RALEIGH -- Consultants who reviewed a troubled state mental hospital in Goldsboro have issued a report that describes a dysfunctional institution with managers too detached to effectively solve problems.

The Compass Group, an Ohio-based health-care consulting firm, was hired to assess conditions at Cherry Hospital last month after a patient death and beatings spurred federal regulators to cut off Medicare and Medicaid funds.

The report, completed last week and released by the state Tuesday, says workers at Cherry are distrustful of their leaders. They are often hesitant to report incidents of patient neglect or abuse for fear of retaliation and doubt it will do any good.

Top managers, including hospital director Jack St. Clair, communicate poorly with those they supervise, often sending mass e-mails rather than talking face-to-face. They rarely visit wards where patients are cared for.

Though the report says the hospital's leadership is deficient, the consultants advised against firing them.

"These leaders have not demonstrated that they are collectively up to the challenge of managing organizational change," the report says. "[However,] leadership instability interferes with mounting a sense of urgency. Changing the players will not, by itself, create a leadership team strong enough to enact changes quickly."

The staff is so demoralized by recent media reports about the hospital's problems, employees often remove their name badges when leaving the hospital so people won't know where they work, the report said.

The front-line workers constantly fear for their safety and react by more frequently using physical force for "takedowns" of problem patients -- the opposite from the intended outcome.

"They blame senor leadership for ignoring the need to have better procedures for dealing with combative patients," the report says. "Staff members stated that fear of retribution from other staff members allows events to go unreported."

The workers also said "bad apples" -- those who abuse patients -- are too often returned to their same jobs by management, emboldening them to continue bad behavior.

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