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Dempsey Benton, who became head of the Department of Health and Human Services in September, announced in January that a 5 percent raise would be granted to psychiatrists and other doctors to help retain and attract qualified professionals to the state hospitals. Boosting pay for lower-ranking positions is under review.

With doctors and nurses policed by licensing boards that oversee those professions, it is nurses' aides and health-care technicians, the least-trained and lowest-paid members of the clinical staff, whose names end up on the employee blacklist. They also have the most one-on-one contact with patients.

Becoming a health-care tech requires no special certification beyond a high school diploma or GED. Starting pay is $11.42 an hour.

The reported offenses range in severity from stealing patients' clothes and money to beatings and rape. Cases of abuse confirmed by investigators included:

* Forensic-health technician Daniel Lang repeatedly had sex with a mentally ill woman at Dorothea Dix Hospital in Raleigh. Lang was fired in January 2003. But before he was arrested on six felony rape and sexual offense charges, he slit his wife's throat and dumped her body in woods near the hospital.

* Matthew Allen Rose, a health-care technician at Broughton, performed oral sex on a mentally ill child in August 2002.

* Broughton employee Justin Travis Wood hit a resident in the genitals with his keys while the patient was strapped down in restraints in July 2007.

* Romaine Keith Earnest, a health-care technician at the Caswell Center in Kinston, abused a resident in October 2001 by inserting a broom handle into the patient's rectum, causing severe internal injuries.

Each employee in these cases pleaded guilty or was convicted of a criminal offense. But many employees who abuse patients are never charged.

An example is nurse's aide Bettie Ruth Mercer. While she was an employee of the Longleaf Neuro-Medical Treatment Center in Wilson in September 2003, a state investigation concluded Mercer abused a patient "by holding a razor at his throat and threatening to cut him, by pulling on the resident's penis, threatening to pull it off and by hitting the resident with her fists."

She was fired but not charged with a crime.

Many of those who abused patients have faced criminal charges before. Michael Eugene Dalton of Marion was fired from the Alzheimer's unit at the Black Mountain Center for hitting a resident in the head, pulling the chair out from under a resident and pushing a resident, causing a stumble. Before he was hired, Dalton had a lengthy record that included multiple DWIs and an assault conviction.

A review of conditions in North Carolina's mental hospitals by the U.S. Department of Justice in 2004 concluded that staff members routinely violated patients' civil rights. The inappropriate use of physical restraints and seclusion was specifically cited. So was failure to "ensure the reasonable safety of patients."

Attack in a quiet ward

Dean Smith, who has bipolar disorder, was involuntarily committed in October 2006 to Cherry Hospital, a sprawling campus of brick buildings in Goldsboro originally founded in 1880 as an institution for African-Americans.

Desegregated in 1965, Cherry is now the designated state psychiatric hospital for a region that includes 33 Eastern North Carolina counties. Though it once housed more than 3,500 patients, the hospital now has 274 patient beds.

Smith admits he wasn't well-behaved during his stay on Ward U-2, No. 3 East, making fun of the health-care technicians and complaining when they refused to give him requested medicine.

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