N.C. aims to improve Broughton Hospital

State aims to improve mental facility after patient death
Plan: Regain hospital funding

Tuesday, Sept. 25, 2007

By Marcie Young
Charlotte Observer Staff Writer

The state will improve supervision, communication and training at Broughton Hospital to prevent the kinds of problems that led the federal government to cut its Medicaid and Medicare funding in August.

A Department of Health and Human Services team that evaluated Broughton this month found problems that may have contributed to the death of one patient, who died after being restrained by a staff member, and an injury to another.

The team found that top medical personnel had grown distant from the healing process and the clinical staff was not being properly supervised or getting enough training.

"We need to put more emphasis on training and supervising staff to therapeutically communicate with patients," said Jim Osberg, chief of state-operated services with the Division of Mental Health. "That should help to prevent some of the needs for restraint."

Division directors, who are among the top-level employees at the hospital, must be more accountable and responsible for patient care and staff, said Dr. Michael Lancaster, the state's chief of clinical policy, who led the evaluation team.

Over the years, Lancaster said, directors who oversee the divisions of nursing, psychiatry, social services and psychology have become more like administrators than caretakers.

"They are our best-trained and our most-qualified people," he said. "Staff is getting hands-on direction from their supervisors, but what we're looking for is more accountability from the (division) leaders."

Lancaster, who will lead the reorganization, said he does not expect anyone to be fired as a result of the changes. "There was no malintent on anyone's part here," he said.

He expects to have a reorganization plan in place within a month, and he hopes the federal government will approve Medicaid and Medicare payments to Broughton within two months, he said.

"We have to be comfortable that this is the right thing and staff is comfortable," Lancaster said. "We do not want to be premature. I'm more considered about getting it right than doing it quickly."

The state doesn't conduct regular reviews of service at its state hospitals, Osberg said, but has created a department at each facility to make sure patients are getting safe and quality care.

"Of course that's one of the things we are looking at now," he said. "Do we need some sort of (system of review)?"

The federal government has threatened to stop Medicare and Medicaid payments to other hospitals in the past, he said, but the state had always been able to fix problems before funding was pulled.

The federal government also is considering stopping Medicaid and Medicare payments to Cherry Hospital, a state psychiatric hospital in Goldsboro, but Osberg said the problems are being fixed, and he doesn't expect to lose federal funding there.

Broughton receives about $1 million a month in Medicaid and Medicare funding. State officials are waiting until they know how much money it will lose before they adjust the department's $713 million budget to cover the gap, said Mark Van Sciver, spokesman for the N.C. Department of Health and Human Services.

The federal government will review the plan and make at least one unannounced visit to the hospital to check its progress before deciding whether it should reinstate payments, he said.

About Broughton
Broughton Hospital in Morganton, one of four state mental health hospitals, serves North Carolina's 37 western counties.Voluntary and involuntary patients are directly admitted or referred through outpatient providers. About 4,000 patients are treated each year. The hospital has a $98 million operating budget and about 1,200 employees.

SOURCE: Broughton Hospital

Recent Problems
In February, 27-year-old Anthony Lowery, a Broughton patient with schizophrenia, died of asphyxia after a staff member sat on his torso, according to an autopsy report. Lowery tried to bite the man during that time, the report said. No charges have been filed.

As the federal government finished its investigation into Lowery's death, another patient was injured on Aug. 19. The patient, who was supposed to be under close supervision, fell and hit his head while he was unattended. He was recovering when the federal government decided to stop Medicaid and Medicare payments.


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