The state budget approved by legislators July 8 let Benton, secretary of the state Department of Health and Human Services, decide when a new mental hospital in Butner is safe to open, stripping a provision that would have required an outside review.

In letter to Gov. Mike Easley dated July 9, but not made public until Tuesday, Benton says Central Regional Hospital is safer than either of the two aging facilities it is set to replace -- John Umstead Hospital in Butner and Dorothea Dix Hospital in Raleigh.

The secretary then cited assurances the new $130 million facility is safe -- assertions made by the hospital's administrators, state construction officials, the state's architecture firm, state hospital regulators and a panel of psychiatric experts Benton appointed.

"These reports justify the determination that Central Regional Hospital is ready for the transition of patients ... and the staff is prepared to operate the hospital so that a safe and secure environment is provided," Benton wrote.

In a second letter delivered to the governor Tuesday, Benton formally declared the hospital ready and says the first patients will be moved from Umstead next week.

The secretary did not give a specific date for Dix to close, but timetables previously released by the department show patients from the venerable Raleigh hospital moving about two weeks after those from Umstead.

A budget bill approved by the state Senate last month forbade Benton from opening Central Regional 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 Umstead and Dix for months.

In the final version of the budget that legislators approved last week, the requirement changed to allow Benton alone to determine when the hospital complies with the standards of the outside regulators.

Easley has not yet signed the state budget into law, but DHHS spokesman Tom Lawrence said Benton saw no reason to wait.

"We're moving forward," Lawrence said.

Rep. Verla Insko, a Chapel Hill Democrat who is influential on mental heath issues, said Benton is the appropriate person to make the call.

"I believe the secretary is very aware of the price we all would pay if this doesn't go well," Insko said.

'Profound doubts'

The opening of Central Regional has been delayed at least four times in the past year amid concerns about projected staffing shortages and internal state safety reviews that identified dozens of hazards that could allow patients to kill themselves.

John Rittelmeyer, the director of legal services for the advocacy group Disability Rights North Carolina, reiterated concerns Tuesday that the state was rushing to open the new hospital without sufficient staffing or preparation.

On a tour of the facility last week, Rittelmeyer said hospital administrators were unable to answer basic questions about how prescription medications would be safeguarded, saying those procedures had not been developed.

"It seems as though they're trying to pour three gallons into a two gallon can," said Rittelmeyer, whose group had pushed legislators to require an outside review. "We have significant, profound doubts it's going to work."

Even after the main hospital at Dix closes, the state plans to operate a 60-bed satellite ward with Wake County until 2011 to alleviate the lengthy waiting lists for admission that have become commonplace as reforms of the mental health system have floundered.

The state has not indicated when that new ward might open, however, and workers at Dix slated to operate that facility have been told they are to report to Butner indefinitely to help ensure the new hospital has sufficient staff to operate.

Rep. Deborah Ross, a Wake Democrat, said the state budget requires Benton to certify that Central Regional meets all Centers for Medicare and Medicaid Services and Joint Commission standards before Dix can close. However, the approved provision does not explicitly say inspectors from those outside agencies would actually have to visit the hospital for Benton to declare those standards met.

Ross said if that is the case, then Benton must write another letter providing specific details, rather than just making a declaration. She said he should list the requirements and say how they were met.