Asheville Times Editorial

http://www.citizen-times.com/apps/pbcs.dll/article?AID=200880611051

Slow-motion train wreck of state's mental health crisis continues .

published June 12, 2008 12:15 am

The crisis at North Carolina's state mental institutions appears to have gotten so bad and the need for additional staff so great that the state can't hire enough people in the next year to bring staffing to the level recommended by a group of health care experts.

How did care at the hospitals degenerate to this point? The Department of Health and Human Services and the lawmakers who instituted reform seven years ago ought to have recognized and fixed the disastrous decline in quality of care long before now. Their negligence and apparent indifference and/or incompetence continues to contribute to the suffering of thousands of mentally ill North Carolinians and waste millions of taxpayer dollars.

Serious shortages

A report presented to Department of Health and Human Services Secretary Dempsey Benton in mid-May recommends North Carolina hire more than 700 people to address staffing shortages in its state psychiatric hospitals.

Needed are 202 nurses, 33 psychiatrists and more than 300 healthcare technicians, according to the report.

But Benton, who commissioned the report, is asking state lawmakers for only 250 new employees for the hospitals.

"That is as many positions as we can fill in 12 months," he said Friday during a telephone interview with an Asheville Citizen-Times reporter.

He said the national shortages of nurses and psychiatrists and the rural locations of Broughton and Cherry hospitals are part of the problem.

Gov. Mike Easley's budget for next year recommends an additional $68 million in new mental health spending. Fully implementing the report's recommendations would cost far more than that.

Broughton lost its Medicaid and Medicare certification in September and still has not regained it, a circumstance that's costing state taxpayers
$1.2 million a month. Workers affiliated with the North Carolina Public Service Workers Union have been staging protests across the state to complain of conditions at the hospitals.

The Raleigh News & Observer reported Wednesday that a patient with a history of violence severely beat a nurse at John Umstead Hospital in Butner Monday.

Federal regulators cited the hospital in December for the failure of administrators to control violent incidents involving staff and patients.

Bones were broken in the nurse's face and clumps of her hair were pulled out.
Broughton's decertification occurred after Medicaid officials, who were investigating the death of another patient at Broughton, found the records of Lori Arwine. Arwine was seriously and permanently injured during several falls after being given medications that cause dizziness, agitation and unsteadiness. After the medications were administered, Arwine was allowed to roam the halls unsupervised.

Mike Pedneau, who chaired the group assigned to review mental hospitals that issued the report recommending 717 additional full-time employees, told the Raleigh News & Observer that he feared the report and another given to Benton at the same time would be deep-sixed.

"It's going to get buried until the legislature is ready to put the budget to bed," Pedneau, a former director of the state mental health system, told the News & Observer. "I think these things need to be out in the public and I gave Dempsey two weeks and I haven't heard a thing from him."

Benton said he had distributed the report to everyone who was supposed to get one. He did not, however, distribute it to the media.

Staff, pay issues

Staffing ratios and pay at North Carolina's mental hospitals lag far behind similar facilities in other states, the report filed by Pedneau'
s group found. Current staffing levels are inherently dangerous, the report said.

Serious overcrowding of the state's mental institutions has been one of the ironic results of the failed reform effort. The need for those hospitals was supposed to diminish as new outpatient services became available in communities. But those services have, for the most part, failed to materialize. Just last week a 16-bed unit to stabilize people in crisis opened in Asheville, but more beds are needed in communities across the state, according to a second report, also commissioned by Benton. Both reports, one from the Hospital Management and Operations work group chaired by Pedneau and the other from the Crisis Services work group, urge a drastic change of course.

In his defense, Benton inherited an impossible job. The state's mental health system had been effectively dismantled before he arrived on the scene. But he should be aggressively advocating for higher wages for mental health workers, which would make recruiting them easier, and keeping the public informed in order to keep the pressure on lawmakers.

"I knew the hospitals weren't in good shape," Sen. Martin Nesbitt, D- Buncombe, who co-chairs the legislative oversight committee for mental health, told a Citizen-Times reporter. "But I had no idea how neglected they were. We need to fix this, and I'm willing to recommend whatever the secretary thinks he needs."

Now that he knows and Benton knows and the governor knows, failing to fix a truly dangerous situation is indefensible.