Dan Morain

Dan Morain: Ruling shows little regard for mentally ill

At least, U.S. District Judge James C. Mahan was being honest.

From his lifetime seat on the federal bench in Las Vegas, Mahan provided a clear explanation for Nevada’s practice of banishing mentally ill people from its borders.

Officials simply were allocating resources by busing indigents to other states.

Mahan held Feb. 13 that Nevada’s Rawson-Neal Psychiatric Hospital did not violate the constitution or any statute when staffers bought a Greyhound ticket for James Flavy Coy Brown, a mentally ill man who called Nevada his home, and bused him to Sacramento, where he knew no one.

No matter that Brown arrived in Sacramento penniless, with only the clothes he wore and the discharge papers from Rawson-Neal, and that some Rawson-Neal staffer actually told him to call 911 upon his arrival.

“Indeed,” Mahan wrote, brushing aside Brown’s civil rights lawsuit as if it were lint on his robes, “plaintiff’s account indicates that defendant gave him enough medication to last for the entire trip to Sacramento, and that shortly after he arrived, he was treated at the University of California at Davis Medical Center.”

In other words, UC Davis carried out its duty to treat Brown. There was, therefore, no harm.

The Sacramento Bee first wrote about Brown one year ago. Since that first story, our reporters disclosed that Nevada had a long-standing policy of busing mentally ill patients out of Las Vegas, 1,500 in a five-year period, more in later years as Gov. Brian Sandoval and legislators cut mental health care funding.

Sandoval ended the policy after it was exposed. But the attitude that created it remains, as reflected by Mahan’s ruling and by an editorial in the Las Vegas Review-Journal, justifying and lauding Mahan’s thin decision.

Sacramento civil rights attorney Mark Merin and the American Civil Liberties Union, representing Brown and 1,499 other mentally ill people bused in a five-year period across the continental United States, will ask Mahan to reconsider his ruling. Failing that, they will appeal to the U.S. 9th Circuit Court of Appeals.

Mahan, appointed by President George W. Bush in 2001, is viewed as one of the better judges in Las Vegas. But in this case, he is wrong on so many levels. He relieves the state of any obligation to care for people who cannot care for themselves.

“Plaintiff argues his substantive due process rights were violated by state defendants ‘forcing’ him to travel outside the state,” Mahan wrote. “However, this proposition is nonsensical.

“Plaintiff’s complaint does not establish that he was compelled to leave the state, merely that defendants gave him the resources by which to do so.”

True, no one from Rawson-Neal accompanied Brown on the cab ride from the Las Vegas psychiatric hospital to the Greyhound depot.

But that’s one of the issues in the Rawson-Neal story that has unfolded in pages of The Bee during the past year. The hospital recklessly bused mentally ill patients across the country without escorts.

Mahan essentially reasoned that Nevada avoided liability by being so derelict in its duty to care for mentally ill people that it failed to provide escorts.

The judge also neglected a basic point: Brown was drugged, suicidal and hearing voices.

The psychiatrist at Rawson-Neal – a man Brown was supposed to trust and who had the power to release or hold him on the locked ward – told Brown to get on the bus to “sunny California” where he could get services. Mahan’s decision failed to mention that the staff made no attempt to line up those services.

By mere luck, Brown found a sympathetic Sacramento cop who brought him to Loaves and Fishes, the homeless shelter. There, a compassionate staffer, Molly Simones, helped him find the UC Davis emergency room.

Perhaps the most disturbing aspect of Mahan’s ruling is that he accepted Nevada’s justification for the busing policy: that caring for mentally ill people is costly.

“Making policy distinctions in order to best allocate scarce financial resources certainly stands as a rational basis to support the discharge policy at issue in this case,” Mahan wrote. “Indeed, it is one of the key functions of government to decide how to best allocate public resources and to tailor its policies to best serve its citizens.”

By ridding itself of Brown and 1,499 other psychiatric patients like him, Nevada spared its taxpayers what the state’s busing policy described as the “burden” of paying for their care. Of course, Nevada simply was shifting costs to California and Iowa and Ohio and Florida, and every other state where it bused patients.

Mahan was OK with that, writing: “it is not irrational that state defendants would develop policies that make distinctions in the way they treat patients based on the patient’s economic status.”

Mahan revealed a fundamental if outrageous truth: Nevada acted rationally by mistreating Brown. He was, after all, an indigent. As Mahan made clear, people’s economic status determines the level of care they receive.

Apparently, that’s an appropriate standard of care in the adult playground of Las Vegas. Homeless mentally ill people aren’t good for business on the Strip.

It’s not as if Mahan’s ruling stirred much angst in Las Vegas. As the Review-Journal wrote, Brown’s case should end unless evidence shows the “state literally kicked patients to the curb and then dragged them onto a moving bus.” Nevada’s abdication of its responsibility was not that overt. No one claims the bus was moving.

As Mahan wrote, scarce financial resources dictated the policy. But of course resources aren’t scarce. Corporations that own the Vegas casinos are hardly strapped for money. And as the judge wrote, Brown’s constitutional rights were not violated when the Rawson-Neal psychiatrist told him to get on the bus. It’s nonsensical to think otherwise, as the judge said. There is, however, a question of basic human dignity that the judge overlooked.

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