A shiny gold logo on the Georgia West Central Hospital Web Page says, "Joint Commission/ National Quality Approval".

 "WCGRH is accredited by the Joint Commission", boasts the page.

But on Sunday, May 6 2007, Luis Marrero, a patient at West Central Georgia Regional Hospital was severely beaten by another patient badly enough to cause brain hemorrhage and break several bones in his face. Nearly two weeks later on Friday May 18, his condition was considered hopeless, and his family made the decision to remove him from life support.

A short eight hours drive north, nestled in the Blue Ridge Mountains of Virginia, the New River Valley Community Services (NRVCS) serves mentally ill citizens. Their "Newsroom" Web Page has a stylized CARF (Commission on Accreditation of Rehabilitation Facilities) logo and claims that its programs "are of the highest quality, measureable, and accountable"; although ironically the page, dated April 20 2007, neglects to mention that four days earlier in the New River Valley, at Virginia Tech, student Seung-Hui Cho killed 33 people including himself.

 NRVCS was supposed to have recommended a specific course of treatment plan for gunman Cho, but failed to do so, and NRVCS Executive Director Les Saltzberg linked the failure to funding problems at the agency, saying "It's been several years since we've been able to afford to have someone there every day just in case."

That failure raises troubling questions about the NRVCS's certification, according to one Virginia mental health advocate, Cynthia Moon.

"A decision to stop participating in mental health hearings should have been documented at the highest levels", said Moon, "and if there was a funding problem, the Board of Directors should have been informed. As a board member I would be . . . livid if I was left out of that decision. It's lame to say you stopped performing a core agency function for lack of funds and then waited until after the biggest mental health disaster in history to make that generally known."

Furthermore, Moon expressed concern about the agency's Carf certification. "Certification is all about quality control", said Moon, "and to the public, quality control is about trust. It means you can trust these agencies and hospitals to say what they are going to do and follow through. Carf and the Joint Commission are selling trust, and when people stop trusting them, they don't have a product to sell."

Other mental health advocates point to major inconsistencies in ratings between CARF and the Joint Commission, and those of NAMI (the National Alliance on Mental Illness), which in 2006 released what they describe as a ""Report Card on America's Health Care System for Mental Illness". Both Virginia and Georgia scored a grade of D in the NAMI ratings.

But questions about accreditation have come up before in Virginia. In 1996 three inspectors from the Joint Commission on the Accreditation of Healthcare Organizations did an onsite review of Virginia's Central State hospital in, The inspectors gave the facility a glowing recommendation and a score of 92 points out of 100; but they failed to notice Gloria Huntley, who was restrained (strapped in) for 558 hours in the last two month of her life, and whose heart had blown up to 150 percent of its normal size. The day after the inspection, Ms. Huntley died.

Val Marsh, then director of the Virginia chapter of NAMI, asked the following question -- "How could JCAHO give Central State the highest rating in human rights when they were killing people?''

The Hartford Courant, commenting on the tragedy, noted that, "Of the more than 5,000 general and psychiatric hospitals that the Joint Commission inspected between 1995 and 1997 none lost its accreditation as a result of the agency's regular inspections."

An historical pattern of failure by accreditation agencies is important for legal reasons. Commenting on the liability of CARF in the Virginia Tech tragedy, George Mason Law Professor John C. Whitbeck Jr. said it was unlikely that a single mistake by a certifying authority would be grounds for a successful lawsuit, but that a pattern of mistakes or actions that could be interpreted as misrepresentations would be another matter.

"While I think it would be extremely unlikely that a lawsuit against a state agency would be successful in an individual instance", said Whitbeck, "there is a much more tenable lawsuit against a private organization that holds itself out as an expert in giving opinions. It would require a pattern of misrepresentation; and if that pattern were established, then surely you would have a sustainable lawsuit."

Also, in the past, potential litigants have been frustrated in attempts of seek judicial relief from public mental hospitals and mental health agencies because such agencies are generally protected by sovereign immunity. Sovereign immunity is rooted in a principal of early English law that holds that a King or a government cannot commit a wrong and is therefore immune to civil or criminal prosecution; and in general a state, its employees, and its institutions are largely protected from lawsuits; or, in many cases, there are relatively low caps set on the damages that a court can award if they are found to be liable.

But CARF and the Joint Commission are private agencies and do not enjoy the protection of sovereign immunity, and in the future may be targeted by civil lawsuits claiming negligence in instances where they held themselves out as experts in quality and safety but failed to adequately warn the public. Such a lawsuit might pivot on a highly technical set of questions about the role of the certification authority in evaluating a mental health agency or hospital.