May 18, 2013

Understaffed, undersized and under siege: Riverview hospital struggles with safety

'We have major concerns about health and safety at Riverview, and we're trying to address them long-term,' union representative says

By Betty Adams
Staff Writer

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This aerial photo, taken on April 30, shows The Riverview Psychiatric Center on banks of Kennbec River in Augusta.

Staff photo by Joe Phelan

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The Riverview Psychiatric Center in Augusta replaced the beleaguered Augusta Mental Health Institute, opening in 2003 with 92 beds for voluntary and court-committed patients. The plan was that 44 beds would be for forensic patients — those who have committed crimes — and 48 for general psychiatric, or civil, patients.

But forensic patients now take up some of the civil beds — an Aug. 1 census listed 57 forensic and 35 civil patients.

Riverview, which is licensed by the Department of Health and Human Services, houses the only unit in Maine for forensic patients who are committed to care by a court. Civil patients can be treated at Spring Harbor in Westbrook, Acadia Hospital in Bangor and the state-operated Dorothea Dix Psychiatric Center in Bangor.

Riverview has four inpatient treatment units and admits about 300 people a year — some of them for short periods for evaluation or stabilization — and it also has an outpatient unit. The hospital's $30.7 million budget is funded 54 percent by Medicaid, 41 percent from the state of Maine general fund and 5 percent from reimbursement revenue.

Since May 2006, the per-patient cost at Riverview — whether for the civil or forensic units — has averaged about $870 a day, according to the hospital.

Maloney's office represents the state when some Riverview forensic patients seek court approval for changes in the conditions under which they are held. The Office of the Attorney General handles cases in which patients have been found not criminally responsible by reason of insanity for murder, meaning they were in the throes of severe and persistent mental illness and not able to understand their actions were wrong.

Even though those patients — referred to as NCR, or not criminally responsible — may instill the greatest safety fears in the public's mind, they're not the biggest concern for Riverview officials.

"The NCR clients tend to be our most stable clients," McEwen said. "By the time they get around to an NCR plea, they have been here a couple of times maybe for a stage evaluation, they've been treated. Those are not the clients likely to get aggressive with staff."

In early April, Riverview's population included 37 people who were found not criminally responsible for their offenses.

McEwen said there are about 80 not criminally responsible patients in custody, with the remainder in the community "in various stages of recovery." About 45 are seen on a regular basis by the Assertive Community Treatment team, and the rest have been in the community for years.

People found not criminally responsible for murder and arson remain inside the hospital the longest: Their average stay is six to 12 years. After that they may move to a group home outside the hospitals grounds and from there into the community while still under state supervision, McEwen said.

Patients committed for less serious offenses generally spend between three and five years at the hospital.

Staff needs

The hospital also holds people being evaluated by the State Forensic Service and those found incompetent to stand trial.

McEwen said she is always looking for ways to make the hospital safer and that the hospital has contracted with the security firm Securitas to monitor both inside the grounds.

Staff are trained to use non-abusive psychological and physical intervention, otherwise known as NAPPI, which is a behavior intervention program with shared terms and responses. McEwen said the program emphasizes non-physical interventions — mostly talking.

"Then if you have to absolutely put hands on a client, how to do that without injuring yourself or a client," she said.

Perry, however, disagrees, saying existing restraint training such as NAPPI "are not effective when dealing with the acute clients in question to assure the safety of staff and other clients."

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