Health officials: State didn’t follow patient discharge policies

Nevada health officials acknowledged Thursday that proper discharge policies weren’t followed in the case of a mentally ill man “dumped” in California when he was put on a bus to Sacramento after his release from a Las Vegas psychiatric hospital.

But an initial review didn’t turn up any systematic problems in Nevada discharge policies, according to a presentation before the Senate Health and Human Services Committee.

“We own it. We blew it. And we’re taking corrective action,” Mike Willden, director of the Nevada Health and Human Services, told the Senate panel.

Richard Whitley, administrator of the Nevada State Health Division, said the state already made two changes in procedures. Now, a second doctor must sign off on any patient release before a mentally ill person is discharged. And the head of the Rawson-Neal psychiatric hospital must sign off on any out-of-state discharges to ensure proper care is available at the other end.

“We know there was a failure somewhere,” Whitley said, adding state officials “will take corrective action to make sure this doesn’t happen in the future.”

State Sen. Justin Jones, D-Las Vegas, the committee’s chairman, praised the health authorities for admitting mistakes and for working to fix the problems.

“I appreciate that you guys have accepted responsibility and are trying to get out ahead of this,” Jones said.

However, Jones also questioned whether there are enough psychiatric beds available in the state to ensure patients aren’t discharged too soon. Rawson-Neal is budgeted for 190 beds, but it has about 100 more. Also, an older hospital nearby has 77 licensed beds sitting empty.

Dr. Tracey Green, the state health officer, said the older facility has some plumbing and air conditioning problems. But she added, “We are looking at what would be safe for the clients to use.”

Adding beds, however, would cost the state more money. And Republican Gov. Brian Sandoval didn’t propose any additional mental health spending for additional beds. Sandoval recommended spending some $800,000 to open a 24-hour, seven-day-a-week urgent care center at Rawson-Neal.

The patient dumping case highlighted Nevada’s lack of services for the mentally ill, according to critics.

California accused Nevada of patient dumping after James F. Brown turned up in Sacramento last month and told homeless advocates he was forced to go there and didn’t know anybody in the city.

Brown, 48, has since disappeared.

Nevada opened internal and external investigations and asked the federal government to review the case, too. Those separate inquiries are continuing and are expected to conclude soon.

Under Nevada policy, mentally ill patients can be transported to other states if there is a support system or individual at the other end to help them.

In Brown’s case, his discharge papers from the Southern Nevada Adult Mental Health Services said, “Discharge to Greyhound bus station by taxi, with 3 day supply of medication.”

The daily medication is to treat schizophrenia, anxiety and depression.

After the initial review, Nevada health officials determined Brown’s case wasn’t properly handled.

“Discharge did not follow our policy and procedure,” said the official presentation prepared for the Senate hearing. “Our initial review reveals this is not reflective of a systematic issue.”

Nearly 92 percent of patients in Nevada psychiatric hospitals are state residents, according to the state presentation. Three percent come from California.

Some 4,740 patients were discharged between July 1, 2012, and Feb. 28.

Of those, 99 were transported to California. Some 81 percent were California residents, 10 percent had family or friends in California, 7 percent requested treatment in the state, and 2 percent went there on their way to other countries, France and Italy, the presentation said.

The presentation also said most of the patients Nevada discharged overall were released to a private residence, or 64 percent. Eighteen percent were released to other residential or institutional settings, which can include group homes. Some 12 percent went to homeless shelters;
4 percent went to another agency or treatment facility; and the remaining 2 percent were discharged “to self-care,” such as a weekly motel.

Loaves & Fishes, the Sacramento agency that helped Brown, was skeptical of Nevada’s finding that it wasn’t dumping more patients. Joan Burke, advocacy director for Loaves & Fishes, said Brown told her organization several other discharged patients were put on buses to other California destinations at the same time as he was.

“If Mr. Brown’s account was accurate, it wasn’t just himself,” Burke said. “It was a number of people. It sounds like their policies may not be detailed enough to safeguard against these occurrences. I’m just skeptical about claims that people wanted to go to California across the board. Why should we believe them?”

Las Vegas homeless shelter operators who knew Brown said he expressed a desire to leave the city and move to either Northern Nevada or Northern California, but he never mentioned Sacramento.

Burke said it’s possible that Brown said he wanted to go to California, especially if he were asked “leading questions.” But she said Nevada clearly failed to provide any sort of “warm hand-off” to California organizations, which may have been able to help Brown if they knew he was on his way.

Loaves & Fishes is still asking about Brown, hoping he will turn up in good shape.

“We called the coroner,” Burke said. “They don’t have a record of him. So hopefully he’s doing OK.”