Update on Central Hospital

Mental hospital's opening delayed third time Design, staffing problems plague the centerpiece of reform The opening of Central Regional Hospital in Butner has been delayed three times -- once by fire, once by design defects and now by design problems and staffing shortfalls.
Michael Biesecker and Pat Stith, Staff Writers RALEIGH - Design and staffing problems will again delay the opening of a $120 million state psychiatric hospital, at least until July 1.
Dempsey Benton, secretary of the state Department of Health and Human Services, said Thursday in a written statement that repairs resulting from design flaws were being made to Central Regional Hospital in Butner and that the state intends to meet all standards for psychiatric hospitals. The building had been designed with 30 categories of hazard that could allow patients to hang themselves.
Benton's announcement means that Dorothea Dix Hospital in Raleigh will remain open longer, at least until the new hospital is ready. Most of the campus is scheduled to close then, except for 60 beds that the state will operate jointly with Wake County.
Benton's move comes after vigorous debate within the department about when the new hospital could be opened safely. Minutes from recent meetings of the 16-member Central Regional Hospital Management Team expressed the group's view that the previous opening date for the 432-bed facility, May 1, was unrealistic.
Among the problems raised by the group, which includes Clinical Director Dr. Steve Oxley and the rest of the new hospital's top medical officials, is a projected 37 percent vacancy rate in full-time nursing positions.
Critical shortages are also projected for such highly trained staff as psychiatrists, psychologists and pharmacists.
"It will not be possible to open 197 admission beds due to insufficient numbers of staff," the minutes from the group's Feb. 28 meeting say. "We discussed approaching this conservatively to avoid a disaster, since the less than ideal planning in the mental health system has recently been brought to the public attention in the newspaper."
Benton, along with state hospitals director James Osberg and Central Regional Hospital Director Patsy Christian, declined to be interviewed.
The issue of maintaining an adequate number of hospital beds is one element of severe turbulence for the state's mental-health system. A five-part News & Observer series that concluded Sunday showed that more than $400 million in public money has been wasted in the mental health reform effort, while patients in state hospitals have been beaten and in some cases died because of homicides, inadequate treatment or mistakes.
A history of delays
The opening of Central Regional, a centerpiece of the reform plan, was originally set before Thanksgiving. The date was pushed back to February when fire damaged part of the nearly completed building.
The opening was delayed again after a Dec. 16 article in The News & Observer that revealed the list of design defects.
The Feb. 28 meeting minutes reiterate the management group's concern that many problems had not been fixed.
"We unanimously endorsed NOT MOVING UNTIL ALL SAFETY ISSUES ARE ADDRESSED," the minutes say, with capital letters used to hammer the point home.
"We were told that the construction people need '6 weeks notice for construction issues,' which makes the move somewhat unrealistic."
The problems include door and bathroom hardware that could be used to anchor a noose and high openings in stairwells where patients could jump.
Scramble to adjust
Benton released the details about his plans for the hospital after The N&O asked questions based in part on the minutes of the management team's meetings. He said some changes, including modifying bathroom bars and adding impact-resistant glass panels, would cost $23,600. That doesn't include work on restraint rooms at the hospital that are too narrow to allow workers to safely transfer a patient from a gurney to the bed.
"This is an issue of clinical preference and discussions among committee members and state staff are continuing to resolve their concerns," Benton wrote.
In a December interview, Christian said the staff would have to use narrower beds.
In the past year, the state mental hospitals have repeatedly been forced to turn away patients due to insufficient beds, which were cut by about one-third as part of a reform effort.
The management group, however, had said there will be a gap in time between the opening of Central Regional and the opening of the new beds at Dix. The group also said the current plan of admitting new patients at Dix only during daylight hours is untenable.
"The current conceptualization of very limited hours for admitting patients, now Monday through Friday 8-5 p.m. is not realistic," the minutes say. "Most patients are not admitted during regular business hours, and this also would not likely meet federal regulatory standards.