Patients at Dorothea Dix will stay put for now.

The state signed a legal agreement Thursday in response to a lawsuit filed by Disability Rights North Carolina, which outlined numerous safety concerns and technical glitches with a new $138 million hospital in Butner.

Patients would have been transferred to the new facility on Wednesday.

The state's willingness to accept the deal is spurred by the results of a visit to the Butner facility last week by regulators from the federal Centers for Medicare and Medicaid Services.

Though the state has not yet released the full details of what inspectors found, it appears likely that the new facility will be found in violation of federal operating rules.

That would make it illegal for the state to transfer patients there. (N&O 

A state judge has stalled the plan to shut down Dorothea Dix hospital.

Wake County Superior Court Judge Allen Baddour issued a temporary restraining order Thursday that bars the N.C. Department of Health and Human Services from moving the bulk of Dix's patients to the new Central Regional Hospital.

That had been sheduled to start on Oct. 1.

The judge acted in response to a class-action lawsuit filed Tuesday on behalf of patients by the advocacy group Disability Rights North Carolina, which has been monitoring conditions at Central Regional. 

"We are pleased with the decision, obviously," said Vicki Smith, the executive director of Disability Rights. "What the danger is when courts get involved is that the lawyers start arguing small points and we forget why we're there, which is to document that patients are safe."

It is not clear how long Baddour's order will last. (N&O) 

Mike Munger got a rare statewide platform tonight.

The Libertarian gubernatorial candidate made good use of his appearance at a debate on UNC-TV to get off a few zingers. (Mingers?)

On mental health reform: "There was an overhaul in 2001. To me, it looked more like a frat party."

On corporate incentives: "This focus on trying to pay companies to come here is basically economic prostitution that's not going to last in the long run."

On the veto: "I think of the veto like spanking your child. It means that you're a bad parent, that you haven't successfully used all of the things that should come before that. Now maybe it sometimes still happens, but it really means it's a failure for you, and it's a failure for the child."

On voting for third-party candidates: "Unless you have Jedi powers, you're not going to be able to control the way other people vote. You have one precious vote. Your decision on how to cast it will send a signal to our leaders in Raleigh."

A legal advocacy group has asked a judge to stop the pending closure of Dorothea Dix.

In a class-action lawsuit filed Tuesday, lawyers for Disability Rights North Carolina detail 15 safety issues at Central Regional Hospital, the new Butner facility where the bulk of Dix's patients will soon be transferred.

The nonprofit group has a federal mandate to investigate conditions independently in state hospitals, and it has been monitoring Central Regional for months. Its suit asks that a Wake County Superior Court judge issue a temporary restraining order to stop the transfer of Dix patients.

"The new hospital has significant issues regarding the safety and care of patients," said Vicki Smith, the advocacy group's executive director. "The [state] continues to provide assurances they will fix the problems, but to date, serious problems still exist."

Tom Lawrence, spokesman for the state Department of Health and Human Services, said he could not comment on the lawsuit, citing a policy.  

In a separate development, investigators for the Centers for Medicare and Medicaid Services showed up at Central Regional to look into multiple complaints. (N&O)

The acting director of the state's Medicaid office told co-workers Monday he is leaving that job.

Dr. William Lawrence, who has been in the position for about a year, said in a e-mail message to DHHS staff that he wanted to return to clinical work, reports Lynn Bonner.

Lawrence was left with much of the fallout from the bungled mental health reforms of 2001. He was the main person dealing with federal government in its audit of payments to private companies providing a low-level mental health service called community support.

Lawrence is the third person in a little more than a year to quit as the state's Medicaid leader.

The federal government has revoked the certification of the state's troubled mental hospital in Goldsboro after determining that the facility presented a danger to its patients.

The decision means that Cherry Hospital will lose federal insurance payments averaging about $800,000 each month, reports Lynn Bonner.

Cherry drew national attention after a patient was left sitting in a chair for more than 22 hours without food while staff members in the room played cards and watched television. Nursing staff members did not follow a doctor's orders to regularly check Steven Sabock's vital signs and give him fluids. At least two hospital workers were caught falsifying Sabock's medical records. Sabock, 50, died of a heart condition April 29.

After being warned that it was in danger of losing its money, Cherry started a staff re-education program on proper patient care to show investigators that it was trying to solve its problems. While those classes were under way, two staff members were accused of beating a patient.

Dempsey Benton, secretary of the state Department of Health and Human Services, argued in a letter to a federal administrator last week that Cherry should keep its federal insurance payments.

As part of its plan to improve Cherry, the state hired an Ohio management company to evaluate the hospital's operations and management.

Is there a difference between physical and mental health?

In recent years, mental health providers and advocates have sought to blur the line between diseases of the mind and body, arguing that it is a false distinction that leads to common misperceptions of how mental illness works.

In pop culture, mental illness is caused by childhood trauma or an inability to cope and is solved with Freudian talk therapy. But increasingly doctors are finding that genetic problems or brain injuries are behind many problems and prescription drugs are the answer.

(Advocates also hope that erasing the distinction will lead to mental health parity — meaning that insurers and the government do not distinguish between heart disease and bipolar disorder, for example, when paying for care.)

It would be mostly an academic question, but Democratic gubernatorial candidate Beverly Perdue used the distinction during a debate Tuesday to argue she was not responsible for the problems with the state's mental health reform efforts.

When Republican Pat McCrory noted that Perdue has called herself a "health leader" in the state, she responded: "Physical health, not mental health, Pat. There's a real difference."

Since 2001, Perdue has chaired the N.C. Health and Wellness Trust Fund. Although the group did not play a role in mental health reform, it has tackled the issue of mental health.

In this May 2007 press release, for example, the group announced that it was providing a grant for mental health providers to help with prescription drug needs.

Update: The Perdue campaign responds here. 

Beverly Perdue took the strongest step away from Gov. Mike Easley yet on Tuesday.

At a debate on WRAL last night, the Democratic gubernatorial candidate said several times that she would be a "more hand's on governor" than Easley. 

After being pressed by moderator Pam Saulsby to be specific, Perdue said that she would have handled mental health reform differently.

"If the mental health crisis had happened on my watch, I would have been there," she said. "I would have gone into the institutions."

Still, Perdue was careful not to attack Easley too much, adding that he did "a great job" in the budget crisis of the early 2000s and saying she would be different from Govs. Jim Hunt or Jim Martin as well.

Republican Pat McCrory also said he would have handled mental health differently, but he went after Easley and the "power elite" in Raleigh much more forcefully.

"I would not have decentralized the mental health care system without telling anyone about it and then not taking accountabilty for it," he said. "We've had people die in our mental health care hospitals while people are playing cards."

He included Perdue in his attack, noting that she's claimed to be a health care leader and is "second in command" to Easley.

Perdue responded by saying she worked on "physical health, not mental health," and noting that the lieutenant governor is elected independently of the governor.

RALEIGH - A large team of federal regulators arrived at Cherry Hospital on Tuesday to perform a top-to-bottom review of the state mental facility's operations and investigate new complaints of patient neglect and abuse at the Goldsboro hospital.

The group is expected to seek information on the beating of a patient by two hospital employees last week, as well as a previously undisclosed incident from December when a patient fell down a laundry chute.

The increased scrutiny could further imperil the hospital's ability to receive federal money, potentially costing North Carolina taxpayers millions in lost revenue.

The Centers for Medicaid and Medicare Services threatened this month to withdraw federal insurance reimbursements from the hospital after the April death of a patient who choked on his medication, hit his head and then was left sitting in a chair 22 hours while nearby staff played cards and watched television.

Federal officials have accepted a plan submitted by hospital administrators to address the multiple violations cited in a report last week. The surveyors now at the hospital, state employees working on behalf of the federal agency, are charged with making a recommendation by Sept. 1 as to whether Cherry's certification should be withdrawn. (N&O)

The state mental health division wants to start moving mentally ill patients from Dorothea Dix hospital in Raleigh to a new hospital in Butner, even though the division has not met conditions set out in state law for the transfer.

The law required assurances that the new hospital, Central Regional in Butner, would be accredited by two agencies before Dix patients move in, reports Lynn Bonner.

But one of the agencies, the Joint Commission of Accreditation of Healthcare Organizations, has said it will not even visit Central because Dix patients and staff are not there.

That set up a Catch-22, said Dr. Michael Lancaster, co-director of the state Division of Mental Health. Central Regional cannot be accredited because Dix staff and patients are not there, but staff and patients aren't there because it is not accredited.

Lancaster said he would recommend to his boss, state Department of Health and Human Services secretary Dempsey Benton, that Dix patients start moving, and leave the decision up to Benton.
Tomorrow, Dix will stop accepting patients to its geriatric ward. Central Regional will take them instead.

More after the jump.

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