Monday, April 14, 2008

Editorials from N&O

Editorial: Good health ideas
One benefit of election season is the potential for good ideas.
Candidates for governor have some for mental health reform
The News & Observer asked the four main Republican and two Democratic
candidates for governor what they would do to address the state's mental
health reform gone bad, and voila! -- up came some ideas with merit.
The state needs all of those ideas it can get, in view of a series of
articles published recently by The N&O that found too little money spent on
people with serious mental illnesses, millions of dollars wasted on a
program aimed at less serious cases, failure of communities to set up local
programs for the mentally ill, and too many (and
unreported) deaths and injuries at the state's four large mental hospitals.
The Easley administration finally is paying proper attention to the issue.
But there are stubborn, ingrained problems that the state needs to solve,
such as determining to what extent the private sector ought to be allowed to
provide mental health services and attracting professionals willing to work
in this area of medicine.
State legislators, in fact, based their 2001 reform bill on letting private
companies (instead of counties) both determine what services many patients
needed and deliver those services. In the intervening years, companies, some
of them new, flooded the market and made millions -- often with a mismatch
between the rates they charged and the value of the services provided.
Meantime, some patients who needed more intensive forms of care had to go
without. State oversight was lax or missing altogether.
Bob Orr, a Republican candidate for governor and former state Supreme Court
justice, says North Carolina should reconsider whether privatization of
mental health services can work at all. Fellow Republican Pat McCrory, the
mayor of Charlotte, suggests tougher standards for private companies, and
setting up citizen councils to review contracts and possibly certify
nonprofits that want the work.
Both ideas should be explored.
Republican Bill Graham, an attorney, and Democrat Richard Moore, the state
treasurer, say sensibly that the state should spend more in counties that
have deficient services, either because they are rural or poor. Republican
Fred Smith, a state senator, suggests paying community college tuition for
nursing students willing to practice in state institutions.
Democrat Beverly Perdue, now lieutenant governor, proposes another good
idea: have state universities and community colleges set up a "center of
excellence" to train mental health professionals and conduct research.
Modest pay, in the context of work that can be grueling, hinders North
Carolina in hiring and keeping good personnel to staff public mental health
facilities. For those drawn to the field, Perdue's center would provide
expert training, benefiting provider and patients.
Treating mentally ill North Carolinians is a hard but sacred duty.
It's costly, like most medicine in the United States. Fresh ideas about how
to do it effectively, efficiently and compassionately are critically needed,
and a credible plan for improvement should be on every aspiring governor's
agenda.
* * * *
http://www.newsobserver.com/opinion/editorials/story/1033019.html
Published: Apr 11, 2008 12:30 AM Modified: Apr 11, 2008 05:55 AM
Editorial: ... hospital action urgent
Officials at John Umstead Hospital in Butner say they're moving to correct
problems that could cost the hospital millions in federal insurance
reimbursements. Certainly they want to fix things, and not just because of
the money. Most of those who oversee and work in the state's four public
mental hospitals want to provide compassionate and safe care.
The state has to make up for any loss of federal revenue. Broughton Hospital
in Morganton lost the money in August after a patient who was being
restrained by staff members died. North Carolina taxpayers have had to pay
more than $8 million to cover absent federal revenue from Medicaid and
Medicare programs. State officials say the problems at Broughton are being
addressed, and anticipate the flow of money will be restored.
At Umstead, a November review found repeated incidents of "patient to
patient and patient to staff abuse." The following month, more problems were
identified and federal officials determined that some problems still hadn't
been fixed. A warning about the loss of funds has been issued.
The problems include staff members not wearing body alarms, which enable
them to call for emergency help. Federal inspectors found that several
months after that situation came to light, some staff members still weren't
wearing the alarms. And the hospital also had a problem with broken door
locks.
Umstead and Dorothea Dix in Raleigh are to close July 1, to be replaced with
a new hospital, Central Regional, in Butner. But some beds in the older
hospitals will have to stay open because there is a statewide shortage. So
it's important that the problems be fixed, and quickly.
The issues at Broughton are only a few additional signs of deep-seated
troubles within the state's mental health care system. This is the 21st
century, and no public agency should tolerate treatment for the mentally ill
that is inadequate, and certainly cannot put up with treatment that on
occasion ventures into danger zones.
Despite all the plans to return mental health care to communities -- one
objective in reform that began several years ago -- and to close hospitals
and make the system more efficient, it's clear many balls have been dropped
and many mistakes made. It's harder to fix mistakes than it is to do things
right in the first place, but the state must do what needs to be done, no
matter what.

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