In January an employee of Riverview Psychiatric Center was attacked by a resident who had been living there for the past seven years under court order, prompting federal regulators to tour the facility in March and again in May.
Regulators uncovered dozens of deficiencies, some of which were so serious that the federal government is now threatening to withhold $20 million in Medicaid and Medicare reimbursement starting Sept. 2 unless Maine takes corrective action.
That’s half of the facility’s entire budget. If that funding is slashed, conditions at Riverview are going to get a whole lot worse.
In 2004, the last of the Augusta Mental Health Institute's patients moved to Riverview and AMHI was shuttered after 164 years in operation. At the time, Riverview was seen as a bright, modern hospital that employees said would boost staff morale and improve patient care. The 92-bed, $31 million hospital boasted of its 94 treatment and recreation programs, offered on what it called its “treatment mall.”
Now, just nine years later, we’re talking about patient overcrowding, abuse of patients and dangerous conditions for staff.
Riverview was constructed to replace AMHI, which was the subject of a class-action suit brought by the Maine Disability Rights Center claiming that Maine had fallen short of its responsibility to provide adequate care for patients there. That suit resulted in a 1990 consent decree that provides special, everlasting and individualized protections to all former AMHI patients. That order of protection also carries over to anyone who has ever been, is now housed or who will be housed at Riverview.
If Riverview is already governed by this consent degree, how did conditions inside the place get so bad?
It’s not like Riverview is one of dozens of psychiatric centers treating criminal defendants and inmates across the state, and was overlooked. It’s the only one.
Every person who is found incompetent to stand trial or found not criminally responsible for their crimes is housed there, some of them for years. Riverview is also home to defendants who have been ordered to undergo psychological evaluation to determine whether they are competent for trial.
If Riverview was a tiny hospital existing in a sea of institutions across the state, it might be a little easier to understand why lawmakers and regulators might not have been aware of the conditions there. But, given that it’s Maine’s only forensic institution, there is absolutely no reasonable explanation how we reached this crisis point.
The attack in January was not the first time a worker has been injured.
In February 2006, an employee was nearly killed by Mark Murphy, a violent patient confined to Riverview’s forensic unit for the criminally insane.
As a result of that attack, the hospital went through a comprehensive review of security, including looking at staffing levels in various parts of the hospital to ensure adequate patient supervision. That’s important because the hospital houses violent offenders and sexual predators, including Christian Nielson of Bethel, who was treated there before being convicted of four murders in 2007, and former police officer Steven Goozey of Westbrook, who was treated there before his trial on child sex abuse charges in 2010.
If any action was taken as a result of the 2006 attack, it was not enough to prevent the current federal health and safety violations. According to the Centers for Medicare & Medicaid Services, violations at Riverview now pose an “immediate jeopardy” to the health and safety of patients. The deficiencies “have been determined to be of such a serious nature as to substantially limit the psychiatric hospital’s capacity to provide adequate care,” according to a June 4 CMS report.
Specifically, the hospital failed to ensure that all patients received care in a safe setting, failed to ensure that patients were free from all forms of abuse by Taser and the use of handcuffs, failed to protect patients’ civil rights, failed to hold the medical staff responsible for quality of care, failed to adequately train staff and failed to install proper locks, among other things.
As a result of these findings, the federal government has put Maine on notice that it will stop reimbursing for services for patients admitted after Sept. 2, and will pay for only 30 more days for patients admitted prior to that date unless radical changes are made.
Federal regulators also ordered the Kennebec County Sheriff’s Department and hospital staff to participate in education on standard protocol to comply with federal laws prohibiting inhumane treatment and corporal punishment.
The list of deficiencies measures 93 pages, much of which is repetitive, and there is not time to fully comply with federal law before the CMS reimbursement cut-off date.
So, when the Legislature convened in special session Thursday, Department of Health and Human Services Commissioner Mary Mayhew announced a short-term fix to segregate 20 forensic residents who are no longer eligible for CMS funding from the rest of the hospital population, which she said may address federal regulators’ concerns and give Riverview time to correct the reported deficiencies.
Regulators are reviewing the DHHS corrective action plan now.
It’s not an ideal solution, Mayhew said, but it might preserve funding.
We hope she’s right.
It doesn’t solve the long-term problem, though, of adequately funding mental health services and correcting Maine’s long history of not properly caring for the mentally ill.
In 1990, AMHI was found to be out of compliance with federal law by not providing adequate care for patients, resulting in the death of 10 patients there.
Now, Riverview — the hospital that was supposed to do a better job than AMHI — has been found to be out of compliance and not providing adequate care for patients.
We're repeating history by reliving our mistakes, or are we simply thumbing our nose at the consent degree?
The opinions expressed in this column reflect the views of the ownership and the editorial board.