Nevada Patient Busing

Two hospital workers fired over 'dumping' of Nevada psychiatric patients

Nevada state officials said Monday that two employees at Rawson-Neal Psychiatric Hospital in Las Vegas have been fired and another three will be disciplined as a result of an internal investigation into the hospital's practice of busing mentally ill patients to other states.

The investigation found that 10 out of roughly 1,500 patients may have been placed on buses during the last five years without "a support system/family/friends/housing at the destination," according to a statement from Mary Woods, spokeswoman for the Nevada Department of Health and Human Services.

"All individuals who violated release policies have been or will be disciplined," Nevada Gov. Brian Sandoval said in a prepared statement. "These disciplinary actions include terminations effective today."

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 since 2008, the hospital has transported about 1,500 mentally ill patients out of southern Nevada, dispatching them via Greyhound to cities and towns across the nation. About 500 of those patients were sent to California, and 19 of them to Sacramento, according to The Bee's review of Greyhound bus receipts.

One of those patients was James Flavy Coy Brown, a homeless, schizophrenic man who was bused from Las Vegas to Sacramento two months ago despite having no connections to the region.

He said Rawson-Neal staffers gave him a one-way ticket and told him to call 911 when he arrived.

The Bee uncovered his story after he turned up confused and suicidal at a Sacramento homeless services agency, having exhausted the three-day supply of medications the hospital gave him for his journey.

Nevada officials have acknowledged that Brown should never have been sent to Sacramento, but contend that his case does not represent a "systemic" problem.

State health authorities declined Bee requests Monday for copies of their internal investigation. Instead Woods, the spokeswoman, sent an email that she said summarized its contents.

She also declined to provide details about the employees disciplined, or the specifics of the 10 busing cases identified as problematic.

Woods said that in all 10 cases "insufficient documentation" made it unclear whether a patient had been properly bused. Of the 10 patients, nine were discharged directly from the hospital's psychiatric observation unit after treatment for substance abuse issues, she said.

The state's investigation determined that nine Rawson-Neal medical staff members were responsible for those 10 cases. Five no longer work at the hospital, two were fired, and three will be disciplined.

During the five-year period reviewed, Rawson-Neal maintained an aggressive practice of discharging patients to the Greyhound terminal in Las Vegas, sending them off, unaccompanied, with Ensure nutritional supplements and a limited supply of medications.

The policy called for staffers to "confirm client has housing/shelter available and a support system available to meet client at destination," according to a copy provided by Woods.

"While the investigation showed the vast majority of patient releases were done correctly, it also revealed policies were not followed by certain individuals," Sandoval said. "I will continue to evaluate the need for further action if necessary."

Neither Woods nor the governor addressed the larger issue of whether the practice itself – sending mentally ill patients alone on bus trips that often spanned multiple days and states – was an acceptable form of patient care.

An array of mental health experts have described the practice as both dangerous and unusual. None of the 10 state mental health agencies contacted by The Bee said that placing a psychiatric patient alone on a bus would be permissible.

After defending their policy for several weeks, Nevada health officials changed course last week, announcing that they would no longer pay to bus patients to other states without a chaperone.

Sandoval also said Monday that the state has "obtained proposals from national experts in the mental health field to provide an objective and comprehensive analysis of our state facilities to ensure that best practices are being implemented and followed."

Nevada's mental health system remains under investigation on several fronts. The federal Centers for Medicare and Medicaid Services last week sent a letter to Nevada authorities saying Rawson-Neal, the state's primary mental health facility, is out of compliance with federal regulations and risked losing critical federal funding if the hospital failed to submit "evidence of correction."

Meanwhile, the city attorneys in Los Angeles and San Francisco have opened probes to see if Nevada engaged in systematic "patient dumping."

Former Nevada State Sen. Sheila Leslie, a Democrat who focused on mental health issues during more than a decade in the Legislature, said the governor's actions are likely more about damage control than fixing a problem.

"I think clearly the governor's office wants this to go away," she said. "They are reacting with whatever practical solution will accomplish that."

The state should discipline those who put patients on a bus without a family member or friend waiting at the other end, Leslie said. But it's more important, she said, to reverse some of the mental health cuts that may have motivated Rawson-Neal employees to bus patients out of state.

"Our public mental health system is in shambles," she said. The problem, she said, "is us. It's not a single staff person."

Call The Bee's Phillip Reese, (916) 321-1137.