AUGUSTA — Specialists brought in to help prevent dangerous situations at Riverview Psychiatric Center proved their worth Saturday after an incident in which a patient allegedly used a chair to attack a nurse, leaving her hospitalized with head and eye injuries.
Riverview Acting Superintendent Jay Harper told legislators on Tuesday that the acuity specialists — who are hired to assist with behavior and safety concerns — were sent to the unit where the attack occurred and brought the unit back under control within minutes. Harper spoke at a joint meeting of the Appropriations and Financial Affairs and the Heath & Human Services committees in the Appropriations hearing room at the State House.
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The hospital, which cares for people with serious and persistent mental illness and co-occurring substance abuse disorders, had sought funding from the Legislature for four acuity specialists but now has eight of them and is considering adding several more to cover for days off and vacations, Harper said. The acuity specialists replaced corrections officers after a March 2013 incident in which a patient attacked a mental health worker, beating her head and stabbing her with a pen.
The presence of corrections officers and the use of a stun gun on another patient attracted the attention of federal regulators who did a survey that ultimately resulted in the loss of certification by the Centers for Medicare & Medicaid Services and the cutoff of federal funding in September 2013. The former superintendent, Mary Louise McEwen, was ousted in March; and Harper, who recently had retired as a patient advocate there, took her place.
The state Department of Health & Human Services has yet to make plans to repay $11 million in federal money it has used to continue to operate Riverview Psychiatric Center since the state hospital lost its certification, and it has an appealed that action, said Ricker Hamilton, deputy commissioner of programs for the department.
“We feel strongly we have a good case and we should never have been decertified in the first place,” Hamilton told legislators on Tuesday. Harper noted that only three units, with a total of 72 beds, are in the request for recertification.
Certification of the 20-bed Lower Saco Unit, where patients have the most behavioral challenges, is not being sought at this point.
Harper spoke briefly about Saturday’s incident at the state hospital in Augusta in which Frank Stewart, 23, is accused of aggravated assault in an attack on Nancy Austin, a registered nurse there. Stewart reportedly was angry and refusing to return an aluminum plate to the staff, according to an affidavit by Capitol Police Officer Joseph Morelli.
“This is an unfortunate reality of the work that we do,” Harper said.
Harper said the hospital is in the process of its own review and would be able to share results only at the final stages.
He described the process as “first fact-finding, then a clinical review and root cause analysis.” He said that should be completed by the middle of next week.
Stewart was sent to the hospital in 2012 under a court order after he was found not criminally responsible for assaulting corrections officers at Long Creek Youth Development Center. Stewart had been living in Riverview’s Upper Saco Unit, a longer-term care facility for forensic patients — those sent there through the criminal court system.
As of a report filed May 30 in Kennebec County Superior Court, both of Stewart’s psychiatric care providers had retired recently, and he was being treated by temporary providers.
The report was made in response to Stewart’s request to have community visits supervised by a woman who is a surrogate grandmother rather than Riverview staff. The hospital staff did not support that proposal but had suggested extending his four-hour limit for community events with one-to-one staff supervision and increasing the 10-mile radius from Riverview to which he is limited.
Stewart was taken to the Kennebec County jail after the attack and plans were being made to send him to a special mental health unit at the Maine State Prison while the charges are pending.
With regard to the hospital’s certification by the Centers for Medicare & Medicaid Services, Harper said the hospital is being evaluated as if it were a new facility.
Harper said the hospital is working on the recommendations, addressing first security, safety and patients’ rights, and now moving on to “the paper path that goes with those issues.”
In the most recent assessment, the hospital failed to meet treatment plan standards.
“We spent July looking at their comments and revamped our treatment plan format to their standards,” Harper said, adding that the hospital is training the different clinical professions in how to document the carrying out of those treatment plans. “The hope is we should be able to gain the certification we deserve.”
When Sen. Margaret Craven, D-Lewiston, asked why the hospital recently changed the words on the sign in front of the hospital building to “Riverview Psychiatric Recovery Center,” Harper told her it was his decision and resulted from monthly meetings he had with patient groups.
Harper said it reflects the hope of the patients to recover, get jobs and return to their families.
Harper said the hospital is focusing on psychological testing and occupational therapy. “The better they learn it in Riverview, the longer life they will have out of Riverview,” he said.
Rep. Henry John Bear, who represents the Houlton Band of Maliseet Indians and serves on the Health & Human Services Committee, told Harper, “I’m a member of your family.” Bear said both his mother and his brother were treated at Riverview and its predecessor, the Augusta Mental Health Institute.
“Are you getting enough money, and is that the solution?” Bear asked.
“It’s difficult for me to say that there’s a big dollar gap,” Harper said, adding he was grateful for the funding provided recently.
More important, he said, is a way to help patients found not criminally responsible for offenses who behave aggressively toward the staff. They cannot be sent to the new unit at the state prison unless they face new charges. “We don’t want to criminalize people just because they have psychiatric illness,” Harper said.
Harper said the Centers for Medicare & Medicaid Services told Riverview that if it has the level of security that the prison unit does, it no longer will be considered a hospital.
“When your No. 1 issue in treatment is behavioral control, as opposed to psychiatric change, you’re beginning to look like a behavioral facility,” Harper said.
Harper said patients with cognitive challenges and head injuries pose the greatest challenge for Riverview, which specializes in psychological treatment and offers patients freedom to choose among various treatment sessions.
He also said funding for a new psychology III position and doubling the number of psychology interns also will help the facility do more neuropsychological testing and help determine the type of treatment plan needed.
Betty Adams — 621-5631
Twitter: @betadams
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