Nevada Patient Busing

Nevada hospital that bused mentally ill across U.S. on verge of losing accreditation

A Nevada state hospital that discharged and bused hundreds of mentally ill patients across California and the nation during the last five years is poised to lose its accreditation.

A committee of the Joint Commission, an independent agency that accredits more than 4,000 hospitals across the country, decided late last week to issue a preliminary denial of accreditation at Rawson-Neal Psychiatric Hospital in Las Vegas "due to the hospital placing patients at risk for a serious adverse outcome," said commission spokeswoman Elizabeth Eaken Zhani.

The hospital can appeal the decision, Zhani said. It would remain accredited until appeals are exhausted.

Joint Commission surveyors visited Rawson-Neal twice in May following a series of Bee reports about patient discharge practices at the facility, which serves as Nevada's primary hospital for the mentally ill.

The Bee launched its investigation after Rawson-Neal bused a mentally ill homeless man to Sacramento in mid-February without making arrangements for his treatment or housing. James Flavy Coy Brown, 48, arrived in Sacramento confused and disoriented, and ultimately landed in the UC Davis Medical Center emergency room. He told The Bee that a Rawson-Neal doctor had suggested he would like "sunny California" and advised that he call 911 when he arrived.

A subsequent review of Greyhound bus receipts purchased by the state for Rawson-Neal patients found the hospital has bused roughly 1,500 patients to states across the nation over the past five years, a third of them to California.

By policy, those patients were put on buses alone, with one-way tickets, a small supply of medication and several bottles of Ensure nutritional supplement for the journey.

In the months since The Bee published its findings, Nevada health officials have defended the hospital's busing practices as safe and humane, arguing that the vast majority of patients transported out of state were mentally stable and heading to their home communities. They acknowledge, however, that they have done no follow-up checks to determine whether patients actually made it to their destinations.

In April, Nevada health officials revised the policy, announcing the hospital no longer would bus patients to other states without a chaperone. Two staff members were fired and others disciplined in connection with Brown's case.

"We are disappointed by the Joint Commission's decision to move for a preliminary denial of accreditation, which appears to be based on outdated survey information and is not an accurate reflection of the hospital's current practices and policies," Mike Willden, director of the Nevada Department of Health and Human Services, said in a statement.

The Joint Commission decision does not detail the specific conditions or treatment that surveyors found troubling. It simply lists numerous agency standards the hospital did not meet.

During their first May visit, a routine inspection that takes place every few years, Joint Commission inspectors cited Rawson-Neal for failing to meet 35 standards, many related to patient safety.

During the second visit, they found 23 standards had not been not met. Among them: ensuring that staff are competent to perform their responsibilities; educating patients during discharge about follow-up care; and giving adequate information to other service providers who will care for patients following discharge.

The state is considering whether to appeal the Joint Commission decision, said Mary Woods, a spokeswoman for the Nevada Department of Health and Human Services. The appeal process generally takes four to six months, Zhani said.

The hospital's reputation and some of its funding could be at stake.

The federal Medicare system deems accredited hospitals to meet conditions for federal funding. Losing accreditation does not mean the hospital is automatically ineligible for funding, but it would result in more active federal oversight, said Steven Hirsch of Steven Hirsch and Associates, a Southern California firm that helps health organizations obtain accreditation.

In addition, private insurers usually will not pay hospitals unless they are accredited, Hirsch said.

Woods minimized the possible financial consequences of losing accreditation, given that the state of Nevada provides the bulk of Rawson-Neal's funding. She said 85 percent of patients at Rawson-Neal have no insurance coverage. The remaining 15 percent rely on Medicare.

Still, losing accreditation would be considered a rare and shocking blow. Fewer than 1 percent of hospitals surveyed by the Joint Commission lose accreditation each year, Zhani said.

If Rawson-Neal does appeal, it would not be able to retain accreditation merely by promising to fix the problems cited during the inspections, Hirsch said.

Instead, "it's based on what they are doing at the time of the survey," Hirsch said. A hospital's best hope during appeal, he said, is to prove that it actually was in compliance at the time of the survey.

Hospitals often close after losing accreditation. But some don't. Broughton Hospital, a public psychiatric facility in western North Carolina, operated without Joint Commission accreditation for about three years until 2011.

Nevada officials previously cited Rawson-Neal's accreditation as proof that the hospital provides quality care. When the busing controversy first broke, Nevada Gov. Brian Sandoval said the hospital was "safe, modern and has a five-star accreditation."

On Wednesday, Sandoval spokeswoman Mary-Sarah Kinner said in a statement that "the governor continues to evaluate the progress of Rawson-Neal. He is calling for special legislative action to accelerate the authorization of already budgeted funds" to help Rawson-Neal correct any lingering problems.

Call The Bee's Phillip Reese, (916) 321-1137. Follow him on Twitter @PhillipHReese.