San Francisco City Attorney Dennis Herrera on Monday opened a formal investigation into whether the state of Nevada improperly "dumped" psychiatric patients in his city and throughout California.
In a letter to the director of Nevada's Department of Health and Human Services, Herrera demanded that the state turn over documents related to its aggressive practice of discharging patients from a Las Vegas state mental hospital via Greyhound bus and transporting them to cities across America.
The letter, copied to Nevada Gov. Brian Sandoval and Nevada Attorney General Catherine Cortez Masto, cites a Bee report that found the Rawson-Neal Psychiatric Hospital in Las Vegas bused roughly 1,500 patients from July 2008 through early March 2013, sending at least one person to every state in the continental United States.
Rawson-Neal bused 500 patients to California during that period, according to a Bee review of Greyhound bus receipts purchased by Southern Nevada Adult Mental Health Services, which oversees the hospital.
One of the hospital's clients, James Flavy Coy Brown, recently turned up suicidal and confused at a Sacramento homeless services complex after he was sent by Greyhound to the capital city – a 15-hour bus ride – with no preparation for his housing or treatment.
The director of San Francisco's Behavioral Health Services department told The Bee earlier this month that at least two Rawson-Neal patients had arrived in San Francisco in the last year "without a plan, without a relative."
In the past five years, Rawson-Neal has bused 36 psychiatric patients to San Francisco, according to The Bee's review. Among the issues the city attorney will probe is whether Nevada was routinely busing mentally ill patients across state lines with no plan for their care.
"Assuming the reports are true, Nevada's practice of psychiatric 'patient dumping' is shockingly inhumane and illegal," Herrera said in a statement. "We intend to investigate these reports thoroughly, and I am inviting input from providers of services to San Francisco's homeless, who may be willing to volunteer evidence and testimony to assist the city in a potential civil action."
Herrera said the city would seek compensation from Nevada if it determines that patients have been transferred improperly.
"We're prepared to litigate aggressively on behalf of San Francisco and its taxpayers to recover whatever costs or damages we're able to identify," he said.
Nevada health officials have acknowledged that they erred in shipping Brown to Sacramento without any arrangements for care. But they maintain that his case was an exception and that the vast majority of those bused from Rawson-Neal have family or treatment waiting for them on the other end.
Between 2009 and 2012, Nevada slashed its mental health budget to address deficits, reducing spending by 28 percent. During that same period, the number of psychiatric patients bused out of Rawson-Neal grew 66 percent. By last year, the hospital bused out patients at a pace of more than one a day, shipping nearly 400 patients to 45 states.
Nevada Health and Human Services director Michael Willden did not return calls for this story. But he told the Las Vegas Sun, in a story published Saturday, that the spike in patient busing was not a reflection of budget cuts. Instead, he attributed the rise to a policy change in 2009 that removed administrative oversight from the busing decisions.
Mary-Sarah Kinner, spokeswoman for Sandoval, said the governor visited Rawson-Neal on Friday and talked extensively with the hospital's administrator.
Kinner said hospital officials have completed two investigations and are in the midst of a third, and that, as a result, have undertaken "a corrective plan of action." But she also defended the state's busing policy, saying Las Vegas is an international destination that draws people from across the United States.
"Rawson-Neal regularly treats patients who reside outside of Nevada," she said. "Once a patient is stable, Rawson-Neal provides patients with assistance in returning to the home of the patient's choice, as is the patient's right and which most patients choose to do.
"The governor supports the new strengthened discharge procedures and is committed to continuing to treat patients with a high level of care," Kinner said in an email.
Nevertheless, several other agencies are pressing forward with examinations of patient care at Rawson-Neal.
A spokeswoman for the Joint Commission, which certifies hospitals across the country, said last week that the organization is "aware of complaints around the discharge issue" and is gathering information to determine whether a special on-site survey is warranted.
The U.S. Centers for Medicare and Medicaid Services, a federal watchdog agency, also is reviewing Rawson-Neal's discharge practices.
The city of Los Angeles – which received 149 patients from Rawson-Neal during the five-year period The Bee reviewed – is gathering information to see if an investigation is warranted, officials there said.
In San Francisco, the city attorney's office has asked Nevada to provide details on patients bused out of state since July 2008, documents related to any discharges that have been challenged, copies of any citations from federal and state regulators, and documents detailing Rawson-Neal's public funding, among other items.
The discharge practices at Rawson-Neal "may be civilly actionable under federal, state and local laws," city attorney Herrera wrote in his letter.
Call The Bee's Phillip Reese, (916) 321-1137.