AFA Update- January 5, 2017- Riverview stepdown facility public hearing

Thursday afternoon the Joint Standing committees on Appropriations and Financial Affairs (AFA) and Health and Human Services (HHS) met at the direction of Legislative Council to ask questions about the Administration’s plan to build and privately operate a secure forensic mental health facility.

Initially the Department of Health and Human Services (DHHS) and the Bureau of General Services (BGS) planned to construct a facility on the Riverview Psychiatric Center (RPC) campus in Augusta. This location requires the approval of Legislative Council.

The Department and the Administration have chosen to not provide sufficient answers to specific questions surrounding the construction and operation of the proposed facility.

The Department and the Administration did not choose to attend today’s hearing.

Immediately prior to today’s meeting BGS submitted a letter to Legislative Council withdrawing their request for the Council to approve a project in Augusta, confirming the Governor’s statements of his intention to build the privately operated facility in Bangor.

Dan Wathen, Court Master for the AMHI Consent Decree and former Chief Justice of the Maine Supreme Court joined the committees.

Take-aways from Judge Wathen’s testimony

  • RPC has improved
  • 9 nursing vacancies of the 15 total vacancies
  • Incidents of seclusion, restraint are reduced
  • Sense that staff morale is better than previously
  • Supports a new unit for increased forensic capacity
  • 28 forensic clients now at Dorothea Dix in (DDPC) Bangor
  • Recommends approval of facility by the committees and by Legislative Council
  • Has seen draft operation RFP, has made recommendations about ensuring staffing meets the terms of the Consent Decree, Wathen is comfortable using the existing process to address his concerns should the Department not act on them
  • Transfer from RPC to the proposed facility will require the approval of the court in Wathen’s opinion, the Department may disagree but is not available to share their thoughts
  • Understands that this would be a locked facility, equal security to RPC with more treatment and freedom within the facility
  • Wathen’s assumption is that only those found not criminally responsible (NCR)but stable yet still not ready for release would be served in the proposed facility
  • 21 beds is likely the appropriate number
  • Per patient costs at RPC are $1,300/day or $475,500/year, at $3.6M per year for 21 beds the projected annual costs per patient are $171,429, or $470/day.
  • In October DHHS disclosed to Wathen that most of the construction funds come from substance abuse and mental health services accounts
    • DHHS told Legislative Council that these vague sources are intended to be used
      • Construction $3.5
        • Mental Health GF $650K
        • Unspecified “unobligated unspent funds”- $900K
        • Unspecified “unspent” funds- $500K
        • Federal case management gr ant- $1.5M
      • Operation- $2.6M
        • Mental health GF- $1M
        • Consent Decree- $550K
        • A piece of current $1.4M appropriation for “forensic patients”
      • Augusta may be preferable due to continuity of treatment
      • The judge is not weighing in on the likelihood of this facility restoring CMS certification and federal funding to RPC
      • When asked, the judge said he could think of no advantages to build the facility in Bangor

Members of the public then testified including current, forensic patients at RPC, family, staff from the facility, representatives of Disability Rights Maine, and the Maine branch of the National Alliance on Mental Illness.

Several people raised the possibility of using these funds for community based services to help people before they enter RPC.

Questions from Donald Beauchene, a forensic client in a letter filled with questions from other patients cover such basic issues as will TV’s be allowed in rooms, will laundry facilities be available on site, how will meals be provided, what sort of onsite supports will be available  and what will the staffing ratios be?

Simone Maline Executive Director of the Consumer Council System of Maine let the members know that these facilities are patient’s homes. Stakeholders have not been consulted in the view of the councils.

The Maine Hospital Association (MHA) reiterated support for construction of the facility. They feel the proposed facility to provide more capacity at RPC, capacity that will alleviate the number of civil patients waiting in emergency rooms for a bed at RPC. MHA stresses that they do not have answers to questions posed by the legislature, advocates or consumers. Despite this lack of information from the department, MHA supports the construction of the facility.

The ACLU of Maine (ACLU) provided testimony expressing concern over the due process rights of patients, the proposal to privatize the operation of the facility.

Further, the ACLU provided a memo arguing that the Governor does not have the authority to build a new facility anywhere or create a new program without the assent and backing of the Legislature.(Updated document)

Sharing the testimony of a worker who needed to leave, Sarah Bigney of the Maine AFL-CIO spoke of concerns about the privatization of a facility, highlighting increased violence at private prison/forensic provider Correct Care’s facilities. Some states have reversed course on privatization of these kinds of facilities. Marianne Turowski of the Maine State Employees Union (MSEA)Turowski also noted that in her years here policy surrounding mental health treatment it has always been a full, public discussion.

She also cannot recall a Governor building any facility without the participation of the legislature.

Citing continuity of care and seamless transitions it was also questioned how privatization meets those concerns.

After a brief break, the committees reconvened giving them until Noon Friday to submit questions to the Office of Fiscal and Program Review (OFPR) for submission to the Administration.

Wednesday, January 18 was set as the deadline for each committee to make their recommendation to Legislative Council. It was also agreed that it be requested that DHHS respond to any and all questions by Friday, January 13.

It was also asked that the Attorney General provide their opinion on the Governor’s authority to construct a new facility without the participation and funding of the legislature

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