Increased violence at Maine’s psych hospital prompts reform

Posted Sept. 15, 2013, at 12:41 p.m.
Last modified Oct. 29, 2013, at 2:06 p.m.
Mary Mayhew, commissioner of the Maine Department of Health and Human Services. Mayhew and Riverview Psychiatric Hospital Superintendent Mary Louise McEwen are working in part to progress a corrective-action plan for Riverview in an effort to decrease the levels of violence and other issues at the location.
Contributed photo
Mary Mayhew, commissioner of the Maine Department of Health and Human Services. Mayhew and Riverview Psychiatric Hospital Superintendent Mary Louise McEwen are working in part to progress a corrective-action plan for Riverview in an effort to decrease the levels of violence and other issues at the location.

AUGUSTA, Maine — Of the 92 people in state custody who were found “not criminally responsible” for crimes, 18 have been charged with at least one count of murder.

That’s more than 20 percent of the state’s “not criminally responsible” population, while less than 2 percent of those serving time in Maine prisons have been convicted of murder.

Seven people with mental illnesses who were found not criminally responsible for murder are still confined to the state’s high-security Riverview Psychiatric Center in Augusta. Two are in prison, and the nine remaining have been released — under varying degrees of supervision — to the community, according to the Maine Department of Health and Human Services.

And because — unlike those on the state’s official sex offender registry — they have never been convicted of crimes, neither their whereabouts nor their treatment plans are public information. Most of those treatment plans include mandatory and anti-psychotic medications.

One of the most high-profile patients still at Riverview is William Bruce. He was released from state custody, against the wishes and fears of his family, only to kill his mother with a hatchet in 2006 before returning to state custody. He was later found not criminally responsible for that crime.

Bruce had refused to take medications that kept his schizophrenia at bay.

Another patient, Donald Beauchene, charged with murder in 1970, has twice escaped or “eloped” from state custody. During one of those escapes, Beauchene raped a woman in New York, where he was convicted of the crime and served 15 years in prison before returning to state custody in Maine.

Beauchene has a long history of suing DHHS for infringing on his liberties, including a case filed in the law court in 2009 in which he claimed that DHHS violated his civil rights when it canceled his supervised community release to visit his parents. He claimed that right was part of his Comprehensive Service Plan. The court did not agree and upheld the DHHS decision.

Meanwhile, Guy E. Hunnewell III, serving a life sentence for murder at the state prison, is facing another murder charge in the slaying of a fellow inmate. He is asking to be found not criminally responsible for his actions. If a judge or jury finds in his favor, Hunnewell could end up at Riverview.

Others at the hospital have been charged with arson, aggravated assault, assault on children and cruelty to animals, among other charges. At least two patients at Riverview were facing violent sex-crime charges before being ruled not criminally responsible.

“Some of these people have true mental illness; some of them are simply sociopaths with no real chance of recovery. Others just have good lawyers,” a Riverview employee, who asked not to be identified for fear of retaliation, told the Sun Journal recently.

That same employee said the treatment plans for many of the most violent clients include supervised public forays. Some go out to dinner and others have regularly attended Portland Sea Dogs baseball games.

Almost all are allowed a personal phone line, and until recently, pornography was not considered contraband at the hospital.

“The most violent clients continue their behaviors because there are few real consequences to those behaviors,” the Riverview employee said.

Problems with violence in March drew the attention of the federal government, which funds about half of the hospital’s annual operation costs via Medicaid and Medicare, after a patient attacked and injured a health care worker at the facility.

That same patient had attacked a health care worker in 2006, causing serious injuries.

After two “surveys,” or inspections, of the hospital, the Centers for Medicaid & Medicare Services directed the hospital to develop a corrective action plan or risk losing $20 million in federal funding.

Inspectors found a laundry list of shortcomings at the facility. Some practices used to control dangerous patients — such as shocking them with Tasers — were not compliant with federal law.

The CMS report also determined the hospital was not compliant in treatment plans that focused on reintegrating patients to the community.

But the Riverview worker said reports of the inspections and subsequent criticism by advocates for the mentally ill or civil rights groups were unfair and misrepresent what really goes on behind the facility’s locked doors.

Since the CMS report, the use of Tasers has been suspended; two officers from the Department of Corrections continue to staff a six-bed section of a newly segregated 20-bed wing at Riverview known as the Lower Saco Forensic Unit. Those officers are still armed with and allowed to use pepper spray on patients when they pose a danger to themselves or others.

“The few months when we had officers with Tasers were the only times we had relative peace on the unit,” the Riverview worker said. “Due to their jail mentality, most of the violent clients were somehow able to finally maintain control of their behaviors knowing that officers with Tasers, rather than just a nurse or mental health worker with no real ability to control them, were present. The officers were kind, professional and attempted to build relationships with the clients. They were not there to abuse them.”

Efforts to improve safety for staff and patients are moving forward, but long-term solutions for the hospital will likely take both time and money, state lawmakers on the Legislature’s Health and Human Services Committee learned last Wednesday.

The committee was updated on the progress of the corrective-action plan Riverview is implementing under the auspices of the federal CMS by hospital Superintendent Mary Louise McEwen and DHHS Commissioner Mary Mayhew.

The committee was also updated on the implementation of a new law passed by the Legislature during a special session in August that aims to ease some of the problems at Riverview.

That legislation will lead to increased staffing and treatment capacity for a mental health ward inside the Maine State Prison in Warren.

But many of the issues that led the federal intervention and the threat of a $20 million funding cut remain works in progress, McEwen told lawmakers.

Among the problems McEwen identified was the need to adequately pay Riverview staff so they are not lured to better-paying jobs in the private sector. McEwen said the best-trained and most experienced often leave the hospital after only a short time. Nurses on average are paid between $2 and $5 less per hour than their counterparts in the private sector, she told lawmakers.

Mayhew also told lawmakers they should consider expanding — by one full-time officer — the Capitol Police force. Part of the Maine Department of Public Safety, the Capitol Police provide security for state properties in Augusta, including the State House. Mayhew said 95 percent of the agency’s criminal investigations involve Riverview incidents and a full-time officer assigned to the hospital would have a positive impact there, she said.

The new law provides five months of funding for the expanded prison staff, money that will be redirected from DHHS to the Department of Corrections.

Full funding of the change will likely come as part of a supplemental state budget in 2014. The new law also sets up a new government oversight committee that includes lawmakers and is meant to monitor progress at Riverview and the prison while developing policy and legislation to ensure that safety and treatment improves.

The legislation received overwhelming support, but critics, including many who voted for it, say it falls far short of solving Riverview’s problems.

Under the law, both those deemed not criminally responsible and those determined to be “incompetent to stand trial” would remain at Riverview. Only inmates or suspects who are too violent to safely receive a proper psychological evaluation at a county jail would be moved to Warren for treatment and evaluation.

The law helps stem the flow of county inmates awaiting trial to Riverview but does little to reduce the crunch for not criminally responsible beds at the facility. Some, including state Rep. Mike Carey, D-Lewiston, have questioned the transfer of DHHS funds to the DOC, instead of using those funds to shore up Riverview.

Carey voted for the bill, but said he did so knowing it was not a total fix for the problems the state was facing.

“Whatever the mix of management, governance, inadequate staffing, the human rights violations detailed in the report are unacceptable and require the continued attention of the administration and this body,” Carey told his colleagues during a House floor speech in August.

The expanded mental health unit at the prison would also be available for inmates needing segregated mental health services.

Helen Bailey, a lawyer at the Maine Disability Rights Center, which advocates for people with mental illnesses, said the center still has deep concerns about the implementation of the corrective-action plan at Riverview.

Bailey told lawmakers last week that while meetings and conversations with Riverview and DHHS officials have been productive, they still had differences in interpretations of how the plan should be implemented. She said they have had discussions about individual patients and “interventions that we thought might be appropriate.”

“We have some Gordian knots that have been really frustrating,” Bailey said. “We have serious problems with the correctional officers being there. What’s the justification for that? These are not correctional patients, most of them.”

Her organization is concerned that the patients on the Lower Saco Forensic Unit will be mistreated. “There are 16 patients over there who have some interventions that are being permitted that ordinarily wouldn’t be allowed in a regular hospital setting,” Bailey said.

The state is waiting for another unannounced federal survey at Riverview aimed at determining whether the corrective-action plan implemented by the state is working.

That plan, as approved by CMS, makes the Lower Saco Forensic Unit ineligible for federal funding but allows the continued presence of two full-time Maine Department of Corrections officers to ensure safety.

Those officers will provide security for a six-bed section within the new segregated unit, which will be used only for the most violent and out-of-control patients.

The new law also will allow county jails to send to prison suspects in need of an inpatient mental health assessment to determine whether they are competent to stand trial.

State Sen. Margaret Craven, D-Lewiston, the Senate chairwoman of the Health and Human Services Committee, said lawmakers will be following the issue closely.

“Until there’s a reevaluation by CMS, we won’t know exactly,” Craven said. “But I do know they are working very hard at it.”

She agreed that the new law isn’t the end answer for Riverview, but it’s a start.

“The worse part of this whole thing is this clinic [at Warren] is attached to a prison,” Craven said. “If it 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.”

Craven suggested her committee, which has jurisdiction over DHHS, should find ways to visit Riverview and tour the facility in a way that is less sanitized than what has occurred with visits in the past.

“Not that we want to be put in a dangerous situation, but to be able to visit there in a way where we can get better and more direct information from staff and patients,” Craven said.

She told Mayhew and McEwen that she knows the work at Riverview is difficult and dangerous.

“I know this is one of the most difficult jobs in the state of Maine for you and your staff,” she said. “No matter how much we complain, I acknowledge that it is a very, very hard job.”

 

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