Patient dumping points to something worse

The sad reality is, Las Vegas can be a cold, hard town.

If you’re not contributing to the city’s No. 1 industry, if you’re down on your luck, broke, or otherwise incapable of supporting the fabulous Las Vegas Strip, this town couldn’t care less about you.

Whether it’s drunk club-goers tossed onto the casino floor when their credit runs out, good-faith homeowners tossed out of underwater houses when their money runs out or mentally ill people tossed onto buses when their sanity runs out, Las Vegas can be the harshest city in America.

That’s why the really surprising thing about Nevada’s “patient dumping” scandal isn’t that it happened at all, but that it’s not more widespread.

(It’s important to note that not every patient sent somewhere by bus has been dumped. The state says 1,473 mentally ill people were sent to another state between July 2008 and March 2013. Of those, it claims just 10 were “dumped,” or that documentation can’t be found to show they were properly discharged. The rest had friends, family or a mental health facility waiting at the other end of that bus ride.)

Then again, we were originally told it was just one case — that of James F. Brown, who was bused to Sacramento, Calif., although he’d never been to that city and knew no one there. After that, it was reported that three or four other cases had been found. Then six. Now that number has been fixed at 10.

As Gov. Brian Sandoval (finally) said, more than a month after news of the patient dumping scandal broke, one is too many. And he’s right about that. It’s impossible for most of us to imagine how frightened, frustrated and confused Brown and at least nine others must have been, riding those buses with packages of state-provided crackers and cans of Ensure, not knowing what would happen when that bus finally stopped rolling.

That this happened at all is an outrageous combination of limited state budgets, misguided and misapplied state policies and good old-fashioned Nevada callousness. That we care about it now primarily because of embarrassing media scrutiny, the potential loss of Medicare funds and politics only adds to the outrage.

The reaction to patient dumping has been typical: Some defended Nevada. Why should we have to pay for the mentally ill residents of other states, who just happen to wind up on our doorstep? Why shouldn’t their home states defray the cost?

Cold. Hard.

Nevada’s Democratic Party — though, curiously, not its elected leaders in the Legislature — has pounded our state’s thus-far Teflon Republican governor for his tardy response to the situation. Although the story broke in early March, Sandoval didn’t weigh in until April 23.

“I take the concerns regarding Rawson-Neal [Psychiatric] Hospital very seriously and it is not the policy of the state of Nevada to engage in ‘patient dumping,’ as had been alleged by some,” Sandoval said. “Rather, patients have a right, and a desire, to return home to their friends and families.”

Set aside for a moment that this conflates two very different things: Actual “patient dumping” involves cases where there are no friends or family waiting for a patient. Instead, let’s check what those policies say.

Up until April 23, the policy of the state was to “... assist patients who may be transported back to their home community in order to provide more appropriate care and to remove the burden of treatment from the state of Nevada.”

Burden?

It’s easy to see why the new policy is unburdened by that language, saying simply that the state’s policy is “... to assist patients who may be transported back to their home community in order to provide continuity of care.”

That’s not the only change — the state will now send a chaperone with each patient to make sure they reach their destination without incident. Up until now, patients rode alone.

Not only that, but two members of the medical staff at Rawson-Neal were fired, and three more disciplined in the wake of the incident. (Another four involved in the dumping incidents no longer work at the facility.)

“As I stated before, improperly discharging one patient is one patient too many,” Sandoval said in announcing the terminations. “It is important to me and all Nevadans that we treat our most vulnerable members of society with dignity and care.”

But is it, really? Nevada’s Legislature had as personal an example of mental illness as possible this year, in the person of now-former Assemblyman Steven Brooks. His problems led to a tense, tearful session to expel him from the Assembly, the first such action in 149 years of state history.

Today, Brooks sits in jail in California. And in the Legislature, there’s been no major push to improve Nevada’s approach to mental health, to augment its funding, to expand the beds available for some of the most vulnerable people society will ever see.

Investigations — initiated in San Francisco and Los Angeles — will go on. More stories will be written. Policies will be revised. Nevada might not see another case of actual patient dumping.

But the cold heart of the city hasn’t changed. The climate that made it possible, even inevitable, remains. And that’s the final outrage. 

Steve Sebelius is a Review-Journal political columnist and author of the blog SlashPolitics.com. Follow him on Twitter (@SteveSebelius) or reach him at (702) 387-5276 or ssebelius@reviewjournal.com.