Yet another report, required by a longstanding court order, has found deficiencies at the Riverview Psychiatric Center. The Department of Health and Human Services, which runs the facility, disputes many of the findings and has renewed calls for a new, separate facility for some patients.
To move beyond the merry-go-round of deficiency reports and state responses, Daniel Wathen, the former Maine supreme court chief justice who oversees the state’s compliance with a mental health care consent decree, is launching his own fact-finding mission. He plans to soon visit Riverview to observe patient care, speak with staff and review relevant files.
“I’ll be looking at what [DHHS] said they’d do. Have they done it?” he said.
Answering this question will determine what must be done to improve patient care at the state facility in Augusta.
The Centers for Medicare and Medicaid Services pulled Riverview’s federal accreditation in 2013 for reasons that included overcrowding, inadequate staffing and using handcuffs and Tasers to subdue violent patients. The state lost $20 million in annual federal funding as a result.
In late 2014, Wathen had consultant Elizabeth Jones, who briefly ran the facility when it was called the Augusta Mental Health Institute, visit Riverview several times. She reported that staff still relied on seclusion and restraints too often and that the facility needed more staff. She warned that “there is sufficient reason to question whether the state is in compliance with the consent decree provisions regarding individualized treatment and adequate staffing.”
As a result, Wathen successfully advocated for more funding for Riverview, as well as changes in patient treatment.
Jones returned to Riverview in October to see if the officials had addressed the deficiencies. She reported that staff shortages remained, causing staff to work more than 1,000 hours of overtime in July and August, and that staff hired for specific roles were instead filling in elsewhere to alleviate staff shortages.
She also found continuing treatment problems. Treatment plans were often developed without patient input, for example. Jones was given copies of seven forms labeled “Your Input Is Essential.” Four forms were blank; patients had filled out three. Staff also were not sufficiently familiar with new methods for dealing with aggressive behavior.
“Regrettably, based on observation and report, there is insufficient evidence to conclude that staff and class members are sufficiently involved in reshaping recovery-oriented practices and policies at Riverview,” Jones concluded.
The Department of Health and Human Services responded that it had only recently received additional funding from the state and that it has implemented numerous changes to better address patient needs. Restraint use has been dramatically reduced. The only real, long-term solution, the department said, is to create a separate facility for violent patients who have been found criminally not responsible by the court system or incompetent to stand trial.
Wathen and mental health advocates are not opposed to such a facility — if it is run like a hospital by the Department of Health and Human Services, not by the Department of Corrections.
However, with or without a new facility, Wathen must ensure that patients at Riverview are receiving adequate care — now, not just in the future. His fact-finding mission should set an important baseline. If he finds that changes are needed, he says he will go to the court with recommendations.
After years of reports citing inadequate care, many predating Gov. Paul LePage’s administration, this analysis promises a productive way to identify and fix these persistent problems.
