Spurred by concerns that a Nevada hospital bused hundreds of mental patients across the country, in some cases to cities where they had no support system or treatment arrangements, Rep. Doris Matsui has introduced federal legislation that would impose hefty fines on facilities that engage in so-called “Greyhound therapy.”
Matsui, a Sacramento Democrat, introduced the House bill last week; it would be the first federal law to specifically address “dumping” of mentally ill people by psychiatric hospitals onto other facilities or jurisdictions without a discharge plan. If approved, the measure would impose fines of up to $10,000 on facilities that fail to follow discharge requirements for psychiatric patients set out by the U.S. Centers for Medicare and Medicaid Services. Repeat offenders would have 45 days to correct issues or lose federal reimbursement for the care of Medicare patients.
The legislation follows a series of Sacramento Bee reports on patient discharge practices at Rawson-Neal Psychiatric Hospital in Las Vegas. A review of bus receipts purchased by the hospital over the past five years showed Rawson Neal was routinely discharging psychiatric patients to a Las Vegas Greyhound station, giving them one-way tickets to cities across the continental United States. Over the five-year period The Bee reviewed, the hospital bused about 1,500 patients out of state, a third of them to cities in California.
As part of that coverage, The Bee shared the story of James Flavy Coy Brown, 48, a homeless man who was bused from Las Vegas to Sacramento in February after landing at Rawson-Neal with symptoms of psychosis. Brown had no ties to Sacramento, and the hospital made no arrangements for his care, instead advising him to call 911 when he arrived. He found his way to a homeless services center, and ultimately landed at the UC Davis emergency room.
Nevada health authorities maintain the majority of patients bused out of state from Rawson-Neal had treatment or family waiting at the other end. But The Bee, in its ongoing investigation, found multiple instances in which patients were discharged to other states without any arrangement for care. Earlier this month, the San Francisco city attorney filed a class-action lawsuit against Nevada and Rawson-Neal, demanding reimbursement for the taxpayer-funded services the city provided to two dozen indigent patients he maintains were improperly bused from Rawson-Neal and “dumped” in the Bay Area.
In the wake of The Bee’s reports, the hospital has lost its accreditation, and is facing a second class-action lawsuit from Sacramento attorney Mark Merin alleging the hospital’s discharge policies violated patients’ constitutional rights.
The hospital has said it no longer buses patients out of state without escorts, and is working to ensure patients are discharged only after arrangements have been made for care.
Matsui, in a written statement, emphasized that “the vast majority” of hospitals handle psychiatric patients with “care and sensitivity.” She said her legislation is aimed at hospitals that “engage in truly atrocious examples of patient-dumping.” It would give CMS the tools necessary to make sure such hospitals “are held accountable, and that they realize it is not in their best financial interest to continue such behavior,” said Matsui.
CMS investigators have twice visited Rawson-Neal in recent months, and determined it suffers from “systemic” problems that compromise patient safety. Rawson-Neal stands to lose about $3 million in annual federal funding unless it corrects the problems.
The federal agency said the hospital’s handling of some cases violated the Emergency Medical Treatment and Labor Act, or EMTALA, which requires that hospitals either stabilize a patient in crisis or, at the patient’s request, transfer the individual to another facility. Nevada officials have challenged whether the government can charge Rawson-Neal with violations of that law, arguing it applies only to emergency services. Rawson-Neal has no emergency room, Nevada officials pointed out.
Some experts said Matsui’s bill would close that loophole by holding hospitals without emergency rooms accountable.
California Senate President Pro Tem Darrell Steinberg, a Democrat who has joined Matsui in hosting mental health roundtable discussions in Sacramento this year, said the proposed penalties in Matsui’s bill are “significant,” but also noted that government fines “are always negotiable,” and the most severe ones are rarely imposed. Still, he said, “It’s hard to argue against a bill like this.”
DJ Jaffe, executive director of the Mental Illness Policy Organization, said the bill is “a move in the right direction,” but may not go far enough in holding hospitals responsible for problematic discharge practices. Among other things, Jaffe has proposed making state mental health departments fiscally accountable for improperly discharging mentally ill people who subsequently are incarcerated.
“This simple accounting trick would remove from states the financial incentive to discharge patients from state-funded hospitals to county-funded jails,” he said.
Mark Covall, president and chief executive officer of the National Association of Psychiatric Health Systems, an industry group, said he was unfamiliar with Matsui’s bill and declined to comment specifically about it. But he said hospitals already are mandated by the government and outside agencies to meet quality standards, and most adhere to the rules.
“Psychiatric hospitals and inpatient psychiatric units have to abide by lots of requirements to ensure that patients are cared for in the hospital, and after they leave the hospital,” he said. “They have to follow very strict requirements for discharging patients. The issue, to me, is not the need for more regulations but working to make sure that the ones already in the books are being followed.”
That includes “making sure that the patient, once discharged, gets to the next level of care,” Covall said. “That’s standard practice. You can’t force it. But you don’t just give someone a bus ticket and say, ‘Here you go.’ ”
Matsui’s legislation would require bipartisan support to win approval in the Republican-controlled House. Rep. Timothy Murphy, a Republican who along with Matsui has championed mental-health legislation in Congress, declined through a spokesman to predict the outcome.