AUGUSTA — The Riverview Psychiatric Center has failed to implement a number of changes it proposed to comply with a consent decree, so the court master has made formal recommendations about staffing, record-keeping and transitioning times for patients ready for placement with community outpatient providers.
In a progress report issued Monday and covering the past six months, Court Master Daniel Wathen, a former chief justice of the Maine Supreme Judicial Court, laid out those recommendations.
If the state Department of Health and Human Services does not accept them, it has 30 days to file a challenge in court.
“We just received the final report today — the Commissioner is still reviewing,” said department spokeswoman Samantha Edwards in an email sent Monday.
The consent decree settled a lawsuit brought against the department over how it treated people with severe and persistent mental illness.
The 92-bed hospital handles both civil and forensic patients, those who are sent to Riverview in connection with criminal charges. The hospital lost its certification from the Centers for Medicare and Medicaid Services in September 2013, costing the state an estimated $20 million annually in federal funds.
The loss came as a result of the hospital’s use of corrections officers to handle patients who had proved aggressive and violent to other patients and staff members. The officers were then replaced with acuity specialists, who are hired to help manage patients considered dangerous to themselves and others.
Wathen had previewed some of his findings Jan. 22 during a work session of the Legislature’s Government Oversight Committee. That committee was looking into how staffing affects patient and staff safety at the hospital.
At that meeting, Wathen provided the committee with numbers from his report, saying that the hospital had 51 vacancies on Jan. 19 with 47 of those direct care workers.
In particular, he notes in his report that there were 23 vacancies among the 87 nursing positions authorized. He also says psychiatric providers are “adequate in numbers but lacking in continuity. Out of a total of 11 providers, six are engaged long-term and five are engaged for terms ranging from six weeks to six months.”
He said Monday that the hospital has the funding to address his recommendations.
“The budget is not the problem,” he said. “They have the money to do it.”
Riverview workers told lawmakers on Jan. 19 that forced overtime has crushed morale and driven away good workers. Sen. Roger Katz, R-Augusta, led the public forum to listen to concerns from the workers prior to the Government Oversight Committee meeting.
In his report, Wathen recommended the following:
• Not counting acuity specialists as mental health workers when doing staffing ratios.
In his report, Wathen says, “Routinely, however, acuity specialists have been assigned to perform as mental health workers in order for the hospital to deal with unit acuity and to maintain the mental health worker/client ratio of 1 to 6 or 1 to 8.”
• Adding a mental health worker to a unit if a client on the unit needs one-to-one staffing. Currently staffing is not adjusted until a second patient on the same unit requires one to one staffing.
• Recommending that mental health workers and, when appropriate, acuity specialists attend treatment team meetings partially as a way to address a “significant turnover in the psychiatric and nursing staff.”
• Implementing unit-based staffing on a pilot basis in one unit by April 4; implementing it in the three other units by Aug. 1.
• Maintaining activity logs on each unit and reviewing the logs monthly to see whether limits are imposed on a patient’s access to treatment, services or outdoor areas.
“In fact, activity logs are not maintained on all units and there is no readily available means of determining the validity of complaints regarding the limitation of outdoor access or other treatment or services occasioned by the staffing shortages that the hospital now experiences,” Wathen says.
• Enforcing penalties if contract agencies fail to accept prompt placement of Riverview patients deemed clinically ready to move to group homes or supported apartments. Wathen provides an example from the week of Jan. 18 when 12 civil clients awaited placement in a community setting.
“Those 12, one quarter of the hospital’s civil capacity, had been waiting anywhere from 15 to 90 days for placement,” he says. “Collectively, they represent 444 days of unnecessary hospitalization at a time when the hospital is struggling with staffing and has other clients waiting for admission.”
• Having an independent consultant conduct an annual review of the hospital’s restrictive practices and the management system.
“The Consent Decree requires a semi-annual examination of restrictive practices by an independent consultant; no such reviews have been conducted in recent years,” Wathen notes, adding that a review done by the hospital in 2015 was “neither complete nor independent.”
Betty Adams — 621-5631
Twitter: @betadams
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