LEWISTON — Gov. Paul LePage’s suggestion that the state reject $20 million in federal funds for the state’s psychiatric hospital would be the “pinnacle of mismanagement,” a local Democrat said Wednesday.

State Rep. Peggy Rotundo, D-Lewiston, criticized LePage for suggesting the state need not follow federal regulations at the state-run Riverview Psychiatric Center in Augusta.

“It’s the pinnacle of mismanagement to dismiss these federal rules meant to protect patient and worker safety,” Rotundo said in a prepared statement. “We risk lawsuits and ongoing budget challenges if we cease to comply with the federal law.”

The center, the state’s only facility for forensic patients — individuals deemed not criminally responsible for violent crimes — lost its federal certification and the funds that go with it in 2013.

The decertification came after a pair of inspections by the federal Centers for Medicare and Medicaid Services discovered a number of patient and staff safety problems. The facility was also cited for using prison guards from the Maine Department of Corrections in a violation of patients’ rights.  

Many of the patients at Riverview are there under court orders. Others have voluntarily committed themselves to the secure facility.

The hospital houses some of the state’s most violent people with mentally illnesses, including several who have killed other people.  

“Frankly, I think we ought to just go it alone and not take federal money,” LePage said Monday.

He said federal safety regulations were impractical for Riverview, which has recently been reinspected by the federal government and is still working to correct safety problems.

“With the federal money, some of the fine print is so atrocious that sometimes we do more harm than good,” LePage said. He said regulations that disallowed nurses and other staff to work with forensic patients and others who have not been implicated in crimes made no sense to him.

“That’s insane,” LePage said. “They are all mentally ill. They all have issues.”

He also said it was financially impractical to provide a 1-1 staff to patient ratio. “There’s not enough money.”

The governor made his comments during a visit to Hope Haven Gospel Mission in Lewiston.

Rotundo, co-chairwoman of the Legislature’s budget-writing Appropriations Committee, said Wednesday that the last state budget included funding for making improvements at Riverview.

She said committee members believed they had the support of the LePage administration on moving forward with fixes that would satisfy the federal government and regain the federal funding to help prevent a $20 million state budget gap. 

“Giving up on that would create a new budget hole in future years, putting at risk funding for other key programs that help our seniors or schools or our towns,” she said.

Lawmakers and LePage attempted to address some of the federal government’s underlying concerns with legislation passed during an emergency session of the Legislature in September 2013.

That legislation expanded capacity and staff for a mental health ward at the Maine State Prison in Warren, in an attempt to transfer some of the patients at Riverview who were there for pretrial psychological evaluations. The change did not allow the state to move patients who have been deemed not criminally responsible for their crimes.

Riverview costs the state about $42 million a year to operate, and houses about 50 so-called “forensic” patients at the 92-bed facility.

Maine Department of Health and Human Services Commissioner Mary Mayhew said Wednesday that the state was still pursuing federal certification and funding for the facility, despite LePage’s comments.

Mayhew said she understood LePage’s frustration with the federal government but was confident the hospital would regain its certification.

Mayhew and DHHS, which oversees the state-run hospital, worked to turn it around, even replacing Riverview’s chief in March. But Mayhew also left the door open to the idea that the state would move ahead with or without federal certification for the hospital.

“We want to make sure that we’re able to effectively support a center of excellence at Riverview, and that we have high-quality services and a safe environment,” Mayhew told the Bangor Daily News Wednesday. “To the extent that actions taken by CMS related to certification detract form that, we would certainly evaluate a different path.”

Other health policy experts, though, said Wednesday that going it alone would be an irresponsible move that would put taxpayer dollars and patient safety and rights on the line.

“It’s simply unthinkable that in modern times you would have a hospital housing large numbers of desperately sick people operating unaccredited,” said Sara Rosenbaum, professor of health policy at George Washington University. “I’m sure a court would not hesitate to shut it down.”

Rosenbaum said CMS standards represented the “minimum” requirements for operating a safe and functional hospital. Not complying would mean not only a massive reduction in federal funding, she said, but could invite a deluge of lawsuits against the state.

Bangor Daily News reporter Mario Moretto contributed to this report.

sthistle@sunjournal.com