Monday, September 29, 2008

Video Message from CSWA and NASW

CSWA and NASW Joint Video Message


Please take a moment to view an important joint video message from the Clinical Social Work Association and the National Association of Social Workers.
http://www.youtube.com/watch?v=4mBxzgPolRA

Send a letter to your Senators in support of the Social Work Reinvestment Act!http://capwiz.com/socialworkers/issues/bills/?bill=11274081

Send a letter to your Representative in support of the Social Work Reinvestment Act!http://capwiz.com/socialworkers/issues/bills/?bill=11030061

Learn more about the Social Work Reinvestment Initiative:www.socialworkreinvestment.org

Visit the Clinical Social Work Association:www.clinicalsocialworkassociation.org

Visit the National Association of Social Workers:www.socialworkers.org

Editorial: A thorough housecleaning

There's only one way to fix something as broken as North Carolina's mental health care system: tear it down and start over.

Extreme? Maybe. But the care of mentally ill and developmentally disabled people in this state is a basket case of extremes: extreme incompetence, extreme waste and, in the case of Cherry Hospital employees who couldn't interrupt their card game to bother with a patient who died after sitting in a chair for 22 hours, extreme indifference.

Health and Human Services Secretary Dempsey Benton, appointed by Gov. Mike Easley to clean up the mess he and the Honorables helped create, has managed to bring some semblance of organization to the chaos. But his task is like that of the Little Dutch Boy, trying to stop a flood by plugging a few holes.

No, it's time to stop tweaking and start shoveling.

Go agency by agency, institution by institution. Examine every program. Make all employees - from the top administrators right down to the housekeeping crew - reapply for their jobs. Put all contracts up for rebid. Make contractors and employees justify why taxpayers should rehire them.

Disruptive? Yes. And there are many dedicated employees in this historically underfunded and dysfunctional system, which imploded after the governor and Honorables adopted mental health "reform" several years ago. But patches aren't working.

A logical place to start the purge would be at Cherry Hospital, followed by the other psychiatric hospitals. In addition to the aforementioned death, two Cherry employees were accused of beating a patient while administrators were busy trying to convince federal investigators that conditions were improving. That would be known as getting off on the wrong foot.

Not surprisingly, investigators are now recommending that Cherry lose federal funding. State taxpayers would have to pick up the tab to avoid throwing patients onto the street.

Don't stop with the hospitals. Work all the way down to the local agencies such as Southeastern Center for Mental Health, where budget shortfalls already have cut services to clients and may require more. Among them: some children with developmental disabilities may not be able to attend day care centers designed to meet their needs.

The state's mental health system has been allowed to disintegrate largely because the people who need its services - the mentally ill and substance abusers, especially - are often swept under the rug in our society.

But they are here. They are our neighbors, our sons and daughters, our siblings and our parents. And they deserve much better than the system North Carolina has patched together.

*Note: This an editorial from the News and Observer

Letter to the Editor

http://heraldsun.southernheadlines.com/opinion/hsletters/index.cfm


Director backs local mental health services

---------------------------------

A great deal has recently been written and debated about how best to fix the state system that provides services and supports for individuals with mental illness, addictions and developmental disabilities. Much of the discussion often seems very detached from actually providing services to the people who need it. On the surface, the discussion about whether to have a statewide vendor for "utilization management" of services or to return that authority to the local management entity seems to be that type of esoteric, detached and academic discussion. In reality, it has a great deal to do with improving the care, quality and coordination of the services being provided.


Utilization management simply means that someone is reviewing requests for services, seeing if the request meets the identified needs of a person, and approving (or not) those services for payment. With a statewide vendor such as Value Options, that process is essentially a paper review. But individuals served by our public system often have very complex needs and many will need some level of support in our communities for an extended period of time. A paper review is insufficient to fully understand the individual and his or her circumstances, much less understand the types of services and expertise available at the local level that might best support that individual.

Local management entities such as The Durham Center have an intimate knowledge of the individuals we serve, the providers in our community, and the natural supports available. As reported in The Herald-Sun in recent days, Durham providers recognize that offering the best services to an individual often requires not a paper review, but a conversation about how best to meet the needs and preferences of the individual. At the local level, being aware of and staying involved in the care of the individuals we serve is easier because it is closer to home -- our home as well as the homes of the ones we serve and the agencies we partner with.

We strongly support the efforts to move the management of services, in a way that is thoughtful and well-planned, back to the local level.

ELLEN S. HOLLIMAN
Durham
September 20, 2008
The writer is area director of the Durham Center. The length rule was waived.

Editorial on Dix Move

The transfer of Dix hospital patients to a new mental health facility in Butner seems rushed. Standards must be met

http://www.newsobserver.com/opinion/editorials/story/1225511.html

And the move goes on. By Oct. 8, 170 patients from Dorothea Dix Hospital, the 152-year-old mental health facility in Raleigh, will be moved to Central Regional, a new facility in Butner. Dix will remain open with 60 beds, a crisis step funded by the state and Wake County, whose residents in need of mental health care have long used Dix.

Given the troubled -- and that's putting it mildly -- state of North Carolina's mental health system, the move from Dix seems a curious risk, at least right now.

A News & Observer series earlier this year demonstrated widespread chaos, wasted money, problems with staffing and shortcomings in care for many patients needing help. Closing Dix and having a consolidated facility in Butner were originally part of a plan to make mental health care better by de-institutionalizing some patients and shifting responsibility for some services from the state to the county level, and from public agencies to private companies. It didn't work. Some counties lacked needed facilities and personnel, and some companies providing "community services" appeared to be charging a lot for very little.

Enter Dempsey Benton, the now-secretary of the Department of Health and Human Services, as part of a promise by Governor Easley to fix things. Benton's a proven administrator (a former Raleigh city manager). Closing Dix remained in the game plan. But in recent months, there have been complaints about the new hospital in Butner, and even officials acknowledge there are staffing problems, technical difficulties, space shortages for doctors. Also, the facility hasn't passed muster with a couple of accrediting agencies.

Yet Benton insists the time for closing Dix -- which has also stirred a legislative debate about what to do with the choice property on which it sits -- is right.

Presumably the secretary believes the problems with the new hospital, or most of them, will be ironed out in the next couple of weeks. We must all hope so. There must be a sense of urgency about ensuring that more than minimum requirements are met, that this becomes a world-class facility.

If Benton can deliver that, he will have put at least some parts of the mental health system in order. If he suspects that the move was precipitous, he must absolutely reverse himself, until the public can be assured that Central Regional is doing the job for patients.

Yes, there's the point. In all the political hullabaloo (ramped up by the campaign for governor between Republican Pat McCrory and Democrat Beverly Perdue) about how to fix a horribly broken system, and the legislative debate, and the public outcry, it must be remembered that ensuring a competent, compassionate and sturdy mental health care system is about people. It's about the patient with a severe psychiatric disorder who must be hospitalized a lot, or the patient with a problem that can be treated in the community. It's about elderly people, young people, even children. It's about all those who care about these people.

Closing Dix is a risk. Benton needs to be ready should his optimism not prove accurate.

Wednesday, September 24, 2008

Letter to the Editor: Travesty of Mental Care

I must respond to the Aug. 30 letter "Mental state."

The analogy with cancer was a good one. I would not begrudge those with cancer any of the resources they have. But if we contrast those resources to what we provide someone with schizophrenia, the person with schizophrenia gets a raw deal.

When my sister was diagnosed with breast cancer, she met a team of health care professionals who devised a plan of care focused on a cure. They are accessible and responsive to her needs. They are familiar with the latest research and provide cutting edge treatment. They respect her preferences and make her an active collaborator in treatment. She has had access to patient education materials, support from volunteers and can attend yoga class for free at Cornucopia House.

We provide these resources for persons with cancer because it is the humane thing to do. We recognize that treating the whole person is important in dealing with such a devastating illness.
Such comprehensive treatment is often not available to persons with severe mental illness. The state stepped in years ago because no one else wanted to provide this care. There has never been adequate funding, and it is a travesty that the limited funds available are spent in such a wasteful way. We still have a long way to go to get things right.

Barbara B. Smith, Durham

All rights reserved. This copyrighted material may not be published, broadcast or redistributed in any manner.
The writer is a clinical social worker who works in the Schizophrenia Treatment and Evaluation Program at UNC.

Dix Doctors Urge Delay of Move

RALEIGH - More than 30 doctors and psychologists from Dorothea Dix Hospital have sent a letter to their bosses protesting the pending move to a new facility in Butner as premature and risky.

Central Regional Hospital, where the bulk of Dix patients and staff will be transferred in little more than two weeks, still has serious safety and staffing problems, the Dix staff members warn.
Signed by doctors representing the entire medical and psychological staff at Dix, Friday's letter is the second of its kind sent to top administrators at the state Department of Health and Human Services. A similar one in May helped prompt administrators to delay the move to the $130 million building in Butner, which partially opened in July with the transfer of patients and staff from nearby John Umstead Hospital.

The new letter lists numerous concerns that have since cropped up at Central Regional, including a security system that frequently sends out false alarms and emergency pagers that often don't work. The letter says planned staffing levels in some wards at Central Regional are insufficient and many workers set to handle some of the facility's most dangerous patients have not been properly trained.

The letter warns that current conditions at Central Regional would not pass muster with accreditors or federal regulators.

"We appreciate that you incorporated some of the suggestions we made in our previous letter," write the doctors and psychologists, some of whom have already worked shifts in the new hospital and are set to hold managerial positions there. "Nevertheless, we believe that serious questions about safety and treatment programs remain. ... We urge postponement of the move."
Dempsey Benton, the secretary of the Department of Health and Human Services, and other top administrators insist the new facility is safe and that any lingering problems will quickly be fixed.
They argue that it is a far greater risk to patients for the state to delay the merger any longer and that regulators won't accredit the new hospital until the transfer of Dix's patients and staff to Butner is complete.

Health and human services spokesman Tom Lawrence could not be reached Saturday to comment on Friday's letter.

The Dix doctors and psychologists raised particular concerns about wards where children are being treated and the criminally insane will be held.

Because of a lack of space at the new hospital, children and adolescents are staying in a building on the old Umstead campus, about a mile from the new hospital. Under the current plan, that unit is not always staffed with doctors and medical nurses.

In the event of a medical emergency, such as if a child stopped breathing, psychiatric nurses would have to call for help by telephone. The plan is for a doctor and medical nurse at the new hospital to rush to one of two cars stationed outside and drive to the old hospital, according to Michael Lancaster, head of the state mental health division.

In test runs, it took the medical staff up to 16 minutes to respond to a life-threatening emergency on the children's ward, according to internal department e-mails.

The Dix staff also raised concerns about the yet-to-be-opened forensic unit at the new hospital, which is to house patients either awaiting trial for criminal offenses or previously found not guilty of such crimes as rape and murder by reason of insanity. Their letter says the maximum security forensic unit for men will be staffed by health care technicians "who have not worked in a forensic unit and have not yet received forensic training." It also cites "very concerning design issues," such as the inability to keep violent forensic patients from entering the nursing station.
In a statement released Thursday, Benton said that Dr. Anthony Lindsey, vice chair of the UNC Health Care Department of Psychiatry, and other experts from UNC and Duke University had determined that earlier safety concerns at Central Regional "had been addressed and corrected."
But Lindsey said Friday he was surprised to see his name used in Benton's statement.
Lindsey and others toured the hospital in June, before any patients or staff had moved in, and sent a letter to Benton praising progress in fixing issues such as bathroom fixtures that patients could have used to hang themselves. But the group also cited problems that remained to be fixed and questioned planned staffing levels at Central Regional -- points Benton's statement omitted.
Lindsey said he had not been to Central Regional since June and was not consulted before his name was included in Benton's statement that the new hospital is ready.

"We were writing in June solely about the issues with the building," Lindsey said. "We weren't saying anything about how they're running the place."

Child Welfare Bill to be Signed

This bill is supported by NASW. Our National NASW lobbyist, Nancy McFall Jean reports that we are in full support.

For those who have not yet learned about the new federal law

15 Highlights of HR 6893

This could be law within a week... (it is on its way to President Bush, who will sign it).

HR6893 is:

"The Fostering Connections to Success and Increasing Adoptions Act"

Full text at:
http://thomas.loc.gov/cgi-bin/query/C?c110:./temp/~c110Q4WOEz

Gives states option to draw down IV-E $ for foster kids 18-20

Adds to those a state child welfare agency can claim IV-E reimbursement for training: Current or prospective relative guardians (provided they receive federal guardianship or adoption assistance), staff of state-approved private agency service providers, and members of the staff of abuse and neglect courts, agency attorneys, attorneys representing children or parents, GAL, or CASA. Phased in over several years (55% in 2009, 60% in 2010, 65% in 2011, 70% in 2012, and then 75%)

Extends & expands the Adoption Incentive Program (more $ for adoptions of older foster youth)

De-links Adoption Subsidy eligibility from AFDC (family of origin) or SSI (child's disability) eligibility

Creates a Permanent Relative Guardianship subsidy & national Kinship Navigator program (also authorizes Children's Bureau to spend $ for Family-Finding and Family Group Decision-Making)

Makes Indian tribes Title IV-E eligible (and creates a new grant program with authorized $ for state-tribal collaborations)

Authorizes waiver of licensing standards for relative caregivers but in non-safety areas only

Allows Independent Living/Education & Training Vouchers for youth, even after they've exited care (but only if the exited after age 16 for adoption or relative guardianship)

Requires agency due diligence to identify relatives within 30 days of removal and notice (including to current relative caregivers) on right to participate in child's care/placement (including option of a subsidized relative guardianship)

If placement goal is relative guardianship, case plans must show efforts to accomplish this

Requires reasonable efforts to place siblings together & provide for frequent visitation if not

Gives access to the Federal Parent Locator Service for IVB/IVE purposes (aid in quickly locating parents and relatives)

During 90 days before a youth emancipates from care, agency must engage the youth to develop Personal Transition Plan (it must be as detailed as the youth wants) & addressing housing, health, insurance, education, mentoring, support services, workforce support & employment aid

Requires all foster children to be enrolled in their school of origin (with language about agency reimbursement for transportation costs to and from there) and agency must coordinate with school system to assure immediate enrollment in a new school (with all records) if that new school placement is in the child's best interests

Requires state IV-E plans to show interagency coordination with Medicaid and physicians in planning for foster children's health care

Clarity on an Election Rumor

Rumors are spreading that people will be turned away from the polls if they are wearing any stickers, buttons, t-shirts, or other campaign paraphernalia that identifies support for a candidate on the ballot. THIS IS ABSOLUTELY FALSE.

Onslow Memorial In Bind Over MH Patients

http://www.jdnews.com/news/mental_59613___article.html/patients_health.html


Hospital CEO says state decision is sending more patients its way
September 23, 2008 - 12:37AM

LINDELL KAY

Since the state closed the local mental health crisis center two months ago, the Emergency Department at Onslow Memorial Hospital has been flooded with potentially dangerous mental health patients, said OMH President Ed Piper.

The hospital sent letters asking Gov. Mike Easley and state representatives from Onslow County for help in resolving the issue, but so far those officials have not responded, Piper said.
When the N.C. Department of Health and Human Services determined that Onslow / Carteret Behavioral Healthcare Services at 215-B Memorial Drive was operating without a valid license, the state ordered the facility to stop providing certain mental health services July 18.

"Within hours, by default, our Emergency Department assumed the awesome challenge of accommodating this population of patients with mental illness, developmental disabilities and substance abuse and addiction while trying to provide emergency care services to a large patient volume of over 120 patients a day," Piper wrote in a Sept. 17 letter.

When local authorities take someone into custody who needs to be involuntarily committed, they have no choice now but to take them to OMH. The person is brought into the waiting room where patients with physical injuries are waiting to be seen, sat down in a chair, and his or her handcuffs are removed, hospital staff said.

"Police alert our security and triage nurse before leaving, and we try to isolate the mental health patients in a separate waiting room," said Michael Jenkins, the nurse manager for the Emergency Department at OMH. But the Emergency Department only has 21 bends. Nine of them were taken up by involuntary commitment patients Monday morning.

"We average three to five mental health patients a day," Piper told The Daily News on Monday. "It takes an average of 17 hours to have them sent to a mental facility, but it has taken up to 63 hours."

Emergency Department doctors and nurses are trying to provide life-saving services for trauma victims, patients suffering from cardiac arrests or strokes and other acute illnesses while having to deal with three to five mental patients who need one-on-one attention, Jenkins said.
Piper said the mental health patients present a safety issue not only to themselves, but to hospital staff and other patients.

"Many of these mental health patients are coming in with active states of psychosis, schizophrenia, alcohol intoxication, drug overdose, suicidal and homicidal ideations to mention a few," Piper wrote in letters to Gov. Mike Easley, Lt. Gov. Beverly Perdue, N.C. Senator Harry Brown, N.C. Rep. Robert Grady, N.C. Rep. George Cleveland and DHHS Secretary Dempsey Benton.

Hospital spokesman Tim Strickland said the only response the hospital received was from an assistant in Perdue's office who said the lieutenant governor would be in touch, but the hospital has not heard back since.

Piper sent letters to state officials in August, and twice in September. In the Sept. 17 letter, he wrote "our community hospital is being faced with an unmitigated and unfunded duty to serve as a mental health crisis center."

Grady told The Daily News on Monday that he received only the Aug. 14 letter.
"I received a one-sentence letter saying a letter to the governor was attached," he said. "The hospital did not ask for help or money, and I took it to be an informational letter."
Grady said he would be more than happy to sit down with hospital representatives and members of DHHS. He said he looked into the situation after receiving the Aug. 14 letter and found that the state would give the required license to Onslow / Carteret Behavioral Healthcare Services if they would apply for it.

The facility was operating as a mobile crisis unit, which it was not approved for; and so far the facility has not applied for a license, said Tom Lawrence, public affairs director for DHHS.
Lawrence said two new mobile crisis units were just approved by the state to operate in six Eastern North Carolina counties including Onslow.

"Hopefully this will help relieve some of the pressure Onslow Memorial is feeling," he said. "The purpose of these units is to keep people out of hospital emergency rooms by treating them at their home for two or three days."

Strickland said the answer lies in a facility for Onslow County similar to the Oaks in Wilmington where mental health patients can receive proper care without having to go through the Emergency Department at the hospital, which "should not be the portal of entry for mental heath patients into the mental health system."

Contact crime reporter Lindell Kay at 910-219-8456.
Read Lindell's blog at http://onslowcrime.encblogs.com.

Editorial: Patients At Risk

http://www.newsobserver.com/opinion/editorials/story/1228676.html

When your doctor advises you to lay off the doughnuts and potato chips, you of course are free to keep on scarfing down the fried, fatty stuff. But you're just asking to be whacked by the harmful consequences. In other words: ignore doctors' warnings at your peril.

In Raleigh, the Easley administration is fielding the advice of doctors that a scheduled decommissioning of Dorothea Dix Hospital could have unpleasant side effects among the mentally ill patients who are on track to be relocated to the new Central Regional Hospital in Butner.

The Dix phase-out has been controversial ever since it was planned as part of a larger effort at mental health reform that would bring more services into communities where patients lived. That reform effort has proved troubled in concept and execution. Meanwhile, the Butner hospital was opened only with difficulty because of design flaws that had to be fixed and ongoing staff shortages.

In a letter Friday to administrators at the Department of Health and Human Services, a group of Dix doctors and psychologists who were said to be speaking for all of their colleagues cited still-unresolved problems at Central Regional that they said would make the facility hazardous for patients and staff alike.

For instance, they said that some children would have to be housed at the old Umstead hospital nearby. Umstead is also being phased out, and sometimes is not staffed with doctors and medical nurses who would be needed in the event of a medical emergency.

The Dix group also pointed to what it said were inadequacies in the planned forensic unit at Central. That maximum security unit would house mental patients either awaiting trial on criminal charges or those found not guilty of violent crimes by reason of insanity. Technicians have not yet been appropriately trained, according to the letter, and the unit's design would not keep patients out of the nursing station.

The transfer of patients from Dix already has been delayed. But whatever urgency administrators now are feeling, their higher responsibility is to protect their patients and staff by holding off on this move until it plainly can be accomplished with no additional risk to anyone.

Religious Institutions: What's Allowed in an Election Year?

RELIGIOUS INSTITUTIONS: What's Allowed in an Election Year?

Blueprint NC, a project of the Justice Center, is sponosoring an online workshop for faith leaders, staff, lay leaders and other volunteers on what election-related activities are permissible for churches. An attorney from Alliance for Justice will teach participants the rules so they can be effective at engaging people in this election while still following the law.

Alliance for Justice: Protecting Churches in an Election Year - Permissible Election-Related

Activity for 501(c)(3) Religious Organizations

Public Schools: Preparing Educaiton Advocates

PUBLIC SCHOOLS: Preparing Education Advocates

In October, the Justice Center's Education and Law Project will host an Education Leadership Institute in Duplin County for individuals who want to become better advocates for public school students. During the four-day training, participants will learn about the major challenges facing North Carolina's schools and students. They will also learn how they can influence education policy decisions and receive updates on the Leandro court decision. If you or someone you know would like to attend the free training, please contact us at 919-861-2064.
Interested in working to improve public education in North Carolina? NC Community Advocates for Revitalizing Education (NCCARE) is a statewide coalition of parents, teachers and community leaders dedicated to ensuring that every student in North Carolina receives a sound basic education.
For more information, contact Beth Jacobs at beth@ncjustice.org.

Justice Center: From the Ground Up - Coalition Building + Parents' Rights

Justice Center: Fall 2008 Education Leadership Institute in Warsaw, NC

Financial Crisis: Administration Plan to Buy Mortgages Flawed

FINANCIAL CRISIS: Administration Plan to Buy Mortgages Flawed

Rather than just bailing out banks and investors, Washington needs to focus on helping homeowners. While stabilizing financial markets is important, the latest plan from the Treasury Department to purchase troubled mortgages leaves much to be desired. The true cause of the crisis - reckless lending practices that are leaving thousands of homeowners at risk of foreclosure - goes unaddressed in the Bush administration’s plan.
Much can be done to keep homeowners in their homes. The government can truly address this crisis by creating programs to modify loans to affordable levels, giving homeowners additional bankruptcy protections, and changing the complex agreements that limit the modification of these loans.

Center for American Progress: Neither Fair nor Effective

Progressive Conditions for a Bailout: Progressive Conditions for a Bailout

Immigrants Rights: Why Sheriff Bizzell Needs to Go


IMMIGRANTS' RIGHTS: Why Sheriff Bizzell Needs to Go

The NC Justice Center has joined a broad coalition of organizations calling on the Johnston County Board of Commissioners to seek Sheriff Steve Bizzell’s resignation. Bizzell made numerous derogatory comments about Latinos that were reported in the Raleigh News & Observer earlier this month. In a letter to the commissioners, the groups argue that Sheriff Bizzell’s comments raise serious doubts about his and his department’s ability to enforce the law fairly with a blind eye to race, ethnicity or national origin. Organizations who signed onto the letter included El Pueblo, Inc., North Carolina NAACP, Black Workers for Justice and Latino Community Credit Union, among others.
If you haven't read Sheriff Bizzell's comments, check out the links below. And if you are as outraged as we are, make plans to attend

a prayer vigil on Sunday, September 28, at 3 p.m. in front of the courthouse in Smithfield.
TAKE ACTION: Sign the Online Petition Condemning Sheriff Bizzell's Derogatory Statements about Latinos

Raleigh News & Observer: Tolerance Wears Thin

Raleigh News & Observer: Activists Push for Johnston Sheriff to Quit

El Pueblo: Coalition of Organizations Condemns Sheriff's Bizzell's Recent Statements

Unemployment: Jobless Rate Hits Recessionary Level

UNEMPLOYMENT: Jobless Rate Hits Recessionary Level

North Carolina's seasonally adjusted unemployment rate reached 6.9% in August -- its highest point since January 2002 and above the national rate of 6.1%. This level is generally seen only during recessions. The only time this decade that the unemployment rate was higher than 6.9% was in January 2002, when the effects of the 2001 recession still were being felt. Even during the recession of the early 1990s, the state unemployment rate was never this high.

The escalating unemployment rate is a cause for concern and deserves action and attention like that lavished on financial markets recently. At a minimum, federal lawmakers should again temporarily extend the number of weeks for which unemployed workers can receive unemployment insurance benefits. This would help families struggling with unemployment and stimulate the economy. During the high-unemployment period of 2001-02, for instance, unemployment insurance payments had a net impact of $3.8 billion on the state's economy.

An estimated 42,000 North Carolinians will exhaust their unemployment benefits by the end of the year. There is legislation now in Congress (S. 3506/H.R.6867) that would extend unemployment benefits in all states by an additional seven weeks and provide a further 13-week extension for states, like North Carolina, with unemployment rates over 6%.
Use the toll-free number 1-888-245-0215 and tell your members of Congress to extend unemployment benefits.

Move to new hospital risky, Dix staffers say

Move to new hospital risky, Dix staffers say By Michael Biesecker, Staff Writer

More than 30 doctors and psychologists from Dorothea Dix Hospital have sent a letter to their bosses protesting the pending move to a new facility in Butner as premature and risky.

Central Regional Hospital, where the bulk of Dix patients and staff will be transferred in little more than two weeks, still has serious safety and staffing problems, the Dix staff members warn.

Signed by doctors representing the entire medical and psychological staff at Dix, Friday's letter is the second of its kind sent to top administrators at the state Department of Health and Human Services. A similar one in May helped prompt administrators to delay the move to the new $130 million building in Butner, which partially opened in July with the transfer of patients and staff from nearby John Umstead Hospital.

The new letter lists numerous concerns that have since cropped up at Central Regional, including a security system that frequently sends out false alarms and emergency pagers that often don't work. The letter says planned staffing levels in some wards at Central Regional are insufficient and many workers set to handle some of the facility's most dangerous patients have not been properly trained. The letter warns that current conditions at Central Regional would not pass muster with accreditors or federal regulators.

"We appreciate that you incorporated some of the suggestions we made in our previous letter," write the doctors and psychologists, some of whom have already worked shifts in the new hospital and are set to hold managerial positions there. "Nevertheless, we believe that serious questions about safety and treatment programs remain. ... We urge postponement of the move."

Dempsey Benton, the secretary of the Department of Health and Human Services, and other top administrators insist the new facility is safe and that any lingering problems will quickly be fixed.

They argue that it is a far greater risk to patients for the state to delay the merger any longer and that regulators won't accredit the new hospital until the transfer of Dix's patients and staff to Butner is complete.

Health and human services spokesman Tom Lawrence could not be reached Saturday to comment on Friday's letter.

The Dix doctors and psychologists raised particular concerns about wards where children are being treated and the criminally insane will be held.

Due to a lack of space at the new hospital, children and adolescents are staying in a building on the old Umstead campus, about a mile from the new hospital. Under the current plan, that unit is not always staffed with doctors and medical nurses.

In the event of a medical emergency, such as if a child stopped breathing, psychiatric nurses would have to call for help by telephone.
The plan is for a doctor and medical nurse at the new hospital to rush to one of two cars stationed outside doors at the new hospital and drive to the old hospital, according to Michael Lancaster, head of the state mental health division.

In test runs, it took the medical staff up to 16 minutes to respond to a life-threatening emergency on the children's ward, according to internal department e-mails.

The Dix staff also voiced concerns about the yet-to-be-opened forensic unit at the new hospital, which is to house patients either awaiting trial for criminal offenses or previously found not guilty of such crimes as rape and murder by reason of insanity. Their letter says the maximum security forensic unit for men will be staffed by health care technicians "who have not worked in a forensic unit and have not yet received forensic training."
It also cites "very concerning design issues," such as the inability to keep violent forensic patients from entering the nursing station.

In a statement released Thursday, Benton said that Dr. Anthony Lindsey, vice chair of the UNC Health Care Department of Psychiatry, and other experts from UNC and Duke University had determined that earlier safety concerns at Central Regional "had been addressed and corrected." Lindsey said Friday he was surprised to see his name used in Benton's statement.

Lindsey and others toured the hospital in June, before any patients or staff had moved in, and sent a letter to Benton praising progress in fixing issues such as bathroom fixtures that patients could have used to hang themselves.
But the group also cited problems that remained to be fixed and questioned planned staffing levels at Central Regional -- points Benton's statement omitted.

Lindsey said he had not been to Central Regional since June and was not consulted before his name was included in Benton's statement that the new hospital is ready. "We were writing in June solely about the issues with the building," Lindsey said. "We weren't saying anything about how they're running the place."

michael.biesecker@newsobserver.com or (919) 829-4698

Ask Questions of the Presidential Candidates

NASW is sending this e-mail along from one of our partners, Every Child Matters Education Fund.
After a smashing success with Step Up for Kids Day, Every Child Matters is now targeting the upcoming 3 official presidential debates and 1 vice-presidential debate as the next opportunities to spotlight the needs of children and families--and to press for new investments in a wide array of social programs. With thousands of organizations and individuals participating in Step Up for Kids Day, we want to direct the emergence of a new national children's movement at all those seeking office, especially the two presidential candidates.

Here's what you can do to help make children a political priority right now:

*1. E-mail Senators McCain and Obama and urge them to address the two questions below at their first debate*-this one on foreign policy-onSeptember 26 at the University of Mississippi in Oxford. (We'll be in touchwith other questions to ask at the remaining debates)

*Question 1:* According to a UNICEF report the U.S. ranks 20th out of 21 rich democracies in child well-being. What would you do to close this gap in order to maintain our global economic competitiveness?
*Question 2:* In perhaps the ultimate measure of homeland insecurity, 28,000 U.S. children have been killed since the start of the Afghanistan/Iraq wars as the result of suicide, homicide or child abuse. What would you do to reduce the violence experienced by children and make our homeland more secure for them?

To send this message to Senator McCain, *Click Here*<http://salsa.democracyinaction.org/dia/track.jsp?v=2&c=elFz5Cgez6zR4XRjfJtpBLWKfot5VGeb>*.*

To send this message to Senator Obama, *ClickHere*<http://salsa.democracyinaction.org/dia/track.jsp?v=2&c=c7V2rh2YmUMLcuBtwwNZ7eqf3teINhtF>*.*

*2. **ClickHere*<http://salsa.democracyinaction.org/dia/track.jsp?v=2&c=XPZjVJYJVZ6edajK91MnEbWKfot5VGeb>* to send a message to PBS's Jim Lehrer*, who is moderating this firstdebate and urge him to pose both questions to the candidates.

*3.* *Forward* this message to your friends, family, and colleagues and urge them to do the same.

If you agree that the candidates and media should be addressing these and similar Q's, please e-mail them now. In addition to this grass roots e-mail, ECM is purchasing advertising to raise the visibility of children's issues during the debates cycle. We also are organizing events in proximity to each debate site which will bring together up to 1,000 children, families and friends to urge the candidates and media to speak to children's issues. The obstacles that children and family issues face during an election are formidable. But with your help we can convince the candidates and the media that these are serious issues that demand their attention right now.
Thank you for your help to make children a political priority.
Comments?
Please contact *ECM@everychildmatters.org

You can visit the Every Child Matters Web site at www.everychildmatters.org

NC Council for Women Voter Registration Drive

The North Carolina Council for Women is sponsoring a Voter Registration Drive on September 30, 2008 at the Bicentennial Mall in downtown Raleigh in the area between the NC Museum of Natural Sciences and the NC Museum of History. (See attached map) The event will be held from 10:00 AM to 2:00 PM. In case of bad weather, the scheduled rain date is October 1, 2008 from 10:00 AM to 2:00 PM at the same location. Please see the attached flier. The NC Council for Women would greatly appreciate it if NC Women United members shared this information with other groups they are connected with. Thank you so much for your assistance in getting the word out.

Mental health clubhouses praised for offering members structure

Mental health clubhouses praised for offering members structure

By Matthew E. Milliken : The Herald-Sun
mmilliken@heraldsun.com
Sep 21, 2008

DURHAM -- Richard Hudson has struggled with paranoid schizophrenia for more than half his life.

Hudson was first diagnosed with the disease in 1977. Now 61, he lives in a group home but is hoping to move into his own apartment soon.

He credits part of his readiness to live independently to the Threshold Clubhouse, a 33-year-old Durham agency. Hudson, who joined Threshold about three years ago, spends at least 25 hours there on weekdays and visits on occasional Saturdays, too.

"It gives me some structure -- tasks to do each day," Hudson said. "It helps my self-esteem. Right away when I first joined my self-esteem started to come up. I'm needed here and I'm expected to be here, and the work I do is very useful."

Clubhouses offer a variety of employment, educational and recreational programs. All members who are able are expected to work alongside staff.
Hudson, who serves on Threshold's board of directors, handles office work, cleaning and cooking; he prides himself on his Texas chili.

Recently Hudson has been asking clubhouses elsewhere -- in 2006, there were 220 certified clubhouses in North America and about 100 on other continents
-- how they run their employment programs. Threshold wants to see if it can get more outside jobs for members by restructuring.

The Mental Health Association in North Carolina, a care-giving and advocacy group, runs some of the state's clubhouses, which are considered psychosocial rehabilitation programs.

"I think one of the intriguing parts of psychosocial rehab is that it really is designed to look at the whole person and not just their mental illness,"
said John Tote, the association's director.

Clubhouses earn the lowest adult Medicaid mental health payments, about $12 an hour. But members benefit tremendously from clubhouses, argued the director of Shelby's Adventure House.

They won't need as much community support or hospitalization if they attend clubhouses regularly, said Tommy Gunn.

"If they start having problems we're going recognize it sooner and get them to the attention of a physician."

That's exactly what happened to Hudson recently. Threshold staff saw that he needed a medication adjustment and arranged for a doctor's appointment.

"We see a member here every day, and we know what their baseline behavior is like," Hudson said.

"And if they're having a bad day, we're the first to recognize it, and the first to get them some help when they need it."

The Durham Center, the local mental-health management agency, recently named Threshold a provider of excellence.

"Threshold is a wonderful program, and they have been a long-standing agency in our community, and we support them 100 percent," said Ellen Holliman, the Durham Center's director.
C 2008 by The Durham Herald Company. All rights reserved.

Red tape strangling some mental health caregivers

Red tape strangling some mental health caregivers

By Matthew E. Milliken : The Herald-Sun
mmilliken@heraldsun.com
Sep 21, 2008

DURHAM -- Some mental health caregivers say that a state rule meant to cut down on unnecessary services and Medicaid payments is producing extra paperwork and problems instead.

The rule in question requires requests for Medicaid-funded services be accompanied by a personal-care plan (PCP) that has been reviewed and signed within the last 30 days. These documents are produced by primary caregivers and typically reviewed every three months. Some secondary providers say primary agencies are loathe to sign plans between scheduled updates, meaning the secondary providers must either give care for free or refuse to take on clients without recently refreshed plans.

"The documentation requirements are sort of out of control for providers,"
said Debra Dihoff, head of the state branch of the National Alliance on Mental Illness. "The billing requirements are out of control. And now this.
This is making it more difficult for people to get the help they need when they need it."

Susie Deter heads Threshold Clubhouse, which helps people with severe mental illness. The Durham agency relies on community support providers or other primary-care-giving agencies to maintain client plans.

"If our authorization falls somewhere beyond the last 30 days it has updated signatures, we have to go back and get [primary-care providers] to revisit the plan and get [an] updated plan and updated signatures for us to be able to get an authorization," Deter said. "And that is difficult because it's extra work for them. And there's basically nothing in it for them. They're not getting their authorization, we're just getting ours."

Threshold helps clients even if there are payment problems, Deter said. She blames various bureaucratic holdups for incurring $100,000 annually in unreimbursed costs. The 30-day signature requirement could cost Threshold $20,000 or more a year.

The rule has affected 17 clients of the Mental Health Association in North Carolina, a statewide advocacy group and service provider. The association recently lost $14,000 for 1,200 service-hours due to the requirement, official Cliff Anderson said.

Leza Wainwright, co-director of the branch of the state Department of Health and Human Services that oversees mental health, developmental disability and substance abuse care, defended the rule.

"The point of having a person-centered plan updated within 30 days of a request for [service payment] authorization is that's the way you say that that is still the appropriate service," Wainwright said. Without such reviews, Medicaid might pay for ineffective or unnecessary services.

Providers that have trouble getting recently signed plans are told to complain to local management agencies. That seems to be working, Wainwright said.

Wainwright and the rule's critics differed on when the rule took effect.

C 2008 by The Durham Herald Company. All rights reserved.

Mental Health Provders Suggest Tweaks to PCP Rule

Mental health providers suggest tweaks to PCP rule

By Matthew E. Milliken : The Herald-Sun
mmilliken@heraldsun.com
Sep 21, 2008

DURHAM -- Depending on whom you talk to, a rule for mental health providers that some say is burdensome can be fixed in any number of ways -- or needs no change at all.

Susie Deter of Threshold Clubhouse has a simple fix. She wants the company that screens Medicaid service requests to exempt some providers from having person-centered plans (PCP) signed in the last 30 days.

"If [the Department of Health and Human Services] and the mental health part of DHHS would instruct ValueOptions to approve authorizations for all our services if the PCP is current, that would solve the problem," Deter said.
"And we understand that they're trying to deal with the abuses of community support [charges], but we're caught in the middle."

John Tote agrees. His organization, the Mental Health Association in North Carolina, provides services to and advocates for the mentally ill throughout the state.

"What we would I think like to see ultimately is a mechanism where the [secondary] program itself can simply write up that aspect of the PCP and get attached to it," he said.

"That would streamline and help really the whole process and ultimately get more people into and through services," Tote said.

Tommy Gunn runs Adventure House, a Shelby operation similar to Threshold that has lost at least $10,000 to the 30-day signature requirement.

"We have to sit and fax like 40 pages of stuff on someone with a long- term mental illness to ValueOptions and then they say, 'OK, they can come to the clubhouse for another six months,'" he said. "These are lifelong illnesses, but every six months we've got to prove that they still have it."

Gunn has asked Leza Wainwright, co-director of mental health and related services for the state Department of Health and Human Services, to change the payment authorization cycle to once a year.

But Wainwright supports the current regulations.

"You don't just keep doing the same thing forever without taking a look and seeing if it's working," she said. "And that's the whole point of these updates."

Because the rules cut down on ineffective services, Wainwright wants to maintain the status quo despite some complaints.

Like Wainwright, Ellen Holliman, the director of the Durham agency that oversees mental health care, said the 30-day requirement is appropriate. She said it had adversely affected only Threshold in this county.

Debra Dihoff, head of the state National Alliance on Mental Illness chapter, wants the impact of new rules to be studied in advance.
Consulting service providers could head off costly regulations that are hard to adjust after the fact.

"Where are [providers] going to find the time to fix the rule when they have to spend all this extra time following the rule so they can figure out how to get paid?" Dihoff asked.

C 2008 by The Durham Herald Company. All rights reserved.

Mental Health Beds At Standstill

Mental Health Beds At Standstill

Brian Haney
Daily Record Reporter
Friday, September 19, 2008

The Good Hope Hospital Board has run into a wall in its efforts to bring 16 in-patient mental health beds to the former hospital facility in Erwin.

That wall, according to the board's Vice Chairman Pat Cameron and Harnett County Commissioner Gary House, is the North Carolina Division of Health Service Regulation, which is now insisting the board needs to apply for a new Certificate of Need to operate the mental health beds."It's the most frustrating thing," said Mr. Cameron, who was part of a delegation which met with the head of Health Service Regulation (formerly Facility Services) in Raleigh in the summer of 2007.

At that meeting, Mr. Cameron said the delegation asked specifically what it would take to secure a license to operate the mental health beds at the Erwin facility."We were assured there would be no problem," Mr. Cameron said. "We currently have a 2001 Certificate of Need for 12 beds and we were told we could transfer four additional beds from the closure of (Dorothea) Dix."Within the past several months, Mr. Cameron said, the state made a 180-degree turn and went back on its word."They changed their minds right before we went to tear down the walls and get started," Commissioner House added.

Recently, representatives from Good Hope met with N.C. Rep. David Lewis, Jimmy Love Sr. and Verla Insko, and with a representative from the Division of Health Service Regulation to determine why the license was being held up and to attempt a resolution in the matter.
Mr. Cameron said he and his fellow board members were told the quickest way to reinstate mental health beds in Erwin would be to write a letter requesting that 16 of the 29 beds licensed, which the board contends the state wrongfully revoked after the hospital closed in 2006, be reinstated.

"We sent the letter in July," he said, "and we have yet to receive the courtesy of a reply to our letter. That tells us the state has no interest in helping this community develop mental health beds. They've thrown up every barrier possible to deny us the ability to move forward with a project this area needs so desperately.""Just one signature, one stroke of the pen could restore the beds and we could move forward," said Mr. Cameron, "but the state won't respond to a letter they, themselves asked us to write."

Jim Jones, a representative with the Department of Health and Human Services Public Affairs office, said after speaking with the acting director of the Division of Health Service Regulation, he could only disclose that "they have spoken with their attorneys regarding a settlement, but they cannot comment further."

'A Tremendous Problem'

There is little doubt mental health care across the state has developed into a crisis. In a recent televised debate, both candidates running for N.C. governor were asked what they would do to alleviate the situation.

"It's a tremendous problem," said Mr. Cameron, "not only for North Carolina, but for Harnett County."Capt. Bill Grady who manages the Harnett County Jail said people who might be better served in a mental health facility are brought to the jail when they commit crimes or have charges brought against them, "and we have no recourses but to take them."If we had a mental hospital, such as Good Hope did, they could be placed there," he said. "That would be a better avenue for them versus coming to jail."

Other local groups have acknowledged the need for something to be done. At a recent board meeting, the Harnett County Board of Commissioners approved a letter of support for the Good Hope Board in its endeavor to put mental health beds in the county.Harnett Health Systems, which includes Betsy Johnson Regional Hospital and is currently at odds with the Good Hope Board over the right to construct a new hospital in Harnett County, has expressed its support of Good Hope's efforts to reopen mental health beds in the county and sent a letter to the state saying so.

Down But Not Out

For now, the Good Hope Board has found itself with few options. While an application for a new Certificate of Need has been prepared, the board has not filed it."We felt like it would be a futile process that would cost the taxpayers $30,000," said Mr. Cameron. "Sure we could have filed, but look at it historically. We haven't had a fair review of anything we've sent up there."The worst part of it all, he said, is that it looks like the board has just given up, which he insists it hasn't.

Mr. Cameron said the board has not ruled out filing again in December, its next opportunity. "The Good Hope Board has tried everything possible to continue to serve the community and try to bring in services no one else is going to bring," he said. "We are definitely still interested in opening the beds. We just need to have some better cooperation from the state."Ultimately, he said, "it's time everybody put our differences aside and do what's right."

Tuesday, September 23, 2008

Volunteers needed for Project Homeless Connect

This Thursday is an important day for homeless people in Wake and surrounding counties. Service providers will gather in Moore Square, downtown Raleigh and have a day long event that will assist between 800-900 people who are homeless. Last year this was a very successful event.

The organizers have 100 volunteers but they need about 150. If you can pass this message on to anyone you know who might want to volunteer or if you can give a few hours yourself it would be for a very good cause.

The contact person is:
Lisa Williams
Executive Director Wake Interfaith Hospitality Network, Inc.
903 Method RoadRaleigh, NC 27606
919.832.6024
execdir@wihn.org

Wednesday, September 17, 2008

Notice from Equality NC

Greetings From Equality NC!

My name is Seth Maid and Im working with Equality NC on the 2nd annual Equality Conference and Gala. Im excited to tell you that registration is now open! Come join us Saturday, November 15th at Duke University in Durham for a full day of cutting-edge workshops, speakers, and celebration.

The Equality Conference is North Carolinas largest lesbian, gay, bisexual, and transgender (LGBT) forum. Last years event got rave reviews from the over 300 participants and this years event is shaping up to be even bigger and better! Our keynote panel will feature remarkable national leaders including Mara Keisling (National Center for Transgender Equality), Kate Kendell (National Center for Lesbian Rights), and Alexander Robinson (National Black Justice Coalition). Attendees will also be able to choose from a wide-ranging set of workshops covering topics such as community organizing in small towns, LGBT health and wellness, an introduction to transgender issues for LGB allies, and much, much more! And, of course, we hope youll join us at the Gala for an evening of food and festivities.

However, we need your help to ensure that communities from all across North Carolina are represented. Please forward this message to members of your organization or community and encourage them to attend! You might even consider organizing a carpool with other members of your group. Student rates are available. Please help us to make the Equality Conference and Gala an enormous success!

For more information and to register, please visit our website at:

www.equalitync.org/conference

If you have any questions or comments, please feel free to email me at seth@equalitync.org.

Thanks, and we look forward to seeing you and your community on November 15th!

NC's Mental Health DISGRACE

License yanked for assisted living home
Woman still missing from facility

Cleveland County officials spent Friday scrambling to find new homes for 60 Unique Living residents after the state's decision Thursday to suspend the adult care home's license.
State inspectors ordered the troubled facility to cease operations by midnight Friday after concluding that conditions put residents in imminent danger.
By Friday afternoon, Cleveland County officials had moved all 60 residents to new homes, mostly adult care homes in counties including Cleveland, Lincoln, Gaston, Iredell, Mecklenburg, Davie, Yadkin and McDowell, said Cleveland County Department of Social Services Director John Wasson.
"I think given the time we had," Wasson said, "we did a really good job."
State regulators found staff at Unique Living "weren't properly supervising residents in terms of their comings and goings," said Jeff Horton, acting director of the state's Division of Health Service Regulation.
The action follows last week's disappearance of Mouy Tang, a 46-year-old insulin-dependent woman with schizophrenia. She's still missing.
Unique Living can appeal the license suspension.
History of problems
The home, in Fallston, about 50 miles west of Charlotte, has been repeatedly accused of poor patient care and unsafe conditions.
Its problems point to a flaw in North Carolina's mental health system. Unique was meant to house elderly or disabled people who need help with activities such as bathing, dressing and feeding.
In fact, it houses mostly residents with mental illnesses, because North Carolina doesn't have enough housing options or services for those citizens.
Unique Living's problems date back several years. Until 2005, the facility was called Yelton's Health Care.
After one resident died from choking on a sandwich and another died from scalding in a tub, Yelton's closed and reopened in 2005 under different ownership -- the former owners' programming director, their son and his girlfriend -- as Unique Living.
It kept the same residents, but the switch erased Yelton's history of violations.
In 2006, the home was fined $16,000 after a man with diabetes and dementia wandered from the facility and died.
In June, the Cleveland County Department of Social Services told the state that utilities were threatening to cut services to the home because of nonpayment, and that water had been turned off for five hours in April. The department asked the state to take over management of the facility, warning it was "only a matter of time" before a resident was injured or harmed.
In July, state inspectors responded to county concerns with their own inspection. They found numerous violations, including door alarms that weren't operating, soiled and ripped mattresses without sheets and stained pillows without pillowcases. But they concluded the violations weren't severe enough to warrant a license suspension or management takeover.
Though Unique Living's main building will soon be empty, about 22 residents remain in trailers on the property. Those trailers aren't affected by the license suspension because they're licensed as mental health group homes.
Warnings not heeded
Family members of Tang, who disappeared Sept. 3 and has not been found, have faulted state officials for failing to heed the county's warnings.
State inspectors visited again after Tang wandered from the building. This time, they found "evidence of neglect and failure to protect residents from potential harm," according to the suspension letter. As of Thursday, they hadn't released written findings.
Wasson, the county's social services director, said the transition to new homes could have been easier had the state adopted the county's request to take over management of the facility. He acknowledged, though, that closing the building was the right decision. "This facility was just unmanageable and untenable."
Prayers for safe return
Tang's niece, SueLee Waller of Raleigh, said Thursday she was relieved residents were being moved. "I hope all the residents who have to leave will find better homes," she said.
Charlotte's Kristen Foundation for Missing Persons has stepped up to help family members search for Tang. On Friday they passed out fliers in uptown Charlotte. They soon hope to put up a billboard with Tang's picture.
"We are just praying for Mouy's safe return," said Quynh Tang, her sister-in-law

N.C.'s mental health disgrace: Nowhere to go but up
There's no way to comprehend how a patient in a psychiatric hospital that's been warned for months about unsafe conditions could have been allowed to sit in a chair for 22 hours without food or help while staff members in the room played cards and watched television.
The patient's experiences sound like something out of a horror movie. Doctors weren't notified that he had fallen and hit his head while choking on medicine, nursing staff members failed to follow doctor's orders to check his vital signs and give him fluid and hospital workers were caught falsifying his medical records, a report in the Raleigh News & Observer.Steven Sabock, 50, died of a heart problem about 22 hours after being left in a chair in the dayroom at Cherry Hospital.Thanks to this and other incidents, the Goldsboro hospital becomes the second state psychiatric hospital to lose its Medicare and Medicaid certification, a move that will cost it an average of $800,000 a month in federal insurance payments. That's money state taxpayers will have to make up unless Cherry's $73.8 million annual budget is cut, an option that's apparently being considered based on comments Leza Wainwright, director of the state mental health division, made to the News & Observer.Broughton's troublesBroughton Hospital was decertified last August, following an investigation into the care of two patients. It regained its certification nearly a year later, but in the meantime the state had to pay $1.2 million a month to care for patients who otherwise would have been covered by Medicaid or Medicare.The state's mental health system has been in chaos since state lawmakers passed legislation in 2001 to revamp it. While their goals of privatizing services to give consumers more choice and of getting people out of state-run hospitals and back into their communities were laudable, underfunding, poor planning and mismanagement utterly undermined the effort. In fact, the exact opposite of the objectives has resulted. Records show that the number of mental patients checking into state hospitals for short visits grew by 83 percent from 2001 to 2005 as a result of dwindling local services and treatment space at community hospitals.A recent report commissioned by N.C. Department of Health and Human Services Secretary Dempsey Benton said the state needs to hire more than 700 people to make its psychiatric hospitals safe.Discord over hiringBut during the most recent legislative session, Benton asked the legislature for only enough to fund about 200 new staff members, saying that was about the maximum the hospitals could hire and train.Dante Strobino, with the N.C. Public Service Workers Union, disagreed."People are looking for jobs out there," he said.Strobino also said salaries need to be raised to attract and keep good people.Staff shortages may well be part of the problem, but staff shortages don't explain workers watching television and playing cards while a patient sits in a chair for 22 hours without food or help.The state's elected and appointed officials have known about the appalling conditions at North Carolina's psychiatric hospitals since before Broughton lost its Medicare and Medicaid certification more than a year ago. How can it be that nothing has been done to rectify the problems at Cherry in all that time?If hiring more staff and paying them more will help, that certainly seems a more cost-effective and compassionate measure than paying a million dollars a month to compensate for lost Medicare and Medicaid reimbursements.Disturbing cultureBut the problem appears to be broader than that. There seems to be a culture of mistreatment that has been tolerated to a shocking degree.It's hard to say who's at fault for that, but one thing is certain, the Department of Health and Human Services, which oversees these hospitals, is responsible for changing it and state lawmakers are responsible for seeing that they do. (Kelley, The Charlotte Observer)

Performance Data for Social Service Programs

With the support and collaboration of the North Carolina Division of
Social Services, staff and faculty at the Jordan Institute for Families
at the UNC-CH School of Social Work established and maintain public
websites with performance data for three major social services programs
including child welfare, Food and Nutrition Services (formerly Food
Stamps) and Work First (TANF). These websites are unique in their use
of longitudinal data on individuals and families to track outcomes over
time and in updating available information on a monthly basis.

Child Welfare (http://ssw.unc.edu/cw)
The data and charts available through this website can help managers and
staff in state and county departments of social services, as well as the
general public, understand what happens to children and families who
become involved in the child welfare system. Its purpose is to provide
easy access to detailed information about the experiences of children
who receive reports of alleged child abuse and neglect and those who
enter foster care. Data are available at the county, judicial district
and state level and for key demographics including age, gender, race and
ethnicity.

Food and Nutrition Services (http://ssw.unc.edu/foodstamps)
This website was developed to help the NC Division of Social Services
and county departments of social services evaluate changes to the Food
Stamp Program. As part of this effort, longitudinal files have been
created that track the experiences of families that participate in the
Food Stamp Program. These data are linked with quarterly earnings data
reported to the Employment Security Commission (ESC). Data are available
at the county and state level and for key demographics including gender,
race and household size.

Work First (http://ssw.unc.edu/workfirst)
Since 1997, staff from the Jordan Institute for Families have been
developing and maintaining a set of longitudinal analysis files to
support the development and use of performance indicators by the
counties and state to assess their Work First program. As part of this
effort, data are collected from multiple sources and integrated in order
to observe the experiences of the Work First families and recipients
while they are on as well as after they leave the program. Data are
available at the county and state level and for key demographics
including age, race and family size.

Tuesday, September 16, 2008

State's Medicaid Director Quitting
By Lynn Bonner, Staff Writer RALEIGH -

The acting director of the state's Medicaid office told co-workers is leaving the job.
Dr. William Lawrence, who has been in the position for about a year, said in a e-mail message to co-workers Monday that he wanted to return to clinical work.
Lawrence was left with much of the fallout from the bungled mental health reforms of 2001. He was the main person dealing with federal government in its audit of payments to private companies providing a low-level mental health service called community support.
Lawrence is the third person in a little more than a year to quit as the state's Medicaid leader. lynn.bonner@newsobserver.com or (919) 829-4821

http://www.newsobserver.com/front/story/1220603.html
State Health Plan

Financial troubles with a state health insurance program won't likely merit a special session of the General Assembly, legislative leaders said Monday. According to data presented by the head of the North Carolina State Health Plan to a legislative oversight committee, the program for state employees and retirees is projected to lose between $264 million and $281 million during the fiscal year that ends next June - more than $200 million more than previously believed. The plan also could run out of cash to pay the claims of its 650,000 members as early as December, said Jack Walker, the plan's recently hired executive administrator. Walker told the Committee on Employee Hospital and Medical Benefits that an influx of at least $100 million would be needed. But he said the plan should have enough money to sustain itself through the end of March by holding back on payments to vendors. "Then we'll need some money," he said.
The health care plan's problems surfaced late in this year's legislative session that ended in July, leading to the ouster of the most recent administrator, George Stokes. Sen. Tony Rand, D-Cumberland, a co-chairman of the committee, said lawmakers will have to act fast to find additional money once the Legislature's regular session reconvenes Jan. 29. "Now we have a much better understanding of the nature of the problem," Rand said after the meeting. Ultimately, lawmakers may force the plan to raise premiums substantially for spouse and dependent coverage and could consider tightening employee health benefits. Walker, who was brought back to run the plan after leading it for more than five years until 2005, spent much of the meeting trying to explain how the plan's budget veered off course. Walker blamed the problem on an outside actuarial firm using the wrong assumptions to project the financial demands on the plan, which handled $2.6 billion in medical claims last year. The budget underestimated how much outpatient care would be utilized and overestimated the size of discounts for services performed by doctors and hospitals as the plan shifted more to managed care, according to plan documents.
Rep. Hugh Holliman, D-Davidson, the committee's other co-chairman, said plan leaders should have given more information to the actuary, but the actuary also should have asked more questions. Ardis Watkins, a lobbyist with the State Employees Association of North Carolina, a 55,000-member union, said the group still isn't persuaded that there are real problems with the health plan. Stokes has said that any problems were overstated. "I heard nothing from (Walker) to substantiate any of the numbers," said Watkins, adding that the committee should have done a better job overseeing the plan. Holliman said health plan leaders are meeting with lawmakers regularly to keep a close eye on the plan's fiscal picture, but he agrees for now that major changes can wait until early next year. (Gary D. Robertson, THE ASSOCIATED PRESS, 9/15/08).

Friday, September 12, 2008

ADA Amendments Act 2008

With speed that was not expected to occur, the Senate this afternoon passed by unanimous consent S. 3406, the ADA Amendments Act of 2008. It is expected, but you can never guarantee anything, that the House will take up and pass the Senate bill clearing it for the President to sign. The House has recessed for the week so members that have constituents that will be effected by Hurricane Ike can get home. So the earliest it will be considered by the House will be next week.

S. 3406 specifically overturns Supreme Court decisions that have caused too many people with disabilities whom Congress intended the ADA to cover to lose important protection. The ADA Amendments Act of 2008 makes it clear that Congress intended the ADA’s coverage to be broad, to cover anyone who faces unfair discrimination because of a disability. The legislation also clarifies the current requirement that an impairment must substantially limit a major life activity in order to be considered a disability. S. 3406 prohibits consideration of mitigating measures in the determination of whether an individual has a disability, with the exception of ordinary eyeglasses and contact lenses. Finally, the bill affords broad coverage for individuals regarded as having a disability under the ADA, but includes a provision to make it clear that accommodations need not be made to someone who is disabled solely because he or she is regarded as having a disability.

Thank you all for the calls, e-mails, letters, and faxes to get your elected members supportive of this important legislation!


Eric Buehlmann
Senior Public Policy Analyst
National Disability Rights Network
900 Second Street, NE
Suite 211
Washington, DC 20002
202-408-9514 ext. 121 (p)
202-408-9520 (f)
202-408-9521 (tty)
www.ndrn.org

Wednesday, September 10, 2008

Tolerance wears thin

Tolerance wears thin

SMITHFIELD — Johnston County Sheriff Steve Bizzell’s territory is one of country stores and fading tobacco barns; but increasingly his work — and his words — reach far beyond his rural county. Advocates and politicians across the state have come to know him as the lawman with the deep country twang who makes incendiary comments about “drunk Mexicans.”

Alcohol vote splits Yadkin

Alcohol vote splits Yadkin

YADKINVILLE — Days before a countywide alcohol referendum, Yadkin residents who oppose the idea are putting up signs on the side of roads asking people to vote no, and local pastors are networking to make sure people go to the polls Tuesday. “We don’t need alcohol in our county,” said Darlene Redman, a member of Shady Grove Baptist Church in Boonville, where people are working with other churches to rally opposition.

Hoyle Stands to Profit off Parkway

Hoyle stands to profit off parkway

CHARLOTTE — An N.C. state senator stands to profit from a planned Gaston County expressway that he voted to fund and build. David Hoyle, a Gaston Democrat, and two family members invested in 327 acres by a proposed exit for the Garden Parkway. His group plans to build high-end homes and one of the county’s largest retail centers.

Study may build legislative pay momentum

Study may build legislative pay momentum

RALEIGH — The muffled movement to raise General Assembly pay — muffled because lawmakers fear a politically radioactive issue — has gained more momentum this year thanks to another branch of government. Current and former judges joined other attorneys this year in persuading legislative leaders to study whether salaries of trial and appellate court judges are high enough to attract and retain topflight legal minds.

Hagan puts Dole in unfamiliar bind

Hagan puts Dole in unfamiliar bind

GREENSBORO — The famous “Dole Stroll” took a decidedly different turn last week. Republican U.S. Sen. Elizabeth Dole is known for her Oprah-like strolls during speeches to past Republican National Conventions. But Dole skipped last week's GOP convention in Minnesota, opting instead for a stroll around the shop floor of Advanced Direct, a small Greensboro direct-mail firm where she picked up the endorsement of a small-business group.

School: Cheif Received Special Deal

School: Chief received special deal

CHARLOTTE — Rodney Monroe got “preferential treatment” and was improperly awarded a bachelor’s degree from Virginia Commonwealth University last year, according to a new report. But VCU investigators found no evidence that Monroe did anything wrong, instead placing the blame on a small group of faculty and administrators who pushed the degree through.

DWI Paperwork Under Scrutiny

DWI paperwork under scrutiny

SMITHFIELD — Dozens of people charged with drunken driving in Johnston County have had their cases essentially erased by dismissal forms that investigators are examining for evidence of tampering. A review of copies of court files seized by agents from the State Bureau of Investigation reveals documents with mismatched dates and inconsistent justification for dismissals.

State Candidates Differ On Unions


Senate candidates differ on unions

GREENSBORO — Two business groups that back U.S. Sen. Elizabeth Dole say the Republican’s stance on union-related issues are a key factor in winning their support. In particular, Dole opposes so-called card-check legislation that would make it easier for workers to unionize by letting a majority of workers simply sign a union card rather than holding a secret election.

Battle Rages Over Textbook Prices

Battle Rages Over Textbook Prices
By David J. Koon

RALEIGH — Textbook publishers have come under intense scrutiny because the prices of textbooks keep going up. Students have been hit by these prices and must pay hundreds of dollars for books from which only small portions are assigned. Yet innovations, from faculty use of online resources to students’ exchange of books through Facebook and online retailers, might soon change this industry.

Drill Baby Drill...A message from Environment NC

"Drill, baby, drill"? Is that for real?I couldn't quite believe it myself when I heard the crowd at the Republican National Convention last week, whipped up into a frenzy over the idea of opening our precious coasts to new drilling. Click here to see and hear it for yourself.

In the last few days, 10,000 of us have urged our representatives and senators in Congress to say no to new offshore drilling, no to putting our beautiful coasts at risk of devastating spills, and no to the false hope of a quick-and-dirty fix to our energy problems. That's a fantastic accomplishment in such a short time.

But frankly, we need to do more to make ourselves heard over the din of "drill, baby, drill" -- especially when Big Oil's propaganda machine can so easily amplify their call on Capitol Hill.As soon as the next few days, Congress will vote on whether to pass an energy policy paid for by Big Oil or one that puts us on a path toward a clean, sustainable energy future.

Tell Congress to put a stop to the Big Oil agenda right now.
http://www.environmentamerica.org/action/drill-baby-drill-congress?id=ES

We're raising the voice of people from all over the country to expose Big Oil's self-serving agenda, which includes:
Saying NO to clean energy and energy efficiency tax credits,
Saying YES to $13.5 billion in tax giveaways to the oil industry, and
Saying YES to new drilling off our coasts.

Let's face facts. Big Oil's agenda is not about saving us money at the pump. It's about making them more money any way they can. As outrageous as that is, we cannot win without Congress hearing from more Americans like you.
http://www.environmentamerica.org/action/drill-baby-drill-congress?id=ES

"Drill, baby, drill" is no solution to our energy problems, not by a long shot. Help us stand up to Big Oil today.

Thanks, as always, for making it all possible.

Elizabeth Ouzts
Environment North Carolina State Director

ElizabethO@environmentnorthcarolina.orghttp://www.environmentnorthcarolina.org

P.S. Thanks again for your support. Please feel free to share this e-mail with your family and friends.

Joint Legislative Oversight Committee for MH/DD/SAS

Provided is a link to the Legislative Oversight Committee on Mental Health/Development Disabilities/Substance Abuse Services (MH/DD/SAS). This committee is made up of Senators and House of Representative members who come together to discuss what is happening across the state. After the meeting has taken place, all handouts and meeting agendas are posted to this site. Check it out!

http://www.ncleg.net/gascripts/DocumentSites/browseDocSite.asp?nID=20

Monday, September 8, 2008

Legislative Update

The two-year legislative session is complete. The decisions made by lawmakers will have an impact on North Carolina for years to come. But all that work can get buried in legalese. So the Civitas Institute’s policy staff has put together a Legislative Recap Series designed to guide you through the session--including what they did and didn't do. The second three installments of nine are: healthcare, higher education and energy & environment.Click the link below to view the report:http://www.nccivitas.org/media/publication-archive/legislative-update/legislative-recap-series