Staff safety at Maine's 2 psychiatric centers back in spotlight

Oct. 16—Maine's two psychiatric hospitals have been plagued by staff shortages and turnover that have contributed to unsafe working conditions, according to lawmakers who have met with several employees in recent weeks.

"I don't think it's too strong a word to say I was shocked by what we were hearing," said Rep. Bill Bridgeo, D-Augusta. "Even if what we're hearing is only 20 percent true, in my experience, that's just not acceptable. And if it's on the higher end of what we're hearing, it's downright scary."

In a joint interview with the Press Herald, however, the superintendents and clinical directors at Riverview Psychiatric Center in Augusta and Dorothea Dix Psychiatric Center in Bangor painted an entirely different picture of conditions and said they have worked tirelessly to address staffing concerns and keep both patients and workers safe.

Bridgeo and Rep. Raegan LaRochelle, D-Augusta, have requested that the Legislature's Government Oversight Committee authorize a thorough review of worker safety at both hospitals.

Committee members directed the Office of Program Evaluation and Government Accountability (OPEGA) on Wednesday to gather more data on staff injuries and worker ratios and report back to the committee by mid-February.

The committee stopped short, however, of backing a full-scale review of the concerns that were brought to the Legislature back in May 2023 but have been ongoing for more than a decade.

OPEGA Director Peter Schleck told lawmakers that it made sense to gather more information before determining the scope of their inquiry and figuring out where it might fit into his workload.

Sarah Bigney McCabe with the Maine AFL-CIO, which represents state workers at the two hospitals, said staffing levels and safety have long been issues, but it's never been this bad. She said many workers feel like they have been "screaming into an abyss."

Hospitals administrators, however, said they are required to keep staffing levels at a certain ratio in order to maintain certification, so the idea that staffing is inadequate isn't entirely true.

"We've worked diligently to supplement our staff with some recent contract (employees)," said Stephanie George-Roy, superintendent of Riverview. "Our current vacancy rate for the hospital is 18%. That's a good number and we're working diligently to bring it down even more."

Carolyn Dimek, superintendent at Dorothea Dix, didn't have the current vacancy rate for her hospital but said it's well below the national average.

Riverview has 92 beds and is located on the grounds of the former Augusta Mental Health Institute, which closed in 2004. Dorothea Dix has 51 beds in three separate buildings on the former campus of the Bangor State Hospital. Together, the two facilities house adults with severe mental illness, most of whom have gone through the legal system or are considered a serious threat to themselves or others.

Decades ago, before the movement known as deinstitutionalization, adults with mental health needs were housed in asylums that had conditions that were often far worse than Riverview and Dorothea Dix. Now, most of those individuals are receiving treatment and resources within the community, but that has been an ongoing struggle, too, for many of the same reasons. Providers that contract with the state to deliver care also can't attract and retain workers consistently and pay has often been inadequate.

Because of the acute care needed for many of the patients sent to Riverview and Dorothea Dix, the state has often struggled to attract and retain staff there and that has led to high-profile problems.

A 2013 federal audit — initiated after an attack on a staff member by a patient — found numerous deficiencies at Riverview. As a result, the hospital lost its certification and the $20 million annual federal subsidy that came with it.

Even after that, staffing problems persisted, according to stories published in 2014 and 2016.

More recently, staff members testified before the Legislature's Health and Human Services Committee in May on a bill that would improve retirement benefits for mental health workers. Some of that testimony included descriptions of physical assaults by patients that led to workers leaving in ambulances.

Lawmakers asked Department of Health and Human Services officials to address concerns at a hearing last fall, but administrators mostly downplayed any problems.

"It seemed then like things were going in a positive direction, but now we hear from staff that it's not the case," said Sen. Mike Tipping, D-Orono, a member of the Government Oversight Committee.

McCabe said workers were frustrated that they weren't asked to testify a year ago because their version of things was much different from what administrators portrayed.

"Workers vehemently disagree with what was presented," she said, adding that some fear retribution for speaking out.

Bridgeo, who was the longtime city manager in Augusta before becoming a lawmaker, confirmed that workers who spoke with him and LaRochelle were worried they might be retaliated against for speaking out.

Hospital leaders said it doesn't surprise them that there continues to be a disconnect, but they couldn't entirely explain it.

"State hospitals tend to run in the background. They absorb the most challenging, difficult patients that others sometimes try to treat and can't," said Dr. Daniel Potenza, clinical director at Dorothea Dix.

Dr. Matthew Davis, clinical director for Riverview, said the state hospitals have seen major increases in admissions and discharges in recent years and the average length of stay has decreased as well.

"That means we're getting patients stable much more quickly than every before," he said.

As for any retribution, George-Roy said: "Every single day we are committed to making whatever improvement or suggestions comes our way. We're very boots on the ground, always trying to evolve, always trying to make the environment safer and improve lives of patients we serve and to have a workplace staff feels proud to go to work every day."

The Government Oversight Committee voted unanimously to direct OPEGA to continue gathering information and talking to staff. Some suggested that OPEGA proceed with a review similar to what happened with the State Fire Marshal's Office this year. That investigation was launched after employees there complained about culture within the office and treatment of fire victims. It led to the early retirement of Fire Marshal Richard McCarthy.

McCabe said workers were pleased to see the oversight committee taking their concerns seriously but also hope things move forward with urgency.

"It's not just staff, patients are suffering, too, because they can't access treatment when there aren't enough workers," she said.

Two years ago, lawmakers backed a $3-an-hour pay raise for the 600 workers at the two hospitals, but the bill ultimately wasn't funded.

Just this year, the state has faced criticism for sending patients to out-of-state to facilities that use isolation and corrections tactics that have been banned at Maine's psychiatric hospitals. In each case, the patient sent away was found not criminally responsible for their crimes.

Although the state is permitted to contract with other facilities — and has done so in part to correct worker-patient ratios here — mental health advocates say the practice is harmful.

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