A top state administrator said Wednesday he plans to ensure basic psychiatric care throughout the state, buy space for the mentally ill in community hospitals, report all institutional deaths to a medical examiner and weed out unqualified private companies.

Some of the proposals by Dempsey Benton, secretary of the state Department of Health and Human Services, would reverse changes from a 2001 reform plan that allowed companies to take the responsibility for providing mental- health treatment from local governments.

The News & Observer recently reported that under the reforms, the state wasted at least $400 million on a service called community support and spent too little on treatment of serious mental illness.

The report also revealed that the state was operating four psychiatric hospitals where, since December 2000, 192 employees abused patients and 82 patients died under questionable circumstances. Some questionable deaths in state mental institutions were not investigated after they were wrongly reported as resulting from natural causes.

Benton announced a policy requiring that all deaths, regardless of suspected cause, be reported immediately by telephone to a medical examiner, and that the body not be moved without approval. The medical examiner will determine whether additional inquiry is needed and whether an autopsy should be performed -- effectively removing state hospital staffers from the decision-making process.

"This is only one step in a comprehensive re-examination of our procedures covering the death of anyone in the care of our facilities," said James Osberg, the chief of state-operated facilities for the Department of Health and Human Services.

Though a central goal of the 2001 reforms was to send fewer people to state mental hospitals, short-term admissions increased. In the 12 months ending in June, 8,805 patients -- more than half of all patients discharged -- stayed a week or less. Six years ago, less than a third stayed a week or less. Short stays can stabilize patients but have little therapeutic value.

Going without care

During the past year, the soaring number of patients seeking help has forced the mental hospitals to delay admission of thousands of patients. Many ended up stuck in medical facilities ill-equipped to handle their psychological problems, languishing in emergency rooms while on the state hospital waiting list.

Complaints about spotty local services have turned into a clamor to restore public mental-health treatment. Benton answered with a proposal to have "basic psychiatric services" in each region.

Local mental-health offices often have psychiatrists on staff who also work for private providers. But Benton said the local offices should have psychiatrists who work only for the public system, "telepsychiatry" equipment to allow doctors to assess patients who are miles away, and social workers.

The state needs to sign contracts with local hospitals for 180 beds for mentally ill patients so it can keep more people closer to their homes and out of state institutions, Benton told members of a legislative committee on mental health.

Benton did not put a price on most of the proposals, but he estimated an annual cost of $65 million to $70 million.

Legislators and Gov. Mike Easley's administration are likely to agree on some ideas for fixing the state mental health system.

Finding more beds in local hospitals is top priority for legislators, and they want to make the policy on reporting deaths a law.

Under the department policy, deaths will continue to be reported to state and federal regulators who oversee the public hospital system. Previously, the reporting requirements were spelled out in at least three separate policies. Those rules have now been consolidated into a single three-page policy.

Osberg said he thought the new policy was needed after the director of Broughton Hospital in Morganton failed to report at least four deaths to regulators.

"Because there had been a failure to report in at least one previous case, we felt it was appropriate to articulate all the various requirements in one place to avoid confusion," Osberg said.

Still some loopholes

There is no requirement in the new policy, however, that the circumstances of the deaths be reported accurately and completely. There is also no guidance about what information hospital staffers must disclose to families of the dead.

Legislators and the Easley administration may present different ideas on how to limit appeals by private mental-health companies that are denied payments or by clients who are denied services.

Now, after an informal department hearing, clients and providers can take their cases to administrative law judges and then to Superior Court. But many think the appeals clog the system.

Benton on Wednesday proposed that administrative judges be cut out of the loop. The idea is certain to face resistance.

Sen. Martin Nesbitt said the state Office of Administrative Hearings, where the administrative judges work, and legislative staffers were working on ideas to "compress the appeals process."

It's important for patients to have a path to appeal that's "transparent and fair and user-friendly," he said.