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RALEIGH Across North Carolina, mental patients are routinely languishing for days in emergency rooms ill-equipped to care for them, waiting for a bed to open at one of four state-run psychiatric hospitals.
Often, they pass the time handcuffed or sedated. Law-enforcement officers assigned to guard patients at community medical centers such as Grace Hospital in Morganton have occasionally resorted to using Tasers to shock them into submission.
Lanier Cansler, the state's secretary of health and human services, plans to ease the strain by paying private hospitals with taxpayer money to admit and treat more mental patients, especially those who don't qualify for Medicaid.
But a survey the department conducted of nine community hospitals raises questions about whether many medical facilities, especially those in rural areas, are capable of taking on that responsibility.
North Carolina tried to reform its mental health system in 2001 by downsizing state hospitals and paying private, for-profit companies to care for the people in outpatient clinics.
Nine years later, the reform has had the opposite of its intended effect. Programs that were supposed to save taxpayers money wasted more than $635 million, according to a recent legislative audit. Meanwhile, demand for state hospital beds has soared.
In the first eight months of this year, the state hospitals placed more than 3,700 patients seeking help on waiting lists because of the lack of available beds, according to the Department of Health and Human Services.
Despite the crisis, the state budget Gov. Bev Perdue signed in August cut $155 million from the state's mental health system, resulting in the loss of 354 jobs at state hospitals.
At Cansler's urging, $12 million was allocated to pay for adding about 100 psychiatric beds at community hospitals - an average of one bed per county.
The money will go to pay for small units of eight to 10 beds each in a handful of medical hospitals across the state. The secretary hopes more money for the initiative will be available in the future, as the economy improves.
Tasers used on mentally ill
Many of North Carolina's small community hospitals far from urban centers don't have access to psychiatrists or other professionals trained to help people with mental illness, especially those who might become violent, according to the health and human services survey.
Emergency room staffs at two of the nine hospitals - Grace Hospital in Morganton and Moses Cone Hospital in Greensboro - reported multiple incidents of disruptive patients being Tasered by law officers in the last year.
Jay Davis, spokesman for Grace, said the security officers at the Morganton hospital don't carry Tasers and stressed it was officers from outside law enforcement agencies that had used the device inside the emergency department.
The Taser fires two small darts that pierce clothing and imbed in the skin, delivering an electric shock of up to 50,000 volts that disrupts the nervous system and renders a person temporarily incapable of controlling his muscles. Being shot with a Taser is extremely painful, but it is touted as a less lethal alternative to a firearm.
"As an institution, our desire is that the use of Tasers would be minimal and only as a last resort," Davis said. "When the person comes into our (emergency department), they are in the custody of law enforcement until we find a bed for them, and that's been a big, big problem. We only hold patients when we have no place to put them."
All the hospitals surveyed reported an increase in the number of psychiatric patients over the past six months, a trend attributed to the weakened economy and shrinking options among the very out-patient treatment programs that were supposed to ease the demand on hospitals under the reform plan.
And when those at the community hospitals contact the government-run facilities for assistance, they said they are too often faced with rude state workers who use bureaucratic procedures purposely to delay admissions, according to the survey report.
Urgent phone messages are sometimes not returned for as long as 12 hours, and it is impossible to get someone admitted to a state facility during nights or weekends, when the need is often most acute.
"Without exception, they report that the single biggest problem they face in the emergency departments is procuring appropriate psychiatric care promptly," the report says. "They expressed confusion and dismay that it would be totally unacceptable for individuals with acute medical problems to languish in the (emergency department) for days, but that is a common practice for psychiatric patients awaiting care."
Unlike most community hospitals, Morganton's Grace Hospital has a 25-bed psychiatric unit. Those beds are nearly always full, hospital employees told the DHHS surveyors. And when they try to get patients admitted to nearby Broughton Hospital, workers at the state facility are often rude and unresponsive, the report said.
The hospitals reported good experiences transferring patients to the few government-funded beds in private facilities that are now available, mostly in the western part of the state.
The report, obtained by The Charlotte Observer and The (Raleigh) News & Observer through a public records request, is far more frank and unvarnished than is typical for a government-produced document. Michael Lancaster, the chief of clinical policy for the state mental health system, described it as raw data intended for use by an internal workgroup.
The report also provides recommendations for what the state can do to help, such as assigning a single staff member to work on admitting patients who have been waiting in an emergency room for more than three days. Those recommendations, as well as a one-page summary of the problems found by the survey, will eventually be presented to senior DHHS administrators, Lancaster said.
Lawmaker calls cuts 'crazy'
Rep. Verla Insko, a Democrat from Chapel Hill who co-chairs the state's legislative oversight committee for mental health, said the survey identified problems that must be addressed.
Insko has heard of patients waiting in emergency rooms as long as 10 days and said the deep cuts to community services made in this year's state budget are "crazy."
"We should act quickly to ensure prompt and courteous communications between agencies and give priority at our state institutions to the most severely ill or violent patients," she said. "The overuse of emergency departments will go on as long as we fail to provide adequate services."
