Employees who abused and neglected patients represent a small minority of the 11,193 employees who work at the 14 institutions managed by the state Division of Mental Health, Developmental Disabilities and Substance Abuse Services.

Safely and compassionately caring for mentally ill or severely impaired patients is a difficult job under the best circumstances, even more so in a system with chronic staffing problems.

State employees fired for abusing or neglecting patients can challenge their dismissal to the N.C. Office of Administrative Hearings, which reviews cases alleging wrongful termination. Employees' written appeals offer insight into working conditions at state facilities.

Betty J. Hastings, a developmental disabilities trainer at the J. Iverson Riddle Developmental Center in Morganton, challenged her 2002 firing for abuse after using her foot to "prompt" residents to move while they were on the floor.

"I did not make a mark on either one," Hastings wrote to the judge. "I had no intent to harm them in any way. They were my favorite residents. ... [Another employee] and I were the only ones working that day. Two people to bath[e], dress and feed 13 people plus watch a monitor and keep an eye on the floor. Now I would like to see some of you do it and never make a wrong move. There is a lot of stress and we were always short staffed."

In February 2003, an administrative law judge dismissed Hastings' appeal.