An independent accreditation agency dispatched a team of investigators to Nevada's primary hospital for the mentally ill on Thursday as concerns mounted that the facility has been "dumping" patients into other states.
Surveyors from the Joint Commission, which accredits health facilities across the country, arrived unannounced at Rawson-Neal Psychiatric Hospital in Las Vegas. Their report could determine whether the state hospital can keep its federal funding and "gold star" accreditation status.
Meanwhile, Sacramento City Attorney James Sanchez has joined legal authorities in Los Angeles and the Bay Area in pressing for details about the cases of hundreds of mentally ill patients from Rawson-Neal who were given one-way Greyhound tickets to cities in California over the past five years.
"From our standpoint, this apparently was not a single instance of someone being bused somewhere without services," said Sanchez. "We feel it could be a significant number of cases, but we won't know for sure until we get into the files."
The Las Vegas hospital and its umbrella agency, Southern Nevada Adult Mental Health Services, have been under fire since a Bee investigation last month revealed that the facility has bused roughly 1,500 patients to cities and towns across the nation since 2008, sending people to every state in the continental United States.
The cities of San Francisco and Los Angeles have launched criminal probes to determine whether Nevada was systematically dumping indigent patients across state lines. The hospital's practices are also under scrutiny by the Center for Medicare and Medicaid Services, which oversees federal funding for health facilities, and the Joint Commission.
Elizabeth Eaken Zhani, spokeswoman for the Joint Commission, confirmed that the agency sent surveyors to the hospital Thursday. Their inspection was a response to possible violations of standards that cover "provision of care" as well as "rights and responsibilities" of patients, Zhani said.
At worst, negative findings by the Joint Commission and CMS could result in the psychiatric hospital losing federal dollars and its "gold star" accreditation status. That rarely happens, however. Most often, hospitals submit evidence of corrective action that would put them into compliance with federal standards.
Nevada Department of Health and Human Services spokeswoman Mary Woods said her agency welcomes the scrutiny.
"We have said from the beginning we were expecting an unannounced visit from CMS and the Joint Commission as part of the review process we requested," she said. "We welcome these inspections and reviews from highly trained professionals with outside views, because they help us either improve our current processes or affirm proper procedures are already in place."
The survey played out as the Sacramento city attorney, along with city attorneys from San Francisco and Los Angeles, and county counsels representing Alameda and Santa Clara, waited for a response to their request for a joint meeting with Nevada Attorney General Catherine Cortez Masto to discuss Rawson-Neal's discharge practices.
In a letter dated Monday, the attorneys said they also want to find out "how Nevada may best assist us" in identifying patients who were dispatched to their jurisdictions "so we may ensure that they receive necessary medical care or medications."
Nevada officials have shielded the identities of those clients, citing federal law that protects patient privacy. They maintain that most patients bused out of state were being sent to their "home communities" and had support services, family or friends at the other end.
The Nevada attorney general's media office did not return a call for comment Thursday.
The Bee's investigation, published last month, found that Southern Nevada Adult Mental Health Services paid to bus roughly 1,500 patients out of southern Nevada since 2008. About 500 of those patients were sent to California.
The practice came to light after one of Rawson-Neal's patients, James Flavy Coy Brown, turned up suicidal and confused at a Sacramento homeless services complex in February. Brown, 48 and suffering from schizophrenia, had been living in shelters in Las Vegas for years.
He was discharged from the psychiatric observation unit at Rawson-Neal to a Greyhound bus bound for Sacramento, a place where he knew no one and had never visited. He said Rawson-Neal staffers told him to call 911 when he arrived.
With the help of Sacramento police and social services workers, he ended up in the UC Davis Medical Center emergency room, where he lingered three days before social workers found him temporary housing.
In their letter to Nevada's attorney general, the city attorneys and county counsels said they did not believe Brown's case was isolated.
"Our own investigations, although still in preliminary stages, have confirmed that Nevada's practice of transferring mental patients to California without an escort and without prior arrangement for an institution or responsible person to receive the patient, is more widespread than the single instance of Rawson-Neal patient James Flavy Coy Brown's transportation to Sacramento," the letter says.
In an interview, Sacramento's city attorney questioned the notion of busing seriously ill patients across the country alone, citing concerns from both a "humanitarian and financial resources" perspective.
"If other entities are shipping individuals to California in an inappropriate manner and shifting the financial burden of their care to another jurisdiction, that needs to be addressed," he said.
"Was this a pattern that turned into a policy of neglect, and of disregarding the rights of those they were serving?" asked Sanchez. "That's what we need to know."
A review of Greyhound bus receipts purchased by Southern Nevada Adult Mental Health Services showed Rawson-Neal had bused 19 patients to Sacramento since July 2008. More than 200 were sent to Los Angeles County, and 36 to San Francisco in that time period.
After defending the unusual busing practice for weeks, Nevada health officials changed course last week, announcing that all patients bused out of state will now be accompanied by an escort.
This week, they announced the results of an internal investigation that they said found that 10 of the patients bused out of state in the past five years may have been sent improperly without "a support system" at the other end. Two employees at Rawson-Neal were fired and three others disciplined in response to those findings.
In their letter to Cortez Masto, Sanchez and the others said they want to know more about the hospital's new discharge policy.
They wish to learn the "scope of the new patient transfer policy," to make sure that patients have guaranteed care and housing waiting for them when they arrive in California, the letter said.
If the attorneys are not satisfied with the answers provided by the attorney general and other agencies, Sanchez said, "we have further recourse," including filing a request for a court injunction or a lawsuit to recover damages.
Call The Bee's Cynthia Hubert, (916) 321-1082. Follow her on Twitter @cynthia_hubert.