AUGUSTA, Maine — Maine Gov. Paul LePage says in the wake of a recent failed bid to qualify for federal certification, Riverview Psychiatric Center here should consider operating without it. Riverview lost its certification last September due to safety issues, and along with it about $14 million in federal funding, according to state estimates. The hospital has been working to improve ever since, but problems persist.
The list of issues cited by the Centers for Medicare and Medicaid Services is long — spanning a few dozen pages. Among the findings: failure to engage patients in active treatment, failure to do one-on-one observations and failure to get informed consent for treatment. Surveyors also found problems with documenting medication needs and errors. Jenna Mehnert, executive director of the Maine branch of the National Alliance on Mental Illness, says she's confident that Riverview will improve, but the current picture is less than ideal.
"I think if I were a family member and my loved one was at Riverview and I was really hopeful that they were going to get the services needed to have an effective path to recovery charted out for them, I would be pretty frustrated and disappointed," she says.
The report is another blow to Riverview, which lost federal certification and funding last year due to compliance and safety issues — including corrections officers' use of tasers on some patients. Dan Wathen, court master of a state consent decree that requires certain rights for people treated with mental illness, says he's most troubled by the lack of one-on-one assistance to help patients who otherwise refuse to take part Riverview's programs.
"You just can't allow people in the hospital to lay around and do nothing," he says. "And the report indicated that they found that to be the case."
At the same time, Wathen points out that Riverview has had a lot of staff turnover recently, including a new superintendent. Wathen says Jay Harper, a former patient advocate, started the job in March — just two months before the federal survey.
"It's a big ship to turn around in two months," Wathen says. "And so I'm not jumping to the conclusion that it still can't be turned around."
Wathen says Harper has brought a welcome focus on the recovery treatment model, where staff help patients learn to confront and manage their illness instead of just medicating symptoms. Wathen is hopeful that Riverview will meet federal certification requirements in the near future. But LePage suggests that it may be time to take a different tack.
"You know, frankly, I think we ought to just go at it alone and not take the federal money," LePage says.
LePage says the federal government takes a one-size-fits-all approach that may do more harm than good. Jenna Mehnert of NAMI says it might be tempting to criticize seemingly petty federal standards, but she says it's not quite that simple.
"They come to be for very specific reasons," Mehnert says. "And sure there's a lot of I's to dot and T's to cross, but those basic health and safety regulations evolve over time because things have happened."
Department of Health and Human Services Commissioner Mary Mayhew says she shares the governor's concern about a disconnect between federal standards and Riverview's role in Maine. She says the state is involved in several court actions to recapture lost federal funds. Overall, Mayhew says Riverview has made progress. When Riverview lost federal certification, it was out of compliance in eight areas. This latest report highlights numerous areas of concern, but the hospital is out of compliance with just one — medical record documentation.
"I am extremely pleased that we were in compliance with many areas of focus related to patient safety," Mayhew says. "Quality. Patient rights."
Calls to Riverview's superintendent were not returned by airtime. Court master Dan Wathen says he visits Riverview weekly, and plans to do a more thorough evaluation this fall.