December 4, 2007

David Deutsch
U.S. Department of Justice
Civil Rights Division
950 Pennsylvania Avenue NW
Washington DC  20530

Richard Slipsky, JD
Special Deputy Attorney General
Department of Justice
P.O. Box 629
Raleigh NC  27602-0629

Dear Attorney Deutsch and Slipsky,

Please find in this email reports on the four North Carolina state hospitals pursuant to my charge in this matter.  All materials are being communicated to you electronically with two exceptions:  1) the annotated Treatment Plans from Dorothea Dix Hospital and 2) components of the medical record of one Cherry Hospital patient.  These are being mailed to Mr. Slipsky for distribution.

The reports speak for themselves.  However, I was asked by Mr. Deutsch to provide my conclusions in regards to compliance.  These follow.

John Umstead Hospital and Cherry Hospital are in substantial compliance.  Each hospital has shown outstanding development over the course of this Agreement.  Each has staff who spent a considerable part of their work week devoted to the improvement of the hospital.  Significant staff education was provided, often by these same individuals themselves.  The hospital staffs responded well.  The outcomes brought the hospitals into practices meeting the standard of care in most regards.

Dorothea Dix Hospital and Broughton Hospital are at best at partial compliance.  Neither was able to accomplish what Umstead and Cherry were able to do.  This is, in part, due to staffing, especially at Broughton Hospital.  Broughton does not have the person power at this time to manage the tasks it must accomplish to function to the standard of care.  Dix seems to be suffering from its transition to the Central Regional Hospital.  One psychiatrist is asked to do three jobs.  The same was true at Cherry Hospital, but that psychiatrist was basically willing to just about live at the hospital to get what needed to be done, done.

John Umstead Hospital and Cherry Hospital would appear to have sustainable change.  There is every reason to believe each can effectively manage its own future while meeting standards of care.  Dorothea Dix Hospital and Broughton Hospital have not achieved an acceptable standard of care so their abilities to sustain a standard of care are moot at this time.

Please feel free to contact me if there is anything unclear about this communication or anything in any of the four (4) reports.

Sincerely,

Jeffrey Geller, MD, MPH

JG:vab