The Maine Department of Health and Human Services is requesting money for more than two dozen new positions at Riverview Psychiatric Center in Augusta as the state continues efforts to regain federal certification for the state mental health hospital.

Riverview staff, meanwhile, said Wednesday that understaffing, inadequate training or mentoring programs and forced overtime are contributing to unsafe working conditions and high employee turnover at the hospital.

“This is probably one of the most dangerous environments I’ve worked in,” Patricia Mason, nurse manager for one of the units at Riverview, told state lawmakers. “In my 20 years in the emergency room, I was assaulted once. In my 7 months at Riverview I’ve been assaulted once, so that should put it in perspective.”

In September 2013, the U.S. Centers for Medicare and Medicaid Services revoked Riverview’s federal certification — yanking up to $20 million in annual federal funding in the process — after finding problems such as the use of stun guns and handcuffs on patients. Subsequent reviews identified additional issues, including medication errors and substandard treatment.

The state has since altered policies on patient restraint and seclusion, sought to hire new employees and made other changes as it attempts to regain certification. But DHHS Commissioner Mary Mayhew told lawmakers that the federal agency now says it will not recertify Riverview as long as a significant percentage of the hospital’s 92 beds are filled by people referred from the criminal court system rather than by “civil” mental health patients either committed involuntarily or by their own will.

Mayhew said DHHS is looking at other models for housing the forensic patients from the criminal justice system who do not need full hospital care. In the meantime, the LePage administration is requesting additional money to fill about 30 new positions at Riverview, partly in response to the issues raised by the federal reviews.

The administration is seeking funding for several mental health workers, more than a half-dozen nurses and 12 “acuity specialists” who are mental health professionals also trained to handle agitated or violent patients. The acuity specialists are intended to replace the correctional officers or state police called in to deal with violent patients.

Figures provided to the Legislature’s Appropriations and Financial Affairs Committee on Wednesday by Riverview staff underscored the safety concerns at the facility and what they said is a severe staffing shortage.

There were 199 reported staff injuries at Riverview last year, 103 of which were mental health workers, according to Lisa Cromwell, a mental health worker at Riverview. Cromwell said there are currently 11 mental health workers and two nurses out of work because of assaults or violent patient behavior.

At the same time, Riverview’s mental health staff were required to work more than 18,000 hours of mandatory overtime last year, said Cromwell.

“The extreme number of overtime and mandated hours shows how understaffed we are, and this leads to an unsafe workplace and an unsafe environment for our patients,” said Cromwell, one of several members or leaders of the Maine State Employees Union and the American Federation of State, County and Municipal Employees unions to testify during the budget hearing.

“In the proposed budget for Riverview, there are many positions created but not enough for mental health workers. We need more people on the floor, working with the patients, not in administrative positions,” she said.

Mason, the unit nurse manager, said the chronic staff shortage, lack of training and the “constant threat of violence” are top reasons why people say they leave Riverview. Mason called it a “self-perpetuating cycle that must be broken” if Riverview is to become a psychiatric recovery center.

DHHS spokesman David Sorensen said the budget hearing highlights the need for the changes the LePage administration is seeking to make at Riverview.

“The testimony today underscores the need for the Legislature to pass the governor’s budget initiatives for Riverview, which include $2.7 million in additional funding, supports hiring new positions and enhances safety and training measures,” Sorensen said.

The Legislature’s Health and Human Services Committee is expected to hold a work session on Thursday on DHHS’ supplemental budget request, which covers the remainder of the fiscal year. The Appropriations Committee is slated to hold a work session on the budget proposal on Friday.


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