The San Francisco city attorney on Tuesday accused Nevada health officials of improperly busing two dozen mental patients from Las Vegas to San Francisco in recent years, and threatened to file a class-action lawsuit if Nevada doesn't repay the cost of caring for them and hundreds of other patients shipped via Greyhound to California during that time.
In a strongly worded letter to Nevada's attorney general, San Francisco City Attorney Dennis Herrera said a months-long investigation had turned up multiple cases in which Nevada's primary state psychiatric hospital bused mentally ill patients who were homeless and poor from Las Vegas to San Francisco, even though they had no ties to the Bay Area and no arrangements for care waiting for them at the end of their ride.
Among the 24 patients improperly bused from Rawson-Neal Psychiatric Hospital to San Francisco since 2008, Herrera said, 20 sought and were provided emergency medical care within a short time of their arrival.
Herrera cited his findings as evidence that Nevada had for years engaged in unlawful "patient-dumping," busing indigent mental patients out of Las Vegas to avoid having to pay for their services, and shifting that financial burden to cities in California.
"Rawson-Neal staff were well aware that the 24 patients bused to San Francisco since April 2008 were all indigent and homeless, suffering from mental illnesses requiring ongoing medical care and medication, and in most cases were non-residents of San Francisco with no family members here to care for them," Herrera wrote in a letter to Nevada Attorney General Catherine Cortez Masto.
"Rawson-Neal staff understood and expected that the bused patients would rely on San Francisco's public health resources for continuing medical care; indeed they specifically directed some of the bused patients to seek care at San Francisco public health clinics and San Francisco-supported shelter and housing upon their arrival here."
A spokeswoman for Masto declined to comment.
Herrera launched his investigation following a series of reports in The Sacramento Bee earlier this year about discharge practices at Rawson-Neal.
As part of that coverage, The Bee shared the story of James Flavy Coy Brown, 48, who was bused from Las Vegas to Sacramento in February after landing in Rawson-Neal with symptoms of psychosis. Like the patients described by Herrera, Brown was bused to Sacramento despite having no ties to the community and with no prior arrangements for his housing or care.
Diagnosed with schizophrenia and other mood disorders, Brown had been living homeless in Las Vegas for years. He told The Bee that a Rawson-Neal doctor told him he would like "sunny California" and to dial 911 when he arrived.
A Bee analysis of Greyhound receipts found Rawson-Neal has bused about 1,500 mental patients out of southern Nevada over the past five years, giving them one-way tickets to cities and towns across the continental United States. About 500 of those patients were bused to California.
Following subsequent probes by federal agencies, the hospital has lost its accreditation and is in danger of losing its Medicare funding.
In an interview Tuesday, Herrera said he would file a class-action lawsuit within 20 days unless Nevada officials agreed to reimburse California for taxpayer-funded housing and treatment of patients who were bused to cities where they were not residents and where Nevada had failed to make prior arrangements for care from family or treatment facilities.
In his letter, Herrera said San Francisco was seeking reimbursement for at least $500,000 in medical care and housing expenses for patients improperly bused. He provided no estimate for what he believed other cities were owed.
As scrutiny of patient care at Rawson-Neal has intensified in recent months, Nevada health officials have largely defended the unusual discharge practice. They said their internal reviews have found that the vast majority of patients bused out of Rawson-Neal were sent to their home communities, with care and relatives waiting for them upon arrival.
But they also have acknowledged they have done no follow-up checks to determine whether patients bused from the facility ever arrived at their destinations. As of April, Rawson-Neal announced it would no longer discharge mentally ill patients to buses bound for other cities without a chaperone.
On Tuesday, Mary Woods, a spokeswoman for the Nevada Department of Health and Human Services, declined to comment on Herrera's letter. But she said Rawson-Neal's practices are similar to a program in San Francisco called "Homeward Bound" that arranges busing for homeless residents who want to be reunited with family.
In both programs, Woods said, those who are bused must be stable and have a support system waiting at their destination.
Gabriel Zitrin, a spokesman for Herrera, responded that "Homeward Bound is focused on getting patients in touch with relatives. That is precisely not what happened with these patients."
When asked about Herrera's assertion that two dozen patients were improperly bused to San Francisco, Woods pointed to earlier statements from Nevada authorities that only 10 patients nationwide may have been improperly bused. She also said that the 1,500 patients bused out of Nevada represented only a small portion of the more than 31,000 discharges from Rawson-Neal during the past five years.
Herrera and four other California city attorneys and county counsels, including the city attorney for Sacramento, wrote a letter to Masto in May asking to discuss discharge practices at Rawson-Neal. That meeting never took place, Herrera said.
In his letter, Herrera asks that Nevada stipulate to "an enforceable contract" governing the future transfer of mentally ill patients to California.
"The manner in which these patients were transported was inhumane and unacceptable," Herrera wrote. "These patients were transported without escorts; without prior arrangements for a responsible party to receive them at their destination; without adequate provisions of medication or food; and without proper instructions for these patients' follow-up medical care, housing or support services."
State funding for mental health and developmental services in Nevada fell by roughly $80 million over the past several years. Some of that funding was restored during the last legislative session.
Earlier this month, a state legislative committee approved $2.1 million in emergency spending to shore up the state's mental health system. The funding will be used largely to add staffing and beds at Rawson-Neal and surrounding facilities.
Call The Bee's Phillip Reese, (916) 321-1137. Follow him on Twitter @PhillipHReese.