Winston-Salem Journal

Recent stories about the mentally ill waiting days for help in local hospitals are a heartbreaking part of a much larger problem. Every day, people with mental problems fill emergency rooms, jails and homeless shelters across North Carolina. This state has failed them and their families miserably. The costs in human and financial terms are high. As legislators hammer out their budget, they must include enough money to begin to correct the many flaws in the state’s mental-health-care system.

A local man having a mental-health crisis recently spent more than eight days in the emergency department at Forsyth Medical Center, at times handcuffed by Winston-Salem police, before being admitted late last month, the Journal’s Richard Craver reported. “Having someone having to wait that long for mental-health assistance, even as their basic needs are met, is getting excessive and almost cruel,” said Andy Hagler, the executive director of the Mental Health Association in Forsyth County. “Would we keep someone dealing with Alzheimer’s disease or a major chronic medical issue waiting like this?”

He blames the state’s flawed overhaul of its mental-health-care system. “It’s not Forsyth Medical Center or really any of the medical centers or the police,” Hagler said. “The sad fact of the situation is that this is the fallout of mental-health reform, and also just a bad economy.”

The overhaul was supposed to shift the responsibility of providing care from state psychiatric hospitals to community programs. But Joe Raymond, the director of Forsyth County’s Department of Social Services, said the long ER stays “appear to be the latest symptom of a system that has been destroyed with uncertain plans to fix it.”

The eight-day stay was the longest in recent memory, but officers say a wait of several days is not unusual. Winston-Salem police had to stand guard over a mental patient at Forsyth Medical Center for at least six days last summer, one of more than 1,000 involuntary-commitment calls to which the department responded last year. Forsyth Medical and other hospitals statewide have limited bed space for the mentally ill.

In early May, a Greensboro psychiatric patient spent five days in Moses Cone Hospital’s emergency room before a bed came open at the state’s packed Central Regional Hospital. Reidsville Police Chief Reece Pyrtle told the Greensboro News & Record’s Lorraine Ahearn that his officers have guarded a patient for 96 hours.

Such cases are called “ER dumping,” and Forsyth mental-health advocates worry that it could be on the rise.

“I’m just concerned that with all the talk of budget cuts for mental-health care, we’re going to see more of these situations happening,” Hagler said.

Care in some of the state’s hospitals leaves much to be desired. Patients’ releases are sometimes delayed because of a lack of appropriate housing. Old Vineyard Behavioral Services, with the help of CenterPoint Human Services, is pursuing a certificate of need for a Winston-Salem center that would have 50 beds and a 24-hour psychiatric-emergency department. But the center, if approved, is at least 18 months away.

The state has been trying to correct the problems caused by its overhaul. But if legislators cut money from the human services budget, as they’re considering doing, the problem-solving process could be further stalled. “What do you think will happen if these services get cut?” asked Betty Taylor, the area director for CenterPoint. “The streets, the jails and the ERs will be flooded.”

One section of the Forsyth County jail for people with mental problems usually stays full as it is. ER doctors and nurses, deputies and police officers will be further burdened with a problem that they’re ill-equipped to handle. Winston-Salem police and Forsyth deputies receive special training to deal with people having mental-health crises, but they shouldn’t have to handle so many of these cases that it takes them away from protecting citizens on the streets.

Sheriff Bill Schatzman said his deputies spend numerous hours on the road taking people to the state hospitals. “We’re basically armed cab drivers,” he said. “We’re just pawns. We follow the magistrates’ orders and the docs’ orders.”

Winston-Salem officers spent more than 5,000 hours on involuntary-commitment calls last year, according to Assistant Chief Barry Rountree. Those calls cost the department at least $250,000, said Chief Scott Cunningham.

The emergency department at Wake Forest University Baptist Medical Center spent more than $740,000 on staffing costs in the last 12 months to handle involuntary commitment calls, officials there said.

Because of the system-wide flaws, problems often aren’t handled in visits with psychiatrists and psychologists. They escalate into crises that can endanger the public and are costly for emergency rooms and law-enforcement agencies. “There are a lot of dollars being used that probably the public doesn’t see when it comes to mental health,” Hagler said. “We’re just spending all this money back-door. It’s not the most efficient use of resources.”

Many patients with mental problems lack insurance, and that problem is increasing as people lose their jobs. Hospitals and insurance companies may pass the cost of treating them to the rest of the public through higher rates.

Local leaders have been working hard to solve the problems caused by the overhaul but have a long way to go, especially in regard to providing more accountability and transparency in the process. State legislators should support their efforts by keeping cost-cutting on mental-heath services to a minimum.

Money spent now could reduce the human and emotional toll the failed overhaul has visited upon this state for too long. We can no longer afford this shame.

By James Romoser.
Journal Raleigh bureau.
RALEIGH, N.C. — State legislators are considering taking away a privilege that hospitals have zealously guarded: their tax-exempt status.

A proposal by Democrats in the N.C. Senate would force large nonprofit organizations to start paying some sales tax on purchases they make. Hospitals say that would cost them millions of dollars at a time when their budgets are already stretched thin by the economic recession and the rising number of uninsured patients.

“This will compromise our ability to take care of the most vulnerable,” said Dr. John McConnell, the chief executive of Wake Forest University Baptist Medical Center.

Legislators, meanwhile, are grappling with their own financial crisis – a projected $3.4 billion shortfall in the state budget. They say they are trying to overhaul the state’s tax system to make it more stable and more fair.

“We’re not trying to gore anybody’s ox here in particular. But we’re just saying we have got to have some help from all segments of our economy,” said state Sen. David Hoyle, D-Gaston.

Hoyle is one of the primary architects of a large package of proposed tax changes that Democrats unveiled last week. In general, they are hoping to lower most tax rates while eliminating many tax deductions and expanding the range of goods and services that are taxed. The changes would generate $1.2 billion in new revenue over the next two years.

Different elements of the plan have already riled up various interest groups. The provision affecting hospitals promises to be one of the most controversial.

“You’re going to have a lot of calls about it,” Hoyle warned fellow legislators Wednesday.

Currently, hospitals are charged the regular sales tax – 6.75 percent in most counties – on all of their purchases, from office supplies to x-ray machines. But at the end of the year, the state gives each nonprofit hospital a refund for virtually all of the sales tax the hospital paid.

North Carolina has a few for-profit hospitals, most are nonprofit. They get their tax-exempt status because they provide “charity care” – free care to patients who have no insurance and can’t afford to pay their medical bills.

The Senate’s proposal would, for the first time, limit the sales-tax exemption. It would put a $5 million cap on the annual sales-tax refund that a nonprofit organization can receive. Any sales tax that a nonprofit organization pays in excess of $5 million would have to come out of its own pocket.

The proposal applies to all nonprofit organizations, but in practice it would affect only the largest ones: mainly hospitals and possibly a few universities.

In Winston-Salem, the economy is largely dependent on the county’s two major hospitals. Both would be affected by the cap on sales-tax refunds.

Baptist Hospital said that it received $8.3 million in sales-tax refunds last year. The Wake Forest University School of Medicine received an additional $5.3 million in sales-tax refunds.

Novant Health, which owns Forsyth Medical Center and eight other hospitals in North Carolina and South Carolina, said that it got $22 million in sales-tax refunds last year.

The Senate’s tax plan calls for lowering the overall sales-tax rate – so the hospitals’ sales-tax bills would be expected to go down slightly. But they would still exceed the $5 million refund cap.

“The challenge that the Senate and state government has overall is how do you fill this big gap that they have?” said Jim Tobalski, a senior vice president at Novant. “I just think they miscalculated and they erred by looking at not-for-profit hospitals. We are already shouldering a large burden of the current economic crisis.”

Tobalski said that Novant lost $187 million last year. A big reason for the loss is the growing number of uninsured and under-insured patients. Over the past two years, North Carolina had a 22.5 percent jump in the number of people without health insurance – the biggest increase in the nation, according to the North Carolina Institute of Medicine.

Senate leaders said that it could be weeks before the Senate votes on the tax plan, and Hoyle said that the tax-refund proposal is not set in stone. But he said the state cannot afford to keep its current policy.

“We are asking everybody to put a little skin in the game,” he said. “We can’t continue to grant refunds in total to a lot of nonprofits.”

The N.C. Hospital Association began lobbying against the proposal the moment that it learned of it last week.

The association estimates that capping sales-tax refunds would cost North Carolina hospitals $100 million a year. The association also worries that the proposal could set a dangerous precedent.

“The larger picture is that this begins to threaten not-for-profit tax-exempt status,” said Don Dalton, a spokesman for the hospital association. “If you have a conditional tax exemption, then you don’t have a tax exemption.”

In Forsyth County, local officials have frequently expressed frustration that the major hospitals, which own so much property in the county, do not have to pay taxes like other businesses.

“Charity should be earned – it shouldn’t just be the nature of who you are, it should be what you do,” said Pete Rodda, the county’s tax assessor and collector. “I’ve always said that the property-tax exemptions, and in this case sales-tax exemptions, should be earned through their charity care.”

Rodda said he is not sure if the two local hospitals fully “earn” their tax exemptions.
Baptist said it spent $41 million on charity care last year. Novant said it spent $116 million on charity care.

“If you try to chip away at tax exemptions, while the number of uninsured and the amount of charity care is almost doubling, those two factors create a crisis that I don’t think anyone wants to imagine,” Tobalski said.

RALEIGH, N.C. – North Carolina state Rep. Becky Carney has returned to a Raleigh hospital a day after she was released following treatment for a heart condition.

The House Principal Clerk’s Office said Carney was readmitted Monday and was being tested for a possible infection. Carney had been released Sunday from Wake Med hospital.

Wake Med spokeswoman Heather Monackey said Carney was in good condition Monday afternoon.

The 64-year-old Carney collapsed at her legislative office last Thursday and went into cardiac arrest due to a heart arrhythmia. A colleague said the four-term Mecklenburg County Democrat had no pulse but was revived thanks to CPR and a defibrillator.

Doctors implanted a combination pacemaker and defibrillator on Carney’s heart late last week.

RALEIGH, N.C.  – A North Carolina lawmaker has been taken to a hospital after collapsing in her office while talking on the phone.

Rep. Becky Carney of Mecklenburg County was taken to Wake Med hospital in Raleigh on Thursday after police and emergency personnel rushed to her office in the Legislative Building.

Carney’s eyes were open as she was carted away on a stretcher. There was no immediate word on her condition.

Another legislator, Dr. Bob England, said Carney went into cardiac arrest and had no pulse but was revived thanks to CPR and a defibrillator in the building.

Carney is 64 years old and a four-term House member. She previously served as a Mecklenburg County commissioner.

RALEIGH, N.C. – Gov. Perdue made an unannounced visit to Cherry Hospital Friday. The visit was a follow up on Gov. Perdue’s pledge to make on-site accountability inspections of state agencies across North Carolina. She was accompanied by Department of Health and Human Services Secretary Lanier Cansler.

“Today I let the leaders of Cherry Hospital know that I’ve raised the bar for state government,” said Gov. Perdue. “With dedicated, hands-on leadership we can work to ensure that North Carolina’s mental health institutions provide high quality patient care. As Secretary Cansler said ‘we will have zero tolerance for patient abuse or mistreatment.’”

During her 90-minute visit Gov. Perdue toured Cherry Hospital, met with hospital administrators, viewed patient care units and spoke to patients and caregivers. 

“I share the governor’s vision of a mental health system that is the gold standard of America,” said Secretary Cansler, “Not only will I be back to Cherry Hospital, but I plan on visiting all of North Carolina’s mental health facilitates.”

Will reports on deaths in the mental health system be more available under a new administration?