Wake County wants Dorothea Dix, the state mental hospital in Raleigh, to stay open for county patients after the new replacement hospital opens in Butner.
County administrators say they need the vacant space at Dix to provide more local services for patients who need short-term care.
The new Central Regional Hospital is set to open next year to replace Dix and John Umstead Hospital in Butner.
State officials anticipated that Wake and other counties would have a variety of alternatives to Dix for people who need immediate short-term care. But those alternatives, such as therapists who go to people's homes, and drug and alcohol detoxification centers, have been slow to develop.
Counties, state officials and legislators are getting down to crunch time as they prepare for Dix to close early next year and for community services and local hospitals to step in and care for some of the patients that now go to the state hospital.
A state report on the hospitals and community alternatives to Dix worried legislators who reviewed it Tuesday because it was full of holes, omitting or giving scant and outdated information on three out of four items required by state law.
For example, the report does not say what state and local mental health offices are doing to attract providers to counties. Under the law, the state must include such information in its plan before it can close Dix.
Lawmakers asked whether the counties are ready for the hospital to close, and from the information the state provided, they couldn't tell where potential problems might bloom.
Joe Durham, Wake's deputy county manager, said in an interview that the county isn't ready for Dix to close, but administrators are working to have more options for county residents by the time the state starts moving people from Raleigh to Butner, in Granville County.
Wake County is planning to build a new mental health crisis center to open in 2010. And under an agreement with the county, private Holly Hill Hospital would add 44 beds for poor patients to make up for the loss of Dix. But the Holly Hill beds would not be available until early 2009.
Dix could fill the gaps for Wake until Holly Hill and the crisis center are open. Durham said county administrators are working for a plan to offer commissioners this fall.
"We can't sit idle while this facility closes," he said.
Local options are critical for Wake because it sends more patients to Dix than any other county. But other communities that send patients to Dix also lack community treatment.
Community care "has some way to go before it will be where it should be," said Dempsey Benton, secretary of the state Department of Health and Human Services.
The state plan for closing Dix calls for some patients that now go there to go to Cherry Hospital in Goldsboro or Broughton Hospital in Morganton. Both are under pressure to improve. The federal government stopped Medicaid and Medicare payments to Broughton after one patient died after being restrained and another was injured. The federal government has threatened to stop payments to Cherry.
Legislators from Wake County said sending more patients to troubled hospitals would only add to the turbulence in the mental health system.
"If Dix is going to close, it certainly can't close under the current conditions," said Rep. Deborah Ross, a Raleigh Democrat.
The new hospital won't be big enough to hold all the patients that now go to Umstead and Dix, so the state is planning to use 115 beds in the old hospital as overflow space.
The state also is counting on making a few single rooms in the new hospital into doubles when space gets tight.
Legislators asked whether the new hospital would be too small even with the overflow beds and assignment of roommates.
The units where adults go for short-term and long-term care will be full or nearly full when the hospital opens.
Jim Osberg, who oversees state facilities for the state mental health division, said the hospital was designed so certain units could expand.
Rep. Jennifer Weiss, a Cary Democrat, asked whether the state was giving legislators accurate information on how many patients Dix can hold. One report on the hospitals' capacity shows that Dix has room for nearly 50 more patients than state administrators count.
Osberg said the report may contain outdated information.
Lawmakers wondered whether the new hospital will be overwhelmed as soon as it opens.
"Just because one is bigger than the other doesn't necessarily solve the problem," said Sen. Martin Nesbitt, an Asheville Democrat. "It's just not a possibility that we're going to leave 100 people stranded."
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