An out-of-state psychiatric facility that Maine patients and a former staff member have described as crowded and unsafe will be sold at auction to help cover its parent company’s debt after filing for bankruptcy.

But Maine’s Department of Health and Human Services has just renewed its $1.4 million contract with the for-profit South Carolina facility, leaving some questions about what will happen to the handful of Mainers in its care and any others who could be sent there.

The Riverview Psychiatric Center, a state-run facility in Augusta that treats patients who have been charged with crimes but were found not criminally responsible because of their mental state, has been contracting with Columbia Regional Care Center for almost 10 years. Under the latest agreement, signed Oct. 30 – four months after its effective date – Maine reserved up to six beds until next summer.

Columbia is relying on contracts with Maine and other states to shore up its financial value after its parent company, Wellpath, filed for bankruptcy this month and announced plans to sell the facility.

Riverview has sent 12 patients to Columbia in the last decade. Its leaders insist they only rely on the center as a “last resort” for patients who pose serious risks to themselves or others. But several patients, their families and a former staff member have told the Portland Press Herald/Maine Sunday Telegram that the facility is more like a prison, where some staff can use physical force on patients, who spend most of their days locked in their crowded, dirty rooms and fear for their safety.

A former employee said the problems stem from a chronic staffing shortage and Columbia’s willingness to regularly take in more people than it can handle to make money.

The employee, who agreed to speak with the Press Herald on the condition of anonymity, said security personnel who restrain patients are often behind on mandated training. They said that while Columbia staff are expected to regularly check on patients throughout the day to ensure their safety, they struggle to keep up with room checks and reporting policies.

One patient, who was recently brought back to Maine and released from Riverview’s custody, has said he felt warehoused and spent the majority of his days locked in a small room with three other men. Another patient’s mother said her son was isolated in a situation akin to solitary confinement and she was afraid of the impact on his mental health.

“None of that was far-fetched,” the former employee said in a recent interview.

“I think people like to disqualify the words of a patient because of the type of hospital they’re in, and what their perceived mental capacity is. But they’re not too far off – they may not have an accurate picture of a situation, but they see it,” the employee said. “There is usually some truth in what they’re saying.”

Both Wellpath and Maine officials have declined interview requests to discuss the allegations.

Lindsay Hammes, a spokesperson for DHHS, said that Riverview is “assessing” Wellpath’s plan to sell Columbia. She said the department “takes the safety of patients very seriously” and checks on them through regularly scheduled meetings, but that the state of South Carolina is responsible for the oversight of Columbia and its patients, “regardless of whether they are in DHHS custody.”

STAFFING CONCERNS 

Columbia Regional Care Center is a 347-bed facility in the capital city of South Carolina, according to its website. It’s licensed as a hospital through the South Carolina Department of Health and Environmental Control.

In the same building, 215 beds are reserved for patients of the South Carolina Department of Mental Health, which contracts with one of Wellpath’s subsidiaries. The department owns the building and Columbia leases half of it to take in patients, including those from other states.

Under Columbia’s most recent contract with the state of Maine, the facility has agreed to offer on-site security, specialized diet orders, medical care and mental health treatment. Columbia is supposed to provide Riverview with updates on how patients are doing and to allow for regular meetings with medical directors from both facilities.

Even when Columbia was able to offer enough physical beds, the former employee member said, it was still hard to enforce treatment and security requirements because of staffing shortages. They said staff were supposed to regularly check in on patients in their rooms, take pictures and document it all on a tablet. Workers were also supposed to take some patients’ vitals, including before and after giving medication.

But those checks were regularly incomplete if they happened at all, the employee said. Technicians and security officers were often fired, but nursing staff were rarely reprimanded because they were a finite resource. Still, the place felt like a “revolving door” of new faces, the employee said.

Those checks are important because when there’s an injury or death, the facility looks back at records to see what went wrong. Supervising the patients can also prevent unexpected deaths, they said. Yet even after injuries and deaths, nothing changed.

At least two Maine patients have died at Columbia: Anthony Reed in December and James Staples in 2018.

Neither Columbia nor Riverview will share details on these deaths. Riverview has declined, citing patient confidentiality laws. Reed’s obituary described his death as peaceful. The Press Herald has been unable to find any obituary or family for Staples.

Justin Butterfield has been at Columbia for nearly four months. He was found not criminally responsible in February for killing his brother during a mental health crisis and has been committed to the state’s care until they believe he’s no longer a harm to himself or others.

Yaicha Provencher, who shares children with Butterfield, said in an interview that she wishes Riverview would have told her about the pending sale. She is scared of what will happen to the facility, and to Butterfield, who has already been impacted by his time there.

“I think it’s important to note that it is going to affect probably the rest of his life. I think it’s been pretty traumatic,” Provencher said. “When he leaves there, I think it’s going to leave long-lasting trauma on him.”

Riverview has declined to discuss why they sent Butterfield to Columbia, citing patient confidentiality laws. But Provencher said she was originally told it was because he refused to take his medication for schizophrenia, which she said wasn’t entirely true – he only wanted to switch medications to one that didn’t make him feel so drowsy.

Provencher said Columbia actually agreed to switch his medications. She’s confused as to why Butterfield is still there.

“He was initially sent down because he was too dangerous to be around people – so now he’s being locked in a room with three other people for 22 hours?” she said. “It’s really contradictory. … It doesn’t add up to me.”

LICENSING VIOLATIONS

The South Carolina Department of Health and Environmental Control, which oversees Columbia’s hospital license, confirmed it has had to visit the facility “multiple times” in the last few months after complaints about staff abusing patients, broken cleaning equipment and a sewage backup that flooded the basement.

Columbia did submit a “plan of correction” for the equipment concerns and said they were working to schedule repairs.

The former employee also described a facility overrun with dead cockroaches that Columbia still hasn’t figured out how to take care of. There are constant plumbing issues in the old building, where some patients make it worse by shoving things in their toilets.

The health department also notably found that Columbia violated its own policies for patient safety and abuse, and they failed to notify the department within 24 hours of the incident as required.

According to records from the department, a patient was cussing at an employee and asked the employee not to change him. The employee then began to pull forcibly on the patient’s arm and dug her fingernails into his rib cage. His roommates witnessed it and the incident was caught on surveillance camera.

South Carolina officials are still waiting for Columbia’s mandated “plan of correction” for the patient abuse, according to a spokesperson.

Department records indicate Columbia’s administrator said they fired that employee.

Hammes, the spokesperson for DHHS, was not able to say whether Riverview is aware of these complaints. Under Maine’s current contract, Columbia only has to notify Riverview of violations when it involves Maine patients.

Hammes did say that Stephanie George-Roy, Riverview’s superintendent, and clinical director Matthew Davis visited Columbia on Nov. 8. It was their first visit in several years.

“The areas of the facility they were shown appeared clean and in working order,” she wrote.

However, the former employee suggested visits like these, which are usually scheduled far in advance, aren’t representative of the Columbia’s true conditions because it gave them time to temporarily straighten up. Hammes did not respond to questions about when Riverview scheduled the visit.

The former employee, who did not discuss these specific violations, described similarly concerning issues.

Security staff were rarely up-to-date on training that addressed how to physically restrain patients. As a result, the former employee said, it was often used excessively.

They recalled one patient who was placed in a four-point restraint bed and left there for weeks, despite policies that favor gradually lessening restraints.

“It wasn’t until someone made a complaint to corporate that that actually got rectified,” they said. “That patient was in restraints for way too long.”

HOW BANKRUPTCY WILL WORK 

So far, the agencies who deal with Wellpath and even the company itself seem unfazed by the financial turmoil, at least publicly.

In their bankruptcy filings, Wellpath estimated that it has anywhere from $1 billion to $10 billion in assets and liabilities. The filing doesn’t state what Columbia Regional Care Center is worth. However, the company announced on Nov. 12 that it reached an agreement with its lenders to reduce its debt by more than $500 million – part of that agreement includes selling Recovery Solutions, the Wellpath business that oversees Columbia.

Wellpath said the sale won’t have any impact on staff or patient care. Its CEO, Ben Slocum, cited challenges from the COVID-19 pandemic and rising inflation.

“Despite the circumstances, we continued to put patient care first and made significant investments to ensure our patients received the highest level of care,” Slocum said in the Nov. 12 announcement.

Wellpath is also the Maine State Prison’s contracted health care provider. It has contracted with the Maine Department of Corrections for years to run health programs in its state prison system. A spokesperson for the DOC said they don’t anticipate any immediate effects from the bankruptcy.

Under a state law that took effect in 2019, DHHS was ordered to create a patient’s rights committee to keep track of those sent out of South Carolina. Hammes said that group was merged with Riverview’s existing Human Rights Committee that the hospital created in 2005.

It’s unclear whether the group has raised any concerns about Columbia’s sale. It is required to meet four times a year and consists of 11 members, including Riverview’s leaders and community members who have engaged in mental health services. Hammes said she could not provide a list of the group’s members on Friday.

The bankruptcy could still have implications in South Carolina.

A spokesperson for the South Carolina Department of Mental Health said that they don’t expect any changes to their relationship with Wellpath as a result of the bankruptcy filing or looming sale. But that state’s health department said in an email Thursday that the facility might have to apply for an amended license, depending on how things shake out.

Recovery Solutions, which is owned by Wellpath and oversees Columbia, did not respond to multiple requests to address the allegations. As to their financial situation, a company spokesperson briefly said in an email that they don’t “anticipate any operational impact” as a result of the bankruptcy process.

“Our dedicated team at CRCC continues to provide high-quality, compassionate patient care,” wrote Senior Vice President of Partnership and Government Affairs Teresa Koeberlein.

The former employee at Columbia isn’t surprised that these concerns aren’t being taken seriously.

“The reason they get dismissed is because they can’t have agencies thinking ‘this is a bad place to send patients,'” they said. “At the end of the day, every state or agency that does business with CRCC has some sort of alternative place where they can send patients. It’s probably most likely not in South Carolina, but they don’t want any kind of bad press to get out there because that would mean losing potential patients.”

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