DRM Death Investigation Leads to Recommendations for Increased State Oversight of Maine’s Progressive Treatment Program

Posted on September 10, 2019

by Kevin Voyvodich, Esq.

Disability Rights Maine (DRM) was contacted by the mother and legal guardian of John Doe[1], a 40 year old man who had been found unresponsive in his apartment and was later declared dead. The mother stated that her son was an individual with mental illness and was living in an apartment that had been staffed by a community residential provider on a 24-hour basis. She stated that approximately a month prior to her son’s death, without warning or notification to her, the residential provider reduced this level of observation from 24 hours to every 15 minutes and then every 30 minutes.

DRM is an independent, private, nonprofit agency that protects and advocates for the rights of Maine citizens with disabilities. Under both state and federal law DRM has the authority to investigate allegations of abuse and neglect involving people with disabilities if the incident is reported to DRM or if DRM determines there is probable cause to believe that the incident occurred.

As a result of Mr. Doe’s mother’s report, DRM initiated an investigation into his death.

During its investigation DRM determined that the residential provider’s obligation to provide this 24-hour level of observation was included in a treatment plan that had been part of a progressive treatment program order issued by the Maine District Court. The Progressive Treatment Program or “PTP” is a Maine law that gives the district court the authority to order an individual to participate in a community mental health treatment plan. This law requires that any “PTP” plan include licensed and qualified community providers who are available to support the treatment plan.

The court may order that the person be committed to the care and supervision of an assertive community treatment team or “ACT” team. These orders often include having the person subject to emergency involuntary commitment if they fail to comply with the terms of the treatment plan. ACT teams are multidisciplinary teams that are on duty 24 hours per day, 7 days per week and are staffed by a variety of mental health and other professionals. The law requires that all ACT teams must include a psychiatrist and registered nurse.

Mr. Doe’s PTP order had him committed to an ACT team with a plan that included receiving services from a separate residential provider. This PTP order expired in March of 2018. A new PTP application was filed within days of the expiration of this order. The plan in the new application, including the 24 hour observation by the residential provider, was almost identical to the one that had expired several days earlier.

Although the ACT team member who signed the application is an employee of a private non-profit mental health agency, in this case the actual petition to the court was filed by one of the state psychiatric hospitals being represented by the Attorney General’s Office.

This PTP application was later withdrawn. Mr. Doe’s mother objected to this withdrawal. She felt that the petition was being withdrawn not due to any clinical assessments regarding her son but rather because the residential provider no longer wanted to provide him with services.

As part of its investigation DRM consulted with Dr. Beth Gouse PHD, a licensed psychologist and former Chief of Staff, Chief Clinical Officer, and former interim chief executive of St. Elizabeth’s Hospital in Washington, D.C., Washington’s public psychiatric hospital, to review the investigative record.

Dr. Gouse is quoted in this report. One of her observations was regarding the residential provider reducing Mr. Doe’s levels of observation. She states the following:

There is no evidence that a risk assessment was conducted to either review his levels of observation or inform the decision to withdraw the PTP application. Rather, the decision to reduce his levels of observation appeared to be due to concern about staff safety and this decision was made without consultation with the ACT team.

As a result of this investigation DRM has made the following recommendations:

1. The State of Maine ensure that all mental health providers involved in any PTP plan are in compliance with all clinical, ethical, regulatory and statutory standards prior to such plan being submitted to the court.

2. The State of Maine develop an effective means to oversee that the provisions of these services are being delivered by the mental health providers according to these standards while the PTP plans are in force.

3. Prior to filing on behalf of a community agency for a PTP the State of Maine ensure that recommendations 1 and 2 are being adhered to.

DRM’s Report is Available Here (PDF)

[1] All names in this report have been de-identified.

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