Dan Morain: California dumps a patient in Nevada
09/08/2013 12:00 AM
09/08/2013 8:55 AM
JOIN THE CONVERSATION: Do we need stronger laws to prevent states from patient dumping? Add your comment below. To write a letter, go to sacbee.com/sendletter. Or comment on our Facebook page at facebook.com/sacramentobee.
Shannon Brandes sat at the kitchen table of her modest home in this small mountain town and told the story of her daughter – a pawn and a costly inconvenience for two states’ mental health care systems.
Amanda Brandes, 26, has spent most of the past decade battling delusions and paranoia. She is back at Rawson-Neal Psychiatric Hospital in Las Vegas today, unless the staff sent her on her way in the past 36 hours as staffers at Rawson-Neal and other psych wards have done so many times before.
Amanda was discharged from Napa State Hospital 23 days ago, after spending many months there and at a locked facility in Yuba City.
Nevada authorities have weathered withering criticism for busing 1,500 Rawson-Neal patients during the past five years to every state in the continental United States, including 500 to California. In this instance, however, California dumped a patient on Nevada.
The Nevada Department of Health and Human Services filed a complaint against Napa State Hospital, saying that upon arrival, “the patient was found to be volatile, in need of medication, and not stable.” Amanda’s dumping was big news in Nevada, and led me to ask questions.
California and Nevada officials won’t discuss the situation, citing a 1996 federal privacy law called Health Insurance Portability and Accountability Act. But I learned enough to know that no one on either side of the Sierra has much to be proud of; no one, that is, other than Amanda’s family.
Shannon was 18 when she had Amanda, and raised her as best she could in Las Vegas, Chicago and Compton, though in some years, Amanda’s grandmother needed to step up. One of Shannon’s half-brothers is James Dold, who is three years older than Amanda. James and Amanda spent part of their childhood together in Las Vegas.
“She was a beautiful, smart kid. She was really funny. People liked being around her,” Dold said, recalling laughter in the backyard swimming pool, having a hard time reconciling what has befallen Amanda.
Amanda met a man who introduced her to meth, which damaged her brain. When Amanda was 17 or 18, Shannon found her huddled in a corner of a train station in Long Beach. Her hair was matted, she had two black eyes, she was telling passengers the end of the world was at hand, and she was many months’ pregnant. She gave birth in a psychiatric hospital near Los Angeles, relinquished her baby, revolved back out of the institution, and ran off again.
“I can’t tell you how many times I went out looking for her,” Shannon said.
In early 2012, Shannon picked up the phone and heard her daughter’s lost voice. “Mom, I’m cold.”
Rawson-Neal had released Amanda, and she had been wandering the Vegas streets, Shannon believes. She told her daughter to go to the Greyhound depot where there would be a ticket bound for Reno, not far from Plumas County where Shannon lives.
Shannon arrived in Reno to find Amanda dressed in men’s pants, flip-flops and a T-shirt from a bail bondsman. Part of her hair was knotted and chunks had been chopped off.
“How do you like my hair?” her daughter asked. Shannon tried not to show her pain. She bought Amanda clothes and a meal, and mother and daughter headed home. It didn’t go well. Amanda would stay in her room for hours at a time, occasionally screaming, and smoking compulsively, turning her fingers yellow.
On April 7, 2012, Shannon called the Plumas County sheriff. The deputy notified the Plumas County Department of Mental Health, the sheriff’s log shows. Two weeks later, a neighbor complained to the sheriff that “a strange woman has been going door to door for the last few days asking for drugs and cigarettes.” Two days later, Amanda was begging neighbors for cigarettes and alcohol, the log shows.
On May 7, 2012, after four more complaints, a deputy 5150-ed her, a reference to the statute that allows authorities to detain severely mentally ill individuals for their own safety.
What happened next is cloaked by federal and state privacy laws. But Plumas County won a court order making it Amanda’s conservator. The county placed her at a facility in Yuba City, and later Napa State Hospital.
In the 1960s, California housed more than 30,000 patients in state hospitals. Few had committed crimes. Political leaders emptied the hospitals, partly to cut costs but also to give patients freedom. Today, the hospitals house 6,560 patients, and 93 percent of them have committed crimes.
There are few state hospital beds for people who have committed no crimes, and there is little demand. The cost is prohibitive, $225,205 per bed per year, especially for small counties such as Plumas, with its 19,000 residents and mental health budget of $10 million. The system fails Amanda and people like her who need intensive care.
Shannon, who has no car, tried to keep in touch with her daughter by calling the hospital. But she rarely got any information. Everything about the placement was confidential, even to the one person who cares most about her, her mother.
She was unaware that on Aug. 12, a Plumas County judge ended the county’s conservatorship of Amanda. Nor did she know that early in the evening of Aug. 16, a Friday, a Plumas County caseworker arrived at Napa State Hospital with $55 in petty cash for meals, and left with Amanda.
They checked into a Best Western in Las Vegas at 3:19 a.m. on Aug. 17. At 4:30 p.m., the caseworker deposited Amanda at the emergency room of University Medical Center, Las Vegas’ public hospital, Nevada’s complaint against Napa State says.
Shannon said her daughter always wants to return to Las Vegas, though she no longer has family or friends there. Clearly, she should have either remained at Napa State or entered an intensive out-patient treatment program, near where her mother and other family members could have provided support.
“Amanda cannot be out free,” Shannon said. “She has to have somebody with her. If she doesn’t, you just don’t know what’s going to happen. Sometimes, people do need to be forced.”
While not discussing specifics, Cliff Allenby, acting director of the California Department of State Hospitals, said that once the state releases a patient to a responsible party, such as a county, “we don’t have responsibility; there isn’t anything the state can do.”
Kimball Pier, Plumas County mental health director, said her staff has the “highest standards and ethics.”
“The goal is the do the best that we possibly can to care for people using the resources we have,” Pier said. “It pains me that there is incomplete information, but I guess that’s how it needs to be.”
James Dold hasn’t seen Amanda much since he went to University of Nevada, Las Vegas, and to University of Maryland law school. Now a lawyer, he works for Polaris Project, an organization in Washington, D.C., that combats human trafficking. Amanda’s story is one of a different type of abuse.
“Who knows what could have happened? A pimp, trafficker, serial killer,” Dold said. “It’s a human rights abuse.”
It happens too often. There are laws against abandoning pets. But when government officials dump human beings who are mentally ill, they claim they are catering to their wishes, and protecting their civil rights.
About This BlogDan Morain has been a columnist at The Bee since 2010 focusing on state government and politics. He previously worked for The Los Angeles Times covering the California Supreme Court when Rose Bird was chief justice, the Legislature when Willie Brown was speaker and the governor's office during Gray Davis' tenure. Dan Morain can be reached at firstname.lastname@example.org or 916-321-1907. Twitter: @DanielMorain.
Join the Discussion
The Sacramento Bee is pleased to provide this opportunity to share information, experiences and observations about what's in the news. Some of the comments may be reprinted elsewhere on the site or in the newspaper. We encourage lively, open debate on the issues of the day, and ask that you refrain from profanity, hate speech, personal comments and remarks that are off point. Thank you for taking the time to offer your thoughts.