RALEIGH - A last-minute change in the state budget approved Tuesday will make it easier to open a mental hospital in Butner and quickly close Dorothea Dix Hospital in Raleigh.

The final budget headed to Gov. Mike Easley for his signature was stripped of a provision that would have required Central Regional Hospital to pass muster with outside inspectors before it can accept patients. It's unclear who rewrote the provision that was part of earlier versions of the budget.

Advocates for the mentally ill decried the change Tuesday, which effectively lets Easley's Secretary of Health and Human Services, Dempsey Benton, certify that the new hospital is safe to open.

"They watered it down to where no certification by a third party will be required," said John Rittelmeyer, the director of legal services for the advocacy group Disability Rights North Carolina. "We are disappointed because we are adamant about protecting the safety of patients, and we just don't believe that an internal assurance that standards are being met is sufficient."

The opening of Central Regional has been delayed at least four times in the past year amid concerns about projected staffing shortages and internal safety reviews that identified dozens of hazards in the $130 million building that could allow patients to kill themselves. Most new hospitals are required to undergo a rigorous DHHS licensing review, but the department's own hospitals are exempt.

The version of the budget approved by the Senate last month forbade Benton from opening the hospital until it met staffing and safety standards from the federal Centers for Medicare and Medicaid Services and the Joint Commission, an independent organization that accredits hospitals.

Benton and other administration officials lobbied hard to kill the provision, which could have delayed the planned move of patients from Dix and John Umstead Hospital in Butner for months.

In the final version of the budget presented to legislators Monday for a first vote, the requirement had changed to allow Benton to determine when the new hospital complies with the standards of the outside regulators. The new bill requires that Benton send a written report to Easley attesting that the new hospital is safe.

The change clears the way for Benton to stick to his current schedule, which calls for moving most patients from Umstead before the end of July and closing Dix within a couple weeks after that. Workers are already converting some patient wards at Dix to offices for hundreds of DHHS employees due to vacate leased space elsewhere in Raleigh.

The sprawling Dix campus, which has been home to mentally ill patients since 1856, has been coveted by both Raleigh officials who want to transform it into a leafy park and legislators who want to sell the land to developers. Among those who have asked for the closing to be delayed is Republican gubernatorial candidate Pat McCrory, who has argued the decision should be left to the state's next governor.

Benton declined a request for an interview Tuesday. A statement e-mailed by a departmental spokesman said the secretary had urged legislators to adopt language that "would not create a barrier to moving patients to a safer environment."

'Some rough edges'

Sen. Martin Nesbitt, who helped shepherd the stricter Senate version of the requirement, said Tuesday he was not sure how the change was made or precisely who changed it.

"It occurred after we had made our recommendation," Nesbitt said Tuesday.

He said the measure was taken out after the budget was sent to the "big chairs," a group of 11 legislators from both chambers who act as chief budget writers. They include Rep. James W. Crawford Jr., a 12-term Democrat whose district includes Granville County, where the new hospital is.

Crawford said Tuesday he was among those who pushed to strip the requirement for an outside review from the budget. He said safety concerns about Central Regional are overblown.

'Rough edges'

"There may have been some rough edges that needed to be refined, but that's not unusual in opening a new hospital," he said. "I think there's a whole bunch of stuff that's been talked about that's not even real. Go look at Dix and go look at Umstead where these people are and then go look at that hospital in that light and you'll see it looks like a castle in comparison."

Supporters of opening Central Regional have long argued that the new hospital will be far safer than the aging facilities at Dix and Umstead, a contention many employees of the older hospitals have disputed. Protests by hospital workers opposed to the move have become a weekly occurrence outside Benton's office.

As word spread Tuesday that the last legislative roadblock to closing Dix and Umstead had been dropped, advocates for the mentally ill expressed anger and resentment at the Easley administration, which in the last eight years has privatized community mental health treatment and shrunk state hospitals despite growing waiting lists for inpatient care.

"We're really upset about this," said Thomas Smith, a retired psychiatrist from Asheville. "It's another deplorable link in this administration's headlong rush to remove patients from the Dix campus and clear the way for private development of the property."