Wednesday, December 3, 2008

Court to Rule on Drug Testing for Teachers

RALEIGH — A state appeals court will decide whether Graham County Schools can subject teachers and other employees to random tests for drug and alcohol use. Three judges heard arguments Monday in a challenge by a Robbinsville High School teacher that has held up the start of the random tests. The district continues to test employees upon hiring or suspicion of drug use under an old policy that seemed to at least one judge to be enough protection.

Collective Bargaining Meeting in Fayetteville

First meeting of Fayetteville team for public employee collective bargaining
Monday December 8 at 6pm

Office of APWU Local 984 (2606 Rayford Road suite 11 - opposite Chris' Steakhouse and upstairs)

Light snacks provided
Please RSVP if possible!

This coming Monday, December 8, we will be having the first meeting of a Fayetteville area team to work for collective bargaining for public employees. You have probably signed our letter to legislators (at Now it is time to come together and take action to regain bargaining rights for state and local employees. Please join your neighbors at the APWU office at 6pm this coming Monday to discuss what steps can be taken locally to advance collective bargaining in NC. Please invite everyone you know who might be interested.

Read more about the coalition at

And please call me at the number below with questions. Here are some possible actions to consider, just to get you started thinking about what might be strategic and doable in Fayetteville.

Thank you for your support!

Possible actions:
Meeting with the local legislative delegation
Meeting with city council
Meeting with county commissioners
Educating your local or organization
Inviting more community organizations to join the team / sign the letter to legislators
Meeting with editorial boards
Writing letters to the editor
Hosting educational public events (with public employees speaking)
Speaking to the media about collective bargaining
Collective bargaining visibility at local events

Chelsea Earles
HOPE Organizer/Administrator
Hear Our Public Employees Coalition
PO Box 12133
Raleigh, NC 27605
Sign our letter to legislators at!

Report on Uninsured Children

December Student Support Services E-Newsletter

The December Student Support Services E-newsletter is attached. This document should be opened with adobe reader. If you are unable to open the newsletter, it will be posted to the website this week at

Monday, December 1, 2008

The Election is Over, What's Next?

NASW-PACE had a successful election with close to 90% of our endorsed candidates winning their election. This was due in large part to our members who responded to our call for volunteering on the campaigns. Thank you for that.

In addition to notifying our members about endorsed candidates through targeted e-mails, NASW-PACE held eight phone banks September through November. Volunteers called nearly 3,000 members in New Hampshire, North Carolina, Maine, Minnesota, Colorado, and Maine, considered key states for the Senate and for the presidential elections. NASW-PACE endorsed 238 candidates for the House and Senate and Barack Obama for President.President-elect Barack Obama wants to hear from you. You can influence his administration by providing your experiences and your ideas here. Make sure that you mention you are a social worker and member of the National Association of Social Workers

Wednesday, November 19, 2008

Child Labor Crackdown

Child labor crackdown promised
Officials say fines must be tougher increased needed
(Charlotte Observer, Nov 13, 2008)

Federal and state lawmakers said this week they will push to strengthen the government's power to keep youths out of dangerous jobs and punish employers who violate child labor laws.
In Washington, some members of Congress want to beef up child labor inspections. In Raleigh, some legislators -- along with the current and incoming governors -- said they will move to stiffen fines for violating child labor laws. The maximum penalty of $250 per violation in North Carolina hasn't changed in nearly three decades.

"The employment of underage workers in high-risk, physically dangerous jobs as uncovered by the Charlotte Observer is alarming," Governor-elect Beverly Perdue said. "The need is clear -- there must be tougher enforcement of our state's child labor laws and stiffer penalties for any business or industry caught breaking them."

Their comments came in response to Charlotte Observer stories this week showing that federal child labor enforcement has declined, despite new evidence that employers are ignoring the laws. As part of its investigation, the Observer interviewed more than 20 current and former House of Raeford Farms workers who said the poultry company often hired underage workers.

Gov. Mike Easley said he would instruct his staff to try to address the problems before he leaves office in January.

"It's hard to believe that's going on in this century and in this state," he said. "You're really talking about a form of child abuse here. We're not a state that wants children abused and endangered."

More inspectors

With a stronger majority in Congress and their party's candidate preparing to enter the White House, Democrats say they will soon find it easier to make federal workplace safety changes.

U.S. Rep. Lynn Woolsey, D- Calif., who heads the House Subcommittee on Workforce Protections, said she'll push to increase the number of inspectors who can investigate child labor complaints and update rules to keep juveniles out of hazardous jobs.

"Your story, I thought, was just heartbreaking," said Woolsey, who held a hearing in September about federal efforts to protect working children. "Nobody should face dangerous working conditions -- particularly our children. ...We have a great deal of work to do."

Federal child labor investigations have dropped by nearly half since fiscal year 2000.

Recent studies have found that a large percentage of young workers are taking on jobs deemed unsafe for people their age. On a typical day, more than 400 juveniles are hurt on the job.

Stiffer state fines

In North Carolina, state Senate leader Marc Basnight said he has directed his staff to work with the N.C. Department of Labor and the Attorney General to look at the issues the newspaper raised. He questioned whether the state's $250 fine was enough.

"You could be penalized more for throwing trash out the window than you could for abusing the laws that are in place as it pertains ... to kids and young folks," he said. "And that should not be."

State Rep. Paul Luebke, a Durham Democrat, called for stiffer penalties and oversight of the Department of Labor, headed by Commissioner Cherie Berry, a Republican.

"This could require some legislation if she doesn't do more on her own," said Luebke, who heads the House Finance Committee.

Berry said it's up to the General Assembly to amend child labor laws, but she's willing to work with legislators.

Berry, recently elected to her third term, said her department has limited authority to investigate large employers for child labor violations, and said that parents have the "ultimate responsibility" to determine what type of work their children do.

Pelosi Speaks of Possible End to Worksite Raids

(Strohm, 2008)
House Speaker Pelosi has touched off a new round of fighting over whether the Homeland Security Department should continue to stage controversial raids of worksites around the country. That may foreshadow a dispute that could move front and center when the new Congress convenes in January.
Pelosi indicated at a news conference Wednesday that she supports an end to worksite enforcement operations nationwide by Immigration and Customs Enforcement, which is part of the Homeland Security Department. She said the urgency of putting together comprehensive immigration reform legislation has been intensified by the raids. "How do we end the ICE raids, have a situation where we can end the ICE raids as we put together the comprehensive immigration reform?" she asked.
She did not offer a timeline for the Democratic-led Congress to take up comprehensive immigration legislation. In response to additional questions, a Pelosi spokesman said the speaker has long expressed concerns that the Raids are ineffective and "unnecessarily divide families at the expense of children." The aide added: "As the speaker clearly stated during her press conference last week, she supports a bipartisan solution that protects our borders, enforces our laws, unites families and creates a path to legalization." But such comments already have come under fire by Republican lawmakers who believe worksite enforcement actions are a valuable tool to dissuade employers from hiring illegal workers. "The last thing we should be talking about is ending ICE raids. We need more enforcement, not less,"
said House Homeland Security ranking member Peter King. House Judiciary ranking member Lamar Smith also weighed in. "Instead of criticizing, the Speaker should be commending ICE for protecting American jobs by ensuring that they don't go to illegal immigrants, targeting identity thieves and holding employers accountable," Smith said. "I'm troubled that the speaker seems to be more concerned with the welfare of illegal immigrants than of the U.S. citizens who have to compete against them for jobs."
The rift between Pelosi and GOP lawmakers underscores tensions that persist over immigration issues, which now fall into the lap of President-elect Obama. A coalition of immigration advocates has scheduled a news conference Tuesday to call on Obama to institute a moratorium on ICE raids when he takes office in January. Some GOP congressional aides said they worry that Obama will appoint a new ICE director who will not make worksite enforcement raids a high priority - a move they believe would be a major mistake. Immigration advocates said they were encouraged by Pelosi's comments last week. "I think that her statement showed a real recognition that the raids that we've seen in the last few months have been largely ineffective," said Grisella Martinez, legislative director for the National Immigration Forum. The raids are a byproduct of a failed immigration system that needs to be revamped, she said.
But those who support strict enforcement of the nation's immigration laws hope Obama's administration will not end worksite operations. Roy Beck, president of NumbersUSA, which favors reduced immigration, notes that Obama's presidential campaign Web site outlines support for employer sanctions. "To remove incentives to enter the country illegally, we need to crack down on employers that hire undocumented immigrants," the Web site said. But the site offered no additional information, other than a statement that Obama supports legislation to create a new employment eligibility verification system "so employers can verify that their employees are legally eligible to work in the U.S."

For more information please refer to:

Friday, November 7, 2008

!Si se pudo!

Hello Friends,
Please check out this petition to President-elect Obama to call for a moratorium on ICE raids.
From The Rise Movement:
Si se pudo! Yesterday, we made history. Latinos, immigrants, and people of conscience voted in awesome numbers. And, overwhelmingly, we cast our ballots for a presidential candidate whose life story and vision promise hope for immigrants and everyone who has not yet been fully included in the American community. Now, we petition the President-elect to deliver the change we need: an end to the anti-immigrant assault. Yesterday, we upheld the promise of 2006. Today, we celebrated this historic victory and began the long march to justice that lies before us.We walked with hundreds of supporters from the Placita Olvera encampment to the nearby federal building, broke the fast with fruit juice in an interfaith religious ceremony, and made a new promise: "Yesterday we voted, tomorrow we march!" And today, we launched a petition to President-elect Obama calling for an immediate moratorium on ICE raids. Please sign the petition right now.Barack Obama's victory and the Democratic landslide offer us a tremendous opportunity. But, as Obama himself says over and again, change comes from the bottom up and never ends with an election. It is up to us to seize this moment and fight to realize the promise of just immigration reform that our votes have created.The Fast has inspired so many to imagine the possibilities for our movement of militant nonviolent action in the tradition of Martin Luther King and Cesar Chavez. How much more can we do if we are willing to make deep personal sacrifices for la causa? To find out, we will have to train and prepare ourselves.First, we must declare our determination to hold our leaders accountable to our vote. Everyone in our movement agrees: the ICE raids must end! Let's let Obama know - sign the petition today and forward it to everyone you know.Thank you so much for everything you've done. Si se puede,The Rise teamP.S. Special thanks to everyone who donated in response to our appeal. We were moved by the response, and we've cut our debt for the Fast in half. Please donate today to help us pay off the expenses of this historic campaign.
© 2008

Thursday, October 30, 2008

NASW-NC PACE releases endorsements for 2008

Countdown to Election Day- NASW-NC PACE Endorsement List for 2008

Your NASW political action committee (NC PACE) has carefully reviewed the candidates for office in North Carolina’s council of state races (Governor, Lt. Governor, Attorney General, Secretary of State, etc) and races for NC House and Senate. NASW staff has gathered information from candidates via questionnaire and occasionally through interviews. Finally we evaluate candidates through their voting records and through information from sister organizations who have also made endorsements and gathered information on candidates.

You will note that we do not endorse candidates in each House and Senate race, as there are times we choose not to endorse or do not have adequate information to comfortably support a candidate.A reminder that the political action committee is established under state law and as such is separate from NASW. We are non-partisan and endorse based on the performance of candidates relative to the general legislative agenda of NASW-NC.

Sometimes we endorse candidates who are friendly to us on only one or two issues but we know that they do not have significant electoral opposition. The NASW-NC Board appoints all PAC board members.Note that National NASW endorses candidates for federal office (President, US House and Senate).We invite your questions and feedback.

NASW-NC list of endorsed candidates:

Governor: Beverly Perdue
District Court Judge District 18: Angela Foster
Lt. Governor: Walter Dalton
District Court Judge District 18: Polly D. Sizemore
Treasurer: Janet Cowell
District Court Judge District 21: Amy Allred
Secretary of State: Elaine Marshall
District Court Judge District 26: John Totten
Attorney General: Roy Cooper
House Dist 3: Alice Graham Underhill
Commissioner of Insurance: Wayne Goodwin
House Dist 9: Marian McLawhorn
Superintendent of Public Instruction: June Atkinson
House Dist 11: Ronnie Griffin
Supreme Court Associate Justice: Suzanne Reynolds
House Dist 13: Barbara Garrity-Blake
Court of Appeals: James Wynn
House Dist: 17: Bonner Stiller
Court of Appeals: Kristin Ruth
House Dist 23: Joe Tolson
Court of Appeals: Cheri Beasley
House Dist 29: Larry D. Hall
Court of Appeals: Linda Stephens
House Dist 30: Paul Luebke
Court of Appeals: John Arrowood
House Dist 32: Jim Crawford
District Court Judge District 10: Christine Walczyk
House Dist 33: Dan Blue
House Dist 34: Grier Martin
House Dist 106: Martha Alexander
House Dist 35: Jennifer Weiss
House Dist 113: Tom Thomas
House District 37: Ed Ridpath
House Dist 115: Bruce Goforth
House Dist 38: Deborah Ross
House Dist 116: Jane Whilden
House Dist 39: Linda Coleman
House Dist 117: Paul D. Goebel
House Dist 40: Marilyn Avila
House Dist 119: Phil Haire
House Dist 41: Ty Harrell
Senate Dist 2: Jean R. Preston
House Dist 44: Margaret Dickson
Commissioner of Labor: Mary Fant Donnan
House Dist 49: Lucy Allen
Senate Dist 7: Doug Berger
House Dist 52: Betty Mangum
Senate Dist 8: RC Soles
House Dist 53: Joe Tart
Senate Dist 9: Julia Boseman
House Dist 58: Alma Adams
Senate Dist 11: AB Swindell
House Dist 59: Maggie Jeffus
Senate Dist 12: Kay Carroll
House Dist 63: Alice Bordsen
Senate Dist 14: Vernon Malone
House Dist 64: Cary Allred
House Dist 69: Pryor Gibson
Senate Dist 15: Neal Hunt
House Dist 70: Pat Hurley
Senate Dist 16: Josh Stein
House Dist 71: Larry Womble
Senate Dist 18: Bob Atwater
House Dist 77: Lorene T. Coates
Senate Dist 20: Floyd McKissick
House Dist 81: Hugh Holliman
Senate Dist 23: Ellie Kinnaird
House Dist 82: Jeff Barnhart
Senate Dist 24: Tony Foriest
House Dist 86: Walt Church, Sr.
Senate Dist 25: Bill Purcell
House Dist 88: Ray Warren
Senate Dist 27: Don Vaughan
House Dist 90: Jim Harrell
Senate Dist 29: Ronald (Ron) Franklin
House Dist 93: Cullie Tarleton
Senate Dist 34: Andrew Brock
House Dist 100: Tricia Cotham
Senate Dist 36: Fletcher L. Hartsell, Jr.
House Dist 101: Beverly Earle
Senate Dist 37: Daniel G. Clodfelter
House Dist 102: Becky Carney
Senate Dist 38: Charlie Dannelly
Senate Dist 47: Joe Sam Queen
Senate Dist 40: Malcolm Graham
Senate Dist 49: Martin Nesbitt
Senate Dist 43: David Hoyle
Senate Dist 50: John Snow
Senate Dist 45: Steve Goss

Wednesday, October 29, 2008

The power of change is in your hands.

Text "Early" to 69866 to find your Early Vote location
1-2-3 Voting
Voting in North Carolina is as easy as 1-2-3.
Vote Barack Obama for President and Joe Biden for Vice-President
Vote Straight Democratic Ticket
Flip the ballot over and vote for Democrats in non-partisan races one by one:
Suzanne Reynolds - Supreme Court (Edmonds seat);
Judge Kristin Ruth OR Sam J. Ervin - Court of Appeals (Tyson seat)
Judge John C. Martin - Court of Appeals (Martin seat)
Judge James A. Wynn, Jr. - Court of Appeals (Wynn seat)
Judge John S. Arrowood - Court of Appeals (Arrowood seat)
Judge Cheri L. Beasley - Court of Appeals (McCullough seat)
Judge Linda Stephens - Court of Appeals (Stephens seat)
For a list of more Democratic judicial candidates, visit Wayne Goodwin for State Insurance Commissioner

Fit Community Program

October 20, 2008 Bladen Journal RALEIGH
— The N.C. Health and Wellness Trust Fund recently released a request for proposals for a fourth phase of its Fit Community deThere is no fee to apply for the Fit Community designation or grant. For more information about the Fit Community program, or to download a Fit Community application, visit Applications will be accepted until 5 p.m. on February 20, 2009.

News from the Polls

Guv Poll
The latest poll from Public Policy Poll puts Democrat Beverly Perdue ahead of
Republican Pat McCrory 47 to 44 percent in the race for governor. Libertarian Mike
Munger had the support of 5 percent of respondents. The poll of 1,036 likely voters,
taken Oct. 25-26, had a margin-of-error of plus or minus 2.8 percent. In the race for
state auditor, the poll put Democrat Beth Wood ahead of incumbent Republican Les
Merritt 44 to 41 percent. Democratic Secretary of State Elaine Marshall led
Republican Jack Sawyer 48 to 39 percent. Republican Commissioner of Agriculture
Steve Troxler led Democrat Ronnie Ansley 46 to 41 percent. A separate poll by the
Democratic polling firm shows Democrat Larry Kissell leading incumbent Republican
Robin Hayes 51 to 46 percent in the race for the 8th District congressional seat.
(THE INSIDER, 10/29/08).

Image v. Substance in the Governor's race

Image v. Substance in the Governor’s race
Will the real Pat McCrory please stand up?
NC Policy Watch with Fitzsimon & Schofield
Check out this link:

Monday, October 13, 2008

Broughton Loses Accreditation Appeal
Broughton loses accreditation appeal

By Sharon McBrayer

The News Herald
Published: October 9, 2008

Morganton -

The Joint Commission has denied accreditation to Broughton Hospital and the hospital could lose payments from private insurance companies.According to a letter from the Joint Commission on Thursday, it denied accreditation following a December 2007 survey of the hospital.The Joint Commission is a nationally recognized agency that certifies more than 15,000 U.S. health-care facilities and programs."After consideration of all materials and information presented, the committee determined that there was substantial evidence to support the Accreditation Committee's decision and concluded to deny accreditation to Broughton Hospital," Ann Scott Blouin, executive vice president of accreditation and certification operations for the commission, said in the letter.

The decision was effective as of Thursday. The letter didn't give an explanation for the denial of the appeal.That means the hospital will have to reapply for accreditation with the commission, said Tom Mahle, director and CEO of Broughton.Losing its accreditation means the hospital will lose money from private insurances that require commission accreditation, Mahle said.Mahle wouldn't way on Thursday how much the hospital stands to lose in private insurance payments, only saying, "We evaluating it."

In August, Broughton's then Interim Director Art Robarge estimated the hospital could lose between $400,000 to $500,000 a year in payments from private insurance companies if it lost Joint Commission accreditation.The loss of accreditation doesn't, however, jeopardize Medicaid or Medicare, Mahle said.Broughton lost its Medicaid and Medicare funding in August 2007 following two deaths at the hospital. It regained its Medicaid and Medicare funding in July.Mahle said the hospital will work with the commission to establish some guidelines for applying for accreditation."And we're going to do that as quickly as we can," Mahle said.

Mahle said he's not sure how long the process will take but plans to talk to Joint Commission officials about it.The loss of accreditation won't mean a loss of employees, Mahle said.Mahle believes the hospital has made a lot of changes since the survey in December 2007, and that's why the Centers for Medicare & Medicaid Services reinstated its funding."We're really looking forward to reapplying as quickly as we can and working with the Joint Commission," Mahle said.

Wednesday, October 8, 2008

Breakdown: A Once Effective System Spins Out of Control

By Taylor SiskStaff Writer

This story is the second about mental health care in North Carolina.

As the mental health care system in North Carolina began unraveling, many critics focused on the new private providers, arguing that most of them are in the business foremost for the money. John Mader, who worked as a mental health therapist for 18 years for the OPC Area Program prior to privatization, disagrees. While a vocal critic of the state's reform measures, he says he believes that most providers genuinely want to provide quality services.That said, though, Mader questions whether it's possible to provide comprehensive mental health care services when certain services are profitably compensated for with state and federal funds and others aren't.

You have a situation, Mader continues, where the service provider, whether a for-profit or nonprofit organization, has to report to its board of directors or parent company, whose interest is in seeing to it that the organization is able to stay in business.

The question Mader and many other mental health care advocates ask is: Should such critical services – mental health care services – potentially be victim to internal fiscal concerns?
Mader says: "You don't hear the fire department saying, 'Sorry guys, it's October 31; we've run out of money. Good luck over the next two months.'"

"Can you imagine doing away with the local STD clinic, privatizing it?" asks Nicholas Stratas, a psychiatrist in private practice in Raleigh and former state deputy commissioner of mental health. "Can you imagine the well-baby program being privatized? I can't. The neonatal program being privatized? I can't. So what the hell are we doing here?"

As part of reform legislation passed in 2001, state government began privatizing mental health care services. Area programs such as OPC that in the past had provided services were now ordered to divest of those services and to contract them out to private providers. The area programs, now called Local Management Entities (LMEs), were tasked to oversee those providers. Under the reform, more services would now be provided in communities and, in theory, the state institutions would be less crowded and better positioned to treat the more critically ill.

Most everyone now agrees these reform efforts have miserably failed. Private providers are going out of business; the mentally ill, most particularly those un- or underinsured, are falling through the cracks; and our state institutions are in crisis.

Finding a solution, Stratas believes, will require once again taking what he calls a systems approach."Mental illness is a fragmenting problem and our system needs to be unified," he says. "We can not treat a fragmenting problem with fragmented services. Piecemeal won't get it."

'Making hay'

At one time, North Carolina had what was considered to be a model mental health care system. Stratas – still active in psychiatry and actively advocating for the mentally ill – was one of the architects of that system.

Stratas came to North Carolina in 1960, recruited by a progressive-minded cadre of mental health care experts, led by Eugene Hargrove, a co-chair of the UNC department of psychiatry who became the first head of the state Department of Mental Health, created in 1963.
Hargrove's vision was to train mental health care professionals within the state to run the system and Stratas was selected as the statewide director of professional education and training.
These were "exciting days; really exciting days," Stratas recalls. "It was all new. It was like a blank blackboard; there was nothing except the state hospitals." Licensing standards for personnel within those institutions were upgraded and Charles Vernon, the newly appointed director of community programs, and Stratas began traveling the state, to all 100 counties, meeting with local officials.

About this time, the federal government got interested in improving public state mental health institutions and initiated two types of grants: Hospital Improvement Program grants and In-service Training Program funds.

Vernon and Stratas met with every county commission in the state, held town meetings and generally laid the groundwork for local involvement in mental health care.
They also had solid support in the Legislature, led by John Umstead.
In 1963, the Kennedy administration pushed through the Community Mental Health Act, and, says Stratas, who at the time had been named deputy commissioner of mental health, "man, we made hay with that."

Local mental health facilities were built across the state. Programs were set up to provide inpatient, outpatient and 24-hour emergency care. Consultation and education was provided to schools, courts and sister agencies that due to the nature of their work needed guidance with mental health issues. The importance of providing continuity of care through the transition from an institution to outpatient services and among essential community-based services was stressed.

In sum, a systems approach to mental health care.

At the same time, the system became racially integrated. Cherry Hospital and the O'Berry Center for those with developmental disabilities (then referred to as the mentally retarded), both in Goldsboro, had previously been the only institutions in the state open to blacks.
Meanwhile, admissions to the state institutions were declining through the '60s and '70s.
In addition, says Stratas, there was a research and a data processing department. If a county official wanted to know where the county stood in terms of, for example, outpatients seen, Stratas says, "You could get that data within 24 hours."

That kind of accounting, says Stratas, is a thing of the past: "Nowadays, I can't get that data if I'm waiting for two or three months. They're not even keeping coordinated, unified data anymore. It's criminal."

'Benign neglect'

Stratas points to the Bob Scott administration of 1969-73 as the beginning of the deterioration of the mental health care system in North Carolina.

"Scott decided there were too damn many state agencies, and I agreed with him," Stratas says. Scott set about reorganizing state government and Stratas was one of two physicians on an advisory commission to plot that reorganization.

The state Department of Mental Health had been created to provide visibility and access to the governor and the Legislature.

"We had total free access, and we encouraged free access to our staffs," Stratas says. The reasoning was: "If legislators want to talk to you, talk to them. We need all the help we can get; we don't need secrecy."

The department now became a division within the Department of Human Resources, which eventually became the Department of Health and Human Services (DHHS).

At the time, Stratas agreed with the rationale of moving mental health care into one department to include all human services. But Scott was succeeded by Jim Holshouser, the first Republican governor of North Carolina since 1901, and, says Stratas, communications between state mental health care administrators and the governor and the Legislature deteriorated.

Jim Hunt was next in office. Hunt's approach to mental health care, Stratas affirms, was one of "benign neglect."

While Scott had appointed a doctor, Lennox Baker, to head the newly created DHHS, the Holshouser administration began a trend of appointing nonmedical directors – the beginning of what Stratas calls the de-medicalization of the state office, which would subsequently happen at the local level as well.

Meanwhile, Stratas says, the area programs became quasi-governmental agencies with autonomous boards. Stratas says communications between the programs and the state institutions began eroding; liaison teams were discontinued.

By the mid- to late '90s, programs were falling on hard days financially due to both state and federal cutbacks; they were letting people go and were cutting back services.

"So the Legislature started talking about reform," says Stratas; "they decided the whole system was sick."

Cutting corners

In a unified, systems approach to mental health care, liaison teams are deployed so that when a patient gets admitted to Dorothea Dix, for example, the area program in the patient's community knows about it and can immediately begin to plan for the discharge of that patient.
Under our current system, that doesn't generally happen.

Marilyn Ghezzi, who for some 20 years worked as a therapist for OPC, says that throughout her tenure the liaison between the institutions and the area programs wasn't great, but that prior to privatization at least the process was relatively straightforward.

"It used to be that a social worker from Umstead would call us when one of our patients was being discharged," Ghezzi says. "Now, with so many different providers, there's uncertainty about who to call."

And, she adds, with patients being let out after such short stays due to overcrowding, "it's hard to handle so many."

Then, once out, services for the more seriously mentally ill are limited.

In a privatized health care system, says John Mader, "compromises have to be made."As private providers have continued to struggle to make ends meet, they're inadequately prepared to deal with those more seriously ill and, in most cases, are unable to provide 24-hour emergency care.

"And when you cut those two things out," Stratas says, "everybody goes to the hospitals" – an ugly cycle.

Update from DRNC

TRO Stopping the Transfer of Dix Patients to Central Regional Hospital Extended

Raleigh, NC

On Tuesday, September 23, 2008, Disability Rights North Carolina (DRNC) filed suit against the North Carolina Department of Health and Human Services (DHHS) to prevent the transfer of patients from Dorothea Dix Hospital to Central Regional Hospital (CRH) in Butner.

On Thursday, September 25, 2008, Superior Court Judge Allen Baddour entered a Temporary Restraining Order prohibiting the transfer and setting a hearing for DRNC’s Motion for a Preliminary Injunction for Monday, October 6, 2008.

DRNC and DHHS have now entered into an agreement extending the Temporary Restraining
Order for an indefinite period. Today, Judge Baddour approved that agreement by Order of the
Court. This order will maintain the status quo and leave the patients at Dorothea Dix Hospital for the immediate future.

During this time, it is anticipated that the results of a recent inspection
conducted by the Center for Medicare and Medicaid Services (CMS) will be made public. The
conclusions made by CMS will shed light on one of the central issue presented by DRNC’s court
action– whether conditions at CRH are in compliance with CMS standards.

“We are pleased that the Department has agreed to postpone transfer of patients from Dorothea
Dix to Central Regional Hospital. We urge the Department to aggressively address the known
safety concerns at Central Regional Hospital so that it’s current and any future patients are in a
safe and therapeutic environment,” said Vicki Smith, Disability Rights North Carolina’s
Executive Director.

Disability Rights North Carolina is the state’s federally mandated protection and advocacy system for people with disabilities. One of the P&A’s primary federal mandates is to protect and
advocate against the abuse and neglect of people with disabilities in the care of state institutions

Media Release

Growing Trade Deficits Cost North Carolina More Than 220,000 Jobs in 2007A new study shows unbalanced trade is hitting the state hard, even in industries once thought to be resistant to trade's effects

Contact: John Quinterno, Research Associate, NC Budget & Tax Center, (919) 856-3185; mobile (919) 632-2292

(RALEIGH, Oct. 2, 2008) --
America's growing trade deficit is costing the country millions of jobs - and North Carolina, which posted a net loss of more than 220,000 jobs last year, is among the hardest hit states.

The trade deficit led to the net loss or displacement of 5.6 million jobs in 2007, according to a new report by the Economic Policy Institute (EPI). The study estimated the employment impacts of the non-oil trade deficit in some 200 industries in all 50 states. North Carolina ranks in the top ten nationwide for net job losses both when measured in absolute numbers and when measured as a share of total state employment.

"North Carolina has been hard hit by unbalanced trade," said John Quinterno, research associate with the NC Budget & Tax Center. "The growing trade deficit is undercutting key state industries like manufacturing and destroying jobs. The result: diminished opportunities for industries, workers and communities."

According to the study, international trade in non-oil products destroyed 220,100 more jobs in North Carolina than it created in 2007. This is equal to 5.4 percent of total state employment. In terms of total net job losses, North Carolina was the ninth most affected state; when ranked by net job loss as a share of total employment, North Carolina was the eighth most-impacted state.
Perhaps most disturbing, the job-loss trend is occurring in industries once thought to be resistant to trade-related displacement.

"The conventional wisdom has been that trade only impacts traditional North Carolina industries, such as textiles, apparel, and furniture," said Quinterno. "But what we're now seeing is that trade-based job losses are actually occurring in a broad swath of industries, including higher-tech, higher value-added ones, like the production of computer equipment and automotive parts."

The consequences of unbalanced trade include lost employment opportunities and an overall decrease in job quality for working people in North Carolina.

"Workers lose when competition destroys jobs in import-competing industries, and forces people out of the labor force or into lower-paying industries. Even workers whose industries aren't affected lose out, since low-wage foreign competition serves to hold down American wages generally."

Responding to the impact of unbalanced trade requires action from both North Carolina's federal and state leaders. On the federal level, officials need to work against barriers that prevent truly fair trade, such as a lack of labor standards and foreign currency manipulation. Congress should also strengthen the social insurance systems designed to help displaced workers by, for instance, reauthorizing and modernizing the Trade Adjustment Assistance program. Finally, Congress must stop under-investing in vital workforce programs that help American workers hone the skills needed to compete.

The role of the state is to help mitigate some of the consequences faced by displaced Tar Heels. State leaders are well-positioned to help the workers, families and communities upended by unbalanced, unfair trade.

To help individuals forced into lower-paying jobs, the state should expand access to vital work support programs such as child-care subsidies and children's health insurance. Similarly, state policies could improve the quality of existing jobs by strengthening employment standards. Finally, the state could enrich the skills of current and future workers by better investing in North Carolina's model system of community colleges.

Psychiatric News

Shattered MH System Not Easy to Repair

Aaron Levin

North Carolina's public mental health system was dysfunctional, so it was fixed and then fixed again.

The road to mental health reform may be paved with the best of intentions, but when the potholes get bigger after the repairs, people start to wonder.

North Carolina is bumping along through another upheaval in its public mental health system as citizens, patients, legislators, psychiatrists, and mental health professionals try to recover from the previous upheaval.

Legislators and policymakers shook up the system about seven years ago, but the resulting reforms proved at least as problematic as the conditions they were intended to cure.
"We tried to fix it, and we broke it," said one legislator, according to news reports.

Now the state is trying again to pick up the pieces and patch together a functional system.
Until 2001, North Carolina's system tied four large psychiatric hospitals scattered across the state with 39 area mental health, developmental disability, and substance abuse programs, supplemented by contracts with private agencies.

"The clinic-based area programs were local, safety-net operations with state funding," Debra Dihoff, M.A., executive director of the North Carolina branch of the National Alliance on Mental Illness and a former executive in the system, told Psychiatric News. Many were overwhelmed by growing caseloads after Medicaid and managed care were introduced.

The state was late in adopting many of the changes developed in public mental health and managed them badly in the process. It mishandled the Medicaid transition, and staffing, record-keeping, and physical-plant problems in the hospitals drew the attention of the Department of Justice in 2001.

Faced with a system on the verge of collapse, the Office of the State Auditor produced a report in 2000.

Among other things, the auditor's report called for cutting 667 beds from the 2,400-bed state hospital system, developing specialized outpatient services for targeted populations, and creating a separate developmental-disabilities division.

The most significant change, however, came in the creation of local management entities (LMEs) to administer, fund, and oversee—but not provide—services in each county. In theory, psychiatrists, social workers, psychologists, and other clinicians would leave the shrinking state system and reassemble into private-practice groups. Proponents argued that privatization would be more efficient and less costly and permit more rapid innovation than the public system.
Children, the elderly, the severely mentally ill, and substance-using populations would receive state-funded treatment, while others would use the county-based community support services.

Psychiatric Input Overlooked

"[The plan] didn't look too bad, but it left out a lot of input from professional groups," said Stephen Kramer, M.D., a professor of psychiatry at Wake Forest University School of Medicine and president of the North Carolina Psychiatric Association, in an interview.

The auditor's report was handled at arm's length by politicians, said Marvin Swartz, M.D., a professor of psychiatry and chief of the Division of Social and Community Psychiatry at Duke University. "There was no visionary leader with influence."

Gov. Mike Easley (D) employed a delegating management style and had little personal interest in mental health, Swartz said. State legislators had a poor grasp of the complexity surrounding mental health and simply said: "Fix it—just tell us what you want."

Whatever its intentions, the new system didn't work, said Swartz, who served as a consultant to the state auditor.

"Implementation was poor," Swartz said. "There were not enough people or knowledge or cash flow to implement a plan that was poorly designed."

"It was supposed to be budget neutral, but funding was inadequate before the reforms and more inadequate afterward," said Kramer.

Privatization also exacerbated an existing shortage of psychiatrists, said Swartz. Psychiatrists had always been "loss leaders" in the state system. Not all the work they did with complex patients was reimbursable, but cost-shifting under the area programs kept the system in balance. That couldn't be sustained with the reforms.

There was another factor as well. "People who work in the public sector are not entrepreneurs," said Swartz. "Some former public psychiatrists joined provider groups, but many left the field or the state because their income stream became too uncertain."

Fewer Psychiatrists Available

The supply of psychiatrists declined in about half of North Carolina's 100 counties during the period, according to a report by Swartz and his colleagues.
"Between 1999 and 2004, five counties lost all their psychiatrists, 48 counties experienced a decline in their supply relative to population growth, and 12 counties had no psychiatrists in either 1999 or 2004," they wrote.

The role of psychiatrists was undercut further because of the "quasi-fraudulent" system that developed in the early years of reform.

Provider organizations were paid a flat $61-an-hour fee to provide services, regardless of who treated the patient. Some (although not all) dispatched low-level (and low-paid) paraprofessionals to perform ill-defined "community support" services and pocketed the difference. The state had no mechanism to monitor these practices until the system went hundreds of millions of dollars over budget, said Swartz.

"The mental health plan did not carry clear lines of accountability," said Vicki Smith, M.S., executive director of Disability Rights North Carolina, in an interview. "It was built on the assumption that all entities would do the right thing. You have to build community capacity first, but they didn't do that."

It's a Long and Winding Road

"I wouldn't say reform failed, but it certainly has taken longer than expected to get it right," said psychiatrist Michael Lancaster, M.D., who in January was named codirector of the state's Division of Mental Health, Developmental Disabilities, and Substance Abuse Services.
Service definitions from the Centers for Medicare and Medicaid Services were approved only in 2006, two years later than expected, said Lancaster. The wholesale privatization of the system was clearly too radical, he said. "You need a public/private partnership to maintain a safety net."
Community support, said Lancaster, was intended to get people connected with services, build skills, and promote recovery, not serve as a substitute for long-term outpatient care.
"But community support became the norm, and the paraprofessionals were providing the maximum amount of services, whether they were needed or not," he said. "The money drove everything. Overutilization of community support meant other services weren't developed."
Now the division requires preauthorization for services other than outpatient treatment and requires national accreditation for providers to weed out the marginally qualified.

"We've seen a decrease in the use of community support and increase in other services," said Lancaster. He pushed in 2004 for the state to stop divesting the public system and halt the outflow of professionals, but the process was hard to stop, he said.

Legislative support will help. The state now offers psychiatrists a tuition-loan repayment program even if they are not working in federally approved health professional shortage areas. Lawmakers authorized funds last spring for 30 mobile treatment teams, 30 psychiatrists, and 30 walk-in clinics, along with expanded telepsychiatry services. Money has been allocated to develop inpatient beds in community hospitals, said Lancaster.

Perhaps because they have no other choice, most observers of the system hold out hope that the future will bring needed improvements.

"There are many naysayers who feel the system is irrevocably broken, but I don't feel that way," said Swartz. The legislature has made a "down payment" to get the system back on its feet, he said, while consumers, professionals, and others continue to pressure the politicians.
"I'm less concerned about the 'why' than in moving forward and ensuring that there is an accountability mechanism now," said Smith.

Dihoff expects consolidation of the local management entities and consequent improvement in efficiency, accompanied by development of family- and peer-support approaches.
"We have funding now for clinics and mobile teams, although they will take two years to put in place," said Lancaster. "We want to improve recruitment and retention, move treatment closer to home and families, and have institutions focus on the most severe cases."

Information about the North Carolina Division of Mental Health, Developmental Disabilities, and Substance Abuse Services and its programs is posted at <>.

Healthy Start Legislation



Today, President Bush signed into law critical legislation to provide low-income children greater access to critical prenatal and early infant care. The Healthy Start Reauthorization Act of 2007 provides community-based grants to help our nation’s most disadvantaged children survive infancy and live longer, more productive lives.

“Providing young children with the care they need is a fundamental right supported by a majority of Americans. It begins by ensuring that pregnant women get proper care to deliver strong, healthy babies, and continues by providing those newborns quality, reliable care as well,” said Bruce Lesley, President of First Focus.

“The evidence is clear that the Healthy Start program not only improves outcomes for low-income pregnant women and infants, but also reduces expenditures associated with providing more expensive and frequent medical treatment that those who do not get proper prenatal and early infant care often require. And because every Healthy Start site develops a consortium of neighborhood residents, parents, medical providers, social service agencies, faith representatives, and business leaders, the whole community is engaged in helping children to survive and succeed. We are thankful to the Congress and the President recognizing the need for renewal of this critical program,” Lesley continued.

While the United States’ infant mortality rate has improved over the past 40 years, it still ranks only 28th among industrialized nations. Further, in southern states, the infant mortality rate is climbing for the first time in decades.

Healthy Start has been enormously successful in reducing the rates of infant mortality that are prevalent in the communities where it operates – most typically, communities with large minority populations, high rates of unemployment and poverty, and those with limited access to health care. There are nearly 100 Healthy Start projects currently operating in 37 states, the District of Columbia, and the U.S. territories. These projects have been tremendously successful at reducing infant mortality, improving prenatal care, reducing low birthweight, and removing barriers to health care for pregnant women and newborns.

“Healthy Start helps ensure that our nation’s most disadvantaged children survive infancy and live longer, healthier lives,” said Senator Sherrod Brown (D-OH), coauthor of the legislation. “Healthy Start provides essential prenatal care for women regardless of their financial situation. This bill advances the public health and promotes the common good.”

“Healthy Start programs, like North Carolina’s Baby Love Plus, have made great progress in reducing infant mortality, premature birth, and low birth weight,” said coauthor Senator Richard Burr. “Healthy Start is a critical program that saves lives and ensures more of our nation’s children stay healthy. I am pleased my Senate colleagues took a step towards ensuring more of America’s children start life in good health.”

For example, low birth-weight babies that survive their first year incur medical bills averaging $93,800 per infant. Healthy start grants have helped to address some of the critical health disparities facing minority communities. For example, African American babies are 2.4 times more likely as white infants to die before their first birthday. In addition, women who do not receive prenatal care during the first trimester have infant mortality rates 40 percent higher than those women receiving early prenatal care.

After decades of decline, 32 states across the country saw their infant mortality rates increase, according to the Centers for Disease Control and Prevention (CDC). Moreover, sixteen of those states face the double negative of having an infant mortality rate above the national average while also having their rate increase. Those states include Alabama, Delaware, Florida, Indiana, Kansas, Michigan, Mississippi, Missouri, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, Tennessee, Virginia, and West Virginia.

First Focus is a bipartisan advocacy organization that is committed to making children and their families a priority in federal policy and budget decisions.
To learn more visit

Child Tax Credit Expanded

While the Bailout bill includes many bad tax cuts that will add to the deficit and it does not do for individual homeowners, there is one piece we can celebrate. As part of the bailout bill, Congress included an expansion of the child tax credit – one of the primary items we asked for in our Stand Up For Children event and letter to congress. Thank you to Louisa Warren who did such a terrific job presenting on this issue at our event! This new legislation adds families earning between $8,500 and $12,050 to those who are qualified to claim the child tax credit. The Center on Budget and Policy Priorities estimates 96,000 more North Carolina children should now qualify for the credit. Read more at

Also today, President Bush signed into law the Healthy Start Reauthorization Act of 2007, which provides community-based grants to help our nation’s most disadvantaged children survive infancy and live longer, more productive lives. Below is a press release from First Focus about this.

Have a good weekend!

Sorien K. Schmidt
Action for Children NC

NC's 11th Annual Homeless Conference

The registration information for NC's 11th Annual Homeless Conference is now available at:

From this site you can access information about registration as well as information about nominations for the annual awards ceremony.

Please forward this to others who may be interested!

Angela Harper, Best Practice Team, NC Division of MHDDSAS, 715-2774

Entry from The Carolina Journal

Just Who Subsidizes Who?
By John Hood


There’s great mischief lurking in fuzzy definitions.

In politics, the mischievous – and most certainly the villainous – prefer to employ ill-defined words that hide their true intentions and reduce their exposure to investigation and refutation.
As John Locke himself once wrote, in An Essay Concerning Human Understanding, “there is no such way to gain admittance or give defense to strange and absurd doctrines as to guard them round about with legions of obscure, doubtful, and undefined words.”

Today’s excursion into the political misuse of the English language, a form of rhetoric Locke compared to “the dens of robbers, or holes of foxes,” concerns the word subsidy.Many politicians and commentators employ the term to describe any payment from one party to another. But that doesn’t capture its true meaning. If I give you a dollar today, and you return the dollar to me tomorrow, neither of us has been subsidized.

There was no net transfer of wealth. Moreover, if I pay you a dollar in exchange for a good or service you perform for me, I’m not subsidizing you. Again, there is no net transfer. It is a trade.Bear with me. This is no mere semantic distinction. It has a bearing on many political debates in North Carolina, on issues ranging from transportation to higher education.

The original Latin term was subsidere, combining two words: sub, meaning below, and sidere, to settle or sit. It is the root of such modern-day English words as subside, subsidiary, and subsidy. The common denominator is the concept of something being left over, as in what solids sink to the bottom of a glass of liquid. Figuratively, it refers to something being supplemental, extra, a remainder.The money you spend buying a chicken dinner for lunch is not a subsidy of Bojangles (I must assume you go to the proper chicken & biscuits outlet).

However, if Bojangles is a partner in a local charitable enterprise, say a juvenile-diabetes philanthropy, and you choose to donate money through a handy jar while eating at the restaurant, you are subsidizing the diabetes program – it isn’t giving you a good or service in exchange (or, at least, one that you’re likely to be aware of at the time).

Subsidies can be voluntary, like the above example. But in the political context the subject is typically an involuntary subsidy, a forcible transfer of money from some group of taxpayers to another group of beneficiaries. The important point is that it has to be a net transfer. It is impossible for everyone to be subsidized. That’s an incoherent concept.

If everyone receives direct benefits in relationship to direct taxes paid, no one is being subsidized.I’ve written before about how the notion applies to transportation funding. Defenders of mass transit like to argue, as several respondents did to JLF’s just-released study of the Charlotte light-rail line, that all transportation choices are subsidized, so fixating on the share of transit cost shouldered by non-transit users is unfair.

This is a case of a little knowledge being a dangerous thing. Sure, if we’re talking about government assets such as unlimited-access highways or airports, it appears as though taxpayers rather than users are financing the system. In reality, however, the taxes and fees that fund roads and airports bear a strong relationship to usage. Moreover, the direct beneficiaries aren’t hard to identify.

You either ride the train or you don’t. Either there’s a net transfer of wealth from transit users to non-transit users, or the money flows the other way. It is impossible for both users and nonusers of transit to receive a net subsidy, unless foreigners or extraterrestrials are involved. One group must subsidize the other.

It is, of course, the transit users who are heavily subsidized. In the case of the Charlotte rail line, more than 90 cents of every dollar spent to transport a rider come from taxpayers other than the rider.To distinguish the subsidized from the subsidizers is not necessarily to invalidate the government program in question. You might say that even though students at public universities derive the vast majority of the benefits from their education, those who don’t attend public universities should help pay the bill.

But at least you’d be admitting that a subsidy exists (in this case, from the relatively less-affluent to the relatively affluent).Using precise language helps to clarify the issue – which is why so many politicians and commentators prefer to keep things nebulous.

Implementation Update

Implementation Update #49 is now accessible from the DMH/DD/SAS web page (

Link to NY Times Article

WASHINGTON October 6, 2008

Bailout Provides More Mental Health Coverage

By ROBERT PEAR The new law, which will affect more than one-third of all Americans, comes after 12 years of advocacy by friends and relatives of people with mental illness and addictions.

From Sunday N&O

Employees travel widely on hospital gifts Workers at the psychiatric hospital take fancy trips with money from drug makers, medical schools Michael Biesecker, Staff Writer

RALEIGH - Employees at a troubled state mental hospital in Goldsboro used money from drug companies and foreign medical schools to visit destinations such as Hawaii and Hungary.

In less than four years, administrators at Cherry Hospital approved more than $139,851 in spending for overnight travel to more than 100 medical conferences and professional events, including at least 48 trips to other states or overseas.

Using both state revenue and money from a nonprofit foundation created to benefit the hospital's patients, employees have spent an additional $215,650 since 2005 on fundraisers, catered meals for hospital staff, and an annual retreat at a Wrightsville Beach resort.

The director of Cherry Hospital, Jack St. Clair, said the spending through the hospital's Continuing Medical Education program is essential to attract and retain qualified professionals who could earn higher salaries in private jobs.

"We're in a highly competitive, highly demanding market in the world of medicine as it relates to the psychiatric world," St. Clair said.

Though at least five other state-run mental institutions in North Carolina have similar accounts used for medical education and recruitment efforts, Cherry raised and spent at least eight times the other institutions' combined totals on employee travel.

Dempsey Benton, secretary for the state Department of Health and Human Services, said Friday that oversight of such spending has been inadequate.

"Steps have been taken to better monitor and utilize these monies to include patient care and needs," Benton said in a written statement.

Federal officials withdrew Medicare and Medicaid funding from Cherry Hospital last month after the death of a patient who choked on his medication, hit his head and was then left sitting in a chair for 22 hours. It was the latest in a string of instances of patient neglect and abuse at the hospital.

The money for the employees' excursions came from two checking accounts controlled by managers who are also the hospital's most frequent travelers: Dr. Kimberly Johnson, the clinical director; and Judy Howell, an administrative assistant who coordinates Cherry's medical education program.

Johnson and Howell each attended a dozen conferences in the last three years, visiting such cities as New York, Chicago, Boston, Washington, San Diego, San Francisco and Toronto.
The pair often traveled together and stayed in upscale accommodations. An example is a two-bedroom, two-bath condo they rented at the Scottsdale Links Resort, a luxury spa next to a renowned golf course in Arizona. They were accompanied by Phyllis Neal, Johnson's administrative secretary and then reigning champ of Cherry's annual golf tournament.
The four-day trip to an annual meeting of the Alliance for Continuing Medical Education cost at least $4,364.

Johnson, Howell and Neal were not available for comment, according to a departmental spokesman. All requests for interviews were referred to St. Clair, who said conferences in the medical field are usually at expensive locations.

"You're not going to go to a national conference involving the clinical world of the disciplines that we deal with and have your conference at Tom Bodett's Motel 6," he said. "That's one of the attractions they use to bring people from all over the country, and sometimes internationally. There are some perks that come with that."

Getting trips approved

St. Clair said he had not taken any trips out of state, but as Johnson's direct supervisor he signed off on most of her expenses. Johnson, the hospital's top medical doctor, approved expense requests for Howell and others.

Before Johnson, Howell and two others made a $6,920 trip to Orlando earlier this year, they signed out $500 cash advances to themselves.

Other trips included one for a physician assistant who spent three days at Walt Disney World's Polynesian Resort for a conference titled "Dermatology for the Non-Dermatologist."

Two Cherry psychiatrists went to Budapest, Hungary, while a food service director and dietitian went to Honolulu.

The hospital spent at least $10,000 in May to send seven employees, including Johnson and Howell, to a meeting of the American Psychiatric Association in Washington.
St. Clair said the large contingent, which included employees with no medical credentials, was needed to staff long hours at the hospital's recruiting booth.

The hospital spent an additional $2,855 on banners featuring the hospital's logo, carpet, tablecloths, a table and a stool for the booth. Another $8,429 was spent last spring on Cherry Hospital embossed pens, key caddies, Frisbees and bags.

St. Clair said he could not name a Cherry Hospital doctor who was recruited at such an event.
"It's a work in progress," he said. "We're learning as we go."

Cherry has gone to great lengths to attract doctors. Of the 19 physicians on staff at the hospital, 12 are graduates of foreign medical schools in such distant locales as Addis Ababa, Ethiopia, and Chittagong, Bangladesh. Several of the psychiatrists are not board-certified, and the hospital is paying tuition and fees for them to further their educations.

Money from Caribbean

Most of the travel for Cherry employees was paid through an account called the Preceptor Fund, which receives about $125,000 a year paid to the hospital by six medical schools in the Caribbean. In exchange, the hospital hosts medical students who earn academic credit by doing rotations at Cherry.

Hospital employees who spend state time teaching the students, who number about 100 per year, are rewarded with annual allowances to pay for trips to medical conferences of their choice.
Most trips paid for through the Preceptor account were reviewed and approved in advance by the DHHS finance office.

"I want to go too!" wrote a reviewer in e-mail approving a May 2005 trip for a conference in Orlando. "Doctors certainly know how to select conference venues!"

The director of the state system of mental hospitals, Jim Osberg, ordered last month that spending from the Preceptor account be suspended after an article in The News & Observer detailed a hospital nurse's $5,000 trip to South Africa to learn about AIDS.

But as that account was frozen, employees continued spending from an account of the Cherry Hospital Foundation, a nonprofit corporation chartered by hospital employees in 1997 for assisting the mentally ill of Eastern North Carolina.

Tax returns and financial records for the foundation show that of the $166,781 it raised from 2004 to 2007, more than 90 percent was spent on medical seminars and conferences.

Grants spent on travel

Much of the money came through donations and grants hospital employees solicited from private companies that manufacture or distribute psychiatric drugs, including companies that have lucrative contracts to supply the state hospital system.

Correspondence sometimes included with the checks showed the companies saw a connection between their grants and their relationship with the hospital's staff.

"Eli Lilly and Company appreciates your support of our vision to deliver innovative medicines that enable people to live longer, healthier and more active lives," the company's chief grants officer wrote to Cherry Hospital's Howell, enclosing a $5,000 check. Lilly makes the antidepressant Prozac.

"We appreciate your dedication to the healthcare community, your patients and your professional relationship with Forest Pharmaceutical," said a letter from the makers of Lexapro, another antidepressant, with a $2,500 check.

St. Clair said the drug companies paying for his doctors' trips had no influence on whether those doctors then prescribed the drugs those companies sell.

"If it happens to be a drug that is more popular, more efficacious to treat the doctor's patient who has bipolar disorder or schizophrenia, so be it," St. Clair said. "Me and every other hospital in the state of North Carolina, and probably the country, tries to position themselves to try to be competitive for those grants. ... I'm after the money because I think it could benefit my staff through further education."

It is against state law for government employees to accept payments or gifts from companies profiting from state business.

By cycling the corporate money through its nonprofit foundation and then to the employees for travel, the state hospital may have found a loophole.

"The state's statutes of that kind are pretty hit-and-miss, and they're not comprehensive," said David M. Lawrence, a professor of public policy at the UNC School of Government in Chapel Hill. "I don't think it violates the statute."

The practice, though common at some private facilities, is the subject of intense debate within the medical field.
"It is considered inappropriate for pharmaceutical companies to be paying for travel for doctors," said Dr. Ross McKinney Jr., a Duke University professor of medicine and director of the Trent Center for Bioethics. "It's being done systematically because the companies know they will get prescriptions in return."

Wrightsville meeting

In August, Cherry Hospital held its 12th annual Eastern Mental Health Symposium at the Holiday Inn SunSpree Resort at Wrightsville Beach. The event's program, distributed to all attendees, offered a "special thank you" to nine pharmaceutical companies credited with underwriting many of the expenses.

The event happened to be scheduled for the weekend after federal regulators told Cherry officials they were considering sanctions over such issues as staffing deficiencies. Still, the bulk of the hospital's administrators and doctors left town for the annual symposium.

St. Clair said he took work with him to his hotel room, including a draft of the hospital's required plan to show the feds how it would correct the problems. The regulators later cited Cherry with numerous violations and removed the hospital's accreditation to receive Medicare and Medicaid money.

Asked if he should have canceled the event, St. Clair bristled.

"I work my [butt] off for Cherry Hospital and so do a lot of the department heads," St. Clair said. "We've got a lot of hard-working folks down there and I do resent the fact that a lot of people might get the impression I'm down there playing, having a good time."

The loss of federal money is expected to cost North Carolina taxpayers more than $800,000 a month. But don't expect that to stop Cherry's employees from traveling.

The hospital has prepaid more than $8,000 in registration fees and airline tickets for conferences later this month in Minneapolis and San Diego.

Johnson and Howell are among those scheduled to go.

(News researcher David Raynor contributed to this report.) or 919-829-4698

Big Victory!

Big Victory! President Signs Mental Health Parity

More Info

Congratulations to NASW members who have long advocated passage of mental health and addiction services parity legislation. Just this afternoon the House passed the final mental health parity bill by a strong vote margin (263-171) and the President has already signed the bill into law.

The Senate voted earlier this week to add parity language (the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008) to the much larger Wall Street rescue, tax and disaster relief bill (H.R. 1424). The House subsequently agreed to the Senate’s version of the bill this afternoon. The new federal law will provide mental health and addiction services parity for about 113 million Americans who work for employers with 50 employees or more.

NASW members and thousands of other mental health advocates have battled for years to enact federal mental health parity legislation for private insurance coverage. Throughout this year, advocates have made more progress toward enactment than at anytime since our efforts began. Over the past two weeks, Senate and House leaders struggled to bring mental parity to the floor before Congress adjourns for the elections. Our last major problem was a congressional rule requiring a "pay-for" to offset the impact of implementing parity on federal revenues (estimated by the Congressional Budget Office to cost $3.8 billion over 10 years).

Congressional budget rules require legislation with a fiscal impact to include either increases in revenues or decreases in spending to remain budget neutral. The Senate earlier this week added our parity bill to the huge Wall Street bailout bill as an enticement to gain House approval for the highly controversial package. This final strategy has now proven successful, ensuring the parity bill would be signed into law quickly by the President.

NASW greatly appreciate social workers’ continued commitment to support passage of this landmark legislation. At this time we don’t have a detailed analysis of the law, but more information will be forthcoming. Members interested in seeing the full text of the soono be signed federal mental health parity law may view it beginning on page 310 of this bill:

H.R. 1424 Emergency Economic Stabilization Act of 2008
Congratulations to all NASW advocates, it was a hard fought and truly critical victory!

Parity Passes

FYI - long awaited action...

The U.S. House of Representatives has just voted to pass the Emergency Economic Stabilization Act of 2008 that includes the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act. The effective date is January 1, 2009. The roll call vote (263 yea-171 nay) will be posted at

Recovery Month

Every year, towns, counties, and states around the country observe National Alcohol and Drug Addiction Recovery Month in September. This year, the 19th annual Recovery Month recognizes the impact that real people and real stories have on recovery and celebrates those who work to advance the treatment and recovery landscape.

Share your Recovery Month event photographs, videos, and results!

Please share your event results and pictures for posting on the Recovery Month Web site and for the Road to Recovery Wrap show and send them to Mark Mendez, Road to Recovery Supervisory Producer, or send videos to:

Mark Mendez
Road to Recovery - Supervising Producer
Macro International
11420 Rockville Pike
Rockville, MD 20852

Pictures should be good quality stills with a resolution of 300 dpi or higher. Include shots that provide context, for example a banner with the name of your event or city in the background Include with your pictures any press release or promotional documents that will help us describe the event Please note the City, State and Recovery Month ID number of your event in your email. For video submissions, please send DVD, miniDV or Betacam SP formats Compressed video on a CD cannot be used for production. The materials will not be returned.

All materials must be received by October 10, 2008.

Next Webcast: Wednesday, November 5, 2008:The Road to Recovery 2008: A Showcase of Events (Wrap Show)

In this program, we will look at the array of events conducted in communities large and small as the country comes together in celebration of National Alcohol and Drug Addiction Recovery Month in September 2008. Individuals, families, and entire communities across the Nation unite under the theme, “Join the Voices of Recovery: Real People, Real Recovery.” This program will showcase Recovery Month community forums, music-based activities, walks and runs for recovery, Major League Baseball games, and other uplifting events intended to raise awareness of recovery and increase accessibility to treatment. In addition, the show will highlight the positive and affirming message that addiction is treatable and recovery is possible.

Join Ivette Torres, Associate Director for Consumer Affairs, Center for Substance Abuse Treatment (CSAT), Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (HHS) as she highlights Recovery Month 2008 activities.

Many Faces of Trauma: Community Engaged Trauma Research Conference

Many Faces of Trauma: Community Engaged Trauma Research Conference
October 20-21, 2008 Renaissance Hotel Tampa, Florida
To register, go to

Act now to receive the $140 SPECIAL CONFERENCE RATE at the 4-star conference hotel. After 10/06/2008 rooms start at $315.00 per night.
Trauma-informed Knowledge is Key to Effective Services
This is first state-wide conference to take an in-depth look at the full spectrum of trauma impacts, from the aftermath of disaster, to military service, to interpersonal abuse. The content is up-to-the-minute, pertinent, and multi-disciplinary; what you need to know to best support the citizens in your community.
This conference features state-of-the art information on trauma assessment, intervention/treatment and community and system responses to trauma. Our goal is to promote further research, and ensure that trauma-informed policy and practice support well-being of Florida's citizens across the lifespan. This forum will create opportunities for community-engaged trauma research partnerships.

Sample Sessions (full agenda now online):
Florida's Implementation of Trauma Informed Care in Residential Settings
A Trauma Informed Curriculum Addressing the Needs of LGTQI2-S Youth
Evaluation of a Trauma Treatment for Women in Dependency Court
Responding to the Mental Health Needs of Children Post-Disaster
Personal Narratives and Resilience among Stroke and Brain Injury Survivors
Integrating Trauma-focused Treatment into a Jail-based Substance Abuse program

Who should attend?
If you represent advocacy, child welfare, corrections, law enforcement, health care, mental health, social services, education or civil service, this is information you need. The impacts of trauma cross all boundaries.

Tentative Agenda
October 20

Keynote Address by Dr. Fran Norris: Resilient Communities: How Do We Study, Assess, and Create Them?
12:00 - 1:30pm
Networking Lunch
1:30 - 5:00pm
Concurrent sessions: Intensive Workshops, Paper Presentations, and Panel Discussions
5:30 - 7:00pm

October 21

9:00 - 10:30am
Plenary Panel Presentation
10:45am -12:15pm
Concurrent sessions: Intensive Workshops, Paper Presentations, and Panel Discussions
12:15 - 1:30pm
Lunch on Your Own
1:30 - 5:00pm
Concurrent sessions: Intensive Workshops, Paper Presentations, and Panel Discussions

Key Contacts:
Registration and Conference Information: Norin Dollard at 813-974-3761 or

About the Sponsors:
The University-Community Trauma Research Group, Louis de la Parte Florida Mental Health Institute, University of South Florida, was formed in 2006 to provide a forum to promote transdisciplinary approaches to prevention, intervention and research on trauma across the lifespan and to understand its biological, psychological and societal effects. To date, participants have looked at traumatic stress as a result of child physical and sexual abuse, interpersonal violence, disasters, and war. This work was supported, in part, by the University of South Florida Internal Awards Program under Grant No. R011759.

Free Webinar

Essential Learning Offers a Free Webinar: Strategies to Help Community Providers Prevent Suicide in Veterans on Wednesday, October 15 @ 2 pm EDT

Suicide and factors that contribute to suicide, such as depression, PTSD and increased drug and alcohol use, are steadily on the rise among veterans returning home from war. With limited access to veteran’s healthcare services in rural areas and the stigma that is associated with veterans seeking help for mental health needs, this has made it increasingly challenging for community providers to serve this population.

Join us for a free webinar, Strategies to Help Community Providers Prevent Suicide in Veterans on Wednesday, October 15 at 2pm EDT with Paul Quinnett, PhD and President and CEO of The QPR Institute, to learn about what you can do to prevent suicide among the veterans and military personnel you serve.

Date: Wednesday, October 15, 2008
Time: 2-3 PM EDT,1-2 PM Central, 12-1 PM Mountain, 11 AM- 12 PM Pacific

Register Now

Highlights of the presentation include:

Brief overview of suicide in America and who is most impacted

Discussion about why veterans are a high risk group for suicide

Overview of the National Suicide Prevention Strategy and how this impacts practice standards and staff training and competencies for community providers

Introduction to Reliability Theory and how this model can be applied to enhance consumer safety

Presentation will be followed by a review with Sue Erskine, Founder and CEO and Chief Development Officer of Essential Learning, of The QPR Institute and Essential Learning suicide prevention packages and other online courses that prepare clinicians for working with veterans.

A demonstration of the Build Your Own WRAP® web service for veterans will also be provided.

About Essential Learning
Essential Learning is the largest provider of e-learning services serving more than 450 behavioral health and human service organizations in 46 states. Request a demo of our Organizational Learning Management System and Community Access Site that is available to organizations on a subscription basis.

Essential Learning offers an extensive course library – the most comprehensive in the industry – on timely clinical, recovery and compliance topics. Our course library is included with a subscription to our Organizational Learning Management or courses may be purchased individually or in packages.

Visit our website at for more details.

Request a Demo of Our Services Today!

About The QPR Institute
The QPR Institute is a suicide prevention training organization committed to reducing suicide attempts and completions. The Institute offers comprehensive suicide prevention training programs, educational and clinical materials for the general public, professionals and institutions.

QPR stands for Question, Persuade, and Refer -- 3 simple steps that anyone can learn to help save a life from suicide. Just as people are trained in CPR and the Heimlich Maneuver to help save thousands of lives each year, people trained in QPR learn how to recognize the warning signs of suicide and how to question, persuade, and refer someone for help.

Visit the QPR Institute website at for more details.

Mental Health Advocates Rejoice as Health Insurance Discrimination May End

White House Is Last Stop

The Bazelon Center for Mental Health Law-the leading national legal-advocacy organization representing individuals with mental disabilities--salutes Congress for passing mental health and addiction parity legislation."After years of debate and discrimination, the door to equitable coverage ofmental health services is open at last," said psychologist Robert Bernstein,the Center's executive director.

The Paul Wellstone and Pete Domenici Mental Health and Addiction Equity Act of2008 ends differing coverage by health insurance for the millions of childrenand adults who require mental health and addiction treatment. Many havedelayed or avoided seeking treatment because of high out-of pocket costs andinequitable treatment restrictions."Parity is essential for a healthy nation," said Bernstein.

"The Equity Actwill lower the barriers to mental health care that have led to a host ofadverse outcomes, including custody relinquishment to get access to care for achild, school failure and even suicide."The law passed today provides parity between medical-surgical and mental healthand addiction benefits in plans that offer mental health coverage.

When signedby the President, it will prohibit health insurance plans sponsored bybusinesses with 50 or more employees from imposing day and visit limits orapplying different deductibles, co-payments, out-of-network charges and otherfinancial requirements for treatment.

The Equity Act builds on the 1996 ParityAct, which provided limited parity for lifetime and annual dollar limits.

Integrating cognitive and behavioral techniques in the treatment of Obsessive Compulsive Disorder

Come join us for
The UNC-CH School of Social Work's Clinical Lecture Series
Integrating cognitive and behavioral techniques in the treatment of Obsessive Compulsive Disorder
presented by Jon Abramowitz, PhD
Monday, October 13, 2008

When: Monday, October 13, 2008, 12noon - 2pm (Arrive 11:30 for sign-in, "meet and greet," and refreshments.)
Where: Tate-Turner-Kuralt Auditorium, School of Social Work, 325 Pittsboro Street, Chapel Hill
Registration: On line pre-registration ($20/event)
Directions and parking:
For more information:
Two contact hours available

This workshop highlights the use of cognitive therapy and imaginal exposure therapy techniques in the treatment of clients with so-called “pure obsessions” (obsessions without compulsive rituals), who are considered to be poor candidates for traditional behavior therapy for OCD. Dr. Abramowitz describes strategies that focus on clients’ interpretations of, and responses to, otherwise normal intrusive thoughts, as a way to manage their obsessional problems. Throughout, Dr. Abramowitz draws on empirical research and his rich clinical experience, and will use video and interactive demonstrations to illustrate the therapeutic techniques.
Jonathan S. Abramowitz, PhD, ABPP is a Licensed Psychologist, Associate Professor and Associate Chair of the Department of Psychology, and Research Associate Professor in the Department of Psychiatry at the University of North Carolina at Chapel Hill. He is also Founder and Director of the UNC Anxiety and Stress Disorders Clinic. Dr. Abramowitz conducts research on obsessive-compulsive and other anxiety disorders and has authored/edited five books and published over 100 peer-reviewed research articles and book chapters on these topics. He is Associate Editor of two scientific journals in the field of cognitive-behavior therapy, and has received awards for his scientific and professional contributions by the American Psychological Association, Mayo Clinic, Obsessive Compulsive Foundation, and the National Institute of Mental Health.

Questions? Contact Debbie Barrett PhD, MSW at or 919.843.5818
For more information on the clinical lecture series, please visit

AMHC funding shortfall forcing cuts

State official blames agency’s management
Staff Writer
Saturday, October 04, 2008

Albemarle Mental Health Center has already exhausted its state funding four months into the fiscal year, prompting the regional agency to reduce staff and cut funds for at least one mental health service.

An official with the N.C. Division of Mental Health blamed AMHC’s funding shortage on the agency’s management.

But AMHC officials placed blame on state officials for reducing reimbursement rates and “service authorizations,” the amount of a particular service that state funds will provide for a patient.
AMHC, which provides mental health services in 10 area counties, released a statement Thursday explaining that the agency no longer would provide Community Support Services because of reductions in state funding. The decision would result in a reduction in staff and the movement of patients to private care providers, the press release states.

“Because ensuring that everyone in our community receives the quality care they need, we are transitioning patients to the care of private providers of their choice already working in our community,” the press release states. “For consistency of care, all existing Albemarle Mental Health Center Community Support Services staff have been given the opportunity to seek employment with the private provider as well. Patients receiving Community Support Services should have a seamless transition as they continue to receive care from staff they know and trust....”

But several of the private providers said this week they might have trouble providing the services to AMHC’s former patients given state funding cuts.

Dick Oliver, team leader for the Local Management Entities Performance Team of the N.C. Division of Mental Health, acknowledged last week that there has been some reduction in state funding to mental health service providers. But management at AMHC had made the funding shortfall worse, he said, because of a lack of proper oversight.

The reduction in state funding is “a statewide issue” but “no one else has run out of funds because of it,” Oliver said. “They (AMHC) have appeared to have run out of state money eight months ahead of schedule, which usually points to failure of their financial system internally.”
AMHC’s shortfall will mean “very limited funding if any at all for state-funded services, the money that helps those consumers not funded by Medicaid,” Oliver said.

He estimated AMHC’s non-Medicaid clientele is about 40 percent of those receiving services.
“When we see this happen it usually means that the local management entity doesn’t have a system in place to connect the authorizations and payments.” Oliver said, explaining that if a patient is authorized to receive 10 units of service, the local management agency must keep track of the relationship between those 10 authorizations and how much is being paid out.
He said it wasn’t unheard of for local management entities or LMEs to deplete their state funds in the spring.

“Typically this occurs in April or May of a year,” Oliver said. “I have never known it to occur in October. It’s pretty serious for the consumers who are not Medicaid-eligible in these counties that are managed by Albemarle.”

But Cecil Perry, chairman of the Pasquotank County Board of Commissioners and a member of the AMHC board of trustees, believes state funding cutbacks are to blame. The AMHC board has not received any information suggesting any misappropriation of funds or overspending in last year’s budget, he said.

“I think just needing more funding for services is basically what has happened,” Perry said. “More money is needed. There’s no question about that.”

Charles Franklin, AMHC’s longtime director, could not be reached for comment for this story.
The local mental health board has not discussed a need for tighter internal controls, Perry said.
“This is really the fist time that I have heard that,” he said.

Perry said he thought Oliver’s analysis might be overlooking the differences between regions of the state — especially the prevalence of poverty in northeastern counties.

“I don’t know that (AMHC is the only LME in the state already out of funds) is all accurate, because people are doing all different things throughout the system,” he said. “Providing community services has always been an issue in eastern North Carolina. ... Trying to provide the services in the 10 poorest counties — as long as (the state funds LMEs) all the same — it will always be an issue.

“People down here experience more poverty than they do in other areas of the state of North Carolina.”
Annie Meloy, executive director of Greensboro-based Central State of the Carolinas, which provides residential services and other programs in about a dozen communities in the state, said AMHC had informed her it would be reducing its state funding to the company as well as to other providers of mental health services.

The reduced funding will affect both patients and employees, she said.

“The reduction in dollars clearly means change in our services,” Meloy said. “We may have to downsize our employee pool. We don’t know yet. Albemarle has not told us yet the exact dollar level our state money is being reduced.”

She said she was “guessing” the cuts might be “in the $100,000 range.”
Those affected most drastically will be two people who don’t live in Central State housing but have been receiving developmental therapy through the company.
Developmental therapy “is completely being cut out,” Meloy said.

Meloy said the company had not run into this type of funding shortage anywhere else in the state.

Central State serves about 17 clients who live in seven community homes in the Pasquotank County area, she said. Another three or four receive services from the firm but don’t live in its housing, she said.

Todd Key, director of Health Services Personnel, which has an office in Edenton, said the company had been told by AMHC that no funds would be released for this quarter until there had been a chance to look more closely at the available funding.
“We’re still looking into how that might affect us,” Key said.

A severe cutback in funds could require eliminating some staff positions, he said.
“Employment for our employees hasn’t been affected just yet,” Key said.

Contact Reggie Ponder at