James Flavy Coy Brown arrived at Loaves & Fishes carrying his walking papers from a Nevada state mental hospital and a schedule detailing his 15-hour bus ride from Las Vegas to Sacramento.
"Discharge to Greyhound bus station by taxi with 3 day supply of medication," reads the paperwork from Southern Nevada Adult Mental Health Services that he handed to Loaves & Fishes staffers. "Follow up with medical doctor in California."
Brown, 48 and suffering from mental illness, "was completely confused and had no idea why he had been sent to Sacramento," said Molly Simones, a staff member at Loaves & Fishes, a social services agency on the industrial outskirts of downtown Sacramento that offers daytime services to homeless people.
Simones said Brown told her he had never been to the capital city before his arrival Feb. 13, and that he had no family in Sacramento. From what she could glean, Simones said, "he had absolutely no reason to be here," other than instructions from the Nevada mental hospital where he said he had spent the previous couple of weeks.
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The hospital, he reportedly told Simones, gave him a bus ticket to Sacramento and told him to dial 911 for help when he got to the capital city.
Loaves & Fishes personnel and others said they believe Nevada has engaged in a clear case of "patient dumping" – in this case sending a mentally ill patient to California without showing that he had relatives here or a place to get care.
Patient dumping – some call it "bus therapy" – has been an ongoing problem for shelters across the country. In recent years, Los Angeles city officials have successfully prosecuted several cases of hospitals "dumping" patients onto Skid Row, arguing that the acts violate laws against abuse of dependent adults and even false imprisonment. A relatively new federal law prohibits shipping sick patients from one location to another before confirming they have a place to live and get treatment.
California Senate President Pro Tem Darrell Steinberg, a Sacramento Democrat, has pushed legislation to improve services for mentally ill people.
"This is what we have come to?" he asked, told of Brown's situation. "This is a disgrace. It's a terrible thing to do to a human being who is suffering."
The documents Brown carried identified the facility that discharged him last month as Southern Nevada Adult Mental Health Services, a state-run psychiatric hospital in Las Vegas. A hospital official referred questions to the Nevada Department of Health and Human Services.
Nevada's state health officer, Dr. Tracey Green, declined to discuss Brown's case, citing patient privacy laws. She did not dispute the signed documentation provided to The Bee, which was written on Southern Nevada Adult Mental Health Services letterhead, but said she was prohibited from addressing specific cases.
However, Green said patients being treated in state facilities who are deemed stable can work with their care managers to decide future living plans that may include trips to California.
"It is possible that a competent individual who is stable would choose to receive services in another state," Green said. It also is possible, she said, that a person's mental status could change significantly between his release from the psychiatric hospital and arrival in his new destination.
"So many things can happen in between, so it's hard to draw a conclusion as to any fault," she said.
By the time Brown made it to Loaves & Fishes, he had no identification other than his discharge papers, Simones said, and was out of money and medications, including one to treat schizophrenia.
He spent at least one night at the downtown Union Gospel Mission, but has since disappeared onto the streets of Sacramento. Before he vanished, Loaves & Fishes staffers got his written permission to disseminate his story, including his personal information and discharge papers from the Nevada hospital.
Brown's discharge papers include a blurry photocopied picture of him, but reveal little about his background. They say he was born in 1964 and list his birth address as Catholic Charities in Las Vegas. His "address at discharge" reads: "Greyhound Bus Station to California."
Brown is about 5-foot-6 and slightly built, with gray hair and green eyes. His discharge papers show that he is to take three powerful psychiatric medications daily, one that is commonly used to treat schizophrenia and another for depression.
Simones said Brown told her that his group home in Las Vegas had closed recently and he had been sent to Southern Nevada Adult Mental Health Services with four other patients. He claimed all five had been shipped to different cities in California.
Simones said Brown identified his former group home as Annie's Place in Las Vegas. A spokeswoman for the Nevada Department of Health and Human Services confirmed that a facility by that name no longer operates. She said she could not disclose whether Brown ever lived there.
Simone said Brown also told her that the psychiatric hospital gave him a bus schedule that had him leaving Las Vegas by Greyhound on the afternoon of Feb. 11, a Monday. The bus made nine stops before arriving in Sacramento about 15 hours later, around 6:30 a.m. Tuesday. When he arrived in Sacramento, he told her, he had been instructed by his doctor to call 911 from the Greyhound station. Instead, he found a nearby police department.
Sacramento officers took him to Loaves & Fishes that day as the complex was closing, staffers said. He spent the night at the Union Gospel Mission and returned to the homeless complex the next day.
"James was very confused and scared," Simone said. "He told me he had nowhere to go, and that maybe he should do something to go to jail or just jump off a bridge."
Sacramento County health authorities, Simone said, advised her to write a letter explaining Brown's predicament and send him to a local emergency room. From there, they told her, he might find a bed at a treatment center.
Officials with the Sacramento County Mental Health Treatment Center refused to release information about whether Brown made it to UC Davis Medical Center, where Simone sent him by bus. A source who spoke on condition of anonymity because of patient privacy laws told The Bee there was no indication Brown had been admitted to the Sacramento County Mental Health Treatment Center.
Steinberg said Loaves & Fishes should have done a better job ensuring that Brown got help.
"I don't blame any individual agency, though," he said. "What is inexcusable is the failure of various different providers at various points of access to make sure that he got proper care."
Joan Burke, advocacy director at Loaves & Fishes, said the program frequently receives "drop-offs" of homeless people who need medical care. But the agency offers only daytime services and is not equipped to handle people with complex psychiatric problems, she said.
Beds at treatment centers and group homes are scarce, she said, and the county no longer accepts walk-in patients for mental health crisis care. "We do the best we can with the limited resources we have," she said.
"Here you have someone who is pretty severely disabled by his illness and a system that is stretched to the limit. It's survival of the fittest," said Burke, and many fall through the cracks.