BMHI labors to upgrade license Problem solving continues under conditional status

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BANGOR – More than a year after the Department of Human Services gave it a conditional license, Bangor Mental Health Institute is continuing its struggle to meet the state’s standards.

This summer, DHS’ Division of Licensing and Certification found that while many problems it identified last year have been addressed, remaining issues warranted keeping the 94-bed state mental hospital on conditional status for another year.

If it receives a conditional license, a hospital usually has one year to fix its problems. The state granted the extension because “the public would be best served by offering the opportunity to correct conditions which resulted in the serious and substantial failure of Bangor Mental Health Institute to comply” with state laws, Eugene Gessow, director of DHS’ Bureau of Medical Services wrote to BMHI Superintendent Mary Louise McEwen in July.

The continuing problems identified by state inspectors in June include:

. No evidence of therapeutic efforts in seven of nine records reviewed;

. No formal treatment plan for patients refusing medication;

. No peer reviews of doctors’ decisions;

. No audits of complications arising from care;

. Important personnel information routinely unavailable at the time of reappointment of medical and professional staff.

Gessow noted that BMHI has begun to take corrective actions, but that at the time of the last review, it had not corrected the problems.

Improvement expected

In an interview this week, McEwen said the hospital weathered the serious violations uncovered last summer, and she expects more changes to improve care further.

“I feel very confident that we have it under control,” McEwen said.

But she added the conditional license carries the threat that BMHI will lose its standing and its federal reimbursement if problems persist.

Just a year ago, McEwen told employees in a newsletter that the hospital’s very future was at stake after investigators found problems then. The findings included:

. Mental health workers didn’t “see patients as humans”;

. Some patients were lying on mattresses without sheets;

. Inadequate security and access restrictions were discovered;

. There was inadequate documentation of treatment;

. Family members were not always interviewed for information;

. There were minimal or absent social histories for patients;

. There was a failure to provide therapeutic activity tailored to patient needs.

McEwen said the finding that mental health workers weren’t treating patients as humans was based on an isolated incident involving two workers and is not indicative of overall care.

Superintendent resigned

After DHS found problems during two visits in 2001, Superintendent Larry Ventura resigned after 13 years in the job. McEwen, who had been director of patient care services under Ventura, wasn’t formally appointed to replace him until June.

How did the problems become so serious that BMHI’s license was downgraded?

Jamie P. Morrill, associate commissioner for systems operations for Maine’s Department of Behavioral and Developmental Services, said problems began to collide a few years ago.

Issues of a similar nature had hit the state’s other mental health hospital, Augusta Mental Health Institute, a few years earlier. That hospital, which had far more serious problems than BMHI, was given a conditional license and eventually was placed under court supervision.

For years, the goal of mental hospitals has been to get patients rehabilitated to the point where they can return to the community in group homes or other settings. As that happened, mental health hospitals have become places for people with the most acute mental illnesses.

“It changes the role and character of the hospitals,” Morrill said.

In the cases of both AMHI and BMHI, the staff and care plans didn’t evolve fast enough, he said.

At BMHI, the level of distrust between staff and administration was at a fever pitch when the problems were identified by DHS, he said.

Two years ago, for instance, one of the unions leveled “big brother” charges against Ventura over the installation of security cameras. The union charged the cameras were meant for workers, not patients.

“It was an organization that wasn’t talking to itself,” Morrill said.

Immediate goals

McEwen said one of her immediate goals as superintendent had been to improve communication. One way she’s tried to do that is by issuing newsletters that deal frankly with issues instead of offering feel-good articles. This week, for instance, she tackled mandatory overtime issues that have bred unrest among mental health workers. She has also set up regular meetings with mid-level managers.

McEwen said the initial violations included structural problems with the 100-year-old facility. There were inadequate suicide prevention measures, for instance. An expedited work plan and nearly $1 million in repairs has remedied those problems.

“This is not a modern psychiatric facility like the one we are building in Augusta,” Morrill said. Opened in 1901, the BMHI building is on the National Register of Historic Places.

There were also problems with the administrative structure of the hospital. Those have been improved by a new reporting method. Where Ventura had 12 people reporting directly to him, McEwen now has five.

New staff have been hired, and the hospital is trying to hire more to fill vacancies. A new psychiatrist has been hired and more may be able to be hired from elsewhere. Morrill said it’s difficult to get psychiatrists to come to Bangor.

McEwen said BMHI gained some registered nurses as a result of EMMC’s decision to lay off registered nurses.

The hospital has new bylaws and new procedures to ensure that patients get adequate care. McEwen is proud of several programs BMHI offers. For instance, it now has an “AIR [active inpatient rehabilitation] Mall.” The idea is to create a centralized place where patients can go, away from their wards, for activities and treatments. Pooling the activities outside the ward can bring together patients with specific needs for more tailored programs. Morrill said the idea may be exported to AMHI.

BMHI also is providing services to the Penobscot County Jail. The jail has a contract with Eastern Maine Healthcare’s Acadia Hospital, but BMHI provides additional services free since Acadia can’t always meet the demand, McEwen said.

Close BMHI?

Nancy Grimes, president of the National Association of Mentally Ill chapter for Bangor, says while BMHI has many problems, its new superintendent seems to be on the right path.

“A lot of people really like this woman who’s running BMHI now,” Grimes said. But while there are a lot of good people at BMHI, some of the mental health workers are not “adequately professional,” she said. Echoing one of the state’s findings, Grimes said some employees don’t care about the patients.

Grimes also warned there is still a concern the state would like to close BMHI in order to consolidate services in Augusta.

McEwen said she doesn’t think that will happen. “I see us being needed more than ever.”

Dr. Marjorie Snyder, BMHI clinical director, said as she works on getting staff members to create individualized treatment plans, she knows BMHI is important to the region.

“I think BMHI has provided a safety net for northern Maine that has been indescribably valuable over the years,” Snyder said.

She said BMHI hasn’t been among those hospitals that, spurred by managed care, have discharged patients before they were ready to enter the community.

“A lot of people think mental illness is more of an infection, that when you treat it, it is fixed, instead of like diabetes that needs constant attention,” Snyder said.

McEwen said the problems identified by DHS are getting constant attention and will be fixed. The alternative, she said, is for the hospital to lose its license, which would mean it would lose federal insurance reimbursement, which makes up more than two-thirds of its funding.