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Mentally ill, addicted to pain pills, homeless at 53, Betty Ann Scott went through jail, hospitals, rehab, every place but where she wound up the afternoon of Feb. 15.

For once, her hospital stay would be long — 15 days. But there is no treatment here, and the room temperature is 42 degrees in this part of Moses Cone Hospital: the county morgue, where Scott was dead on arrival after a suspected drug overdose.

Her ambulance ride took three minutes, no flashing lights, from a Yanceyville Street apartment rented by Recovery Innovations. That is a low-rules, private-contract program intended to divert mentally ill people from costly stays in state psychiatric facilities.

She was diverted after an entry-level peer counselor on duty found her dead, according to former workers. At Moses Cone, Scott ended up as an unclaimed body, until Guilford County Department of Social Services determined once and for all that Scott’s next of kin would not pay for her funeral.

Moses Cone then agreed to release Scott’s remains to friends. At 12-step program meetings in Glenwood, they had passed the basket to pay for a cremation and arranged for the Rev. Frank Dew to say a funeral March 8 at New Creation Community Presbyterian Church.

So when asked Friday about Scott’s death, Lanier Cansler, the state’s newly appointed secretary of Health and Human Services, said it was hard to answer “without knowing all the pieces.” But Cansler, in Greensboro for a conference sponsored by the Mental Health Association, said there is mounting concern over lack of oversight in an outsourced public system designed to work like a private HMO.

Cansler had barely taken the reins of the $2.6 billion system when the National Alliance for Mental Illness recently gave the state a “D” on its annual report card, and an “F” for “family and client empowerment.”

“There’s no continuity of care under reform,” Cansler, a former state lawmaker and health care industry executive, said in an interview Friday about the eight-year effort to privatize services and close large state hospitals. “In some cases, we threw the baby out with the bathwater.”

In the case of Scott’s death, a spokeswoman for Cansler said the local mental health authority, the Guilford Center, had done an investigation and found no negligence on the part of its private contractor, the Phoenix-based Recovery Innovations.

But according to the Guilford Center’s community relations manager, Anne Kimball, the incident report on Scott’s death is considered confidential client information covered by the federal HIPAA Privacy Rule and will not be released.

Meanwhile, there was no answer Friday at either phone listing published for Recovery Innovations, and director Tom Bufkin’s personal phone mailbox was full and could not receive messages.

As of Friday, the Office of the State Medical Examiner had not yet determined the cause of Scott’s death.

Sheri Paris, a former recovery coach at the nonprofit, said Scott had only been in the program three days when she was found face-down in a fetal position in her apartment at Dogwood Creek.

Property manager Dennis Keller, who lived two doors down, said it was the second time in two days EMS had been to the apartment, but the first time, Scott refused to go.

At Grace Community Church on West Lee Street, where Scott had stayed for a few weeks at the winter overflow shelter for women, an outreach minister said volunteers felt Scott’s medical problems were too severe for the shelter to handle.

Grace Outreach Director Marshall Benbow said Scott was kind and well-liked, but had a back injury and was prone to falling, which made volunteers fearful that Scott might injure herself.

In severe pain after a car accident, according to her friend Teresa Huffman, Scott had battled not only long-term alcoholism but pain pill addiction, causing her to lose her apartment on Glenwood Avenue.

Estranged from her family and two grown children, friends at the Unity Club in Glenwood said, Scott was an unemployed furniture assembly line worker who suffered from worsening depression toward the end of her life.

“She had a real hard time there at the end, and she was getting put out of her place,” said Huffman, who met Scott in 2001. “I could see something bad was going to happen.”

Mike Weaver, president of the local chapter of NAMI, said the case raises questions about whether such “diversion” programs have enough supervision and experienced staffing, or whether Guilford County simply needs more local hospital beds for people in psychiatric and substance abuse crises.

Currently, both state psychiatric hospitals for this region are operating at capacity — the new Central Regional Hospital in Butner and Dorothea Dix — amid devastating reports of patient abuse and deaths.

The new administration in Raleigh has made a pledge, reiterated in Cansler’s speech Friday at Elm Street Center, of a “zero tolerance” for negligence and abuse.

The reality in the interim, given the hospital bed crunch, is that beat patrol officers, social workers and magistrates will have more contact with mentally ill people returning to the community from state hospitals, as Greensboro Police Chief Tim Bellamy noted in a recent talk at the High Point Road Merchants Association.

Under the law, notes Guilford Center Director of Nursing Paula Snipes, people can only be committed for treatment if they are a danger to themselves or others. But Snipes also emphasizes that mentally ill people can be a danger to themselves if they are incapable of taking care of themselves.

“Last night, someone brought in a man who had just come into town who was yelling and hollering in the parking lot at nobody,” Snipes said. “You might say he wasn’t 'a danger’ to anyone. But if he’s unable to maintain his own basic needs, that’s a danger to himself.”

The question is, where do police take him, if the Guilford Center doesn’t have a bed?

Not jail, warns Maj. Debora Montgomery of the Guilford County Sheriff’s Department, unless he is accused of a crime.

Which is not to say that people showing signs of mental illness aren’t sometimes accused: In 2008, a total of 1,140 inmates in the Greensboro and High Point jails were in need of mental health services, according to Montgomery’s staff, averaging 87 per month.

And in some cases, jail becomes a revolving door — or “three hots and a cot.”

Case in point: The man who showed up last week in the police blotter, charged with a purse-snatching in the parking deck next to the Central Library.

He has a long prison record spanning two decades. Where does he get his mail? Grace Community Church.

Which leads us back to the church overflow shelter where Betty Ann Scott found herself last winter when she lost her apartment in Glenwood.

When Grace volunteers later brought her to the Guilford Center, worried about her condition, it is unclear where she went from there — either to a Charter-type facility for a short stay, or straight to Recovery Innovations.

One thing is clear. When the new Cabinet secretary delivered an applause line to the Mental Health Association in Greensboro on Friday about listening to “consumers” and “people on the ground,” Scott’s story wasn’t the testimony he had in mind.

It was a two-sentence obituary in the paper, no survivors to list, nobody who could even rustle up a photograph of her for the memorial service.

“When you feel so hopeless that she just couldn’t go on ...” said Huffman, recalling that Scott hadn’t seen her children for many years.

“She really needed to be somewhere where they could keep an eye on her, a hospital where they had doctors. She went to the Guilford Center. Years ago, they had a really good program, then they started cutting everything. Now, they see you 5 or 10 minutes, and write you a prescription. Of course, you can’t blame what happened on that.”

Wednesday morning, when the rest of the women left the Grace Church shelter for the last time, they graduated to a program called “Hope for Tomorrow.” The volunteers were supposed to feel they had done a good turn. No one froze to death. No one died in her car.

The truth?

The last time that Benbow, the Grace outreach minister, saw his group, he left them at a budget motel with some food from the pantry and bus passes, waiting for their jobs to start.

“So it’s raining. It’s cold. I’m driving down Elm-Eugene and I see this woman with a suitcase and a garbage bag on top walking past those guys on the block,” he said. “And all I see is hurt. It’s not fixed. Their situations aren’t 'transformed.’ ”

Contact Lorraine Ahearn at 373-7334 or lorraine.ahearn@news-record.com