Saturday, December 7, 2013
By Betty Adams firstname.lastname@example.org
AUGUSTA — Donald Beauchene and Sylvie Perry may not have much in common. He has spent 41 of his 69 years in a psychiatric hospital or a prison, and she is a union representative for many of the employees at the state's only psychiatric hospital for criminals.
This aerial photo, taken on April 30, shows The Riverview Psychiatric Center on banks of Kennbec River in Augusta.
Staff photo by Joe Phelan
But they do share something — the belief that added security measures aren't enough to calm the volatile atmosphere at the state's only hospital for criminals.
A recent attack by mental health patient Mark P. Murphy on a staff member at the Riverview Psychiatric Center has resulted in beefed up security and has underscored long-standing concerns some have about dangers and safety lapses there. Forensic patients are those who have committed violent or serious criminal acts but have been deemed not responsible for their actions because of mental incompetence.
Beauchene, who says he was once assaulted by Murphy, offered a long-timer's perspective on the environment at the hospital in a recent phone interview.
"It is my belief that there is not enough staff to cover the potential situations that come up," he said.
Problems at the hospital go deep, said Perry, the field representative for American Federation of State, County and Municipal Employees Council 93, which represents about 110 workers at Riverview, many of them mental health workers and recreation aides who are direct-care providers.
"We have major concerns about health and safety at Riverview, and we're trying to address them long-term," she said.
Data the Kennebec Journal received through a records request show the total number of injuries reported at Riverview is the highest it's been in three years, though lower than in years before that. Riverview officials say new safety measures are a reason for the decline.
People who work at the state forensic hospital and the unions representing them say the numbers don't tell the whole story. They cite increasingly brutal attacks, thrown into the spotlight by a March 16 assault in which Murphy, 47, formerly of York County, is accused of punching a Riverview worker and stabbing her with a pen.
The reported attack by Murphy resulted in an immediate measure aimed at adding another layer of protection from patient violence. The Kennebec County Sheriff's Office has signed a new security deal with Riverview that puts county jail officers inside the hospital's forensic unit to monitor patients with a history of violence against staff.
The $81,400, two-month contract, formalized April 29, calls for the county to supply a corrections officer for three shifts a day for the next two months, and a longer contract is expected to be in place when the new fiscal year begins July 1.
In 2012, there were 37 OSHA-recordable injuries at Riverview, 23 of them categorized as client related, according to Department of Health and Human Services data made available to the Kennebec Journal through a public records request. That injury total is the highest in three years — there were 25 in 2011 and 31 in 2010 — but it's also significantly fewer than the 53 recorded in 2009 and 48 in 2008.
Under U.S. Department of Labor regulations, OSHA-recordable injuries are those that result "in death, days away from work, restricted work or transfer to another job, medical treatment beyond first aid or loss of consciousness."
An investigator's report said the attack involving Murphy ended when patient Kirk Lambert intervened. The employee later had surgery to remove the pen's point from her hand.
On April 18, a Kennebec County grand jury indicted Murphy, who has a history of unprovoked attacks on staff, on two counts of elevated aggravated assault and one count of aggravated assault.
Following the attack, the Department of Corrections stepped in to provide security first with state corrections officers, then sought and received aid from the county sheriff.
"I view this as being a good stakeholder in the entire system," Kennebec County Sheriff Randall Liberty said of the corrections officer deal. "We're trying to find the best way to help — and the mentally ill clients need to be the least restricted — while maintaining order and safety for the staff. We're able to do that with ease."
Corrections officers stationed at the hospital carry a chemical agent, Cap-Stun pepper spray, and a Taser stun gun, but no firearms, Liberty said.
Murphy was arrested four days after the assault and brought to the county jail in Augusta. He is being held at the Maine State Prison.
The victim, meanwhile, remains "extremely emotionally traumatized," said Perry.
She said she sat in on an in-house Riverview investigation into why and how the attack occurred.
"Employees were being brutally honest" about their safety concerns and administrators listened, she said. "I feel seriously that the intent is to start addressing issues that make people feel safer. It's a shame that something like this had to happen to get it addressed."
She said that previously there was an expectation that "you're going to get hurt dealing with these types of clients."
"Our position is that it shouldn't be the expectation," Perry said.
Chances are that if someone works at Riverview long enough, he or she will be hurt by a patient — sometimes intentionally. The hospital has about 300 employees, all but 30 on site, and there are an average of 79 patients at the hospital every day.
Patients are responsible for at least half of the injuries to staff that are reported to the Occupational Safety and Health Administration. Many of those assaults are committed by forensic patients — patients who have committed violent or serious criminal acts but have been deemed not responsible for their actions because of mental incompetence.
"The current situation is not safe for the staff or for the patients," said Maeghan Maloney, district attorney for Kennebec and Somerset counties. "The state is obligated to hold some very dangerous people whom the legal system does not designate as criminals due to their mental illness."
On Monday, Riverview Superintendent Mary Louise McEwen testified in support of a bill that would put a mental health unit on Department of Corrections property.
"Riverview does not have the same tools as corrections facilities to manage aggressive, assaultive, and violent behavior," she told the legislative committee on Criminal Justice and Public Safety.
She also told legislators that keeping an aggressive, violent patient limits the number of beds available on that unit.
"Safety is top priority for administration," McEwen said in an earlier interview. "We're constantly looking at how we can make this a safer place because there's things that can happen from slips and falls in the parking lot to an altercation between a staffer as well as a client assaulting a staff person."
McEwen said an environmental safety committee conducts regular rounds looking for safety issues and that a number of upgrades have likely contributed to the decrease in total injuries: additional lighting and security cameras in the parking lot and more cameras inside the hospital to get rid of blind spots.
"We have someone sitting in operations 24/7 watching all the cameras," McEwen said.
Records of the Maine Capitol Police — the force that polices state property — show that officers responded to calls to the hospital an average of 210 times a year from 2009 through 2012.
Augusta police responded to more than 100 Riverview emergencies in 2009 and 2010. That number dropped to 77 in 2011 and to 47 last year, but it's not clear whether that decline by the city's police department represents fewer total emergencies.
If something serious happens, Riverview staff call 911, according to McEwen. She said those who attack fellow patients and employees face criminal charges.
"Some people are purposeful in their intent to hurt staff," she said. "Staff are forgiving when they know it's related to the illness, but (not) when they see someone who says, 'I'm going to hurt you,' and they make good on their threat."
Another union that represents about 100 Riverview employees, mostly nurses and medical professionals, echoed Perry's concerns about staff safety.
"The work can be dangerous; people realize that," said Rod Hiltz, director of field mobilization for Maine State Employees Association Local 1989.
Hiltz said the jobs there are difficult to fill.
"There is a huge recruitment and retention issue around getting nurses to work there. It's not just a freeze on wages — they haven't had an increase in four years — also the governor proposed a freeze on merit, longevity and health plan," Hiltz said. "They end up running short-staffed, and you have a lot of overtime cost. That, in itself, can create a dangerous condition."
Perry also said employees need training and tools as well as support "to carry out their jobs with pride and confidence."
Riverview workers are hit, stabbed and strangled. The chaplain at Riverview is still recovering from injuries he suffered when he was attacked in December 2009 by patient Anthony P. Reed, now 37. Reed went to prison for that assault. He was back at Riverview in April 2012 when he was charged with injuring four employees, including a woman who had to be treated at the hospital for her injuries. Four assault charges are pending against Reed in connection with those attacks.
In February 2006, Murphy, who reportedly suffered a brain injury in an automobile accident years ago, attacked a mental health worker, leaving him with a crushed windpipe and broken teeth.
That attack triggered legislative inquiries as well as an evaluation of hospital security by a national expert.
Caring for clients
Maloney, newly elected as district attorney last fall, thinks there may be better ways of caring for Riverview patients who are deemed dangerous.
"I believe there needs to be a small facility to exclusively house these individuals," Maloney said.
That's the case in two nearby states. Massachusetts uses Bridgewater State Hospital, inside the Bridgewater Correctional Complex, to evaluate and treat people committed by the courts. It is a medium-level security hospital that is part of the Executive Office of Public Safety and Security.
New Hampshire has an equivalent service offered inside its prisons.
Manchester forensic psychologist Charles Robinson said the way that different states treat those found not criminally responsible or mentally ill has evolved both culturally and politically.
Robinson, who has performed mental health evaluations on more than 12,000 patients, doesn't think the different models in Maine or in New Hampshire or Massachusetts offer clear-cut safety benefits.
"People with significant persistent psychological difficulties who are treated in prison settings are not any less likely to assault staff than those in hospital settings," Robinson said. "I would suspect that the likelihood of another patient coming to aid is probably better in a hospital than an integrated facility in a prison."
Injury rates in geriatric residences — where patients might have dementia and where they use walkers and canes — are typically higher than in forensic units such as Riverview, Robinson said.
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.
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."
Perry said other concerns beyond safety make it difficult to retain and recruit, pointing to a state budget that has no wage increases or additional money for staff training.
McEwen said she believes staff levels at Riverview are sufficient. There are 270 staff members for 92 patients in the main hospital.
"I think we're very richly staffed with a good variety of disciplines," she said.
Even so, the superintendent said recruiting registered nurses for the hospital can be challenging. Many choose better paying jobs at nearby MaineGeneral Medical Center and the Maine VA Healthcare Systems-Togus hospital, both in Augusta.
One person who questions whether Riverview has enough staff is long-time patient Beauchene, who has been in the state hospital or in prison since 1972. He escaped twice from Riverview's predecessor, AMHI, and spent 15 years in prison for rapes committed in New York after his second escape. He was returned to the hospital in 1998 and is pretty sure he's never going to get out.
In a recent phone interview from Riverview, Beauchene said he was another victim of Murphy.
"He sucker-punched me one day and knocked my glasses off," Beauchene said. "He hit me one time and then he sat down."
Beauchene said patients have to pitch in because staffing at Riverview to help calm volatile situations isn't adequate.
"It is my belief if female staff were attacked, at least half the clients would help her. We have good staff here. In our minds, males can take care of themselves, but we would help," he said.
Perry, the union rep, said she's encouraged by the hospital administration's response to Murphy's attack in March.
"Working together as a team we can fix what is broken," she said.
Betty Adams — 621-5631
click image to enlarge