05/10/11 — Cherry official asks for latitude, funding

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Cherry official asks for latitude, funding

By Steve Herring
Published in News on May 10, 2011 1:46 PM

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Cherry Hospital Chief Executive Officer Philip Cook, right, questions local state Reps. Stephen LaRoque, left, and Efton Sager on Monday as to how much longer the hospital would have to pay for mistakes made two years ago -- issues that have been addressed with staff and policy changes. Cook made his comments during a legislative breakfast sponsored by the Mental Health Association of Wayne County.

Cherry Hospital CEO Philip Cook Monday morning asked state Reps. Efton Sager, R-Wayne, and Stephen LaRoque, R-Lenoir, how much longer the facility would have to suffer because of sins of the past.

Cook also argued that the hospital would be able to operate more efficiently and fill long-vacant positions if the administration was allowed more budget flexibility. He said the current system prevents him from doing the job for which he was hired.

LaRoque responded by asking Cook if there hadn't been patient abuse at the hospital and whether anyone had been fired because of it. As for budget flexibility, the danger is far too great for nepotism -- something that LaRoque said has been a chronic problem at the Caswell Center in Kinston.

And any positions that have been vacant for two years probably weren't needed anyway, he added.

There were problems at Cherry Hospital two years ago, and workers were fired and a new administration and policies put into place, Cook said.

He invited Sager and LaRoque to visit the hospital and see it firsthand.

The exchange between Cook and LaRoque came as the Mental Health Assoc-iation of Wayne County's legislative breakfast was winding down Monday morning at Wilber's Barbecue.

The two lawmakers focused most of their brief comments on the budget, painting it as one that will require little adjustments during the second year of the biennium.

Rather than encouraging the state to live above its means as it did under Democrats, the budget matches revenues with expenditures, Sager said. It is a realistic budget, he said.

Cherry Hospital Deputy Director Nate Carmichael asked Sager and LaRoque about the reasoning behind eliminating positions that had been vacant since December 2010.

"We have a number of positions that are difficult to recruit and they have been vacant since December 2010," he said. "There was some wording floating around to eliminate them."

Sager said that was correct and that lawmakers had been given advice on those positions.

"You say you still need those positions, but they haven't been filled?" he said.

LaRoque asked how many of the positions had been filled prior to 2010 that are now vacant.

The vacant positions are for doctors, nurses, physical therapists and others, Carmichael said.

"I have been recruiting say for a psychiatrist in this area since December of 2010 with very little success," he said. "It is a critically needed position but the idea of eliminating just because it hasn't been filled ... ."

Sager asked how many positions had not been filled over the past year. About 30, Carmichael replied.

"If you haven't filled them in a year, then you probably don't need them," LaRoque said. "Kind of like clothes. If you don't wear them in a yea,r you probably don't need it."

The problem is that to compensate the hospital has been forced to hire temporary employees at a higher cos, said Dr. Ken Dunham, the hospital's medical director.

"It is hard to actually get a new person or young person out of training because the state does not pay as much as the private sector," he said. "So what we have to do instead is hire an agency sometimes at twice the rate."

Sager said he felt sure that "all of that" had been coordinated through Health and Human Services Secretary Lanier Cansler.

"(Budget writers) were constantly coordinating with the different agencies," Sager said. "So maybe he is the one who needs to answer that question. We asked first from the different departments what they could afford to give before we started making our cuts. That is the best way to it -- what can you do without?"

Sager said that if changes could be made at a later time that he would be in favor of listening to them. LaRoque said that unlike in the past, legislative committees would continuously meet and tweak the budget. He told Cook that if hospital officials came up with efficiencies that could be implemented, to let legislators know and that some changes might could be made.

LaRoque wanted to know where the funds came from to hire people at twice the rate.

"It comes from lapsing salaries," Carmichael said. "Say I have two physician positions open budgeted at $250,000 and I am hiring one physician at maybe $175,000 or $200,000 because the state is just not as competitive."

Cook said that he thinks it is imperative for Cherry Hospital to grow and develop in terms of service capacity. The hospital currently serves about 180 to 200 patients every day. However, the capacity is 251, he said.

"In order to grow capacity, we are going to need more staff available to do that as we move forward," Cook said.

There is already an average delay of two days in eastern North Carolina for people to get to services, he said.

"Many times, I think, in an ideal world, it would be much better if you were able to set a budget and say, 'Cherry Hospital, Mr. Cook here is what you have to spend to operate Cherry Hospital -- now you have discretion on how you are going to do it, how many people you need and what positions you are going to have,'" Cook said. "I know that is pie-in-the sky thinking, but if you could take that away with you and give thought to the fact that determining what positions we actually need and where we need them versus some other expenditures."

Cook said that is why administrators are hired, but that they lack the latitude to perform the duties they were hired to do.

That model is being used with certain programs, LaRoque said.

"I am not as familiar with mental health," he said "The only problem you run into with a much larger organization is that you run into a lot of, I will call it nepotism for lack of a better word, political hirings and that sort of stuff goes on when you just give somebody money and say, 'Spend it as you choose.'

"It has been tradition in North Carolina that that goes on. It is not that we don't trust you. We will have to continue to put in guidelines for you to follow because we don't want to go back to the bad old days -- the way it has been in North Carolina where a bunch of political hirees, people who can't do the job and somebody else is covering for them, but because they are such and such they are hired. That has gone on for too long in this state."

Cook said he couldn't say it would never happen in a hospital, but that it would be very obvious. Also, there are numerous safeguards in place that would prevent him from acting in a way that would be inappropriate, he said.

"It has happened at Caswell a lot," LaRoque said. "That is one of the things we are trying to get away from."

Mental health in the state also has a black eye because of problems in the past that cost taxpayers $400 million and no one was held accountable even though the person in charge of the program was allowed to retire, he said.

"I think it is going to be a while before we give you more of a free hand," LaRoque said.

Cook agreed, but added that the problem had not been with the state's three mental health hospitals. Accountability is vital, but restraints placed on the hospitals make it hard to operate as efficiently, he said.

It was then that LaRoque launched into his comments about Cherry Hospital's past.

"That could play into that as well," he said.

"At what time are we able to demonstrate performance that allows us to get from under that black cloud," Cook said. "I have been there two years now. We have worked very hard to get past that. I can stand here today as a hospital executive of 25 years and tell you Cherry Hospital is a very good hospital.

"I am not going to tell you we won't have any problems. We have 950 people working there. We have 200 folks at the hospital. Cherry gets folks who will not be served in other settings because of the difficulty of managing them. What does Cherry have to do to get past the black cloud?"

Some newspaper accounts only refer back to what happened two years ago and a lot has changed since then to make it a much better facility, he said.