State resumes hospital oversight Officials applaud end of Augusta psychiatric facility receivership

A ruling of the Maine Supreme Judicial Court on Friday returned the management of the former Augusta Mental Health Institute to the state. The facility, now called the Riverview Psychiatric Hospital, has been run by an independent, court-appointed receiver since September 2003, when a lower court judge found the state in contempt of a long-standing consent agreement.

Friday’s ruling was met with approval by state officials, who have maintained that the receivership was inappropriate, unnecessary and perhaps unconstitutional. But a leading advocate for the mentally ill said Monday that patient care at the state’s flagship psychiatric hospital has improved under the receiver and expressed hope that the momentum can be maintained.

Carol Carothers, executive director of the Maine chapter of the National Alliance of the Mentally Ill, said Monday that the receiver, Elizabeth Jones, has brought hope to Mainers living with mental illness. Improvements in such areas as discharge planning, peer support groups and relationships with county jails have been addressed more efficiently absent the cumbersome bureaucracy of state government, she said.

While returning the hospital to the management of the Department of Health and Human Services is “mostly good,” Carothers cautioned consumers to be vigilant in understanding their rights as the state resumes control.

The 1990 consent agreement resulted from a class action suit brought against the state by AMHI patients, former patients and their families after a series of deaths at AMHI, the Civil War-era hospital that now sits vacant across the Kennebec River from the State House. Patients moved to Riverview, a new 100-bed facility on the same campus, earlier this year.

The court agreement set comprehensive goals for improving all aspects of mental health care, both in the hospital and in the community, including basic conditions of inpatient care, treatment plans, medication management, grievance procedures, staff oversight, discharge planning and follow-up care in the community.

Under the terms of the consent agreement, the state was, and still is, required to develop and implement a system for measuring progress toward meeting those goals.

In several Superior Court reviews since 1990, the state has been found deficient in making the needed changes in the mental health care system, and has been faulted for creating a “two-tiered” system that provides better services to AMHI patients than to others needing community mental health services.

In September 2003, Kennebec County Superior Court Judge Nancy Mills determined that after nearly 15 years AMHI was still not in substantial compliance with the court agreement and found the state in contempt for that chronic failure. Mills also said the state had acted in bad faith when it filed notice in 2002 of being in “substantial compliance” when it was unable to demonstrate that compliance.

Mills appointed an independent receiver to direct the day-to-day operations of the inpatient mental health facility and threatened to place Maine’s community health system in receivership as well.

The office of Maine Attorney General Steven Rowe appealed Mills’ decision to the Maine Supreme Judicial Court in April 2004. In its unanimous decision Friday, the supreme court invalidated Mills’ receivership order, which was due to expire next month, and returned administrative responsibilities to DHHS.

The decision, however, also upheld the lower court’s mandate that equal benefits be provided to all Mainers with mental illness. And it established guidelines for defining compliance with the 1990 consent decree, though no time frame was given.

The court also accepted the attorney general’s argument that by expanding Medicaid enrollments under Maine’s Dirigo Health reforms, the state has demonstrated a fiscal commitment to funding mental health services.

Despite the lifting of the receivership, AMHI and the larger mental health system will remain under court oversight until compliance with the consent agreement is fully demonstrated. Former Chief Justice Daniel Wathen acts as the liaison between the beleaguered state agency and the Superior Court. Wathen said Monday that the high court decision validates the work that has been done so far.

Wathen said the primary focus in the immediate future would be to develop a reliable way to evaluate those changes. “If you can measure it, you can improve it,” he said.

Brenda Harvey, deputy commissioner for programs at DHHS, agreed.

“The department has an obligation to demonstrate that we’re adequately meeting the needs of the people,” she said. The process of evaluating and improving mental health services will go forward, she said, until all of the conditions of the court decree are met.