Law requires notice of deaths, but not all comply

Reports missing on 165 patients

State mental hospitals often fail to accurately report critical details of patients' deaths to regulators charged with investigating suspicious cases.

Following an investigation by The Charlotte Observer in 2000 that highlighted 34 questionable deaths in state-run mental facilities, legislators passed a requirement that such deaths be reported to the state Division of Health Service Regulation.

Since Jan. 1, 2001, all public and private medical facilities have been required to file a report providing details of any death resulting from homicide, suicide, accident or unknown cause.

The report has to be made within three days of the death and must disclose whether the deceased patient had been kept in psychiatric restraints or locked in a seclusion room within the prior seven days.

It soon became clear, however, that some state hospitals were still not reporting questionable deaths -- wrongly classifying their causes as natural.

In response, an additional order was sent out in March 2001 that required nearly all state mental facilities to report all deaths, regardless of cause. Patient deaths that occurred within a week of discharge also had to be reported.

A review of more than 500 such deaths shows that state hospitals still often fail to comply with the law, more than seven years after the measure took effect.

Director demoted

Seth Hunt, the director of Broughton Hospital in Morganton, was demoted in December following The News & Observer's disclosure that his troubled facility had failed to report four deaths to the regulators.

According to a database maintained by the state, the death reports from its mental hospitals and developmental disability centers were received by regulators within the mandated three days only 8 percent of the time.

So far, officials with the state Department of Health and Human Services say they have been unable to locate copies of the required death forms for 165 patients who died in state facilities since December. State officials say they don't keep most reports more than five years but acknowledge they can't find some reports less than five years old.

The standardized forms on which state hospital deaths have been reported internally since 2001 have a box to be checked indicating whether the patient had been in restraint or seclusion within 24 hours of death, not the full week required by law. Those forms were not corrected until this January.

State hospitals director James Osberg contended there was no proof the facilities under his supervision had violated the law.

Though state law requires that all deaths occurring in prisons, jails or while in the custody of law enforcement be reported to the state Office of the Chief Medical Examiner for review, there is no such measure covering all deaths in mental hospitals.

Dempsey Benton, secretary of the state Department of Health and Human Services, said last week that he would support legislation requiring that all state hospital deaths be reported.

There is already a law requiring deaths that are the result of accidents, homicide, suicide and unknown or unexpected causes to be reported to the medical examiner for a possible autopsy.

The N&O's review found some examples of deaths in state hospitals or after an emergency transfer to an acute-care facility where that reporting requirement was not met.

An example is Ruth Tidwell, an elderly patient of John Umstead Hospital who died in 2003. Tidwell fell and shattered her leg while in the hospital's geriatric psychiatric ward.

She was transferred to Durham Regional Hospital, where surgeons tried to repair her shattered femur with metal plates and screws. The repair failed, and doctors amputated her leg. Tidwell then developed an infection and eventually died of blood poisoning.

Administrators at Umstead made no report to the state medical examiner. It was nearly five months before the medical examiner for Granville County learned of Tidwell's death, which was ruled to be the result of an accident.

By then it was too late to perform an autopsy. Her body had been cremated.