Accused of patient dumping, Nevada health officials on Monday said they’re investigating what led Southern Nevada Adult Mental Health Services to release a 48-year-old mentally ill man from a Las Vegas psychiatric hospital and put him on a Greyhound to Sacramento, Calif.
Nevada lawmakers also plan at a hearing next week to review the case and determine whether there are gaps in the state’s mental health system, said Sen. Justin Jones, chairman of the Senate Health and Human Services Committee.
“We’re going to ask some tough questions about what they’re going to do to make sure people don’t fall through the cracks,” said Jones, D-Las Vegas, who added he was disturbed after reading about the case.
Jones said he wants his committee to tour the Northern Nevada Adult Mental Health Services and Lakes Crossing, the facility that houses mentally ill offenders in Sparks, to learn more about the system. He also will visit Rawson-Neal, the psychiatric hospital in Las Vegas, accused of dumping.
The patient, James F. Brown, arrived Feb. 12 in Sacramento after a 15-hour bus ride from Las Vegas, according to documents provided by Loaves & Fishes, a social services agency that helped him find shelter that night. He told social workers he was forced to go to Sacramento, where he had never been and knew no one.
Loaves & Fishes in an article published Friday by the Sacramento Bee accused Nevada of dumping Brown on California. Joan Burke, advocacy director for the agency, said Monday that Brown has since disappeared. Social workers suspect he may try to return to Las Vegas.
“At least I know where the homeless shelters are in Las Vegas,” he told a social worker, Burke said in an interview.
“Putting somebody on a bus who indicates a high level of disability and inability to function is reprehensible,” Burke said. “This gentleman was adamant that he had no connections here.”
Nevada State Health Officer Dr. Tracey Green said state policy does not allow patient dumping, but sometimes people are transported out of state for care. She said she couldn’t discuss details of the case because of privacy rules and because it is under investigation.
“The reason we’re investigating is because this is awful,” Green said. “We are saddened by this. We would never want it to be misconstrued that we’re doing any dumping. We want to make sure everything was done correctly.”
Green said there are two investigations — an internal one by the Nevada State Health Division and an external one by the Bureau of Health Care Quality and Compliance, which licenses medical facilities.
“There is a lot more information” state authorities are learning about Brown’s situation, Green said, which will shed more light on the matter once the investigation is completed in two to four weeks. She said the probe will determine whether any policy violations occurred and whether anyone should be disciplined.
According to written policy, psychiatric patients are discharged from state care if a doctor determines a patient is no longer a danger to himself or others and can function outside the hospital. A treatment plan that includes the need for medication and continued outpatient services is drawn up.
State policy also allows for transportation back to a patient’s “home community in order to provide more appropriate care and to remove the burden of treatment from the state of Nevada.” But hospital staff must first confirm there is housing or shelter “and a support system available to meet (the) client at destination.” Staff also should provide information and an appropriate appointment for mental health services in the home community.
Green said patients participate in their discharge plan.
“That allows them a choice of where, how and what they want to do in their discharge plan,” Green said. “Sometimes that is to a place, to a person or a friend. But as adults, we do sometimes like to go to other states. There are many scenarios where we would consider discharging to other states.”
In Brown’s case, the discharge paperwork from Southern Nevada Adult Mental Services had no detail about who or what organization might help him in Sacramento. The paperwork, signed by Brown and a discharge nurse on Feb. 11, lists his address on discharge as “Greyhound bus station to California.”
“Discharge to Greyhound bus station by taxi, with 3 day supply of medication,” the handwritten instructions said. “Follow up with mental health, NA (Narcotics Anonymous) meeting in California. Follow up with medical doctor in California for any medical concerns.”
The discharge papers list three daily medications to treat schizophrenia, anxiety and depression. He was given Ensure, snacks and a bus schedule.
Brown agreed to let Loaves & Fishes make the documents public.
Molly Simones, the social worker who interviewed Brown, said he told her he had been living in a group home, Annie’s Place in Las Vegas, for the past two years, but it closed. He said he and his roommates were taken several weeks ago to a state mental hospital, in his case the observation unit at Rawson-Neal.
Rawson-Neal has a 30-bed observation unit. It is an acute-care facility with a total of 190 beds, designed to stabilize psychiatric patients but not provide indefinite care.
Brown told Simones he thought the hospital was working to find him a new group home, but then he was “told that he would be given a Greyhound voucher to Sacramento.”
“He was told by his psychiatrist to call an ambulance once he arrived in Sacramento & that the ambulance would take him to the ER and he would be admitted to the mental hospital,” Simones wrote in a report on the case.
Brown said his roommates were given bus vouchers to San Diego, Los Angeles, San Francisco and Seattle.
Brown also told the social worker he was suffering the first stages of Alzheimer’s and was hearing voices.
“These voices told James today that he should either do something to go to jail or should jump off a bridge,” Simones wrote. “James had no desire to come to California.”
In a postscript, Simones noted Brown was out of money and confused.
“James gets lost very easily & had a hard time remembering things,” she wrote.
Brown listed his address as 1511 North Las Vegas Blvd., Catholic Charities, a homeless shelter.
“That’s probably proof he stayed here,” said Leslie Carmine, spokeswoman for Catholic Charities. “But I don’t have any information about the gentleman. I hope he’s OK.”
Contact Laura Myers at email@example.com or 702-387-2919. Follow @lmyerslvrj on Twitter.