Democratic lawmakers say LePage administration misled them on psychiatric hospital crisis

By Scott Thistle, Sun Journal
Posted Oct. 15, 2013, at 11:24 a.m.

LEWISTON, Maine — Democratic state lawmakers on the budget-writing Appropriations and Financial Affairs Committee are saying they were misled and misinformed when they agreed to back Gov. Paul LePage’s proposal aimed at preserving about $17 million in federal funding for the Riverview Psychiatric Center.

Despite passage of a law change expanding the staff and treatment capacity of a privately contracted mental health ward at the state prison in Warren, federal regulators announced in September the state will still lose much of its Medicare and Medicaid funding for Riverview, which is in Augusta.

State officials say they will appeal the decision and Maine Department of Health and Human Services Commissioner Mary Mayhew told lawmakers last week she was confident the state would prevail.

LePage made a brief note of the funding cut during his weekend radio address on Saturday, Oct. 9, saying, “The feds pulled $20 million for Riverview Psychiatric Center, even though the center is now in compliance with federal law.”

Meanwhile, Riverview’s superintendent, Mary Louise McEwen, said new concerns raised by the federal government include, “a standard that we cannot find in the rules that govern participation in the Medicare program.”

Officials have said that in addition to addressing safety concerns, Riverview staff created a process improvement team that looked at the entire hospital.

That team made recommendations to address problems such as contraband, staffing, physical characteristics of the hospital, client expectations regarding behavior and taking a proactive approach to preventing and dealing with violence.

“Riverview has implemented all of the recommendations of this group, which received federal approval,” a news release on the issue stated.

According to McEwen and Mayhew, the remaining issues cited by the federal Centers for Medicare and Medicaid Services deal with “the creation of the two distinct areas of the hospital, the need to develop specific forms for each unit, not communicating when a piece of equipment moves from one area to another and sharing staff across the two areas. In addition, CMS noted the failure to allocate staff costs to each area of the hospital, which has already been corrected.”

“We cannot find in any of the federal rules a requirement that staffing in these units be separate,” McEwen said. “The staffing ratios in the hospital clearly meet federal requirements and can provide for appropriate care for our clients.”

McEwen said the original issues about staff and patient safety, quality and well-documented treatment plans have been addressed.

“The remaining issues do not rise to a level of severity that warrants termination,” McEwen said in a prepared statement. “Most are easily addressed and in one case, we are being held to a standard that we cannot find in the rules that govern participation in the Medicare program.”

The 92-bed hospital, which houses some of the state’s most dangerous mental health patients, first came under federal scrutiny in March after a patient attacked and seriously wounded a health care worker.

That review led to several corrective action plans for Riverview that were ultimately rejected by the Centers for Medicare and Medicaid Services, which determines the hospital’s eligibility for the federal funding.

On Monday, Rep. Mike Carey, D-Lewiston, a member of the Legislature’s Appropriations and Financial Affairs Committee, said state lawmakers, who now must figure out how to fund Riverview if the federal funding cut is upheld, were left largely out-of-the-loop as DHHS delayed informing them of the funding problems until they had reached a crisis stage.

While DHHS was notified of the potential funding cut in March and again in May, lawmakers were never informed of the problem until late August, Carey said.

Additionally, they were led to believe LD 1515 would be part of a temporary fix that allowed the state to work on a longer-term solution while retaining much of the at-risk federal funding for Riverview.

How the state now covers that funding loss and whether the underlying safety and patient care concerns that led to the cut in the first place are being addressed properly remain questions for him and other lawmakers, Carey said.

While he backed the bill, which moved about $3.3 million from the Department of Health and Human Services, the department responsible for Riverview, to the Department of Corrections, the department responsible for the prison, he now questions the move.

Carey said had lawmakers been informed more quickly, they could have attempted to fix the problems during the Legislature’s regular lawmaking session, which ended in July.

“Not only did we have time to do what they thought was a fix, we could have actually been part of fixing the problem,” Carey said.

He said when the federal government first threatened the funding cut, lawmakers were still working on the state’s latest two-year budget.

“That was a $6 billion document and the staffing problems and shortages that caused this were many, many orders of magnitude less than that,” Carey said.

An emergency special session called by LePage in August to address the crisis produced the bill moving some funding from the Department of Health and Human Services to the Department of Corrections.

At the same time, the state offered a third corrective action plan that would see a portion of Riverview’s beds placed in a segregated unit that would become ineligible for federal funding but would allow the state to temporarily ensure staff and patient safety.

Lawmakers were notified in early October that the federal government had returned to inspect Riverview again and had determined the hospital was no longer eligible for federal funding. Mayhew said the hospital will appeal that decision but will also reapply for certification, although it remained unclear what the time frame for that would be.

Rep. Peggy Rotundo, D-Lewiston, the House chairwoman of the Appropriations and Financial Affairs Committee, said Monday the way forward for Riverview and the state’s budget remain frustratingly unclear.

“The whole issue of communication is extremely frustrating,” Rotundo said. “You can’t govern well when people are withholding information from you and keeping you in the dark and telling you that you are getting the complete information and then weeks later it turns out you haven’t gotten complete information.”

She said LD1515 came to the Legislature during its regular session but lawmakers were never informed that failing to pass and fund it would lead to a crisis. But even after they passed the measure during a special session, the crisis remained, Rotundo said.

“This governor has a track record of creating crisis so he can then go ahead and do what he wants,” Rotundo said. “We’ve seen that over and over again.”

Rotundo said she and other lawmakers are still unsure what the administration’s plan is for Riverview.

“We all know that we need to address this issue because we don’t want Riverview to be unsafe,” Rotundo said. “If [Mayhew] decides she’s not going to present us with a plan, then the Legislature comes up with a plan, but the goal is for all of us to work together to come up with one plan that will get us in compliance.”

http://bangordailynews.com/2013/10/15/health/democratic-lawmakers-say-lepage-administration-misled-them-on-psychiatric-hospital-crisis/ printed on September 23, 2014