Nevada Patient Busing

Embattled Nevada psychiatric hospital in danger of losing Medicare funds

A federal agency is moving to terminate Medicare funding for Nevada's embattled state psychiatric hospital, which has been under fire for busing hundreds of patients to states across the nation in the past five years.

Deficiencies at Rawson-Neal Psychiatric Hospital, which discharged a patient and bused him to Sacramento with no plan for care in February, "substantially limit the hospital's capacity to render adequate care to patients" and "adversely affect patient health and safety," federal regulators wrote in a letter to state officials released late Friday.

Most of Rawson-Neal's funding comes from the state of Nevada, so losing federal dollars would not necessarily be a death knell. But it would add to a growing list of challenges the hospital faces, including the recent loss of its accreditation from the Joint Commission, an independent agency that evaluates medical facilities.

The Las Vegas hospital has been under intense scrutiny since The Sacramento Bee published a series of reports examining its patient discharge practices.

The Bee found that the hospital had bused roughly 1,500 patients to states across the nation over the past five years, about a third of them to California.

"We're concerned," said Rufus Arther, director of hospital operations for the U.S. Centers for Medicare and Medicaid Services' Western division. "We're concerned whenever a hospital is not in compliance."

CMS officials launched an investigation into Rawson-Neal in March.

A month later, they sent a letter that said the hospital suffers from "systemic" problems that compromised the safety of patients who were being discharged. Rawson-Neal officials promised to fix the problems and submitted a plan of correction to regulators.

Around the same time, CMS also embarked on a second investigation of the hospital's policies and practices.

That investigation was meant to determine whether Rawson-Neal violated the federal Emergency Medical Treatment and Active Labor Act (EMTALA), also known as the patient anti-dumping law, which restricts a hospital from refusing treatment to a patient during an emergency just because the costs may be high.

The results from both investigations, released Friday, were unfavorable to Rawson-Neal.

One set of results, based on an inspection conducted in June, found problems with the hospital's governance, medical and nursing staffs. The letter did not specifically state the nature of the problems.

The EMTALA investigation found that the hospital failed to provide stabilizing treatment to patients, failed to provide appropriate medical screenings and failed standards relating to having physicians on call.

CMS has forwarded a copy of its EMTALA report to the Office of the Inspector General within the U.S. Department of Health and Human Services, Arther said. The inspector general's office could impose fines on the hospital.

Arther said Southern Nevada Adult Mental Health Services, which oversees Rawson-Neal, has 10 days to submit a "plan of correction" of the hospital's problems. If it does so, it will be subject to another unannounced visit by inspectors.

That follow-up inspection will determine whether the hospital will continue to be deemed eligible to receive federal reimbursement for care of Medicare patients, he said.

Arther said it is rare for a hospital to permanently lose that designation. "We try to work with providers to the extent that we can, and more often than not the hospitals will make the necessary corrections to come into compliance," he said.

Joel Dvoskin, an outside consultant who evaluated Rawson-Neal earlier this year at the state's request, said the potential loss of Medicare funding is a serious issue for any facility.

It's important, he said, "especially at a time when mental health budgets at every level all over the country have been cut. This certainly isn't going to help them."

Dvoskin, a psychologist based in Arizona, said he is convinced that state and hospital officials "took our process very seriously" and are working to correct the problems that he and another consultant, psychiatrist Kenneth Applebaum, cited in their lengthy review of Rawson-Neal.

Among other things, they said hospital staff often feels pressure to discharge patients to make room for more, that the facility relies too heavily on treatment with medications and not enough on psychotherapy or behavioral therapy, and that staffing levels are not adequate for the large volume of patients seen at the hospital.

Nevada state health officials did not return calls for comment Friday afternoon.

Earlier this week, Nevada Health and Human Services Director Mike Willden told a legislative committee that CMS officials have put the hospital under constant scrutiny.

"Quite frankly, they've been in our facility every other week," he said, referring to CMS inspectors. "We've had multiple teams in recently."

Nonetheless, Willden and others have insisted that conditions at the hospital have improved since CMS first threatened to cut off funding in the spring.

For instance, in criticizing the Joint Commission's decision to issue a preliminary denial of accreditation late last month, Willden said the ruling was based on an inspection that is "not an accurate reflection of the hospital's current practices and policies."

Several legislators at this week's hearing, which resulted in the release of about $2 million mostly for improvements at the Rawson-Neal campus, expressed frustration with continued problems at the hospital. "We're not serving our community," said Assemblywoman Lucy Flores, D-Clark County.

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