Conditions at the state psychiatric hospital in Augusta have improved over the last year for both patients and the people who care for them, according to the latest reports from both the court master who oversees them and the institution itself.
“The care and safety provided by the hospital has definitely improved,” wrote Daniel Wathen, in a report filed last week at Kennebec County Superior Court. It’s a remarkable turnaround from January 2016 when Riverview Psychiatric Center workers subjected to repeated mandated overtime shifts told legislators they were exhausted and worried about their families as well as their patients.
Wathen, who oversees a consent decree governing how the state must treat people with mental illness, says he sees improvement “particularly in areas of operation that have been chronic trouble spots in the past.”
Wathen includes the numbers to back up his conclusions about Riverview, saying that between March 2014 and March 2018, monthly overtime hours have dropped from 2,900 to 240.
“Monthly mandated shifts have been reduced over the same time span from 69 to 3,” he wrote. “Nursing mandates, that had been as high as 14, were reduced to zero in the most recent reported quarter. Mandated shifts for mental health workers occurred only four times in the last quarter, down from a historical high of 49.”
The hospital defines mandated shifts as those that occur when no one volunteers to cover the staffing need.
“This creates difficulty for the employee who is required to unexpectedly stay at work up to 16 hours,” according to a Qualify Assurance & Performance Improvement assessment in Riverview’s latest quarterly report.
“It also creates a safety risk.”
Riverview handles both civil and forensic patients. The latter are those people sent to the hospital via the criminal justice system. The lower units on each side are dedicated to patients who are acutely ill and need stabilization before they can move to the upper units.
One of the hospital’s mental health workers, Laura Fisher, who is also president of AFSCME Local 1814, agreed with Wathen’s assessment. “Things have changed and hopefully things will continue to go in a new direction,” she said on Friday.
The union represents about 100 mental health workers plus 20 or so others working there, include rehabilitation staff and dietary workers.
“The mandatory overtime has significantly gone down,” Fisher said. “Currently our vacancies are very minimal; we’ve been keeping them at full staffing levels.” She cited the successful emergency legislation — which included overriding Gov. Paul LePage’s veto — that brought hospital workers, both at Riverview and at Dorothea Dix Psychiatric Center in Bangor, wage increases that took effect in July 2016.
The new law gave acuity specialists, licensed practical nurse positions and mental health workers $2 more per hour and certain nurse and psychologist positions received $4 per hour increases.
“That helped significantly so we have more people who are coming in and decreased mandates,” Fisher said. She has some other suggestions for moving forward as well: “We’d like to see some more state-paid education for mental health workers in the mental health field.”
She said the union is working with Riverview Superintendent Rodney Bouffard to look at different staffing patterns and levels in the various areas.
“They switched schedules so that people have more days off together, working every other weekend and 12-hour shifts,” Fisher said. “It’s beneficial for people to get more time off with families.”
Fisher said the hope is eventually to move toward the three, 12-hour workdays with set schedules that are used in other hospitals, which would mean a 36-hour work week; currently the contract calls for a 40-hour week.
Fisher said mental health workers provide direct care. “You’re not only doing patient checks, you’re really engaged with them, getting them involved in activities,” she said. “We get people outside; it’s really about engagement.”
The Maine State Employees Association SEIU Local 1989, which represents nurses at the hospital, had no comment Friday on the latest report by Wathen, according to Tom Farkas, spokesman for the union.
“I have great faith in Dan Wathen as Court master who believes conditions for all at Riverview has improved,” said state Rep. Donna Doore, D-Augusta, who was one of the legislators who spoke with Riverview staff in 2016.
Wathen’s report also says the hospital is readying for a survey visit soon by the Centers for Medicare & Medicaid Services. “The hospital is reasonably well prepared for such a survey and it would be an important milestone to regain federal certification,” he wrote.
The federal agency that oversees Riverview funding, revoked its certification in 2014 after regulators found numerous problems during an audit, including the use of stun guns, pepper spray and handcuffs on patients; improper record-keeping; medication errors; and failure to report progress made by patients. That action jeopardized $20 million in annual funding reimbursement. Attempts to regain that certification have so far been unsuccessful.
Wathen also remarked that the challenge for Riverview recently “has been to keep pace with the growing demand for admission of persons with a higher level of acuity and behavioral concerns, while at the same time providing safe and appropriate care for all patients.”
He also noted that while the hospital has 92 beds, the occupancy rate is only 80 to 85 percent because of the needs of patients “who are more seriously ill and more difficult to control.”
Wathen said that currently 22 forensic patients are housed at Dorothea Dix, and that Riverview has “a forensic waitlist of 16 and a total waitlist of 29.”
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