State mental health officials want to start moving mentally ill patients from Dorothea Dix hospital in Raleigh to a new state hospital in Butner, even if they have to break the law to do it.
State administrators cannot meet the standards that legislators established last month to allow Dix patients to move to Central Regional Hospital in Butner, Dr. Michael Lancaster, co-director of the state mental health division, said Tuesday.
But the state is facing more than a legal problem with the move. State officials are also dealing with safety and equipment problems in the new hospital that critics say make the building unfit for patients.
Since Central Regional opened last month, top hospital administrators have been getting e-mail messages from staff members who say that the hospital has areas where emergency communication by pager and cell phone is unreliable. They also say that rooms set up for one-on-one talks with patients are unsafe.
The patient advocacy group Disability Rights North Carolina has heard so much about problems that it is convinced that the state is not ready to move Dix patients, said executive director Vicki Smith.
Last week, a doctor was called to a patient emergency, but the pager did not work, a hospital administrator confirmed.
"We do have a problem with pagers," said Dr. Stephen Oxley, Central Regional's clinical director. The hospital does not know what happened last week, he said. It could be that the phone needed a new battery.
But steel in the hospital walls and the hospital's location in relation to a telecommunications tower has resulted in pager dead zones, Oxley said. As back-ups, the hospital has regular telephones and cell phones. But the cell phones don't work all the time, either.
Despite that, Lancaster said he will recommend to his boss, state Health and Human Services Secretary Dempsey Benton, that they proceed with the transfer of Dix patients to Central Regional Hospital. Lancaster also ordered that after noon today, Dix will no longer accept patients older than 65.
The legislature tried to put into the budget safeguards that legislators thought would ensure that Central Regional was safe for Dix patients by requiring that the new hospital meet safety standards set by two outside agencies.
One of those, the Joint Commission of Accreditation of Healthcare Organizations, has said it will not even visit Central Regional because Dix patients and staff are not there, Lancaster said.
That set up a Catch-22, said Lancaster, who is also interim director at Central Regional. The hospital cannot be accredited because Dix staff and patients are not there, but staff and patients aren't there because it is not accredited.
'It's not safe'
State Rep. Jennifer Weiss, a Cary Democrat, is convinced that Central Regional is not ready for Dix patients. She was bothered that state administrators now say they cannot meet move-in requirements they helped write into law just weeks ago.
"It's not safe to add new patients," she said, and to move now "is not in keeping with the spirit of the law."
Staff members are working through problems and will be for months, Lancaster said. But he assured legislators at a mental health committee meeting Tuesday that Central Regional is safe.
But late last month, Lancaster was copied on an e-mail message from a Central Regional psychiatrist about the lack of safe rooms where doctors can evaluate patients. Most of the interview rooms are isolated from busier areas, making it hard for staff to spot dangers.
"As you know, there are concerns from the medical staff as well as other clinicians about the dangerous design of the new (patient care units) as well as the lack of appropriate rooms in which to evaluate patients," the message says.
Lancaster said the interview rooms were a known problem, but the staff is working on alternatives. The hospital is going to keep finding things it has to fix, he said, but they should not stop Dix patients from moving.
Not all Dix patients will be moving to Central Regional.
-- people who cannot stand trial or who are found not guilty of crimes because of mental illnesses -- who live in their own building on the Dix campus and hold jobs in the hospital or the community. These patients are entitled to their jobs and less restrictive housing, under federal law, and they cannot be offered comparable work and living arrangements in Butner.
Raleigh will keep space for about 40 children, rather than move them to the old John Umstead Hospital that needs renovations. Costs have not been determined, the problems may take four to six months to fix, Lancaster said.
Additionally, Dix will have 60 beds for other adult patients that it will keep for about three years.