Patient dumping allegations ignite detailed review from Nevada officials

Nevada health authorities said Friday they’re examining every case of busing psychiatric patients out of state since July 1, 2008, as part of an intensive review after allegations from California of patient dumping.

A preliminary look indicates “the bulk” of 1,508 patients bused out of state as part of their discharge plans were sent home and asked for help getting there, said Mike Willden, director of the Department of Health and Human Services. That includes 508 sent by Greyhound bus from Las Vegas to California, he said.

In all, the total number of patients admitted from out of state during the past five years was 2,402, including about one-third of those, 771, from California, according to Willden.

The number of out-of-state transfers is dwarfed by the sheer number of patients admitted to Rawson-Neal, the state psychiatric hospital run by Southern Nevada Adult Mental Health Services.

Rawson-Neal admitted 31,043 patients from July 1, 2008, through March 31, 2013, according to the state. About half of those patients, 16,646, were released within 72 hours after being held in the psychiatric observation unit. The remaining 14,397 people were admitted as in-patients at the hospital, or were held for longer periods of time.

Of the 31,043 patients, about 28,600 of them were Nevadans, according to the state.

Nevada’s mental health services have been under fire since the Sacramento Bee published a story about a mentally ill homeless man who was sent by bus from Las Vegas to Sacramento with no support services at the other end.

Nevada health authorities admitted patient discharge policies were not followed in the case of James F. Brown, and a state investigation turned up two other unsafe discharges out of 30 cases examined from February.

Willden said Friday that personnel involved in the Brown case have been disciplined and reported to licensing boards, whether for psychiatric, psychological or social services. He said discipline could include a letter, demotion, suspension or termination. He said privacy rules prevented him from revealing the specifics.

The state also imposed new rules after the Brown case, requiring a second doctor to sign off on all discharges and requiring Rawson-Neal’s hospital administrator to approve all discharges involving travel.

The U.S. Centers for Medicare & Medicaid Services is conducting an investigation at the state’s request. The results could be delivered as soon as next week, according to a spokesman for the federal organization.

Willden said Las Vegas is known as a “magnet city” that, like Hollywood and Washington, D.C., more frequently attracts people who can have mental health problems.

“Mentally ill patients are sometimes drawn to certain locations,” he said, noting Las Vegas attracts close to 40 million visitors a year. “People go there for a reason — politics, fame, gaming, a desire to have fun.”

Willden said the state treats all patients equally, however, regardless of where they are from: “We don’t quibble over providing people with services who are not Nevadans. We take them all. We really don’t look at whether they’re from Canada, California or Utah.”

But when it comes time to develop a discharge plan with patients, their home states, countries and where they want to go comes into play. Of those 1,508 bused out of state, most said they wanted to go home, Willden said.

“We believe the bulk or majority were Californians who requested our assistance in getting back home,” he said. “We’re reviewing all 1,500 cases.”

The results of the transportation review probably will be released next week.

Southern Nevada Adult Mental Health Services has had the same transportation policy since 1984. It has been approved with no reported problems by every previous administration, according to Willden.

In two recent cases, patients were transported at Nevada’s cost by plane, one to Canada and one to Utah. In both cases, he said the patients had escorts, which aren’t required for bus transfers.

Dr. Tracey Green, who is Nevada’s health officer, said some mentally ill individuals have such severe problems that they need “wrap-around services” and close supervision and care upon discharge.

But others can make their way home after suffering some sort of temporary mental health problem.

Willden said that Nevada hopes to develop interstate compacts with states such as California, Utah and Arizona to handle patient discharges and transfers.

Contact Laura Myers at lmyers@reviewjournal.com or 702-387-2919. Follow @lmyerslvrj on Twitter.