Riverview certificate controversy

On Monday, September 14, Maine lawmakers argued over plans for the Riverview Psychiatric Center, one of the two state-run psychiatric care facilities in Maine and one that lost its certification in 2013. The issue has to do with so-called “forensic patients”— those tried for violent crimes such as murder and assault and then found to be criminally insane. Riverview treats these patients alongside the civilly committed, employing stringent security measures to ensure the safety of all patients and staff.

Riverview lost its certification on June 4, 2013. The report cited the use of handcuffs, stun guns, and pepper spray on patients, along with insufficient record keeping. The stakes of certification were high: of the $32 million it cost to run the facility, $20 million came from federal funds, which are contingent on Riverview’s certification. The administration made immediate changes in staff and record keeping in order to address the report’s concerns, but still the facility has yet to qualify for recertification.

Maine’s other state-run psychiatric care facility is the Dorothea Dix Psychiatric Center in Bangor. Decades older than Riverview, Dorothea Dix rarely receives forensic patients; Riverview’s more modern facilities and advanced security are better equipped for their treatment. Members of staff at Dorothea Dix learn only non-confrontational methods of handling patients, using hands as a last resort. They neither use nor need equipment like handcuffs, so accreditation has never been an issue. However, on the occasions that Riverview is full and Dorothea Dix has to take in forensic patients, these non-physical techniques can fall short. In 2011, William H. Hall escaped from the Dorothea Dix facility. He was a murderer, having confessed to strangling an acquaintance and throwing him out a window on the second floor. Though his escape caused no real harm—he was captured shortly after and transferred to Riverview—the incident highlights that the techniques most favored in the certification process are not always adequate in handling violent offenders. That is to say, if Riverview did not treat forensic patients, it would have far less trouble meeting the criteria for recertification.

At the meeting this past Monday, Department of Health and Human Services (DHHS) commissioner Mary Mahew presented two proposals to the Maine Legislature regarding plans for recertification. Because of the $20 million in federal funds at stake, tensions were running high, as they had been for years. The DHHS and the Legislature have blamed each other entirely for Riverview’s problems. It was in this milieu of pent-up tension and toxicity that Mahew presented her proposals, but not before reading eight pages of critical testimony targeted at the Legislature, chastising it for not solving the problems sooner. After some choice words between Mahew and legislatures, Mahew laid out two plans that the Legislature had rejected earlier in the year for being insufficiently detailed.

The first of these was a 16-bed facility exclusively for forensic patients, as a way to remove them from Riverview. Operating at a projected cost of $3.8 million annually, Mahew called it a “no-brainer.” Some, however, worried that a separate facility would stigmatize forensic patients as being the only ones prone to violent outbursts, when others may be dangerous as well.

The next proposal was more controversial: a 55-bed unit for holding the accused before their psychiatric evaluations. Currently, they have to wait in county jails, putting a strain on facilities. This Behavioral Assessment Safety Evaluation (BASE) unit would cost an estimated $18.5 million a year. Legislatures balked at this proposal, worried it would mark a shift toward privatizing mental health services. Such shifts generally do not end well; in Florida, for example, a for-profit corporation called Geocare ran a psychiatric care facility in which staff overmedicated patients and failed to report when a patient fell into a scalding bathtub and died. Disability Rights Maine attorney Kevin Voyvodich said that his concern was less about whether the BASE unit would be public or private and more about the amount of oversight it received, and whether it would be based on a prison or a mental heath facility.

Tensions were, if anything, higher after Mahew made her presentation than they were before. Legislatures tore apart her proposal and blasted her for yet again not having enough specifics. They could not tell which, if either, of the proposals she was endorsing.

“I want you to tell me what the solution is to this problem,” said Rep. Jef- frey Timberlake, R-Turner. “We need to move from here. I need to know what it is we have to do, whether we bite the bullet and do something different. I’ve listened to this for an hour now and I still don’t know what I’m supposed to do.”

The legislature will vote on the proposals in January, and until further notice, Riverview will remain uncertified. U.S. District Judge Jon Levy noted the irony that it would have been more efficient to fight the original ruling than to make improvements: “The ensuing process penalized the state for having directed its energy and resources toward achieving regulatory compliance, rather than contesting the alleged deficiencies.” The Riverview saga represents the realities of government, the red tape and tangle of bureaucracy involved in every major decision. It illustrates, according the Mahew, “the reason people are so frustrated with the government.”

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