Dan Morain

Dan Morain: Nevada's shame: patient dumping

Dan Morain
Dan Morain

CARSON CITY, Nev. – To attract tourist dollars, Nevada Gov. Brian Sandoval unveiled a cheery little ad that displays the Silver State's sunny side and is set against a toe-tapping version of "Don't Fence Me In," the sort of tune that can worm its way into your head.

The governor proudly displayed a new slogan: "Nevada: A world within. A state apart."

Funny thing, but Sandoval can't bring himself to talk about a policy that truly sets Nevada apart: busing patients from Rawson-Neal Psychiatric Hospital in Las Vegas to every state in the continental United States.

"We are going to decline to comment," Sandoval's press secretary, Mary-Sarah Kinner, said in a recent email, before she stopped bothering to respond to my requests for comment.

The 30-second commercials with the snappy sounds of "Don't Fence Me In" will start airing Monday in Los Angeles, San Francisco and Phoenix, appropriate given that Nevada draws millions of tourists from those markets.

Also noteworthy, Nevada buses many of its psych patients to those areas, 240 to the Los Angeles-Orange County area, 48 to the Bay Area and 71 to the Phoenix-Mesa-Tucson area since mid-2008.

"We're not amused by what they're doing," said Orange County Supervisor John Moorlach, who, like other California officials, had been unaware of Nevada's practice.

For years, Nevada carried out its policy quietly, failing to inform mental health care professionals on the receiving end of the bus rides.

But in February, Rawson-Neal's staff stumbled by giving James Flavy Coy Brown a three-day supply of anti-psychotic medication, four bottles of Ensure and what he called "cheesy peanut butter crackers," and sending him on a 15-hour Greyhound bus ride to Sacramento, where he has no family and no connections.

Brown, who has schizophrenia, made his way to the Loaves & Fishes shelter in Sacramento, where a social worker listened to his story and got his permission to call my colleague Cynthia Hubert. She has been writing about Brown ever since.

We also used the Nevada public records act to get receipts of all bus tickets purchased by the Nevada mental health department back to mid-2008 and found that Nevada authorities bused 1,500 human beings from its Las Vegas psychiatric hospital to cities in every corner of the country.

Nevada sent people to Eureka, Chico and El Centro, and to Idaho Falls, Kansas City and Raleigh. Nevada sent 29 people to Chicago and 19 to New York City. It recently bused two people from Rawson-Neal's inpatient wing 2,200 miles to Miami and three people 2,400 miles to Boston – presumably with no escort, but with 18 bottles of Ensure each, as per its "travel nourishment protocol."

During his two years in office, Sandoval has presided over cuts in mental health funding, as Nevada expanded its out-of-state busing program, from 290 people in 2010, the year before he took office, to 361 people in 2011, his first year in office, to 388 in 2012.

Another 81 patients were bused out of Nevada in the first 10 weeks of this year. At that rate, Nevada will have bused more than 400 people in 2013, though the rate might slow now that it is being exposed.

I don't know who the individuals are. Nevada authorities were cavalier in their care of James Brown. But they are strict about privacy laws, careful not to release any names. That leaves questions.

How ill were the people who were bused? Did they make it to their destinations, or get lost? Did they take their meds or sell them? Did any of them harm themselves or others en route to where they were headed?

Sandoval, a Republican on the rise, ought to be asking those questions. He portrays himself as solid family man, with three children and a first lady who works "to advance awareness of children's mental health issues." How nice.

A former Nevada attorney general and federal judge, Sandoval is mentioned as vice presidential timber, or a 2016 candidate for the U.S. Senate seat held by Senate Majority Leader Harry Reid.

After President Barack Obama carried Nevada easily, Sandoval deftly became the first Republican governor to accept Medicaid expansion offered through the Affordable Care Act. Earlier this month, after Hubert wrote about Brown, Sandoval announced he wants to increase mental health funding by $25 million.

I spent a day in Nevada's Capitol last week to get a sense about what politicians thought of Brown's story and its implications. Not much, as it happens.

David R. Parks, Nevada's Senate president pro tem, wasn't aware of the story, even though a Senate committee held a rather perfunctory hearing on it last month. Parks had no idea about the magnitude of his state's busing program.

"When a state like Nevada funds its health care programs as poorly as we have, there are going to be problems," Parks said.

Sen. Richard Segerblom, a Las Vegas Democrat who goes by the nickname "Tick," said Brown is "lucky" to have landed in California. At least, California provides some sort of safety net.

"We're like the Mississippi of the West," Segerblom said. "I think you'll find that people couldn't care less."

In a hallway outside a legislative committee room, Mike Willden, longtime director of Nevada Health and Human Services, explained the busing policy. When out-of-towners deteriorate, he said, "We're using our funds, our resources, to treat that mentally ill patient."

"That said, our policies are pretty clear. We want to get that person back in the community," Willden said. "We're going to attempt to get you connected with your family, your friends and your resources in your community. So if you look at most of the bus transports we've done, that's what we've done. We've connected them to their community."

If Nevada authorities truly wanted to reintegrate the individuals, rather than dump them, Nevada's case workers probably would have picked up the phone and called mental health workers in counties that receive them.

"I have not received any communication from anyone in Nevada," Orange County behavioral health director Mary Hale said, echoed by many other officials outside Nevada.

Willden explained: "I don't know that the county would know about it. But the family, friends and the treatment program we're sending them to should know about it."

And he had a justification: "We don't know when we're receiving interstate mental health placements. So the street runs both ways."

Could it be that other states place individuals on Greyhound buses to Las Vegas with supplies of Ensure and cheesy peanut butter crackers? Hale could not think of a single instance in which Orange County had bused patients to another locale, certainly not unescorted.

Willden said Sandoval has been reading articles about Brown and "is very concerned."

"He cares about people," Willden said. "You'll have to ask the governor beyond that what his opinion is."

I tried on the day I was in Carson City. But Sandoval was busy unveiling what he called Nevada's "awesome" new brand. Nevada: A world within. A state apart. One that has a cold-blooded policy born of lack of compassion for people who cannot care for themselves. Think of it every time you hear the catchy new rendition of "Don't Fence Me In."

Follow Dan Morain on Twitter @danielmorain.

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