RALEIGH - Administrators at a troubled state mental hospital in Morganton failed to report recent patient deaths to investigators, as state law requires.

At least four Broughton Hospital patients have died since Aug. 25, when federal officials cut off Medicare and Medicaid payments to the facility after the death of a patient who suffocated while being held down by staff members.

At least two of the unreported deaths happened after the patients were restrained, potentially imperiling Broughton's efforts to regain federal insurance reimbursements. It has not yet been disclosed what role the restraints might have played in the deaths. Restraints can include straps, as well as drugs that dull consciousness.

Dr. Mike Lancaster, a top state mental health administrator overseeing an effort to improve conditions at Broughton, said administrators at the hospital failed to report the deaths after misinterpreting the law.

"It was an error," said Lancaster. "I don't think there's any question that decision was an error, now that we have looked at it. But it wasn't that anybody was trying to hide anything."

Broughton, one of four state mental hospitals, is about 200 miles west of the Triangle.

The state Division of Health Service Regulation, which investigates patients' deaths in North Carolina for the federal government, is supposed to receive reports of all fatalities that occur in state-run hospitals.

A 2001 law, enacted after news reports disclosed questionable deaths in state facilities, explicitly requires hospital officials to immediately alert state investigators of fatalities from homicide, suicide, accident or violence. Deaths that occur within a week of the patient's being placed in restraints or locked in seclusion must also be reported, the law says.

'Considerable confusion'

Hospital officials at Broughton first reported four deaths to investigators Thursday, after an article in The News & Observer questioning why an Aug. 31 death had not been disclosed. Broughton's director, Seth P. Hunt Jr., wrote officials in Raleigh that he was unaware his facility was violating state law until he read the newspaper article.

Hunt, who did not return calls seeking comment Friday, wrote that he thought his staff was no longer required to disclose patient deaths to investigators following the cutoff of federal funds Aug. 25.

"There has been considerable confusion on the manner by which reporting should continue directly to DHSR as we have never been decertified and have never had to address the many issues related to decertification," Hunt wrote, referring to the hospital's loss of federal insurance reimbursements. "I believed that we were in compliance with the law. ... We understand now that we are required to continue to report" hospital-related deaths.

Hunt said the deaths were reported internally to other state officials.

Vicki Smith, the executive director of the advocacy group Disability Rights North Carolina, said Friday she found Hunt's explanation troubling.

"I'm not sure which is more alarming -- ignorance of the law ... or a blatant attempt to mislead," Smith said. "I'm not sure one excuse is better than the other."

Documents filed Thursday

According to the documents Hunt filed Thursday, the man who died Aug. 31 was 47 and had a form of schizophrenia. A box is checked indicating the patient had been restrained and placed in seclusion either at the time of his death or within the prior seven days.

There is no indication whether the man was sedated before he died, though a separate report released earlier this week indicated he died shortly after receiving medication. The preliminary cause of death listed by a Broughton doctor is "anoxic encephalopathy" -- a lack of oxygen to the brain that can be caused when the heart stops beating.

An autopsy was performed, but a spokeswoman for the N.C. medical examiner's office said the results are still pending.

The report of a second death Nov. 29 also indicates the patient had been restrained in a chair at Broughton within the week before he died.

However the report says the man, a 71-year-old with bipolar disorder, died after being transferred to another facility in Asheville. The cause of death is listed as "cardiac arrest," though the report indicates he died immediately after receiving electroshock therapy. It is unclear whether an autopsy was performed.

The other two deaths involved a 41-year-old patient who died of kidney cancer and a 58-year-old man who died of "urosepsis" -- a usually treatable urinary tract infection that spread to the kidneys and then the bloodstream.

Investigations coming

Jeff Horton, the chief operating officer of the state Division of Health Service Regulation, said his office will investigate the deaths when Broughton applies to get its federal insurance privileges reinstated. Meanwhile, state taxpayers are footing the bill for more than $1 million a month in lost revenue.

Meanwhile, state investigators are focusing on claims of patient abuse at Broughton. They recently substantiated a report that Justin Travis Wood, a health care worker at the hospital, abused a patient in July by hitting the patient in the genitals with his keys while the patient was restrained. Wood was found guilty of misdemeanor assault last month.

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