Patient dumping leads to firings at state hospital

Two Nevada state employees were fired Monday, and three others will receive lesser discipline, in the investigation of alleged cross-border dumping of mental patients, state officials announced Monday.

Nine employees were involved in improper discharge of patients over the past five years, officials said. In addition to those terminated or disciplined, four no longer are employed at the hospital.

Mary Woods, spokeswoman for the state’s Department of Health and Human Services, said she couldn’t say what positions the employees held, but medical staff include physicians, nurse practitioners and physician assistants.

Gov. Brian Sandoval announced the firings Monday, saying, “All individuals who violated release policies have been or will be disciplined. These disciplinary actions include terminations effective today.”

The action follows a state review of cases involving more than 1,500 patients who were released in the past five years from Rawson-Neal, the state psychiatric hospital run by Southern Nevada Adult Mental Health Services, and bused out of state.

Most of those releases followed the rules, the investigation by the state Department of Health and Human Services found, but “certain individuals” violated policy.

The governor also announced that the state has obtained proposals from national experts in mental health to help the state improve its practices.

According to the Department of Health and Human Services, in 1,473 cases in which patients received an out-of-state bus ticket, 10 were insufficiently documented, making it difficult to know whether staff had confirmed there was support — such as family, friends and housing — waiting at the patient’s destination.

Only one patient’s case can be classified as “patient dumping” because he had no one waiting for him after being discharged and transported out of state.

“This information indicates that more than 99 percent of the time staff followed the discharge policy and documentation was accurate and complete,” Woods said in a statement Monday.

Of the 10 patients, nine were admitted with substance abuse issues as their primary diagnosis and didn’t need inpatient hospital admission after discharge, Woods said.

During a five-year period, 31,043 people were admitted to the Rawson-Neal Psychiatric Observation Unit, according to Woods’ statement. Of those patients, 92 percent were from Nevada.

Of the 31,043, officials initially identified 1,508 patients who had received an out-of-state bus ticket. After reviewing the cases with an out-of-state ticket, officials found some duplicates, and only 1,473 patients had received an out-of-state bus ticket, Woods said.

In each of the 1,473 cases, officials reviewed the patient’s diagnosis at the time of admission and discharge, and whether staff had followed policy for the patient to return to his or her community and whether the patient was released from the Psychiatric Observation Unit or from the hospital’s inpatient services, Woods said.

The hospital received $3.8 million in federal funding during fiscal 2012. During the same year, it received $32.5 million from the state’s general fund.

Late last week, the hospital was given 10 days by the federal Centers for Medicare and Medicaid Services to correct “serious deficiencies” in its mental health discharge policies or face a loss of federal funding.

The warning from the federal centers came days after Sandoval announced a new discharge policy to have a second doctor review a patient’s discharge plan and have a chaperone travel with the patient out of state.

The hospital came under scrutiny after the Sacramento Bee in California reported that James F. Brown, who had been discharged from Rawson-Neal, was bused to Sacramento, where he had no family or support waiting for him.

The issue has become politicized, and on Monday the Nevada State Democratic Party released a statement saying that almost everything Sandoval’s administration has said about the issue has proven to be false, citing new allegations after the governor’s corrective action.

“Gov. Brian Sandoval has proven yet again that he cannot be trusted and Nevadans should be skeptical of anything he says on the scandal,” the statement said.

There are several investigations into the issue, including those launched by the Los Angeles and San Francisco city attorney’s offices.

Contact reporter Yesenia Amaro at yamaro@review
journal.com or 702-383-0440. Contact reporter Richard Lake at rlake@reviewjournal.com or 702-383-0307.