Lewiston’s two hospitals illegally turned away emergency room patients in mental health crises and sometimes had them arrested for trespassing, according to documents from the hospitals and state licensing inspectors.

Central Maine Medical Center and St. Mary’s Regional Medical Center have pledged to change their policies and increase staff education, according to inspection reports and correction plans posted on the Disability Rights Maine website.

“The reason this is so important is if you feel you need more resources and you don’t have them, the emergency room is where you go,” said Kevin Voyvodich, a managing attorney with Disability Rights Maine. He tipped inspectors to the issues after hearing from patients and advocates.

“If you are cut off at that point, or are fearful of getting arrested for going to get help, you are less likely to seek assistance,” Voyvodich said Friday.

This kind of so-called “patient dumping” is illegal under federal law, which requires any Medicare-participating hospital to screen and stabilize emergency room patients.

In some of the Lewiston cases, inbound EMTs were directed to take patients to other facilities, or emergency room personnel questioned paramedics about why they were bringing in someone with a mental health issue. Inspectors found that police were called to arrest “uncooperative” patients and, in some cases, patients who were arrested had their hospital records altered or deleted.

Central Maine Medical Center’s director of security sent an email to the Androscoggin County Sheriff’s Office saying if individuals in custody are “in need of mental health issues (sic) that person is to be transported to (other hospital). CMMC is a trauma center and cannot provide the proper care for mental health,” according to a report by the Centers for Medicare & Medicaid Services, or CMS, the agency that administers the federal programs. St. Mary’s patients who were arrested wound up on suicide watch in jail.

CORRECTIVE PLANS SUBMITTED

Under threat of losing federal funding, both hospitals have since submitted plans detailing how they will correct the violations, allowing them to continue receiving Medicare payments. Those changes include more prominent “It’s the Law” signs explaining patient rights. CMMC, for example, said it will better train employees on the law, create a new process to ensure disruptive patients get evaluated and create a barrier in the electronic registration log so emergency patients’ names can’t be deleted once they’re entered into the system.

“Central Maine Medical Center has taken steps to prevent future incidents such as the one which earlier this year triggered (the investigations) at both local hospitals. Signage has been improved, and substantial training in rules and protocol was undertaken,” spokeswoman Kate Carlisle said in an email Friday. “A recent inspection by CMS found that appropriate steps were taken and the investigation was closed.”

The violations at the two hospitals and the correction plans were first reported by the Bangor Daily News.

Voyvodich said he did not have any data on whether these kinds of violations happen in other hospital emergency rooms in Maine, but he hopes the findings in Lewiston send a message.

“The hope is that other hospitals recognize that if they are doing this, CMS sees it as a problem and they address it sooner rather than later,” he said.

‘CRIMINALIZATION OF MENTAL ILLNESS’

Providing emergency room care for people with mental health problems has been an issue for years, worsening since the deinstitutionalization of psychiatric patients in the 1960s in favor of community-based mental health support services – which have largely turned out to be inadequate and fueling a mental health crisis in many communities. Without community-based supports, many people with mental health issues turn to emergency rooms for care, or are arrested for behaviors tied to their illness.

“It’s the criminalization of mental illness,” Voyvodich said.

It’s not just in emergency rooms. Local law enforcement authorities report an increasing number of interactions with people in mental health crises, forcing them to adjust their training and procedures to help people in crisis, not just automatically arrest them. The number of calls for service that were mental health-related for the Cumberland County Sheriff’s Office rose from 383 in 2013 to 486 last year, an increase of nearly 27 percent. This year, the pace is continuing to rise, with 278 calls for service through early July, the sheriff’s office said.

A 2016 survey of 1,700 emergency room doctors found that 75 percent reported seeing at least one psychiatric patient requiring hospitalization every shift and more than 70 percent saying that on their last shift, they had psychiatric patients waiting for inpatient beds, according to results shared at a conference of the American College of Emergency Physicians.

St. Mary’s and CMMC have the only emergency rooms in Lewiston.

Voyvodich said Disability Rights Maine will follow up with the Lewiston hospitals, and others, to continue to monitor emergency room patient care, provide training and “try to get the word out there that these are real issues and these are real people with mental health issues that are suffering.”

‘TIP OF THE ICEBERG’

Links to statements of deficiencies and plans of correction for both hospitals are available on the Disability Rights Maine website, drme.org.

Republican gubernatorial candidate Shawn Moody said the situation is an example of why he would reform Maine’s mental health system.

“I am deeply concerned about the news that Maine hospitals turned away patients struggling with mental health issues and had them arrested. I know how difficult it can be to watch a loved one struggle with mental illness,” said Moody, whose mother had mental health issues. “Our correctional system, law enforcement, and EMS professionals are overrun with individuals struggling with mental illnesses. Many of these Mainers simply need access to mental health services, rather than incarceration.”

Democratic candidate Janet Mills said, “This is unacceptable and underscores both the inadequacies of our mental health system and the urgent need to fix them. The criminalization of those with mental illness is wrong, and after too many years of neglect and instability on the part of the state, I believe it is imperative that we reorient our mental health system to ensure that those with mental illness are able to access the care they need, not face incarceration.”

Alan Caron, an independent candidate, said the situation “is the tip of the iceberg with the mental health crisis in Maine. ”

“The state needs to take a comprehensive approach to dealing with this crisis,” he said. “I am pleased that the hospitals acknowledge their failings and are taking corrective action, but this is a much bigger problem than what happened in Lewiston.”

“This is indicative of the current state of our mental health system, and the pressing issues that Mainers are facing,” stated Terry Hayes, independent candidate for Governor.  “The Hayes Administration will work with providers to mend the gaps in our mental health system so that Mainers have access to the treatment and care they need, recognizing that jail is not a treatment venue.”

This story has been updated online to add comments from candidates for governor.