Nevada Adjusts Controversial Psychiatric Policy

In a dramatic change to their controversial discharge practices, Nevada health officials no longer will send state psychiatric patients alone on buses to cities across the country, they said Wednesday.

Effective immediately, a chaperone will accompany any mentally ill patient discharged from state facilities "for whom the state is paying transportation costs" to points outside of Nevada, said Mary Woods, spokeswoman for the Department of Health and Human Services.

Family members, legal guardians or state employees could serve as chaperones, Woods said.

The policy change was announced as the state and its primary inpatient facility for the mentally ill, Rawson-Neal Psychiatric Hospital in Las Vegas, face allegations of "patient dumping" stemming from a Bee report published earlier this month.

The Bee's investigation found that Rawson-Neal purchased Greyhound tickets for more than 1,500 patients since July 2008, dispatching people to every state in the continental United States. About a third of those patients were sent to California.

One of those patients, James Flavy Coy Brown, who suffers from schizophrenia, was discharged in February to a Greyhound bus bound for Sacramento, a place he had never visited and where he knew no one. He said a doctor at Rawson-Neal told him to call 911 when he got to Sacramento.

Brown arrived confused and agitated at a Sacramento homeless services complex after spending 15 hours on a bus with a few bottles of Ensure and three-day supply of medication to sustain him. He spent three days in the UC Davis Medical Center emergency room before social workers found him temporary housing.

The Bee's findings have prompted federal probes into patient care at Rawson-Neal, and criminal investigations by the city attorneys in San Francisco and Los Angeles into whether the aggressive busing policy was a form of cross-state patient dumping.

An array of psychiatric specialists interviewed have called the hospital's long-standing practice of putting mental patients on buses without escorts troubling and dangerous.

"Let me count the ways," Dr. Marye L. Thomas, a physician and head of behavioral health for Alameda County, said earlier this month. "If the person is truly disabled, there would be the possibility that some event could happen ... ."

Nevada health officials have defended the busing policy, saying most patients sent out of state were being returned to their home communities and arrangements were made for their care. They said Brown's case was an exception.

Woods said the policy change announced Wednesday stemmed from an internal review of files of the 1,500 patients bused out of state since 2008. She said the review uncovered additional cases in which the facility's discharge policies were not followed.

Health and Human Services Director Michael Willden told news media this week that "five or six" such cases had surfaced. But Woods said the analysis is ongoing and "it's too early to tell" how many such violations occurred.

"We want to be really thorough, and I'm not comfortable citing numbers," she said.

But she reiterated that the problem "does not appear to be systemic."

Woods said two employees have been disciplined in connection with Brown's case, but declined to provide details.

Both the independent Joint Commission, which accredits hospitals across the country, and the Center for Medicare and Medicaid Services, a watchdog group, are looking into complaints against Southern Nevada Adult Mental Health Services, which oversees Rawson-Neal.

The hospital got a visit Friday from Nev. Gov. Brian Sandoval, who has defended the facility while acknowledging it made a mistake in Brown's case.

"Improperly discharging one patient is one patient too many," he said in a statement earlier this week. But, he added, "It is not the policy of the State of Nevada to engage in 'patient dumping' ... Rather, patients have a right, and a desire, to return home to their friends and families."

The Nevada State Democratic Party on Wednesday weighed in on the Republican governor's visit to Rawson-Neal and the newly announced changes to the hospital's discharge policies.

"Today's announcement is essentially an admission that the Governor's patient-dumping policy is far more widespread than he originally conceded," spokesman Zach Hudson said in a news release. "It is shameful that it took weeks of damaging press coverage for the governor to come close to admitting that his administration's busing policy is reckless and irresponsible."

In California, where most public mental health treatment is overseen at the county level, agencies contacted by The Bee said they rarely bus psychiatric patients to other states and never without an escort.

In Los Angeles County, "staff are required to escort the client," said county Department of Mental Health spokeswoman Kathleen Piche. "They are never alone when they travel."

Several political leaders and former agency administrators in Nevada traced Rawson-Neal's unusual discharge practices to a mental health budget that has been steadily dismantled in recent years. The number of psychiatric patients bused out of Nevada grew 66 percent from calendar year 2009 to 2012. During that period, Nevada slashed its mental health budget by 28 percent to address deficits.

In published news reports, Willden has denied budget was a factor, attributing the steady rise in busing numbers to a policy change in 2009 that removed administrative oversight from the decisions.

Following The Bee's report, Rawson-Neal tightened its discharge practices by having two additional people, including hospital administrator Chelsea Szklany, review transfers to other states, officials said.

Call The Bee's Cynthia Hubert, (916) 321-1082. Follow her on Twitter @cynthia_hubert.

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