Both of Lewiston’s hospitals have turned away patients with psychiatric problems over the past year and instead had them arrested, a violation of federal law. In a number of cases, police brought the patients to the Androscoggin County Jail, where their conditions worsened.
Recently released documents from state licensing inspectors detail the failure of both Central Maine Medical Center and St. Mary’s Regional Medical Center to screen and provide basic stabilizing treatment to patients experiencing mental health crises who showed up at the hospitals’ emergency departments. Some patients were threatening to commit suicide and others had extensive histories of mental illness.
In some cases, hospital staff deleted patient records from their registration logs or never recorded encounters that ended in the patients’ arrests.
The licensing inspectors also found that one of the hospitals, Central Maine Medical Center, instructed area law enforcement and ambulance services not to take patients with mental health problems to the medical center because it didn’t provide the services those patients needed.
A federal law known as the Emergency Medical Treatment and Active Labor Act requires that all hospitals that receive Medicare funding screen and stabilize anyone who shows up at the emergency room requesting treatment, regardless of their ability to pay.
Both hospitals risked no longer receiving Medicare payments because of their violations of the law, which officials from both hospitals acknowledged to state licensing inspectors. But the hospitals have since submitted plans detailing how they’ll correct the violations, allowing them to continue receiving Medicare payments, a major source of revenue.
Emergency rooms are the first stop for many patients who need mental health treatment, said Kevin Voyvodich, a managing attorney with Disability Rights Maine, which alerted the state Division of Licensing and Certification and the federal Centers for Medicare and Medicaid Services of potential violations.
“If that’s the entry point and you’re being turned away at the entry point and arrested, people aren’t getting the psychiatric services they need,” he said. “The result of these kinds of situations is, conceivably, people might not show up for fear of law enforcement involvement. Or if they do show up, they could end up in jail for a significant period of time.”
Central Maine Medical Center and St. Mary’s Regional Medical Center run the only emergency rooms in Lewiston.
“These are the two regional hospitals,” Voyvodich said. “If you’re a person who goes to one hospital and gets turned away and diverted, and goes to the other hospital and gets arrested, you have no access point in that system.”
The reports produced by the state licensing inspectors detail a number of individual patient stories.
One patient with a history of mental illness showed up at the St. Mary’s emergency department multiple times over the course of five days early last November. The patient, who was homeless, complained about abdominal pain one day and the next day spoke of a desire to “get back on my meds” for a variety of mental health diagnoses.
On the night of Nov. 6, the patient showed up at the hospital with complaints of nausea, vomiting and leg numbness. The patient left the hospital later that night then tried to return about an hour later. At that point, a security guard stopped the patient, whom police then arrested for trespassing.
In jail, officials placed the patient on suicide watch and found the patient was “highly delusional and incapable of expressing a lucid thought.” In a jail cell and naked, the patient screamed incoherently.
At CMMC, a patient who showed up at the emergency department last October asked for an MRI to detect self-reported brain cancer — a complaint medical staff had addressed days earlier. Hospital staff had the patient arrested after the patient didn’t cooperate with triaging and refused to walk to an exam room.
“We take this situation very seriously and have submitted a corrective action plan which has been accepted by CMS,” Karen Sullivan, a spokeswoman for St. Mary’s parent organization, Covenant Health, wrote in an email. “We are always looking for opportunities to improve our processes and our operation. We are currently especially focused on improving staff training and education because our overriding commitment is to provide the very best care possible for all our patients.”
Kate Carlisle, a spokeswoman for CMMC, said the hospital “has taken steps to prevent future incidents such as the one which earlier this year triggered an EMTALA (Emergency Medical Treatment and Active Labor Act) investigation at both local hospitals. Signage has been improved, and substantial training in rules and protocol was undertaken. A recent inspection by CMS found that appropriate steps were taken and the investigation was closed. CMMC’s highest priority is providing top quality care to all patients who walk through our doors.”
Central Maine Healthcare, that hospital’s parent organization, has been in financial and leadership turmoil recently, with staff at three its hospitals issuing votes of no confidence in the organization’s leadership earlier this month.
State licensing inspectors found other violations at the hospitals as well.
CMMC lacked easily readable signs spelling out patients’ rights to treatment — a requirement of federal law. One sign was hidden by another, others “would be next to impossible for someone on a stretcher to read,” an emergency medical responder told state inspectors.
In addition, neither hospital had complete records for patients who had received mental health evaluations from the hospitals’ contracted crisis service providers.
The correctional plans for both hospitals detail their intentions to educate existing staff and new employees of their obligations under the Emergency Medical Treatment and Active Labor Act. St. Mary’s shared a detailed Powerpoint presentation with the federal government about hospital staff’s legal obligations and a quiz testing employees’ knowledge of the law.
St. Mary’s also showed state and federal regulators that it had updated its policies to explicitly lay out its responsibility to screen patients with mental health problems. CMMC noted that it had ordered 70 new, legible signs indicating patients’ rights to display throughout the hospital.
Voyvodich, with Disability Rights Maine, said this was the first time the organization had used a process specified in the federal law to report violations. If similar violations are happening at other hospitals, he said, he hopes the example of the Lewiston hospitals show that state licensing officials and federal authorities took the violations seriously.
“If someone’s going to the emergency room for any condition, you hope they’re able to get treatment for any condition and that the end result wouldn’t be jail,” he said.
Maine Focus is a journalism and community engagement initiative at the Bangor Daily News. Questions? Write to firstname.lastname@example.org.