As Riverview faces funding loss, lawmakers consider plan to expand psych ward at state prison

Posted Aug. 23, 2013, at 8:19 a.m.
Last modified Aug. 23, 2013, at 2:27 p.m.

AUGUSTA, Maine — Key lawmakers on the Legislature’s budget-writing Appropriations Committee said Thursday they could support a $3.3 million bill that would expand the mental health ward at the Maine State Prison in Warren but weren’t quite ready to sign off on the measure.

Still in question is whether the legislation, offered by Gov. Paul LePage, would help the state avoid losing $20 million a year in federal Medicaid funding for the state’s Riverview Psychiatric Center in Augusta. The figure is about 50 percent of the hospital’s budget.

The Centers for Medicare and Medicaid Services are threatening to cut funding for the hospital because of overcrowding, inadequate staffing and the use of corrections officers to maintain safety in parts of the hospital.

An unannounced survey of the facility by federal staff in May determined several shortcomings, including the use of handcuffs and Tasers on the most violent forensic patients.

For the short term, the state’s Department of Health and Human Services has proposed creating a segregated 20-bed forensic facility at Riverview that no longer would be eligible for federal funding, according to DHHS Commissioner Mary Mayhew.

Mayhew said it wasn’t the ideal solution and didn’t help improve the state’s capacity to treat those with mental illness but it does alleviate some of the federal government’s concerns.

She said DHHS was awaiting word from the Centers for Medicare and Medicaid Services on whether the department’s most recent corrective action plan for Riverview would be accepted.

Mayhew appeared before the Appropriations Committee on Thursday taking questions and updating the panel on negotiations with the federal government.

She said later that in recent conference calls with federal staff she has been encouraged that an agreement will be reached.

Part of the issue is the mixing of forensic patients — those ordered to the facility by the criminal justice system — with other patients being cared for at the hospital. An attack by a forensic patient that left a hospital employee injured first brought shortcomings at the facility to the federal government’s attention in January.

In Maine, those who are found incompetent to stand trial or not criminally responsible for their crimes, along with criminal suspects who are undergoing psychological evaluations to determine if they are competent, are housed at Riverview.

The facility also takes inmates from county jails who are facing mental health problems the jails cannot manage. In recent years, the number of people at Riverview in those categories has steadily grown, consuming staff resources and space, and squeezing out others who may have needed the hospital.

Mayhew said overcrowding from forensic patients was so bad in the spring of 2012 that Riverview was closed to any patients who wanted to voluntarily commit themselves to the hospital. The hospital has 92 beds, with 44 of them set aside for forensic patients, but the hospital has been housing an average of 50 forensic patients, Mayhew said, “Because, by Maine law, these patients have nowhere to go but Riverview.

“The ripple effect of that is felt across the entire adult mental health system. As we lose capacity to effectively serve and meet the demands for the civil beds, that creates challenges in hospital emergency departments, the other two private psychiatric hospitals and the other hospitals that have in-patient psychiatric units within the community hospitals,” she said.

The inability for those hospitals to be able to transfer patients to Riverview when needed reduces the capacity to help those who need in-patient mental health treatment, she said.

“It’s important that we think about these challenges in the broader mental health system,” Mayhew told the committee.

LePage’s bill to expand the forensic capacity at the state prison would free up space in the hospital by moving some of those patients — all but those who are ruled not criminally responsible — to the Department of Corrections.

Mayhew said other New England states, including Vermont, New Hampshire, Connecticut and Rhode Island, have forensic wards at their state prisons.

The governor’s bill, which received the unanimous support of the Legislature’s Criminal Justice and Public Safety Committee earlier this year, was held over for consideration in 2014 because it carried a hefty price tag and lawmakers were struggling to close an $880 million state budget shortfall.

On Thursday, Mayhew said that had the measure passed into law the state would be in a better position as it attempts to alleviate the federal government’s concerns over Riverview. But Mayhew also noted the measure wouldn’t have an immediate effect but would be something the state could point to show it had a long-term plan for handling the ever-growing number of forensic patients in a safer way.

Rep. Peggy Rotundo, D-Lewiston, House chairwoman of the Appropriations Committee, said she believes the committee will pass LePage’s bill on to the full Legislature for consideration when it convenes in a special one-day session next week.

But Rotundo also asked that a stakeholders group be formed to review the bill to see if there were any amendments that might be added to better address the problems at Riverview.

That group will include Department of Corrections and DHHS staff, as well as representatives from the county jails and those who advocate for the rights of the mentally ill in Maine.

“It just seems like LD 1515 gives us the opportunity to address those large concerns that CMS and the federal government have,” Rotundo said. “Clearly we are all very concerned about the safety and well-being of all of the patients as well as the employees there.”

Several lawmakers said that, other than the price tag on the LePage bill, they were supportive of the measure. But they also said they weren’t sure it would be the solution the federal government is looking for, so they also supported having the stakeholders group take a look at the bill.

The issues at Riverview also have an impact on a consent decree the state is obligated to maintain as a result of a class action suit brought by former patients of Riverview’s predecessor, the Augusta Mental Health Institute.

That decree requires adequate services be provided to mental health patients who were treated at AMHI or any that are now treated at Riverview.

Daniel Wathen, a lawyer and former chief justice of the Maine Supreme Judicial Court who is appointed the court master for that consent decree, also addressed the committee Thursday.

Wathen said the idea of a segregated 20-bed ward at Riverview wasn’t in the overall best interests of the mentally ill but the state had little choice.

“They’ve got to do something,” Wathen said. “The federal funding of the entire hospital is at risk, or you will make do with just $20 million, so you will do what you have to do in order to maintain that funding.”

Wathen also said LePage’s bill wasn’t an immediate solution but it does send a message to the federal government that the state is trying to resolve its issues around forensic patients.

“It is part of demonstrating our commitment, that not only are we prepared to do what you would require us to do in the short term, but we have a long-term plan and we are moving forward with it,” Wathen said.

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