State completes review of improper patient discharges at Rawson-Neal Psychiatric Hospital

Four of 10 patients who were improperly discharged from Rawson-Neal Psychiatric Hospital were returned to their state of residence, according to a newly completed analysis of nearly 1,500 cases of patient transports spanning five years.

The in-depth review by medical and administrative staff at the Nevada Department of Health and Human Services also found that the actual number of individuals who received transportation aid was 1,292 from 2008 to March 31, 2013. The state spent $215,637.93 in bus tickets to transport those patients out-of-state, the report shows.

Dr. Tracey Green, the state’s chief medical officer, said she didn’t believe any of those 10 cases constitute patient dumping. All patients involved in those cases provided input for their discharge plans, she said.

Patient dumping “suggests that a patient has been sent somewhere against their will and (is) not ready to be on their own,” Green said Thursday.

Rawson-Neal Psychiatric Hospital came under scrutiny after James F. Brown was discharged earlier this year and bused to Sacramento, Calif., where he had no family or support waiting for him.

Several investigations by government and independent agencies were launched after Brown’s story came to light.

Thus far, the Southern Nevada Adult Mental Health Services, the agency that oversees Rawson-Neal, has retained its accreditation from the Joint Commission, an independent organization that accredits hospitals.

The federal Centers for Medicare and Medicaid Services have accepted a plan of correction submitted by the hospital. Other investigations are pending.

Earlier this month, Mark Merin, a Sacramento civil rights attorney, and the American Civil Liberties Union of Nevada filed a civil rights lawsuit with U.S. District Court in Las Vegas naming Brown as the plaintiff.

The internal report followed a Sunday story in the Sacramento Bee that included interviews with eight patients discharged from Rawson-Neal for various reasons.

A Monday Sacramento Bee editorial accused Nevada and agencies that oversee the hospital of whitewashing the practice of busing patients out of state. The Southern Nevada Adult Mental Health Services policy that allows for returning patients to their home communities was implemented in 1984.

Of the 10 patients singled out in the report, three — in 2009, 2010 and 2012 — were sent to California, their state of residence. In 2011, one was sent to Utah, his state of residence.

Five other discharged patients also were sent to California, but the Golden State was not their state of residence. Two of the five lived in Nevada and were transported to California in 2011 and 2013. A third was staying at a shelter in Nevada and was transported out of state in 2011. A fourth had been in Nevada for about a month before going to California in 2011. The fifth, from North Dakota, was transported to California after being discharged in 2012.

Another patient, who lived in Nevada, was sent to Florida in 2012.

Patients were sent to destinations they requested, said Mike Willden, director of the state’s Department of Health and Human Services.

Patients admitted to Rawson-Neal during the time covered by the report were from nearly every state in the country. The largest number of out-of-state patients were from California, a total of 771 admissions.

As officials have said, in those 10 cases staff didn’t follow policy, and there is not enough documentation to show whether the hospital did or didn’t comply with plans for follow-up care, Willden said.

None of the discharged patients was involuntarily transported, and all of them worked with a medical team in arranging travel.

“They were aware of their transportation and where they were going,” Willden said.

Most of the 10 patients were discharged from the Psychiatric Observation Unit, where an individual can stay for up to 72 hours to determine whether inpatient services are needed. Only two were discharged from the inpatient unit, which treats those with more severe mental health conditions, according to Willden and the report.

The hospital can’t hold patients against their will unless it is ordered by a court, Willden said. If the hospital did so, it would violate patients’ rights.

“These are people that upon discharge are well enough to travel. You can’t hold people against their will, especially if they are well and beyond their need for our service.” Willden said. “They have the right to their own self determination.”

In compiling the report, hospital staff did not attempt to contact the 10 former patients, Willden said, although some former patients have contacted hospital staff.

Green said when patients are found to be well enough to be discharged, the hospital doesn’t have to continue to track them because they are able to care of themselves.

But Allen Lichtenstein, general counsel for the ACLU of Nevada, said that at least in Brown’s case, he wasn’t able to take care of himself.

“If it was necessary to get court approval and give him the treatment that he needed, that’s what needed to be done,” he said. “He was clearly incapable of taking care of himself. I don’t see how anybody can make the argument that that’s proper treatment.”

Green said the process to get the court involved to keep patients against their will starts when a patient is at risk of hurting himself or others. The percentage of patients who are ordered to stay at Rawson-Neal against their will by the court wasn’t available Thursday.

Lichtenstein said other patients could join the lawsuit, but their information is still being reviewed.

The hospital is bringing in new psychiatrists in the next few weeks, and it continues to implement changes, Green said. “We continue to improve, despite the negative publicity.”

Contact Yesenia Amaro at yamaro@reviewjournal.com or 702-383-0440.