In the News: Federal Auditors, Dix Attack, Southeastern Mental Health

Federal Auditors

Federal auditors are in North Carolina reviewing the records of about 200 mental health companies as part of an examination of a lucrative service called community support. The state Medicaid office sent letters to companies June 5 telling them that auditors would be on their doorsteps no later than June 30. Auditors are reviewing 301 patient records, chosen at random, as part of an investigation into whether the state has paid improper claims. The federal government is withholding $138 million from the state because of questions about the service. Federal authorities told the state in April that it was withholding a $175 million payment but later reduced that.

Community support is a mental health service that is supposed to teach clients basic skills and help them control their behavior. State audits have shown, however, that in some cases, companies charged as much as $61 an hour to take clients to malls or movies or to sit with them in school. In most cases, the work was done by employees with high school diplomas. A News & Observer investigation found the state wasted at least $400 million on the service. The audit could result in the state being asked to repay money for claims that aren't deemed proper.
Wayne Peel of Williamston, who runs a training company for mental health providers, said some good may come of the audit. Not all clients with mental disorders can be helped by community support, Peel said, and the audit may result in a clear definition of who should get it. "Right now, it's wide open," he said. State lawmakers have proposed slashing community support spending and putting legal limits on the service. (Lynn Bonner, THE NEWS & OBSERVER, 6/22/08).


Dix Attack

Dorothea Dix Hospital workers again marched Friday to the office of state Department of Health and Human Services Secretary Dempsey Benton after a nurse was beaten by a patient. The beating, which occurred about two weeks ago, is the latest in a spate of incidents raising concerns about safety at state mental facilities. Hospital workers are seeking to delay the pending closure of the Raleigh hospital because of concerns about staffing shortfalls and design flaws with a new facility in Butner that is set to open next month. About 500 Dix employees signed a petition asking Benton to impose a one-year moratorium on the shutdown. A letter also was circulated among legislators last week asking that the state budget for the next year include money to keep Dix open. The letter was signed by representatives of the N.C. Sheriff Police Alliance, the Wake County chapter of the National Alliance on Mental Illness, the N.C. Public Service Worker's Union and a psychologist who works at Dix.

An incident report from Dix Hospital released last week said nurse Carol Latham, 63, was attacked by a female patient. DHHS spokesman Tom Lawrence said the ward where the assault occurred, which houses 32 patients, was fully staffed with 11 workers. He characterized the incident as minor. But Latham told a different story. "I'm so sore I can hardly move," said Latham, who has worked at Dix for eight years. Latham's glasses were broken and her nose bloodied, resulting in swelling and bruising to her face. X-rays showed no fractures. Contrary to what administrators claimed, Latham said she was alone with nine female patients when a woman with a well-documented history of violence attacked her. The other staff members working that night were either looking after male patients in a neighboring hall or were elsewhere in the building. (Michael Biesecker, THE NEWS & OBSERVER, 6/21/08).


Southeastern Mental Health

More than 100 people involved with the state mental health system in southeastern North Carolina gathered for an impromptu rally Friday to voice their concerns about an expected cut in funding for mental health treatment in the region. Most of the anger of those who showed up for the impromptu rally was directed at the Southeastern Center for Mental Health, Developmental Disabilities and Substance Abuse Services, the regional mental health agency in charge of allocating the state funds among service providers in Brunswick, New Hanover and Pender counties.

Center administrators warned providers earlier this month that funding for services likely would be tighter than it has been when the new state budget year starts. Now, many families and clients are being told that their treatment will likely be scaled back -- in some cases from 14 hours a week to a half-hour a month. "My son is not going to be able to work. He could end up institutionalized," Sandra Nesbit of Pender County said about her 21-year-old son. "I'm very, very angry." Even though state budget negotiations are ongoing, the center does not expect to get more than $8.3 million, the same amount it ended up receiving this fiscal year.

The state funding dropped from previous levels after the center did not spend its full allocation two years ago, and center officials are not optimistic the state will bump the total amount back up to previous levels. After scrambling with the drop in state money this year, including dipping into reserve money and scaling back on the number of hours that could be reimbursed, the center was able to cover about $12 million for services, director Art Costantini said. But some of those options will not be available in the coming year, he said. "The problem is we've got $8.3 million to work with. We can't build a $12 million budget," he said. "It's illegal to contract to offer to pay services that we don't have the money to do." Costantini said he is looking at other potential sources of funding to augment the state money, but declined to offer details. (Vicky Eckenrode, WILMINGTON STAR-NEWS, 6/21/08).