Nevada Patient Busing

Consultants report on Nevada psychiatric hospital's busing of patients

Nevada's largest psychiatric facility should hire more staff and shore up discharge protocols to guard against practices that resulted in some patients being bused alone out of state, with no shelter or family waiting at their destination, two consultants hired by the state concluded in a report Thursday.

The report, however, also praised care and treatment at Rawson-Neal Psychiatric Hospital in Las Vegas, and said the hospital often appropriately bused patients to other states. It noted that Las Vegas draws millions of visitors each year.

"In many cases, helping people to get home safely is a kindness to them and to their families." the report said. "The mere presence of a mental disorder does not render an individual unable or incompetent to do the ordinary tasks of life, including traveling independently."

A Bee investigation, published in April, found that Rawson-Neal bused about 1,500 patients to states across the nation in the last five years, giving them one-way tickets out of Las Vegas, along with a small supply of medication and liquid Ensure for the journey.

About 500 of those patients were sent to California, according to a Bee review of Greyhound bus receipts purchased by Southern Nevada Adult Mental Health Services, which oversees the hospital.

Rawson-Neal's aggressive busing practices came under scrutiny after The Bee relayed the story of one of those patients, James Flavy Coy Brown.

Brown, 48, suffers from schizophrenia and depression. He had been bouncing among shelters in Las Vegas for years when he ended up in Rawson-Neal with symptoms of psychosis. Seventy-two hours later, hospital staff discharged him to a Greyhound bus bound for Sacramento, where he had no family, friends or housing.

Nevada health officials have acknowledged a mistake in Brown's case, but maintain the majority of patients bused out of state were reunited with family or friends at their destination. Nevertheless, they have since changed discharge policies to build in more oversight and require that all patients bused out of state be accompanied by a chaperone.

The state hired Dr. Kenneth Appelbaum, a professor of psychiatry at the University of Massachusetts Medical School, and Joel Dvoskin, a clinical psychologist and faculty member at the University of Arizona College of Medicine, to examine the hospital's practices.

The two spent a week at the hospital earlier this month. Among their findings:

Hospital staff often feel pressure to discharge patients quickly to make room for more.

The hospital relies too heavily on treatment with medications and not enough on psychotherapy or behavioral therapy.

Staffing levels are not adequate for the large volume of patients seen at the hospital.

The consultants recommended that the state increase the number of staff positions at the hospital by about 5 percent. They also recommended that the hospital "increase the amount of high-quality, evidence-based treatments beyond the provision of psychotropic medication."

Boosting staff levels, along with ensuring each patient has a clear treatment plan upon discharge, may reduce the number of patients improperly bused out of state without housing or treatment waiting at their destination.

"Every single state has seen massive budget cuts in their mental health system," Dvorkin said in an interview. "Billions of dollars nationally. It isn't just Nevada. In my opinion, we are starting to see the impact."

State officials said they already had adopted many of the recommendations in the report and would work to put the others in place.

"We are committed to implementing the recommendations in this report, and I am confident doing so will help improve the services the state of Nevada provides to the mentally ill," Gov. Brian Sandoval said in a prepared statement.

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