it will be accepted, or prevent the loss of $20 million in federal funding starting Sept. 2.

That's more than half of Riverview's budget, and Republican Rep. Deb Sanderson, the ranking minority member on the Health and Human Services Committee, says the loss would have severe consequences for the state.

"That means is going to cost us $20 million more to fund Riverview, out of state taxpayer dollars," she says. "That's what it's going to mean."

Lawmakers passed a bill in the last legislative session that would allow the creation of a psychiatric unit at the Maine State Prison, alleviating some of the safety concerns at Riverview. But the Appropriations Committee didn't fund the bill, which has a price tag of about $3 million.

Democratic Rep. Peggy Rotundo is co-chair of the committee. "There was no sense or urgency or crisis conveyed," she says. "Certainly if the Appropriations Committee had been told that this kind of crisis was going to result, we would have solved that problem."

Rotundo says a legislative liasion from DHHS even advised Appropriations to wait to fund the bill till the next legislative session. Given the present circumstances, though, she says the Appropriations Committee plans to meet Thursday with Riverview's Mary Louise McEwen and DHHS Commissioner Mary Mayhew to figure out what to do next.

Democratic Rep. Mark Dion, co-chair of the Criminal Justice and Public Safety Committee, says funding the Maine State Prison legislation would be a good start. "But that's a short term solution," he says. "I mean the long term is, if we believe the data at Riverview, there's a growing demographic of patients who are violent, and what do we do about that?"

That's a concern that former Maine Chief Justice Daniel Wathen has raised in recent years. Wathen oversees Riverview as part of a Consent Decree established over 20 years ago that requires the hospital to meet certain operating standards. He says there is a silver lining to the current situation, at least when it comes to fixing problems at the hospital.

"I mean you can't think of a much more effective remedy for dealing with state government than to say, 'Your funding is withdrawn,'" he says. "And they're not just withdrawing it for the forensic population, they're withdrawing it across the board. That's a pretty powerful incentive to address the problem."

Though Wathen says the issues that confront Riverview are serious, he says it's also important to recognize the challenge of operating a psychiatric facility with high-risk patients that can require 24-hour supervision. He says once the issue with CMS is resolved, the Maine Courts will consider whether to ratchet up hospital supervision under the consent decree.

Photo: Courtesy Maine Department of Health and Human Services


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