This is reprinted with permission from The News & Observer of Raleigh.

By Michael Biesecker

and Lynn Bonner

The News & Observer

Among all the failures of North Carolina's eight-year effort to reform its troubled mental health system, Cherry Hospital might be the worst.

Fixing the Goldsboro institution will be a key test for Gov.-elect Beverly Perdue and whomever she appoints as the new secretary of health and human services.

A sprawling rural campus of brick quads and barred windows that could easily be mistaken for a prison, Cherry Hospital is the primary inpatient psychiatric institution for 36 counties in eastern North Carolina.

Federal regulators cut off Medicaid money to the hospital in September after declaring it unsafe for patients. Jack St. Clair, Cherry's director for the past three years, resigned in December, and the hospital is being run largely by a consulting firm. Cherry drew national media attention this fall after the forced release of security camera footage from April, documenting the last day in the life of patient Steven H. Sabock.

In the past year, at least 10 Cherry employees have been charged with assaulting or sexually abusing patients. In November, two health-care technicians were convicted of beating a patient who mouthed off. At their trial, a state prosecutor characterized Cherry as a violent place where staff members have long believed they would not be held accountable for abusing or neglecting patients.

St. Clair, who declined to be interviewed, has portrayed the hospital's problems as more an issue of public relations than systemic shortcomings.

But after Sabock choked on medication, hit his head and was left sitting in a chair for 22 hours without food, water or medical attention, Cherry administrators sent out an urgent internal memo.

"We are a REAL HOSPITAL," it reminded the workers, pleading with them to perform routine medical tasks required of them.

Such problems are nothing new at Cherry. Sabock was at least the ninth person to die under questionable circumstances at the hospital since 2003. Eight deaths were documented by an earlier News & Observer investigation.

When St. Clair came to the hospital as director in December 2005, he had limited experience to prepare him. He had previously served nine years as director of a state home for people with Alzheimer's disease and debilitating developmental disabilities -- patients very different from Cherry's.

Still, he was dismayed by the staff's lack of engagement.

"I see too many staff sitting around, appearing oblivious to their surroundings and to patient behavior," St. Clair wrote in an internal memo in 2006, two years before Sabock's neglect was captured by security cameras. "I see staff literally wandering around campus or engaged in recreational activities without patients. I see patients sitting in day rooms with staff doing nothing. I see little to no direction given to staff by supervisors.

"One of our [health care technicians] sent me correspondence that sums it up this way, 'This is the only place that I know you can come and go as you please, don't work when you are here, tell your ward nurse what you are and are not going to do [without good reason], or just come in complaining.' Folks, this don't get it. Supervisors must deal with this problem immediately."

'In Over His Head'

Ultimately, St. Clair, who supervised the supervisors, could not change the culture.

"I think he was in over his head," said William O. Mann III, a former Cherry psychiatrist. "He was really put into a situation he had no familiarity with. Nor would any hospital administrator. They needed expert advice right off the bat on how to prosecute the abusers and get rid of them."

Mann, whose experience included stints at two state mental hospitals in Pennsylvania, said he saw more cases of patient abuse in the 14 months he worked at Cherry than in the rest of his career. He resigned in disgust in late 2006, after he said he reported a dozen cases of staff members abusing patients but saw little come of his efforts.

Among those he wrote up was William Kenneth Johnson, one of the health-care technicians sentenced last month to four weekends in jail plus supervised probation for beating a patient two years after Mann tried to get him fired.

"These were planned, premeditated attacks," Mann said. "I've never seen anything like it. Abuse occurs in other state hospitals, but having more than one employee coordinating to beat up a patient? It's unheard of. It was a gang mentality."

Brenda Johnson, a nurse who retired after working at Dorothea Dix Hospital and in the state prison system, took a temporary job at Cherry four years ago. She said the violence got worse during St. Clair's tenure. But she stressed that the assaults went both ways -- with staff working in fear of patients who are increasingly desperate and harder to handle.

On Dec. 9, a male patient attacked Johnson, punching her and choking her for nearly half a minute before other employees could pull him off.

"When I walked on the ward that night, I felt like it was like a volcano waiting to erupt," said Johnson, 65. "The man tried to kill me. I honestly felt safer working with death row inmates than I did working at Cherry Hospital."

Replacing Cherry

Administrators of the state Department of Health and Human Services are proceeding with plans to build a $145.5 million hospital to replace Cherry's aging campus.

A 392,000-square-foot building will be constructed at a site just down the road from the old hospital using the architectural plans drawn for Central Regional Hospital in Butner. Central Regional's opening was repeatedly delayed in the past year because of design flaws. A judge recently forbade the transfer of patients from Dorothea Dix Hospital in Raleigh to Central Regional because of safety questions.

Vicki Smith, executive director of Disability Rights North Carolina, the advocacy group that sued to delay Dix's closure, said the state should reconsider building a new mental hospital in Goldsboro.

She fears that Cherry's problems will just be transferred to the new building along with the patients and staff. She said the state should consider building a new hospital for eastern counties in a city that offers a deeper labor pool.

Since Sabock's death, administrators have hurried to squelch rumors circulating around Goldsboro that Cherry would be shut down. The hospital is a major job-generator in Wayne County, having employed generations of local families.

"I think there's some political pressure on political leaders to put these institutions back where they've been historically, because they provide an employment base for people who do live there," said state Rep. Verla Insko, a Chapel Hill Democrat who helps lead a legislative oversight committee on mental health.

State senators pushed hospital construction plans into the budget several years ago.

In her campaign for governor, Perdue backed the position of Dix staff members that patients should not be transferred to Central Regional until all safety and staffing issues were addressed.

In an interview, Perdue said she wants to build a new hospital at the Cherry site while interest rates are low. The hospital's location in Goldsboro should not hinder the recruitment of qualified staff, Perdue said.

The key is to "pay people adequately, train them and continue to retrain them and have an administrator there who has the capacity to run a health-care institution," she said.

Low pay for employees in state mental hospitals has long been an impediment to attracting top-quality staff. Dempsey Benton, the secretary of health and human services, asked the state personnel office last summer to consider raising salaries for health-care technicians and other low-ranking positions where high turnover is common.

Becoming a health-care tech requires no special certification beyond a high school diploma or GED. Starting pay is $11.42 an hour and doesn't get much better with years of experience. About a third of those hired quit within the first year.

ECU Management?

Harold Carmel, a consulting professor of psychiatry at Duke University and a critic of the state's mental health reforms, said the state should consider having East Carolina University manage the hospital and its clinical operations.

"I think it's an obvious solution that has been overlooked," he said.

Having a university manage a state hospital would be unusual for the state. Several years ago, Dr. Sy Saeed, chairman of the Department of Psychiatric Medicine at ECU's medical school, proposed a more typical arrangement: having Cherry's clinical director also hold a faculty position at the school.

Close connections are good for both universities and hospitals, Saeed said. The university benefits from expanded teaching opportunities, and state hospital patients get cutting-edge treatment and high-quality care. Any proposal to have ECU run Cherry would require close study and approval from the chancellor, Saeed said.

Whoever takes over the hospital will face monumental challenges, including figuring out how to stop beatings of patients and staff.

Larsene H. Taylor, a health-care technician at Cherry for more than 16 years, said there are plenty of good workers at Cherry ashamed by the reports of abuse and neglect at the hands of their colleagues. She has considered peeling off the sticker on her car that identifies her as a Cherry employee.

"It's embarrassing," Taylor said. "We've got some bad seeds."