Forensic patients at Riverview Psychiatric Center in Augusta are “running the show,” according to an employee who works there.

This employee, who recently spoke to the Sun Journal on the condition that we not use a name for fear of retaliation, said “the most violent, sociopathic and antisocial clients are in a hospital setting where staff have very little ability — other than standard Non-Abusive Physical and Psychological Intervention (or NAPPI) training — to maintain the safety of other clients and themselves.”

These forensic clients were confined to Riverview after a finding they were not criminally responsible for a host of violent crimes, and are there to receive treatment for psychological disorders. And, according to our source, many of them are smart, manipulative and set very clear goals to harm staff and other clients, and to damage hospital property.

The staff is literally under siege, according to this source, every day.

That’s not a safe setting for employees or clients, doesn’t encourage experienced staff to stay, isn’t conducive to the best possible treatment for all clients housed there, and it may very well be an impossible problem to resolve.

Last week, Sen. Margaret Craven, the Senate chair of the Legislature’s Health and Human Services Committee, suggested that members of her committee visit Riverview. Unannounced.

She wants to see an un-sanitized version of the hospital atmosphere and client behaviors, something that’s not always evident during scheduled visits. It’s a bold suggestion, and a good one.

It’s one thing to talk about this problem in the abstract, sitting in a committee room at the State House. It’s quite another to stand next to a staff member who is being threatened with physical harm, and to understand the skill, courage and hope it takes for staffers to treat the state’s most violent clients.

Take Mark Murphy, for example.

In 2004, Murphy was shot in the chest by a York County homeowner after breaking into the man’s house. He was seriously injured and treated at Beth Israel Deaconess Medical Center in Boston before being charged with the break-in. The homeowner’s actions were ruled justifiable, and Murphy was found not guilty by reason of mental disease or defect and was confined to Riverview.

In February 2006, an employee was nearly killed by Murphy, who had racked up a long history of unprovoked and multiple attacks against staff.

Between then and now, Murphy has been permitted to leave Riverview with permission of the court and under staff supervision.

Then, in January, Murphy attacked another staff member, punching her and stabbing her with a pen. According to police reports, Murphy apologized to the woman for what he was about to do, and then started punching her. The attack, which resulted in horrible injuries to the woman, didn’t stop until another patient intervened.

The report of that attack brought the attention of the Centers for Medicare & Medicaid Services to Riverview, and the subsequent threat that the Feds would withdraw $20 million in funding until Riverview addressed dozens of deficiencies in patient care and staff safety.

That threat brought legislative scrutiny and has fueled public outcry, and the state’s proposed corrective action plan to preserve funding is to move 20 of the most violent forensic patients to the Warren State Prison. It’s not a plan favored by all, though.

The point of courts finding defendants not criminally responsible (NCR) and placing them in the custody of the Department of Health and Human Services at Riverview is to provide treatment, with the goal being the return of mental competency. Critics have argued that moving these NCR clients to prison defeats that purpose.

But does it?

The clients are not going to be housed in general population. Instead, they will be confined to an isolated wing and treated there much like they would be treated at Riverview. And, as Craven pointed out to her peers on her committee, if the clinic wasn’t “attached to a prison, we wouldn’t have that much aversion to it. It would be like a mental health clinic where we have 20 extra beds.”

She’s right. And, in that clinic, there would be greater support to control violent clients and more protection for staff.

The reality at Riverview is that violence exists. The ability of staff to control the most violent clients is not foolproof and people are getting hurt.

According to the DHHS, of the 92 people under its supervision that have been found not criminally responsible for their crimes, 18 have been charged with at least one count of murder. That means 20 percent of the forensic clients at Riverview have been accused of killing another person.

In the general population of Maine inmates, only 2 percent have killed another person, which means the ratio of dangerous people is higher at Riverview than in prison.

And, as our source pointed out to us, when staff members are injured by clients and forced to take sick leave or go on light duty, the work doesn’t go away. Other staffers must step in, creating an inconsistent swirl of staffers working with clients, never mind the health care dollars spent in treating injured workers.

These facts demand a high degree of attention by lawmakers and a great need to expedite a solution to prevent the loss of federal funding for Riverview. If that means that we must move 20 people — who are known to be violent — to a satellite clinic in Warren so we can maintain necessary funding while also protecting staff and providing better treatment for all clients, then let’s do it.

Now.

jmeyer@sunjournal.com

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