Repeating the travesty of AMHI

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?

jmeyer@sunjournal.com

The opinions expressed in this column reflect the views of the ownership and the editorial board.

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Comments

MICHAEL LEBLANC's picture

The problems started much earlier.

My mother was an RN at Togus starting in the 50s, retiring in the early 80s. She worked with mentally ill vets. In good weather, she chaperoned groups of guys sent out into the community for work in the fresh air - cleaning up trash, mowing, landscaping ...

In the 60s, a noisy group protested that those poor fellows must be paid for their work. A noble idea, but they neglected to identify sources for funds to provide that payment. But they won the battle, and those vets spent the rest of their days watching TV and smoking cigarettes.

About the same time, another noisy group (probably with many members in common with the other group) forced AMHI to begin releasing inmates into the community to halfway houses, with lots of new drugs, and lots of new "benefits".

The result was as predictable as sunrise and it continues to this day. The first visible change in Augusta was a suicide fence on the Memorial bridge.

CLAIRE GAMACHE's picture

Just wondering

I have been wondering how it can be legally constitutional to put someone in prison who has been declared "INNOCENT" by reason of insanity. I am certainly not advocating that they should be turned loose on society and I fully appreciate the dangers of caring for some of these people but still prison is prison even if it is called a forensic ward. Seems to me the Constitution is pretty explicit when it comes to putting innocent people in prison.

MICHAEL LEBLANC's picture

Nope.

They have been declared "not guilty by reason of insanity". The jury said OJ was not guilty - they did not say he was innocent, just they could not prove him guilty.

8th amendment: Excessive bail shall not be required, nor excessive fines imposed, nor cruel and unusual punishments inflicted. How is it excessive or cruel or even unusual to confine the violently insane for the good of the rest of society?

CLAIRE GAMACHE's picture

I see

I figured there was a catch. I just could not figure what it was. I am aware many other states are doing the same thing so I don't doubt this has already been argued in court. It just seems that the conditions you stated would apply to people who are accused or who are convicted but not to people who are "not guilty". I realize the criminally insane need to be confined and treated with or without their consent for the safety of the community. I just question the notion of putting them in a prison with convicted inmates. It seems to make the whole notion of trials irrelevant if a judge can find you are not guilty then throw you in a prison.

Steve  Dosh's picture

Repeating the travesty of AMHI

Joyce, Sunday . 11:11 am hst ?
Lot's of - c r a z i e s - out there , some with AK-47s , some institutionalized , some not . When i worked at Togus VA in ME we had two WW I vets who had had lobotomies and had been adjudicated criminally insane in 1 9 2 7 . Thankfully there are new medications for these types and not just surgery , electric shock , valium , lithium and thorazine . In Maine , you may find that most if not - all - mental health patients have relatives living in your Great State or Canada . It's is your task to find and identify them to help carry the burden of assistance to these unwanted individuals http://www.ketzle.com/frost/deathire.htm We'd help out more but we've an abandoned 92 year old WW II vet living with us right now and we are in Hawai'i hth ? / Steve and ohana ;)

MARK GRAVE's picture

Treat or terminate.

Treat or terminate.

Betty Davies's picture

Relatives?!

How the heck do you expect the relatives of desperately mentally ill patients to "help carry the burden of assistance?" It's very kind of "Joyce" to take in "an abandoned 92-year-old WWII vet," but the ability --skills, training, finances, and so on--to provide the level of care necessary for severely mentally ill individuals is extremely rare in most families.

These patients are in the hospital because they need a level of care that is not possible at home.

I grew up with a mother who had a severe mental illness. When I pleaded with her doctor to put her in a hospital, he told me it was better for her to be cared for at home. By a 12-year-old daughter and an alcoholic husband? (We had only 3 living relatives by then, none interested in helping out.) We did the best we could, for years. This was a 24 hours per day job for us both. I got some relief thanks to school, but felt terrified 24/7. My stepfather gradually wore down and killed himself... leaving me in charge.

In terms of patients who have living parents, how old are the parents? How's their health? Is there room in their home for the patient? Who will train them in the best practices for encouraging an unwilling individual to take necessary meds, avoiding being harmed if they act out, preventing suicide? How will their own mental and physical health be affected by taking on the role of psychiatric nurses? Can they afford to pay for help? If the parents aren't fully up to the task and their offspring's mental and/or physical health deteriorates, what effect will this have on parents and child alike? For example, if their desperately depressed offspring steps in front of a truck, the driver could be hurt and/or suffer flashbacks for years from having harmed or killed the patient.

Perhaps "Joyce" simply hopes to drain the bank accounts of any and all relatives of every long-term psychiatric inpatient. This would certainly fit with the conservative mantra of "every man for himself and the devil take the hindmost." Indeed, many would cheerfully apply this philosophy to people with more traditionally "medical" illnesses such as cancer (I won't get into the curious notion that mind and body are somehow distinct entities).

Once the family is thoroughly impoverished, shall they become homeless? If one or both parents have had to quit work to provide care, they'll get little in Social Security. Even before then, they might meet criteria for food stamps or other social safety net aid--dear me, they'll have gone from "makers" to "takers"!

It's a political stance that can sound appealing as long as one is able to avoid noticing that every single one of us could have a child or grandchild develop a serious illness, and we ourselves are not immune.

Allisa Milliard's picture

overcrowding leads to unsafe

overcrowding leads to unsafe conditions in institutions. isn't there a mental health building in bangor? change part of that into forensic holding to lighten the load a bit. the other options are what? keep violent mentally ill in jail hope for the best? send people to halfway houses and hope for the best? not everyone can be, they're just too dangerous and thinking that everyone can be reintegrated with proper supervision is just wishful thinking in some cases. (btw: my uncle, now deceased, had schizophrenia and was released from amhi in the '80s and sent to live on his own in lewiston with no supervision. his elderly father, who couldn't understand the illness, was who had "custody" and put uncle up in his own apartment downtown. the police used to call my mother when they brought uncle in because my grandfather thought that a night in jail would straighten him out. it was only after sj did a story on the mentally ill where my uncle was both pictured and mentioned in the story, that he was finally able to get into a halfway house, which had been claiming a long waiting list, almost 10 years later. until then, the family had done what they could, which wasn't much, with no support system or training or education. the he was one that could be reintegrated with proper supervision and support, as many mentally ill can be.)

Robert McQueeney's picture

Maybe it's just me

But I feel we are spending way too much on "caring" for the criminally insane and those found incompetent to stand trial. I used to work at AMHI, performing renovations to the facilities under public bid for my employer. I even befriended some of the residents.

The sheer amount of money poured into such an institution is mind boggling. I've never worked at Riverview, so I can only imagine the amount of money that goes into it. 40 million dollars a year to operate a 31 million dollar facility, if I read that correctly.

Such people need to be taken care of and the public needs them removed from society. But.... at this cost? I'm guessing that to get it brought up to standards is only going to take more money, and from the sounds of it, a whole lot more.

I'm hoping against hope that some effective method is found to correct this situation, and that "they" don't just throw money at a problem.

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