San Francisco warns Nevada of lawsuit on patient dumping

San Francisco City Attorney Dennis Herrera on Tuesday warned Nevada officials that he plans to file a class-action lawsuit over allegations of patient dumping from Rawson-Neal Psychiatric Hospital in Las Vegas.

The announcement came a day after University Medical Center reported that a recently discharged patient from a public California psychiatric facility had been left in its emergency room. She told UMC officials she had been dropped off by a caseworker from the California facility.

The class-action lawsuit would be filed on “behalf of California local governments to recover costs they incurred to care for indigent patients Nevada improperly bused” from Rawson-Neal, a news release from Herrera’s office says.

Herrera told Nevada State Attorney General Catherine Cortez Masto in a letter dated Tuesday about his intent to pursue litigation. He is giving Nevada officials until Sept. 9 to respond and negotiate an agreement to avoid litigation. As part of a settlement agreement, Herrera asks for reimbursement of half a million dollars or more and calls for Nevada to establish protocols for best practices for the out-of-state transfer of mentally ill patients.

“Nevada’s busing of such patients to California constituted a misappropriation of the destination cities’ and counties’ resources for health care and basic necessities, which Nevada was legally obligated to provide to its own indigent residents,” the letter said.

Rawson-Neal lost its accreditation and was hit with a federal lawsuit in the aftermath of patient-dumping allegations this year. Scrutiny of the Las Vegas hospital intensified after Rawson-Neal discharged James F. Brown, 48, to Sacramento, Calif., in February with no support or family waiting for him.

The announcement from Herrera did not address the questions raised by UMC on Monday about the mysterious arrival of the woman discharged from the California mental hospital. The woman arrived Saturday afternoon at UMC and was carrying paperwork that showed a discharge date of Friday from Napa State Hospital, a 138-year-old psychiatric facility northeast of San Francisco.

Brian Brannman, UMC’s chief executive officer, said it will cost the hospital $1,500 a day to keep the woman at the facility until she can be transferred to Rawson-Neal. The woman’s condition requires further treatment and would have made it difficult for her to travel alone, according to UMC staff.

Mary Woods, spokeswoman for the Nevada Department of Health and Human Services, said state officials wouldn’t be able to comment on pending litigation.

Gabriel Zitrin, a spokesman with Herrera’s office, said the purpose of Tuesday’s letter is “to give Nevada the opportunity to avoid litigation.”

In regard to the woman, who was discharged from Napa State Hospital and ended up at UMC without her guardian having any knowledge of either the discharge or her travel to Nevada, Zitrin said officials were not aware of the case, but “we encourage every jurisdiction to move away from this” practice. “Beyond that, I can’t really comment on the case because we are not familiar with the specifics of it,” he said.

He declined to comment on whether they would consider looking into that case.

Under California policy, “a (Department of State Hospitals) patient is typically discharged after a court order and is released to the county of commitment. …The hospital’s policy is to communicate with the conservator (guardian) regarding … discharge directions and to release the patient to the authority of the conservator,” according to a statement from Ken Paglia, spokesman for the California Department of State Hospitals.

He declined to comment specifically on the case that his department is investigating. But Paglia also said Tuesday that “DSH-Napa does not authorize its employees to transport patients or discharge patients across state lines.”

Representatives with the Los Angeles city attorney’s office, which also launched an investigation into allegations of patient dumping involving Rawson-Neal, didn’t return calls seeking comment.

Herrera’s letter said preliminary results from his investigation identify 500 patients who had been bused to California from Rawson-Neal since 2008. Twenty-four of them were bused to San Francisco, and 20 of them were provided emergency medical care on their arrival.

San Francisco has spent about $500,000, and maybe more, on medical care, housing and subsistence grants for those patients after their discharge from Rawson-Neal, the letter said. He seeks reimbursement of that money, unless Nevada is able to provide proof of San Francisco residency, family members or prior arrangements with a medical facility in the cases. He also seeks reimbursement for patients transported to other California destinations, who at the time when they were bused were not residents of the Golden State.

His investigation shows that a number of the 500 patients transported to cities and counties across California were not residents of the destination they were bused to and did not have family members there who were willing or able to care for them, according to the letter.

Furthermore, Herrera says that his investigation also has “determined that Rawson-Neal staff were well aware that the 24 patients bused to San Francisco since April 2008 were all indigent and homeless, suffering from a mental illness requiring ongoing medical care and medication.”

“Rawson-Neal staff understood and expected that the bused patients would rely on San Francisco’s public health resources for continuing medical care,” the letter says.

The Human Services Agency of San Francisco has A Bus Ticket Home program to help reunite homeless people living in San Francisco with family and friends willing to support them, according to its website.

Zitrin said that program helps reunite people with their family and that prior arrangements are made, unlike the cases out of Nevada.

“In California, I’m not aware that similar issues have arisen,” he said.

Contact Yesenia Amaro at yamaro@reviewjournal.com or 702-383-0440 or Paul Harasim can be reached at pharasim@reviewjournal.com or 702- 387-2908.