Nevada Patient Busing

Accreditation agency looks at Nevada mental hospital's discharges

A Nevada state mental hospital's practice of discharging psychiatric patients to Greyhound buses and transporting them to cities and towns across the country is under investigation by the independent, nonprofit body that accredits hospitals nationwide.

In addition, city attorneys in San Francisco and Los Angeles are exploring whether the practice constitutes a form of cross-state "patient dumping," and might be grounds for legal action against Rawson-Neal Psychiatric Hospital and Nevada health authorities.

The responses follow a report in Sunday's Bee that revealed that Rawson-Neal, Nevada's primary psychiatric hospital, has bused more than 1,500 mentally ill patients out of southern Nevada in the last five years, sending at least one person to every state in the continental United States. About a third of those patients were shipped to California, including more than 200 to Los Angeles County, 36 to San Francisco and 19 to the city of Sacramento, according to a review of Greyhound bus receipts purchased since July 2008 by Nevada's mental health division.

One of the hospital's clients, James Flavy Coy Brown, recently turned up suicidal and confused at a Sacramento homeless services complex after he was discharged via Greyhound bus from Rawson-Neal to the capital city, where he knew no one and had never visited. He was out of food and medication when he arrived, and landed in the UC Davis Medical Center emergency room, where he lingered for three days until social workers were able to find him housing.

In recent weeks, Nevada health authorities have acknowledged making mistakes in Brown's case, but have defended their aggressive policy of busing mentally ill patients out of state. They say the vast majority of clients for whom they bought bus tickets were returning to their home communities and had treatment or family members waiting for them at their destinations.

"Based on the reviews to date, there are not systemic findings," said Mary Woods, spokeswoman for the Nevada Department of Health and Human Services. "Additional safeguards have been implemented to ensure future policy compliance."

But interviews with public health officials suggest Brown's case was not isolated. A San Francisco mental health official told The Bee that at least two patients from the Nevada system arrived in that city during the past year without a plan, advance notice or arrangements for their treatment or care.

The Bee interviewed mental health officials in counties across California that received high numbers of patients from Nevada, and none could recall Nevada contacting them to arrange for care.

In addition, none of the 10 state mental health agencies contacted by The Bee said that placing a psychiatric patient on a bus without a chaperone would be permissible, and none recalled being contacted by Rawson-Neal.

Several mental health experts interviewed by The Bee called Nevada's busing program unethical and potentially dangerous, arguing that mentally ill patients in most cases would have trouble navigating a lengthy bus trip on their own, even if they had someone waiting for them at the end of the journey.

"You never put a mentally ill person unescorted on a bus. Ever. That is ludicrous," said Carlos Brandenburg, Nevada's former commissioner of mental health. Brandenburg retired in 2007 as administrator of the state's Division of Mental Health and Developmental Services. "It never happened on my watch, I can tell you that," Brandenburg said.

Jonna Triggs is former director of Southern Nevada Adult Mental Health Services, which oversees Rawson-Neal. She served from 2002-06, and helped the hospital get its first accreditation. She said she was shocked to hear about prodigious busing practices.

"We couldn't have gotten Joint Commission accreditation if that was happening," she said. "I know how hard so many people worked to get that 'gold star' from the commission. This makes me sad."

A spokeswoman for the Joint Commission, which evaluates and certifies hospitals across the country, said Thursday that the organization is "aware of complaints around the discharge issue" at Rawson-Neal Psychiatric Hospital in Las Vegas, and is gathering information to determine whether a special on-site survey is warranted.

Spokeswoman Elizabeth Eaken Zani declined to reveal the source of any complaint against the hospital. A special survey, she said, would determine whether the hospital continues to meet its rigorous standards for patient safety and care. Based on findings, the commission could alter or even revoke a hospital's accreditation status.

Rawson-Neal currently boasts coveted gold-star status, based on a commission survey conducted in June 2010. The accreditation, a critical seal of approval, among other things, affirms a hospital complies with federal standards for patient care.

The U.S. Centers for Medicare and Medicaid Services, a federal watchdog agency, also is reviewing Rawson-Neal's discharge practices. Spokesman Jack Cheevers said the agency asked Nevada's health division to assist in a probe. Violations could result in a loss of critical federal funding.

The hospital's practices have touched off preliminary inquiries in Los Angeles – which received 149 patients from Rawson-Neal during the five years reviewed, more than any city in the country – and in San Francisco.

In recent years, Los Angeles has cracked down on area hospitals for dumping patients on Skid Row, where the Greyhound station is located, filing lawsuits and criminal charges. Patient dumping is a misdemeanor by city ordinance.

"Clearly, we have an interest," Sandy Cooney, a spokesperson for the Los Angeles City Attorney's Office, said of the bus trips from Las Vegas. "We're trying to determine if this warrants an investigation." San Francisco also is in the early stages of an inquiry, said city attorney spokesman Matt Dorsey.

Nevada Gov. Brian Sandoval has been under pressure to address the busing issue. On Thursday, spokeswoman Mary-Sarah Kinner said Sandoval "takes the concerns regarding Southern Nevada Adult Mental Health Services very seriously," adding, "The governor has been briefed throughout the investigation process and has asked for more information."

Through Kinner, Sandoval declined an interview request.

Other political leaders and advocates traced Rawson Neal's unusual discharge practices to a mental health budget that has been steadily dismantled in recent years. The number of psychiatric patients bused out of Nevada grew 66 percent from calendar year 2009 to 2012. During that period, Nevada slashed its mental health budget by 28 percent to address deficits.

"Our services for mentally ill people have not been good for a long time," said retired Nevada district court Judge Jackie Glass, a longtime advocate for mental health causes.

"I imagine that the hospital is under a lot of stress" because of a shrinking number of outpatient and housing programs, Glass said. "But I don't care if they are swamped. This, to me, is outrageous. There has to be a better way. If officials deny that there is a problem here, then we have an even bigger problem."

Former Nevada state Sen. Sheila Leslie, who focused on mental health issues during her decade in the Legislature, said the state must determine how many patients were bused to family and friends and how many, like Brown, were bused to an unfamiliar place with no one waiting.

"We need to get to the bottom of this," Leslie said.

Call The Bee's Cynthia Hubert, (916) 321-1082. Follow her on Twitter @cynthia_hubert.