Malcolm Moore is supposed to be in a hospital.

He was found not criminally responsible by reason of insanity 12 years ago after stabbing his neighbor. He had been diagnosed years earlier with paranoid schizophrenia, and mental health evaluators believed he had not been taking his medication.

Instead of prison, he was committed to the state’s Riverview Psychiatric Center in Augusta.

He spent 10 years there getting therapy and treatment. He had a room to himself.

But two years ago, Moore, who is 50 and now uses his Muslim name, Jihad Abdullah Mohammed, was transferred for unknown reasons to Columbia Regional Care Center, a controversial, for-profit facility in South Carolina, more than 1,000 miles away.

For years, Maine has quietly sent a dozen people – none of them found responsible for their crimes – to the private center that has been likened to a prison. The facility uses isolation and corrections tactics that Riverview was years ago banned from employing.

One patient from Maine died there in December. The state has yet to answer questions about his death.

Moore said he arrived in Columbia shackled and is now surrounded by corrections officers. A barbed-wire fence wraps around the property.

The facility is licensed as a hospital with the South Carolina Department of Health and Environmental Control, although under a different name.

But to Moore, this is no hospital. It’s a prison, a warehouse.

“You’re just sitting here rotting away,” Moore told a reporter in a call from the center’s common room. “I don’t know how people get help here. They put people here for so long.”

He said he was sent there for “no reason.” A spokesperson for Riverview said they don’t discuss individual patients’ cases and couldn’t say why Moore was transferred.

He had assaulted Riverview staff during his time there. In 2015, the Kennebec Journal reported that he hit a mental health worker in the head repeatedly and threatened to continue assaulting staff until he was taken out of Riverview and sent to prison.

At Columbia, he shares a room with three other men, all from different states, in a space so small that only one person can walk around at a time. Security cameras watch over them, and often there’s no privacy curtain around their toilet. He spends most of his time in that room, watching TV.

The facility has told Maine health officials that they fill residents’ days with activities. Moore’s lawyer said he was given a schedule that starts with outside walks in the morning, horticulture trips and educational programming.

But Moore said these aren’t offered regularly. He suspects this is because of staffing shortages.

He said he has experienced food poisoning and gotten into fights, and his weight has fluctuated by as much as 80 pounds. He said his time outside has been severely limited, and most of his calls – even some with his attorney – are recorded or monitored.

He said the facility has not accommodated his religion, including his requests to be served meals later in the day so he could fast for Ramadan.

NO DUE PROCESS

Columbia Regional Care Center, sometimes referred to as Correct Care Solutions of South Carolina, is owned by Wellpath, the nation’s largest for-profit provider of health care in correctional settings, including Maine State Prison and various county jails.

According to South Carolina news reports, at least three of the center’s employees since 2015 have been accused of physically assaulting or abusing patients. A spokesperson for the South Carolina Law Enforcement Division did not respond to messages asking for more information about those allegations and their outcomes.

Wellpath has also been sued hundreds of times in federal court over patient care at its facilities all over the country – including one case tied to the Maine State Prison. Many lawsuits were filed pro se (without an attorney) by patients who said staff ignored or made their injuries worse. The company was also the subject of a CNN investigation in 2019 that found that some patients had died and suffered injuries at Wellpath facilities.

Wellpath did not respond to repeated requests for an interview for this story and several questions about facility conditions, recorded calls and credentials. Chris Hartline, a spokesperson hired by the company, said in an email that CCRC is an “accredited facility that delivers comprehensive medical and mental health services in a safe and secure environment.”

“Patients have a highly structured milieu and are encouraged to be fully involved in their treatment including treatment team meetings, group activities, patient community meetings, education classes, life skills and spiritual services,” Hartline said. “Our patients are treated in a therapeutic environment that supports recovery through trauma-informed care, promoting patient empowerment, independence and self-sufficiency.”

Maine has spent millions of dollars sending patients to Columbia, according to contracts an attorney shared with the Portland Press Herald/Maine Sunday Telegram. In the latest one-year contract, which ends June 30, the state agreed to pay $1.2 million to reserve six beds for the year. Riverview, where 63 of its 92 licensed beds were filled as of May 30, had a $53.8 million budget for fiscal year 2024, according to the Maine Department of Health and Human Services.

Lindsay Hammes, a spokesperson for DHHS, which is responsible for these patients’ care by court order, said the department is currently reviewing next year’s contract with CRCC.

The Maine chapter of the National Alliance on Mental Illness, which advocates for people with mental illness, has also voiced concerns about these transfers.

Hannah Longley, the organization’s clinical director of advocacy and crisis, questioned whether this is the best use of state funds for mental health care. She said her group generally urges the state to divert people with mental illness away from the court system in favor of more community-based intervention programs.

“When we don’t invest in those systems, what we do see is that we end up having a higher cost in quality of life for individuals,” she said.

Hammes said the people Riverview has sent to South Carolina “have demonstrated a high level of violence” or assaulted other staff and patients. She said sending them there is best for their treatment and has kept others at Riverview safe.

But the department acknowledges there are key differences between Columbia Regional Care Center and Maine facilities, including the use of corrections officers, restraints and “administrative segregation,” similar to solitary confinement in prisons.

These are the same methods of control Maine was chastised for using in 2013 when Riverview lost its certification from the federal Centers for Medicare & Medicaid Services. That certification was restored in 2019 after the state proved it had left those practices behind. Maine had already started sending people to CRCC by then.

There’s no laws or regulations limiting how much time patients can spend out of state, or who gets sent. Several patients have returned from Columbia to Riverview only to be sent back months later.

“These people are essentially in a prison,” said Hank Hainke, a court-appointed attorney who represents Moore and others committed to DHHS custody by the courts. That includes a handful of men who have been sent to South Carolina. “They haven’t been sentenced. It’s illegal to just put someone in a prison.”

And the hospital doesn’t need to get a judge’s approval. As long as Riverview finds it clinically appropriate, it can send any patient in its custody anywhere.

“There’s nothing that prohibits them being sent, and there’s no due process related to having a hearing at the time those individuals are sent, or if they try to come back,” said Kevin Voyvodich, a lawyer with Disability Rights Maine, a federally funded protection and advocacy organization.

DIFFERENT STANDARDS OF CARE

Hainke said he is concerned about his two remaining patients in South Carolina, particularly with the difference in the care they’re receiving.

Riverview is a federally certified psychiatric hospital run by the state under the Centers for Medicare & Medicaid Services. But Columbia Regional Care Center isn’t CMS certified, meaning it isn’t held to the same standard of care.

Hammes, the Maine DHHS spokesperson, said the state has determined the facility is an appropriate health care setting and patients are sent to CRCC based on clinical evaluations. She said the department has never considered any other facilities for these patients.

She wrote in an email that the correctional staff there have “extensive safety and mental health training and are certified by the State of South Carolina.” She said Maine is aware of the center’s highly monitored administrative segregation unit and that it is reserved “for highly dysregulated, dangerous and aggressive patients.”

Hammes said hospital leaders check in with the South Carolina center every week. Riverview staff and attorneys from Disability Rights Maine meet virtually with patients to discuss treatment plans, but Hammes wouldn’t say how regularly that happens.

Riverview staff have not visited CRCC since the pandemic lockdowns began in 2020, Hammes said, but they are planning a visit later this year. Neither has the staff of Disability Rights Maine.

Voyvodich described meeting with clients during those prepandemic trips.

“I can tell you that they don’t have the same rights and protections that they have here,” he said.

He declined to talk about specific individuals and their care, citing privacy concerns, but said the visit did nothing to change his worries about their protections – especially given the distance from Maine.

Brenda Thompson said her son Justin was held at Columbia and described many of the same conditions as Moore.

Justin Thompson was committed to Riverview in 2016 after he was found not criminally responsible for burglary, aggravated criminal mischief and theft, according to a background check from the state Bureau of Identification.

He was sent to Columbia, his mother said, after he was accused of attacking staff after they changed his medication. He came back to Maine in May and pleaded guilty to several assault charges. She worries he will be sent back to Columbia when he completes his 18-month sentence at Maine State Prison.

“He’s so scared that he’s going to have to go back down there,” she said.

AMENDED LEGISLATION

In 2019, lawmakers considered a bill that would have created a commission to oversee these patients and required a judge to weigh in before they could be transferred, thereby giving them more due process rights.

Instead, lawmakers amended the bill to require Riverview staff to tell the judge what they’re doing, though they do not need approval. Neither of the bill’s co-sponsors, Rep. Drew Gattineand former Sen. Cathy Breem, responded to voicemails seeking to discuss how the legislation came to be and what happened to it.

In a letter to the Legislature’s Health and Human Services Committee in 2019, Rodney Bouffard, who was then the superintendent of Riverview, defended the practice of sending some patients to Columbia.

Bouffard, who later became the warden at Maine State Prison (which also contracts with Wellpath), said that Riverview had a duty “to serve as a gatekeeper, ensuring that we only accept patients that we can safely, reasonably, and appropriately provide treatment for.”

“We already lack some of this ability due to statutory impediments,” he wrote, referring to federal laws that bar Riverview from using corrections officers. 

At the time of the bill hearing in 2019, Riverview had only sent three patients to Columbia, Bouffard said, a small portion of its court-committed population. He said those three patients had attacked other patients and hospital employees. They caused concussions and broke someone’s eye socket. Some employees left as a result of these injuries.

One Riverview mental health worker, Sally Nichols, wrote in a May op-ed in the Press Herald that she’s had to leave work in an ambulance and was knocked out twice. She listed several other incidents of violence against staff, who mostly rely on verbal deescalation techniques.

In her column, Nichols begged lawmakers to do something to address unsafe staffing levels that make it harder to handle combative patients.

“We have been punched, choked, kicked, stabbed and sexually assaulted,” she wrote.

As of this month, there were 118 job vacancies at the hospital, Hammes said, out of about 360 positions.

Bouffard said the South Carolina center was the state’s only remaining option. They had tried placing these patients in the mental health unit of Maine State Prison, but Bouffard said corrections staff treated these patients “inappropriately,” which played a “significant role” in Riverview’s 2013 decertification and loss of funding.

There are other for-profit and nonprofit mental health providers between Maine and South Carolina, but it’s unclear which, if any, treat patients who have been found not criminally responsible. Hammes said Riverview has no other contracts with outside facilities.

CONTRACTING WITH COLUMBIA 

Hainke often is appointed to advocate on behalf of people after they have been committed to DHHS custody. He pushes the state to provide his clients with better treatment and, as they progress, more time in the community.

His clients who have been transferred to South Carolina have told him about their isolation, the violence from other residents and a lack of privacy.

“These are people who are mentally ill,” Hainke said. “I cannot vouch for every last word that they tell me – but their tales are so bad that there’s something wrong there.”

Hainke has filed a petition in Kennebec County Superior Court calling Moore’s treatment unconstitutional and pushing for his return.

“Mr. Moore’s current treatment plan is inappropriate,” he wrote, describing the same conditions his client relayed in his interview with the Press Herald.

Anthony Reed, the Maine patient who died at Columbia in December, was another of Hainke’s clients.

Hainke said he doesn’t know much about Reed’s death. And Hammes, from Maine DHHS, has refused to share any information because of patient confidentiality.

A spokesperson for Riverview did not respond to questions about whether the state was still reviewing his death. The Maine Office for the Chief Medical Examiner said it was not involved in any autopsy.

Reed’s obituary described his death as peaceful.

He was sent to Riverview in 2013 after he was found not criminally responsible for three Class C assault charges.

While there, he faced new misdemeanor-level assault charges for attacking staff and a police officer, but he was still found not responsible because of his mental health.

In 2015, he became the first person Maine sent to South Carolina. His transfer raised concerns at the time among mental health advocates and an Augusta judge. Riverview leaders said at the time that they needed to send him out of state because they didn’t have a secure enough facility for him in Maine.

His family and lawyer questioned whether the South Carolina facility was appropriate and why a more secure facility could not be opened in Maine. Reed’s father declined to speak with a reporter about his son’s case.

His obituary noted Reed was an artist, a Christian, and a boxer who won several titles in New England and even represented the U.S. in a match in London.

Reed and his art were the subject of a handful articles in the early 2000s in Casco Bay Weekly, a free alternative paper that ceased publication in 2004. The paper described the abstract pieces Reed hung and sold from multiple galleries in downtown Portland, including a devil-faced effigy carrying the head of boxer George Foreman, which had briefly been displayed at the Congress Square Gallery and Mall in 2002.

“Although Anthony had many accomplishments in his life, he also had an equal amount of challenges,” his obituary states. “Life was not always easy or kind to Anthony.”

A THOUSAND MILES AWAY 

Bob Reed, Anthony Reed’s father, begged lawmakers in 2019 to take another close look at the South Carolina facility.

Reed told lawmakers that he had met with his son’s care team at Columbia several times and believed they were professional – but that the facility still seemed like a correctional center, and his son was not getting better.

Anthony Reed was a thousand miles from home. He was growing more isolated and withdrawn. His father was only able to visit him every six months.

“He has serious mental health challenges,” Bob Reed said, “but l believe … the guidance and support of independent oversight … would have reinforced his hope of returning to Maine and reassured him that he is not alone.”

Longley, from NAMI Maine, said it’s important that people who have been found not criminally responsible receive mental health treatment in facilities in which they can trust their providers and feel secure.

Transferring a patient several states away interrupts that work, she said. It deprives patients of their support system by taking them away from relatives and loved ones in Maine who could more easily visit them at Riverview.

“We are removing their primary relationships,” Longley said. “We’re removing their support systems, and we’re removing their access.”

When Justin Thompson was sent to Columbia about six months ago, his mother said she tried to make up for the distance by answering his calls almost every day. She said the calls cost her hundreds of dollars, and they were all monitored.

“I hated to say anything,” Brenda Thompson said in a phone interview, “because I didn’t want to get him in trouble.”

She said her son was lonely and he missed his family – in particular, his 11-year-old daughter, who he also wasn’t allowed to see while at Riverview.

“Every place that they took him – when they took him to Warren – they isolated him for a couple of months,” Thompson said. “Then they took him down to South Carolina, they isolated him for a couple of months. They bring him up here, and what do they do? They isolate him for a couple of months. There’s only so much they can do to a person.”

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