Caring is at Malaby’s core

Of the five Maine representatives whose districts lie mostly in Hancock County, Republican Richard Malaby of Hancock is the odd man out. But put to him in those terms, Malaby seemed taken by surprise. “How do you mean?” he asked.

Well, his four colleagues are all Democrats, but party distinction doesn’t mean that much to him. Richard Malaby is a man on a mission, and his goals are not partisan. He has spent all six years of his legislative service on the Health and Human Services Committee (HHSC), working to be sure Mainers, especially those with mental health problems, get the treatment they need.

“I always wanted to do something in the political arena, to give something back,” he said. His years on the board of the Maine Coast Memorial Hospital exposed him to the challenges of delivering health care in rural Maine.

Of the Hancock County representatives, only Malaby owns a business, the Crocker House Inn and restaurant. It is a destination for summer travelers and popular with the local community for fine dining. Typical of most coastal businesses, the inn demands his attention during the summer months.

That means Malaby does not make it to Augusta as often as he would like in the legislative off-season, though he is there at least once a month. But a good part of each week at home is spent working the phones on behalf of constituents. People from his area and well beyond bring him an endless string of heart-wrenching and complicated health and social problems.

His policy area weighs on him, particularly when it comes to mental health. After six years on the HHSC, he has developed an expertise with the byzantine department, its rules and regulations, and its budget. He is the “go-to” guy on health care within the House Republican caucus. But the situations in which constituents find themselves take a toll on him, and he has sometimes found himself at odds with his colleagues.

While the House Republican priority in the last session was cutting state government spending, Malaby understands all too well the unmet needs of Maine citizens in the health care arena. Considering the wait lists for substance abuse services, mental health and eldercare, he has advocated for more spending, not less.

He believes that Maine does a pretty good job with some of these areas, but within each there is considerable room for improvement. His caucus will back him only if he can identify offsetting cuts for his proposed expenditures.

“We’re serving people well, within our resources,” he maintained, but acknowledges that those resources are not sufficient to provide the proper continuum of care. “We have set up some very useful programs, like the mental health patient stabilization beds, but they are underutilized.”

Those beds, meant to provide temporary care for mental health patients showing signs of destabilization, but not requiring admission to a regular mental health in-patient facility, were partly funded by a reduction in hospital reimbursements based on anticipated cost reductions if these patients could be managed elsewhere. It hasn’t really worked out.

Malaby is often frustrated by the lack of communication with the administrative branch. “We don’t get good information,” he said. Is it the department’s reluctance? Gov. Paul LePage’s constraints on staff participation? Malaby shrugged wearily. “I’m not sure.”

Malaby believes that people tend to get their biological needs addressed, but not their psychological or social needs. Patients hospitalized for mental health crises often improve, but once they leave the institution, there is insufficient follow-up.

Among the changes Malaby promotes in the current mental health system are earlier treatment, more psychiatrists and more therapeutic options leading to fewer prescriptions for anti-psychotic drugs.

That the system fails for so many Mainers distresses Malaby, but it is not all bad news. “We are moving in the right direction,” he said, “but slowly.” A system previously paper-based is now largely computerized. Once, only the patient’s caseworker had access to the patient’s records. Now there is a call center that can locate patient information when needed by others within the DHHS system.

This has uncovered another need within DHHS. Many longtime employees do not have the technology skills necessary in a computerized system. Retraining has been expensive, and some employees are not able to make the transition.

The list of pressing needs goes on. They include long-term care for ALS patients, appropriate residential settings for developmentally disabled adults, improved coordination of outpatient care for mental health patients living in the community and treatment for substance-addicted newborns.

On the plus side, he identifies the work toward “shared living” arrangements for developmentally disabled young adults, and additional beds for “difficult to place” patients. Though these represent small steps forward, they fall well short of meeting existing need.

Malaby’s primary goal is the availability of quality health care for all Mainers who need it. For six years, he has been threading his way through the complexities surrounding health care delivery in Maine, and he is willing to keep at it. “It’s just …,” he paused. “I just have to do it.”

Jill Goldthwait

Jill Goldthwait

Jill Goldthwait worked for 25 years as a registered nurse at Mount Desert Island Hospital. She has served as a Bar Harbor town councilor and as an independent state senator from Hancock County.

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