Tuesday, April 16, 2013

Why Patient Dumping Scandal Returns to Bite Nevada

As the month has progressed, we've been following the harrowing story of James Flavy Coy Brown. He was receiving treatment at the Rawson-Neal Psychiatric Hospital when he was suddenly discharged, then thrown onto a Greyhound bus with just a 3 day supply of medicine, some peanut butter crackers, and a few cans of Ensure. Brown then arrived in Sacramento, California, with no home and a continuing need for treatment.

After The Sacramento Bee and other California media outlets began investigating this story, the State of California demanded official investigations into this matter. Pretty soon, the State of Nevada and the federal government began investigating this and other tales of patient dumping. It turns out that the story of James Flavy Coy Brown was not an isolated incident, far from it. In fact, Rawson-Neal has placed over 1,500 patients on Greyhound buses heading out of town (and most often, out of state).

Over the weekend, The Sacramento Bee uncovered even more.

In recent years, as Nevada has slashed funding for mental health services, the number of mentally ill patients being bused out of southern Nevada has steadily risen, growing 66 percent from 2009 to 2012. During that same period, the hospital has dispersed those patients to an ever-increasing number of states.

By last year, Rawson-Neal bused out patients at a pace of well over one per day, shipping nearly 400 patients to a total of 176 cities and 45 states across the nation.

Nevada's approach to dispatching mentally ill patients has come under scrutiny since one of its clients turned up suicidal and confused at a Sacramento homeless services complex. James Flavy Coy Brown, who is 48 and suffers from a variety of mood disorders including schizophrenia, was discharged in February from Rawson-Neal to a Greyhound bus for Sacramento, a place he had never visited and where he knew no one.

The hospital sent him on the 15-hour bus ride without making arrangements for his treatment or housing in California; he arrived in Sacramento out of medication and without identification or access to his Social Security payments. He wound up in the UC Davis Medical Center's emergency room, where he lingered for three days until social workers were able to find him temporary housing. [...]

At least two patients from the Nevada system arrived in San Francisco during the past year "without a plan, without a relative," said Jo Robinson, director of that city's Behavioral Health Services department.

"We're fine with taking people if they call and we make arrangements and make sure that everything is OK for the individual," Robinson said. "But a bus ticket with no contact, no clinic receptor, anything, it's really not appropriate."

Robinson said she viewed the practice as "patient dumping," and has reported it to federal authorities. "It's offensive to me that they would show this lack of care for a client," she said.

Los Angeles, San Bernardino, Riverside, Orange, and San Diego Counties have also reported receiving Rawson-Neal patients since 2009. Again, they arrived via Greyhound with no family, no plan, and no home. State and county mental health officials in California (and elsewhere) have had to scramble to figure out how to treat these patients who Nevada officials decided to dump onto them.

Against this scandalous backdrop, Governor Brian Sandoval (R-Denial) conveniently found $25 million to add to his proposed mental health budget. Too bad for him that federal funding for Rawson-Neal is now threatened pending official results of the federal investigation. Meanwhile, US Health & Human Services Secretary Kathleen Sebelius recently received an angry letter from California State Senate President Pro-tem Darrell Steinberg (D-Sacramento) regarding Nevada's patient dumping scandal. Even US Civil Rights Commissioner David Kladney, who's also a Nevadan, has condemned his own state "failing in its duty toward the neediest residents"!

While a couple gun safety bills seem to be advancing in the Nevada Legislature, honest talk of mental health treatment still isn't. Even as the state faces loss of federal funding and increasing scrutiny from the feds, California, and other states over the patient dumping scandal, Governor Sandoval and many state legislators prefer to act as if it doesn't exist. They're in for a very brutal and rude awakening. Sacramento Bee Senior Editor Dan Morain recently traveled to Carson City to see what our legislators think of the patient dumping scandal. And of course, he found this.

"We are going to decline to comment," Sandoval's press secretary, Mary-Sarah Kinner, said in a recent email, before she stopped bothering to respond to my requests for comment. [...]

Sen. Richard Segerblom, a Las Vegas Democrat who goes by the nickname "Tick," said Brown is "lucky" to have landed in California. At least, California provides some sort of safety net.

"We're like the Mississippi of the West," Segerblom said. "I think you'll find that people couldn't care less."

In a hallway outside a legislative committee room, Mike Willden, longtime director of Nevada Health and Human Services, explained the busing policy. When out-of-towners deteriorate, he said, "We're using our funds, our resources, to treat that mentally ill patient."

"That said, our policies are pretty clear. We want to get that person back in the community," Willden said. "We're going to attempt to get you connected with your family, your friends and your resources in your community. So if you look at most of the bus transports we've done, that's what we've done. We've connected them to their community."

If Nevada authorities truly wanted to reintegrate the individuals, rather than dump them, Nevada's case workers probably would have picked up the phone and called mental health workers in counties that receive them.

"I have not received any communication from anyone in Nevada," Orange County behavioral health director Mary Hale said, echoed by many other officials outside Nevada.

As usual, Governor Sandoval and his team are using their perpetually "sunny" rhetoric to try to spin away reality. And all too often, we've seen that work here in Nevada. But this time, I doubt it will work. Why? Officials throughout California are pissed, and it may not be long before we hear complaints from other states. And this time, Rawson-Neal's federal funding is in serious jeopardy.

We've said it before, and we'll have to say it again today. Nevada has been incredibly penny wise and pound foolish in addressing our health care woes. State mental health officials thought they could get away with patient dumping, and Governor Sandoval thought $25 million would be enough to just make it go away. However, this scandal is not going away. And these patients in desperate need of help are no longer going away quietly.

If Governor Sandoval and the Legislature don't try to fix this problem and fully restore funding for badly needed health care services, we will all pay a hefty price down the road. We can no longer afford to simply stuff this problem into a Greyhound bus and wish it just goes away.

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