AUGUSTA, Maine — Despite Gov. Paul LePage’s suggestion Monday that the state give up the quest for federal approval and funding, officials at the troubled Riverview Psychiatric Hospital continue to work toward full compliance with federal standards.
“We have reapplied already, and I am optimistic that [investigators] could be returning by the early fall to resurvey,” said Mary Mayhew, commissioner of the Department of Health and Human Services.
“At this point, I remain confident that we will be recertified,” Mayhew said.
Riverview lost accreditation from the federal Centers for Medicaid and Medicare Services, or CMS, last year, after an inspection prompted by an outburst of violence at the hospital revealed concerns with patient and staff safety, among other issues. All told, Riverview was failing to meet eight different broad conditions for accreditation.
While out of compliance, Riverview is in jeopardy of losing roughly $20 million in annual federal funding for the hospital, though the state has filed an appeal of the reduction and a lawsuit arguing that Riverview should never have been decertified in the first place.
Mayhew and DHHS, which oversees the state-run hospital, worked to turn it around, even replacing Riverview’s chief in March. Riverview re-applied for certification and in May, inspectors once again came to the facility.
Last month, the feds again denied accreditation, citing concerns with document compliance and treatment plans. For example, some patients were admitted to the hospital without meeting admission requirements. Others were diagnosed with specific mental health issues but treatment for those conditions were nowhere to be found in the patient’s treatment plan. Others received treatment that went undocumented.
On Monday, a frustrated LePage suggested that the state give up.
“Frankly, I think we ought to just go it alone and not take federal money,” he told reporters while visiting a homeless shelter in Lewiston. “With the federal money, some of the fine print is so atrocious that sometimes we do more harm than good.”
On Wednesday, the governor backed away from the statement. He told a WABI-5 reporter in Milo that the federal decision not to recertify was “shameful” and “disgusting” but said the hospital would be recertified.
But Mayhew left the door open to the possibility of Riverview operating without federal certification in the future. She said she understood the governor’s frustration, and shared his concern that federal standards had been inconsistently applied throughout Riverview’s 10-year history.
“We want to make sure that we’re able to effectively support a center of excellence at Riverview, and that we have high-quality services and a safe environment,” she said. “To the extent that actions taken by CMS related to certification detract from that, we would certainly evaluate a different path.”
Other health policy experts, though, said Wednesday that going it alone would be an irresponsible move that would put taxpayer dollars and patient safety and rights on the line.
“It’s simply unthinkable that in modern times you would have a hospital housing large numbers of desperately sick people operating unaccredited. I’m sure a court would not hesitate to shut it down” said Sara Rosenbaum, an attorney and professor of health policy at George Washington University.
Rosenbaum said CMS standards represented the “minimum” requirements for operating a safe and functional hospital. Not complying would mean not only a massive reduction in federal funding, she said, but could invite a deluge of lawsuits against the state.
Riverview is the only facility in the state that serves “forensic patients” — those placed into psychiatric care by the criminal justice system after being found guilty of a crime, including murder, or after being found mentally incompetent to stand trial. Additionally it serves civilian clients, some of whom may have been institutionalized against their will.
That means a population of patients at Riverview at any given moment may be forced to stay there, Rosenbaum said. But the U.S. Supreme Court has ruled that no one can be held against their will in a substandard medical facility.
“You have invited a set of conditions that go well beyond just the terrible concept of putting people in an unsafe institution,” she said. “You invite lawsuits against the state for subjecting people to substandard care.”
What’s more, if Riverview were to forgo federal certification, state licensing rules would have to be rewritten for the hospital to stay open. Currently, a state hospital license is dependant upon CMS accreditation, among other standards.
Rep. Drew Gattine, D-Westbrook, is a health care system consultant and member of the Health and Human Services Committee, said it would be “unthinkable” for a private hospital CEO to recommend against accreditation.
“If you said ‘I’m fed up with the feds, I’m not going to be certified anymore,’ your board would fire you,” he said. “They’d look at you like you’re crazy. [LePage] is trying to deflect responsibility.”
Mayhew said that while being turned down was a setback, there was a bright side. When Riverview’s certification was revoked last year, the feds cited eight different conditions — broad requirements that each contain many specific rules and regulations — that weren’t being met. This time around, there was only one.
“Management has changed, and that’s fairly recent,” she said, alluding the the March hiring of Jay Harper to take over the troubled hospital. “It’s changing a culture, and that takes time.”
Sun Journal state politics editor Scott Thistle contributed to this report. Follow Mario Moretto on Twitter at @riocarmine.