For the last nine months, more than 100 beds for patients who need acute psychiatric care in Eastern North Carolina have stayed empty, even as patients wait for treatment.
Administrators at Cherry Hospital in Goldsboro are refusing to fill the beds until they hire more psychiatrists, hospital Chief Executive Officer Luckey Welsh said in an interview last week.
State records, however, show that Cherry Hospital is staffed as well as one of the state’s other mental hospitals and far better than its third.
Late last week, nearly 30 patients waited in emergency departments for a bed to open up at Cherry hospital, according to Welsh.
At least two of those were adolescents at Sampson Regional Medical Center. They have now been waiting on a bed at Cherry for more than a week, said Shawn Howerton, the hospital’s chief executive and medical officer. On Wednesday, three adults also needing a slot at Cherry languished in the Sampson emergency department.
“It is extremely frustrating,” Howerton said. “You watch these patients and what they have to endure to get the help that they really, really need that we can't find a way to provide.”
Howerton said that at a recent meeting, he and other hospital executives in Eastern North Carolina had discussed how the opening of the new hospital had not eased their psychiatric placement needs. Howerton said that no one from the state or Cherry Hospital had informed him that they were not using the new beds, which were designed to bring the hospital’s capacity to 313.
Cherry administrators have persistently complained of a shortage of psychiatrists. Welsh last year obtained hefty raises for his staff psychiatrists and the doctors who manage them, The News & Observer reported in March.
All 15 staff psychiatrists now earn $230,000, a salary that has resulted in significant pay gaps between Cherry’s doctors and those at Broughton and Central Regional, the state’s other two psychiatric hospitals.
A review of emails, salary studies and recruitment data shows:
▪ The number of patients per psychiatrist at Cherry in March of this year was far lower than at Broughton Hospital in Morganton. If Cherry psychiatrists increased their patient loads to those at Broughton, all of the new beds at Cherry would be in use.
▪ The data presented to state officials last fall to petition for raises at Cherry contained errors, including confusing the starting salary with the top of the pay range at another facility.
▪ In March, Cherry officials told the N&O that “no psychiatrists have expressed interest in pursuing employment at Cherry” since September 2015. The Office of State Human Resources, however, received applications from 18 psychiatrists seeking employment at Cherry since October 2014; three of those candidates applied in the three months before the petition for raises was filed, records show.
▪ Though health and human services leaders knew Broughton Hospital also had recruitment and staffing challenges, they approved the raises for psychiatrists at Cherry while not securing similar increases for those at Broughton or Central Regional.
In a meeting with the N&O last week to discuss these findings, staffers at the state Department of Health and Human Services defended their actions and work.
But Mandy Cohen, the DHHS secretary hired in January by Democratic Gov. Roy Cooper, later expressed concern.
“After learning about potential issues in our psychiatric hospitals, I assembled a team last week that will be visiting each facility to document and identify where improvements are needed,” Cohen said in a statement Tuesday. “This new administration is committed to having the right policies and procedures in place that ensure quality care is provided and that we remain good stewards of the public’s resources. Our first priority remains the health and the safety of the patients.”
Rep. Verla Insko, a Democrat from Chapel Hill who sits on the House appropriations committee for health and human services, said she was frustrated that Cherry staff weren’t making use of their new beds yet. She said state leaders should have alerted legislators and asked for assistance.
“Everybody acts like they are helpless,” she said. “If you are helpless, come talk to someone who can make a difference.”
Welsh, who oversaw all state-run medical facilities before becoming Cherry’s administrator in 2012, said he followed the rules.
“We have stayed well within, exactly within what we were allowed to do and nothing outside of this,” Welsh said. “I want that to be clear.”
Ardis Watkins, a lobbyist from the State Employees Association of North Carolina, said even if the rules were followed, the situation has created an unseemly lack of parity among state employees.
“For taxpayers to continue to have faith in the government and for state employees to have faith in their employer, we need all state employees to operate under the same set of rules,” she said.
Questions about data
Last fall, Welsh and a recruiter presented a dire scenario: The hospital’s psychiatrist pay was so far behind other institutions that the hospital was unable to hire.
A brand-new facility had just opened. The larger facility provided 100 extra beds and was supposed to ease the bottleneck of patients with mental illness waiting for help.
But Welsh has held firm: to fill the new hospital’s 313 beds, he needs to hire eight psychiatrists in addition to the 15 now on staff. The state has funded his hospital for those positions since October 2013.
Welsh said he had been ramping up for the expansion since 2015. That year, he hired Connie Wooten, a professional recruiter, to help him find leads on eligible doctors. According to emails provided by DHHS and the Office of State Human Resources, Wooten started studying compensation packages on two online job sites, PracticeLink and Doc Cafe. She made a list.
“The VA in Fayetteville is starting a psychiatrist (3 years of experience – and residency does count – so, fresh out of residency without fellowship) at $320,000.”
That posting was among those cited in Cherry Hospital’s petition to offer raises to psychiatrists and increase their recruiting salary.
The advertisement for that job on the VA’s website differs greatly. The salary tops out at $320,000. According to the listing, a compensation panel assigns a salary in the $101,000 to $320,000 range based on education and experience.
A spokesman for the VA said that $320,000 is the maximum annual salary for psychiatrists hired to any facility across the country. A recruitment incentive can be awarded but is not guaranteed.
Wooten’s research from the two online sites also cited a UNC position for a staff psychiatrist in Goldsboro and lists elements of the compensation package, such as relocation expenses.
Georgia Dees, a spokeswoman for Wayne Memorial, UNC’s medical facility in Goldsboro, said that the hospital does not list benefit details in job postings for doctors. She said the hospital staff didn’t interview or hire any candidates recently.
On Wednesday, Wooten declined to comment or answer questions about her research.
No one at DHHS verified the salary data that Cherry administrators presented last November. “That’s why we have a recruiter,” said Laura White, who oversees the three psychiatric hospitals for the state Division of State Operated Health Facilities. “It’s her job to do that.”
DHHS officials blessed the request and forwarded the petition on to the Office of State Human Resources for approval.
Welsh defended Wooten, the recruiter who prepared the research, saying he “totally trusts” her.
Other raises requested
Patients with the most acute and persistent mental illnesses often end up at the state’s three psychiatric hospitals. Many find themselves there involuntarily; some spent months or years in the facility because the courts have found them incompetent to proceed to trial for their alleged crimes.
For more than a decade, advocates for the mentally ill have pushed for more treatment options outside of hospitals and within the community. But the community services have not developed as broadly as expected.
State leaders have undertaken massive construction projects at the three state hospitals to add beds. But hiring additional psychiatrists at both Broughton and Cherry hospitals has proved challenging.
In March, there was one psychiatrist per 22.75 patients at Broughton Hospital. At Central Regional, that ratio was 1 to 13.77.
Cherry hospital employs 15 staff psychiatrists, and another three who are supervisors. In March, there was one staff psychiatrist for every 13.66 patients.
Asked about the differences, Welsh suggested that his doctors were likely busier, handling more admissions and discharges. Since January 1, Cherry has admitted 643 patients, while Central Regional added 850. Broughton took in 316 new patients.
Broughton Hospital wants to lower its doctors caseloads by filling vacant positions. This spring, hospital officials sought permission to increase the salaries of their psychiatrists, as well as their recruiting salary, to match that at Cherry.
“As you know, we and other facilities have had great difficulty in recruiting psychiatrists for some time,” the hospital’s chief financial officer, Bea Tullis, wrote in a March email to several DHHS officials. Broughton staff submitted a formal request, which included the market survey data that Cherry had prepared for their petition to increase salaries.
The department did not ask the governor or legislature for more money to pay for these raises, according to emails provided by DHHS, suggesting that the raises may not come soon.
Dale Armstrong, who oversees state-operated health facilities for DHHS, said the agency made a “conscious decision” last fall to move forward with the raises for Cherry and hoped to address salaries at the other hospitals in the future.
Welsh said the increased recruiting salary has enabled staff to hire one additional staff psychiatrist, who will join the staff in July.
Despite difficulties attracting qualified candidates, Cherry officials did hire an additional psychiatrist since opening its new facility last fall. Dr. Thomas Larson, who is paid $250,000, was brought in October as a physician manager.
As a supervisor, he carries no patient load.
How many psychiatrists are needed?
The number of doctors it takes to treat patients with mental illness in a psychiatric hospital varies by the type of condition and length of stay.
Appropriate staffing is determined by how many admissions a hospital receives and the complexity of the patient’s illness, said Marvin Swartz, a professor and Director of Behavioral Health Services for Duke University Health. Patients need most attention when they are first admitted.
Broughton and Cherry Hospitals have relatively the same types of units, caring for a range of acute and longer-term patients. Broughton also has a unit devoted to deaf patients.