Maine legislators pass emergency bill to address state psychiatric hospital problems

Posted Aug. 29, 2013, at 3:32 p.m.
Last modified Aug. 29, 2013, at 7:56 p.m.

AUGUSTA, Maine — The Maine Legislature on Thursday took the first tentative steps toward solving overcrowding and understaffing problems at the state’s Riverview Psychiatric Center.

Meanwhile, the federal government’s Centers for Medicaid and Medicare Services approved a corrective action plan for the facility after it found patient and staff safety problems and treatment shortfalls during an inspection in March.

Lawmakers passed LD 1515, a bill first offered by Gov. Paul LePage in May, which expands the resources available, including adding 14 new mental health workers to a 32-bed mental health unit inside the state prison in Warren.

The House approved the bill on a vote of 115-8, while the Senate passed the measure 32-0.

Before those votes, legislators significantly amended the bill, limiting strictly who could be sent to the prison facility. The amended bill also creates a special legislative oversight committee that will continue to work on finding solutions to a host of patient and employee safety problems identified in a recent federal audit of the 92-bed Riverview facility in Augusta.

At stake was an estimated $20 million in federal funding that would have been eliminated if the state’s plan to correct the problems at the hospital failed to gain federal approval.

Riverview treats individuals whose mental illness makes them violent as well as criminal suspects who have been found either incompetent to stand trial or not criminally responsible for their actions.

The facility also has beds for those who have been civilly committed by the courts for being considered a danger to themselves or others, or those who have debilitating mental illness that prevents them from caring for themselves. There is also some bed space for those who voluntarily commit themselves to the hospital.

DHHS Commissioner Mary Mayhew told lawmakers Thursday that her department remained in negotiations with the federal government and while she had yet to receive written confirmation the state’s latest plan would be accepted, she remained “optimistic based on oral conversations that they are increasingly satisfied with what has been submitted.”

Mayhew also said that even if that plan, which calls for the state to decertify from federal funding 24 beds at Riverview and keep them segregated from the rest of the hospital, was approved, the federal government would not restore funding fully until it was able to do another unannounced inspection of the facility.

Meanwhile, lawmakers pushed ahead with a plan that most agreed is only a small part of a broader solution for a burgeoning population of mental health patients who are filtering into the psychiatric hospital from the state’s criminal justice system.

Not all legislators agreed sending those in need of mental health services to a prison facility was the proper approach.

In an impassioned speech from the House floor, Rep. Joe Brooks, I-Winterport, said the move would take the state backwards in its approach to addressing the issues around mental illness.

“I cannot begin to express my disappointment that we are doing this,” Brooks said. “We are turning the clock back 50 years — maybe 100 years in dealing with the issues that exist over at Riverview.”

Brooks’ concern echoed that of civil rights advocates who opposed the bill because it would allow those not convicted of a crime to be sent into the care of the Department of Corrections and to a prison instead of a hospital for treatment.

Brooks said the bill did little more than “criminalize mental illness” while opening the state to a host of civil rights lawsuits.

But supporters of the bill, including Attorney General Janet Mills, said only those who were too violent to be safely cared for at a county jail or Riverview would be sent to the state prison in Warren.

Amendments to the bill added Thursday trimmed back LePage’s original proposal, which would have allowed those who have been found incompetent to stand trial and those who are being evaluated for psychological competency to be moved to the prison when they were too violent to be cared for at Riverview.

Amendments sponsored Thursday by Democrats ensured that individuals who have been found not criminally responsible for their actions and those who have been found incompetent to stand trial would remain in a psychiatric setting.

The move came in part at the urging of civil rights and mental health advocates including the American Civil Liberties Union of Maine, which opposed moving people who have not been tried or convicted to prison for mental health treatments.

Zach Heiden, a lawyer and the ACLU of Maine’s legal director, said the organization still opposed the bill despite the changes.

Another amendment added Thursday pushed off full and permanent funding of the $4.5 million proposal.

Instead the change will be paid for temporarily with funds found within the DHHS budget, according to Mayhew. She also assured lawmakers that funding would not come from eliminating any DHHS positions but through attrition and other means.

Lawmakers likely will address the long-term funding of the change in January.

The legislation also directs DHHS to regularly update lawmakers on the progress at Riverview. A new legislative oversight committee will be tasked with crafting legislation that offers longer-term solutions for the crisis at Riverview.

Problems at Riverview came to light after the federal government inspected the facility following an attack by a patient against an employee there. The worker, who was seriously injured when the patient punched her and stabbed her in the face and hands with a pen, has yet to return to work. The patient who attacked her was involved in a similar attack on a staff member in 2006.

Many of the patients at Riverview have exhibited extremely violent behaviors and several have been indicted on homicide charges but were later found either incompetent to stand trial or not criminally responsible.

A 92-page report from CMS issued in May pointed out staff and patient safety problems related to understaffing and overcrowding but also found improper security and treatment methods being used against patients including Tasers and handcuffs.

Other parts of the report detailed improper locks on containment rooms as well as fire exits and escapes that were obstructed by bars on windows.

At least one lawmaker, Rep. Craig Hickman, D-Winthrop, voiced concern the bill was being dramatically changed and moved to a full vote of the Legislature without proper or adequate public comment.

“I just feel like there is so much that has changed that it would seem wise to have the public weigh in on this because I don’t know what my constituents think about any of this, because it is happening so fast,” Hickman told his colleagues during a Democratic caucus before the vote.

Hickman and Brooks were among nine legislators who voted against the measure.

House Speaker Mark Eves, D-North Berwick, said the bill as amended was an improvement, but he also recognized the concerns of opponents.

“This is a small fix to a big problem,” Eves said. “We need to do this but we also need to keep our eye on the bigger picture.”

In a message to media Thursday, LePage congratulated the Legislature on its fast action and agreed there was more work to be done on Riverview.

“I am also pleased that the Legislature has acted to remedy a serious problem at Riverview Psychiatric Center in Augusta, which is a dangerous situation that needed to be addressed quickly,” LePage said in a prepared statement. “Our first concern is for the safety of the patients and our staff. There is still work to do, but this is the first step in that process.”

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