The state-run Riverview Psychiatric Center has made numerous improvements in the past year and has addressed the patient care problems that led to its decertification by the federal government six years ago, according to a report filed in Kennebec County Superior Court on Wednesday.

However, the report also noted that the lack of capacity for community-based programs is affecting the hospital because it’s often difficult to place patients into programs when they are ready to be discharged.

Daniel Wathen, the special court master who is in charge of monitoring Riverview, wrote in his annual report that the mental health hospital in Augusta has “continued to improve in most aspects of its performance” from July 31, 2018, to Aug. 31, 2019.

Wathen said staff stability is a major reason why the formerly troubled hospital – which lost its federal certification in 2013 over performance issues and abuse of patients by staff – has regained its footing. Riverview was recertified in February by the U.S. Centers for Medicare and Medicaid Services.

“For the first time in more than 20 years, the hospital has a full staff of permanent psychiatrists and psychiatric providers, as well as medical care providers, for both inpatient and outpatient services,” Wathen wrote.

Wathen, a former chief justice of the Maine Supreme Judicial Court, is the court master assigned with overseeing conditions at Riverview as part of the 1990 consent decree. The consent decree is the result of a lawsuit settlement that mandates effective treatment for patients of the former Augusta Mental Health Institute.

Part of Wathen’s duties is keeping tabs on the quality of care at Riverview and reporting his findings to the court.

Daniel Wathen, court master of the 1990 AMHI consent decree Joe Phelan/Kennebec Journal

Wathen wrote that the use of restraint and seclusion has plummeted at Riverview, another sign conditions have improved. Mental health experts frown on such tactics and say they should only be used as a last resort for out-of-control patients.

“The incidence and duration of confinement events, the use of seclusion, manual holds, mechanical restraints and psychiatric emergencies continues to compare favorably with national standards,” Wathen wrote.

He pointed out that there were 30 uses of seclusion and restraints in August 2019, a dramatic decline from an average month in 2016, when there were 58 seclusion and restraint uses by staff.

“Then as now, there are spikes in the number of confinement events, but they are often caused by a single patient and are now responded to more effectively,” Wathen wrote.

Riverview lost its certification after federal investigators discovered that the staff was improperly using Tasers and pepper spray to control patients, as well as improper record-keeping and insufficient treatment plans.

Jenna Mehnert, executive director of the National Alliance on Mental Illness Maine, said there’s no doubt the 92-bed Riverview has improved. But she said Maine’s overall mental health system is lacking in many areas, including capacity with community-based services.

She said too many mental health patients end up in jail when what they need is community treatment. Maine never fully built up its community-based services after AMHI closed in 2004.

“We shouldn’t say it’s all great now,” Mehnert said. “There’s a whole population of people we are failing to serve.”

About 115,000 Mainers receive some form of mental health services, according to federal data, and about 40,000 have more acute disorders.

Jeanne Lambrew, Maine’s health and human services commissioner, wrote an op-ed in the Press Herald on Sept. 26 that said the state would like to “scale up” community-based mental health care, although there is not yet a detailed proposal.

Wathen’s report says it’s not only capacity, but also logistical problems and red tape that delay placement of patients who are being discharged from Riverview. The nonprofit groups are sometimes reluctant to accept certain patients, and Wathen said it’s bogging down the process.

“At times, providers have dictated the terms of their acceptance of a referral,” Wathen wrote.

Nonprofit groups that provide the services have been lobbying for improved reimbursement rates, an issue that will likely come up in the next legislative session.

Meanwhile, Wathen wrote recertification at Riverview is helping with the overall stability of services at the hospital, and making the “financial future of the hospital more secure.”

After the hospital lost its certification in 2013 and the federal funding that goes with it, the administration of Gov. Paul LePage continued to draw down about $20 million per year in federal funds, despite not being permitted to do so. LePage battled the loss of funding in court, but lost numerous court decisions.

Medicare required the money to be paid back, and after Gov. Janet Mills took over this year, the state repaid the federal government $80 million, including $2 million in interest penalties.

 

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