* Because a patient died while being ignored by ward staff, Cherry Hospital is likely to lose federal funding, possibly costing the state millions of dollars.

* Broughton Hospital loses its appeal to keep accreditation from JCAHO (the Joint Commission on Accreditation of Healthcare Organizations) following a December 2007 survey.

* Legislative staff produce a report on the implementation of mental health reform that, to a state representative, resembles "crime scene photos."

* Reflecting an attitude pervading the state Division of Mental Health, the deputy director during that implementation says "no one individual was responsible."

* The Cherry Hospital story is picked up by CNN, the Yahoo home page and news outlets as far away as Germany and India.

* The N&O reveals assaults by Cherry Hospital staff on vulnerable patients.

We must be asking ourselves, "How can this happen -- what can be done?" And it must be daunting for a new administration taking office in Raleigh in four months to contemplate assuming responsibility for this mess.

The safety of patients in our state hospitals continues to be at risk. But as I wrote on this page in December, "Providing a safe environment for patients and staff in a state hospital is not rocket science. The principles involved are well-known:

* Staff in sufficient numbers must be available.. . .

* Hospital staff must be well-trained and well-supervised.. . .

* Transparency is critical.

* Finally, if patient abuse occurs, it is not solely the responsibility of the individual employee. The supervisory and management structure must be held responsible for its failures. It is not enough to say, as a hospital CEO recently did, 'We have good policies in place.'

"Hospital management's responsibilities do not end with 'good policies'; ensuring that they are faithfully executed is far more difficult, far more important."

These are basic principles. They recognize that management must take seriously its responsibility to act in the public interest. Accountability is key. When culpable state hospital directors have been not been fired but are kept in place or transferred laterally, an unmistakable message is sent throughout the system.

The mental health division needs to develop a culture of accountability and responsibility. But even more fundamental is the question of whether the agency can be restored to basic functionality in the foreseeable future -- let alone whether talented leaders and managers can be recruited to it.

It is hard to imagine how the kind of leaders and managers North Carolina needs can be recruited to the division. In fact, moving forward will require bold steps. For the next governor, there may be no alternative to looking outside state government for the vision and leadership that will be needed.

The next governor should contract with the state's universities to provide the expertise and leadership that the next administration will need. This should include providing key leaders at the Division of Mental Health, including state hospital directors and clinical directors; data collection and interpretation; and policy analysis, monitoring and implementation.

There is ample precedent for this in other states. In New York, Columbia University's Department of Psychiatry contains the State Psychiatric Institute, a key resource for clinical leadership. When I was a hospital superintendent in Colorado, the medical staff and I were employed as full time faculty members of the University of Colorado Medical School. In Kentucky, the mental health agency's medical director is a full time faculty member of the University of Kentucky.

One example is particularly pertinent to North Carolina. Before Sy Saeed, M.D., East Carolina University's psychiatry chair, came here from Peoria, Ill., his medical school department of psychiatry had a very close relationship with the regional mental health agency and provided its leadership. This partnership was of great value both to the state mental health agency and to the local state hospital and mental health centers.

This relationship can serve as a model in eastern North Carolina, benefitting local mental health services, ECU and the beleaguered Cherry Hospital.

When, in other states, mental health agencies and state hospitals have reached rock bottom, partnering with public-oriented universities has proved to be of great mutual benefit. This is a creative solution that the next governor needs to consider seriously.

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