Nevada Patient Busing

Federal officials cite Nevada mental hospital for deficiencies

The federal Centers for Medicare and Medicaid Services on Thursday sent a letter to Nevada health officials telling them that, due to "serious deficiencies," the state's primary psychiatric hospital "may be subject to termination of its Medicare provider agreement," according to a copy of the letter obtained by The Bee.

The federal agency, in concert with state officials, conducted a survey March 20 of Rawson-Neal Psychiatric Hospital in Las Vegas after The Bee first reported that one of the facility's patients was discharged improperly to Sacramento with no arrangement for housing or care.

According to the letter, the survey results showed that the hospital was out of compliance with federal regulations for discharge procedures and governance.

CMS gave the hospital 10 days to submit "evidence of correction." After that, a new survey will likely occur. If corrective action is not adequate, according to the letter, "we will notify you that we are initiating action to terminate the facility's Medicare provider agreement," a vital source of federal funding.

Rawson-Neal and its umbrella agency, Southern Nevada Adult Mental Health Services, have been under fire following a report in The Bee earlier this month showing that the hospital paid to transport about 1,500 patients to other states via Greyhound bus since 2008. About one-third of those patients were dispatched to California, and 19 of them to Sacramento, according to a review of Greyhound bus receipts purchased by the umbrella agency.

One of Rawson-Neal's patients, James Flavy Coy Brown, in February was bused 15 hours to Sacramento, a place he said he had never visited and where he knew no one.

Brown suffers from schizophrenia and depression and had been living in the streets and shelters of Las Vegas for years. Out of food and medication when he arrived in Sacramento, he spent three nights in a hospital emergency room before social workers found him temporary housing.

The Bee's report has touched off criminal probes by the city attorneys of San Francisco and Los Angeles into whether Nevada has engaged in cross-state "patient dumping." Los Angeles received 149 Rawson-Neal patients during the five-year period reviewed by The Bee, while 36 patients were sent to San Francisco.

This week, Nevada authorities announced that they no longer would send state psychiatric patients alone on buses. They said a chaperone would accompany any mental patient discharged from state facilities for whom Nevada is paying transportation costs.

Despite the policy change, Rep. Doris Matsui, a Sacramento Democrat, on Thursday called for a congressional investigation into Nevada's long-standing practice of shipping patients out of state.

In a letter to ranking members of the House Energy and Commerce Committee, which has jurisdiction over health matters, Matsui asks for investigative and oversight hearings into Rawson-Neal's discharge policies. She said a congressional investigation is warranted to determine if the practices violated federal laws regarding discharge planning and patient rights.

She called for the committee to look into "the scope, severity and consequences of Southern Nevada Adult Mental Health Services' selective disregard for the health and safety of its patients. Someone must be held accountable."

Before the policy change announced this week, Nevada officials had defended their aggressive busing practices, saying most patients the hospital bought tickets for were being transported to their home communities and had family or treatment waiting on the other end.

Call The Bee's Cynthia Hubert, (916) 321-1082. Follow her on Twitter @cynthia_hubert. The Bee's Dan Morain contributed to this report.