Saturday, April 20, 2013

Don't Deny It Any More.

On Tuesday, we examined the latest developments in Nevada's patient dumping scandal. The Sacramento Bee has been on this story from the start, and it uncovered even more horrifying incidents of Nevada dumping mental health patients into other states with no plan for future care and no home to go. The investigation began when The Bee found James Flavy Coy Brown, a Rawson-Neal Psychiatric Hospital patient who was thrown onto a Greyhound bus with only a 3 day supply of medication, some peanut butter crackers, and a few cans of Ensure. He was left to wander the streets of Sacramento, California, until officials there found him near suicide in a homeless shelter and placed him into treatment.

Earlier this month, Sacramento Bee Senior Editor Dan Morain traveled to Carson City to ask Governor Brian Sandoval (R-Denial) and state legislators why they allowed this to happen for so long. While Senators David Parks (D-Paradise) & Tick Segerblom (D-Las Vegas) expressed their disappointment (and resignation to continued health care underfunding), Sandoval continued to deny its existence. He couldn't quite express that level of denial to KSNV/News 3 Las Vegas this week, he certainly tried to deflect.

And while other legislators are finally starting to speak out on this matter, they still seem reluctant to take action.

According to an initial review, the state’s mental health agency removed administrative oversight of busing patients with a policy change in 2009, prompting an increase in the number of patients bused out of state, said Mike Willden, director of the state Health and Human Services Department.

The agency has subsequently added back that level of oversight following two internal investigations sparked by the Sacramento Bee reporting.

“We’ve taken action to date. We’ve disciplined staff, referred to the licensing boards. We’ve done several policy changes. Additional training has been done to ensure going forward that this can’t happen again,” Willden said. “Zero tolerance is our goal." [...]

“Until we can get that information in the next couple weeks, we will have to see if any policy changes need to be made,” said Assembly Speaker Marilyn Kirkpatrick, D-North Las Vegas.

Assemblywoman Lucy Flores, D-Las Vegas, called the revelations in the Sacramento Bee stories “shameful” but also said that legislators don’t yet have enough information about the hospital’s policies or the details of the investigations.

Assemblywoman Maggie Carlton, D-Las Vegas, said she’s spoken with Willden but also needs to see more detail.

“What we have to separate is dumping versus sending home,” she said. “We need to figure out what this is really about.”

Sure, no one should rush to a conclusion without having all the facts. But at this point, it's becoming increasingly clear what the problems are. The Nevada Department of Health & Human Services implemented a policy change in 2009 that removed administrative oversight of patient busing. And while state officials continue to deny that recent state budget cuts led to patient dumping, that's become increasingly difficult to do, as Think Progress and others have noted the severity of Nevada's mental health care budget cuts. Think about this: Would Nevada's mental health care officials really have allowed all this patient dumping if this didn't look like an attractive option to save money?

We know Nevada state government has been notorious for cutting corners and attempting to provide necessary services on the cheap (meaning hardly at all) whenever possible. But now, this extreme resolve to cut corners instead of properly providing necessary services is causing real problems for our state. Now, Utah officials are expressing outrage over Nevada's patient dumping.

“It's very bad practice and very bad care for people that are psychiatrically unstable,” said [Doug] Thomas[, Assistant Director of Substance Abuse and Mental Health for the State’s Department of Human Services]. “When you go into in-patient care you have that level of care to help you maintain your functioning, when you discharge you're at risk to go back in."

The story came to light when one of Rawson-Neal's patients turned up suicidal and confused at a Sacramento homeless services agency. 48-year-old James Flavy Coy Brown was allegedly discharged in February with only a Greyhound bus ticket and three days worth of medication for schizophrenia and depression.

Dr. Coni Kalinowski is the medical director for Mohave Mental Health. She says the transient problem and severe budget cuts have put Nevada’s mental health services in crisis mode.

“So we have a huge number of people who have acute psychiatric needs who need to be in a hospital but absolutely no place for them to go,” said Kalinowksi.

Still Doug Thomas says that does not justify putting sick people on a bus and shipping them off to places they've never been.

"The only reason why any of our hospitals, or providers, would put anyone on a bus would be to return them to family members or a community where they had a support system and often they would go with that person."

And the outrage continues to flow from California. Now, Los Angeles & San Francisco are considering legal action against Nevada. Meanwhile, accreditation of Rawson-Neal is in serious jeopardy.

A Nevada state mental hospital's practice of discharging psychiatric patients to Greyhound buses and transporting them to cities and towns across the country is under investigation by the independent, nonprofit body that accredits hospitals nationwide.

In addition, city attorneys in San Francisco and Los Angeles are exploring whether the practice constitutes a form of cross-state "patient dumping," and might be grounds for legal action against Rawson-Neal Psychiatric Hospital and Nevada health authorities.

The responses follow a report in Sunday's Bee that revealed that Rawson-Neal, Nevada's primary psychiatric hospital, has bused more than 1,500 mentally ill patients out of southern Nevada in the last five years, sending at least one person to every state in the continental United States. About a third of those patients were shipped to California, including more than 200 to Los Angeles County, 36 to San Francisco and 19 to the city of Sacramento, according to a review of Greyhound bus receipts purchased since July 2008 by Nevada's mental health division. [...]

The hospital's practices have touched off preliminary inquiries in Los Angeles – which received 149 patients from Rawson-Neal during the five years reviewed, more than any city in the country – and in San Francisco.

In recent years, Los Angeles has cracked down on area hospitals for dumping patients on Skid Row, where the Greyhound station is located, filing lawsuits and criminal charges. Patient dumping is a misdemeanor by city ordinance.

"Clearly, we have an interest," Sandy Cooney, a spokesperson for the Los Angeles City Attorney's Office, said of the bus trips from Las Vegas. "We're trying to determine if this warrants an investigation." San Francisco also is in the early stages of an inquiry, said city attorney spokesman Matt Dorsey.

They can't say we (and others) didn't warn them. In fact, we've been warning here that Nevada will pay a hefty price if the state continues to dither while mental health services are underfunded and patients continue to be subjected to "Greyhound Therapy". And now, a federal investigation is underway as Rawson-Neal's accreditation is at risk and two major California cities consider law suits against Nevada for carelessly dumping patients into their cities.

Nevada, we have a problem. We can't deny it any more. Governor Sandoval can't deny it any more, and neither can anyone in the Legislature.

These people need treatment. It's in their best interest, and it's actually in the best interest of the greater community. And if you're wondering why it's so damned important, just remember how much trouble we've been seeing from the Steven Brooks case. It ultimately saves us lives and money to treat mental illness than to let it persist and worsen.

And yes, it's simply irresponsible for us to dump our problems onto other states and communities. It's inhumane to simply treat human beings like garbage in busing them to other states without any plans for future housing and treatment. And as we're learning the hard way, there's a price to pay for engaging in this kind of reckless behavior.

So why are folks in Carson City continuing to deny the severity of this horrid scandal? We can't afford to deny it any more. Nevada, we have a problem. And it's long past time for us to fix it.

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