Drew Thames' parents tried to keep constant watch of their mentally ill 16-year-old son after he was discharged in November from John Umstead Hospital in Butner after a five-day stay.

A hospital social worker's plan: an appointment for drug counseling and a suggestion that he "identify things that he can do for himself during the day." Two weeks later, Thames was dead of a drug overdose.

North Carolina risks lives and violates federal rules by discharging patients from its state mental hospitals without adequate plans for community care, the advocacy group Disability Rights North Carolina said Tuesday.

The group's report focused on the deaths of three people within two weeks of their discharges from state hospitals last year. Executive Director Vicki Smith said its investigation found a "pattern of dangerously inadequate discharge planning practices" and a system "rife with ambiguity and without accountability."

Poor planning for community care leads to increased hospital use by patients who return over and over, and it leads to deaths, Smith said.

James Osberg, the Department of Health and Human Services administrator who oversees state institutions, said patients are not discharged before doctors determine they are no longer a danger to themselves or others. Discharge plans vary in quality, he said. He would not comment on the cases Disability Rights identified, but he said it would be wrong to assume that an inadequate discharge plan resulted in a death.

Hospitals don't have time to do thorough discharge plans for most patients in the hospitals only a few days, he said. And in some cases, Osberg said, community services that patients need are not available.

The state's mental-health system is the subject of great scrutiny. Earlier this year, a News & Observer series revealed hundreds of millions of dollars in waste along with a pattern of abuse and unnecessary deaths in mental hospitals. Two of the deaths highlighted Tuesday by Disability Rights were among those the newspaper listed among 82 questionable deaths since December 2000.

Additionally, the newspaper reported that hospital stays were growing shorter, which makes it more difficult for patients to receive meaningful treatment. In the 12 months ending last June, more than half of all patients discharged from state mental hospitals stayed a week or less.

Drew Thames

Drew Thames, who had twice attempted suicide, stayed five days. When he came home, his father watched him all day, and his mother monitored him at night.

Still, he slipped away from their Orange County home in early December. He was found dead in a Wilmington hotel.

Thames' parents said their son was released from the hospital too soon and without an adequate plan for what would happen after he returned home.

"He really needed to be observed in the hospital longer," said his mother, Patsy Thames, as she dabbed her eyes with a tissue. "We want to try to make sure that the processes get fixed so that the pain and suffering we're going through and many other families have gone through stops."

A federal investigation into the state hospitals begun in 2002 identified inadequate discharge planning as one of their biggest problems; the U.S. Department of Justice has been pressuring the state for most of this decade to do better.

Bryan Lowery

Bryan Lowery's parents, Ernie and Brenda Lowery of Robeson County, talked about their son, who was sent from Dorothea Dix Hospital in Raleigh to a homeless shelter that had been shut down two days before his discharge. Last year, 1,182 people were sent to homeless shelters from state mental hospitals, the report said.

Lowery, 30, died in a motel room of an overdose two days before he was to check into a drug treatment center.

Carl Wayne Tournear

The advocacy group's report included the story of another man it did not identify by name, who bought a gun the day after his Aug. 1 release from Broughton Hospital and shot himself in the head Aug. 3. A recent N&O report identified him as Carl Wayne Tournear, 37, of Mooresville.

Tournear had been involuntarily committed to the hospital after he called his mother and told her he had taken 100 Valium in an attempt to commit suicide and that he would shoot any law enforcement officers who tried to intervene. A SWAT team forced its way into his house, Tasered him, confiscated his guns and took him to a local hospital.

The hospital transferred him to Broughton in Morganton, where he stayed 37 hours. His discharge plan was to promise to call his family doctor, the advocacy group's report said.

State takes action

To improve the connection between hospitals and community services, one of the state's mental health division directors on April 3 ordered the county and regional mental health offices to station liaisons at state facilities to help find appropriate local care for patients getting ready to leave.

Disability Rights recommended other steps, including:

* Hiring more local office and hospital staff to work only on discharge planning.

* Establishing a statewide policy for local mental health offices.

* Defining responsibilities for the hospitals, the local mental health offices and private providers.

Getting patients adequate care after they leave hospitals is "the linchpin to fixing mental health services in this state," Smith said.

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