Disability Rights Maine (DRM) is the federally-mandated and State-designated nonprofit agency tasked with protecting and advocating for the rights of individuals with disabilities in the State of Maine. DRM’s primary responsibilities include preventing and responding to the abuse, neglect, discrimination, and other violations of the rights of individuals with disabilities.
Under both its federal and state authority DRM monitors the treatment of individuals with disabilities, including those with mental illness, to ensure that the services they receive are delivered in conformity with standards mandated by various state and federal laws and regulations. This includes individuals receiving treatment at hospitals and in correctional facilities.
During the spring of 2018 DRM discovered, as a result of our presence in these facilities, that individuals with mental illness were often being denied critical emergency mental health care at St. Mary’s Regional Medical Center (St. Mary’s) and Central Maine Medical Center (CMMC) in Lewiston, Maine. These are the only hospitals with emergency departments in the second largest metropolitan area in the State. These emergency departments should be critical resources for those experiencing a mental health crisis.
However, DRM learned that some individuals with mental illness who were suicidal, in mental health crisis, or both were being turned away from these hospital emergency departments without receiving adequate medical screening, stabilization services, or both.
Instead of receiving emergency treatment for their mental health symptoms some individuals were actually arrested and taken directly to Androscoggin County Jail where they continued to experience the same, or worsening symptoms of mental health crisis or suicidality for which they sought treatment in the first place.
When hospitals choose to call the police instead of providing patients with the treatment they are entitled to receive it essentially criminalizes mental illness. This leads to individuals not seeking desperately needed help out of a legitimate fear that, instead of getting the help they need, they may well find themselves locked in a jail cell.
The mental health system cannot function unless the providers of mental health services are willing to engage with individuals with mental illness who exhibit behaviors that are related to their mental illness for which the providers are legally required to provide treatment.[1]
DRM also learned that CMMC notified local law enforcement officials that they were not to take any individual in their custody experiencing a mental health crisis, suicidality, or both to its emergency department unless that individual was also experiencing some sort of trauma. It was later learned that CMMC had also notified Emergency Medical Services providers not to take individuals experiencing a mental health crisis to its emergency department.
CMMC and St. Mary’s were both found to be in violation of EMTALA (Emergency Medical Treatment and Active Labor Act). EMTALA is a federal law that protects any person experiencing a medical emergency who goes to the emergency department of a hospital that receives Medicare funding, such as St. Mary’s and CMMC. EMTALA requires that the emergency department screen any such individual for an emergency medical condition, such as suicidality, and then stabilize the individual if an emergency medical condition is found before discharging the individual, unless certain criteria are met. EMTALA is intended to ensure that hospitals do not turn away or discharge people who need emergency medical services, regardless of their ability to pay. When a patient is turned away or discharged by an emergency department in violation of EMTALA, the violation is sometimes referred to as “patient dumping.”
DRM was very concerned about EMTALA violations at both hospitals. DRM subsequently pursued administrative remedies with the Maine Division of Licensing and Certification and the regional office of the Centers for Medicare and Medicaid Services (CMS).
The resulting investigations conducted by staff from those agencies substantiated DRM’s complaints regarding the EMTALA violations in both hospitals. In addition the investigations uncovered numerous violations related to Medicare Conditions of Participation for hospitals. Four publicly available sets of documents outline the legal violations as well as the hospitals’ plans to prevent them from occurring again. A link to these documents can be found here.
An example of how the system fails when providers of mental health services call the police instead of providing treatment can be found in the CMS deficiency report as follows:
- On 11/6/17 sometime between departing at 10:18 PM and 11:25 PM, Patient #2 attempted to enter the hospital [St. Mary’s], via the ED entrance, he/she was stopped by security, and was subsequently arrested.
- A review of jail records indicated that Patient #2 was booked into jail on 11/7/17 at 12:27 AM for trespassing. Documentation on 11/7/17 indicated Patient #2 was seen by a mental health representative; per the mental health representative, the individual was placed on suicide watch "due to the individual's deteriorating mental stability"; the nurse at the jail assessed Patient #2 at the jail and determined that the he/she was "highly delusional and incapable of expressing a lucid thought that was trustworthy"; was cooperative but "completely unaware of [her/his] surroundings or situation"; and yelling that he/she thought the jail was going to burn down. On 11/8/17, documentation indicated that the individual was screaming incoherent thoughts; yelling "that [his/her] back is broken, please help me, I have fallen four floors, I'm dying, please help me"; and was naked and banging. On 11/8/17, a mental examination was court ordered to determine the individual's competency and the individual was committed to a psychiatric hospital for observation, evaluation and treatment.
This person’s decision to seek out mental health treatment at an emergency department led to him or her being locked in a jail cell naked. DRM will continue to advocate for the rights of individuals with mental illness who need emergency mental health treatment at emergency departments.
Question or concerns regarding EMTALA violations involving individuals with disabilities can be referred to Disability Rights Maine at 207.626.2774. EMTALA complaints can be made to the Maine Department of Health and Human Services, Division of Licensing and Certification. Visit https://www.maine.gov/dhhs/dlc/facility-information.shtml#jump3 for more information.
Read the documents relating to the complaints against CMMC and St. Mary's. Document links will open in a new tab/window.
Central Maine Medical Center
Conditions of Participation
EMTALA Violations
St. Mary's Regional Medical Center
Conditions of Participation
EMTALA Violations
[DISCLAIMER: NOTHING IN THIS BLOG IS LEGAL ADVICE]
[1] This practice of providers of mental health services calling the police is not limited to emergency rooms. DRM published an extensive report on this problem entitled “Assessing the Use of Law Enforcement by Youth Residential Service Providers.” https://drme.org/news/2017/law-enforcement-youth.