They won. The state won. The case was dismissed. So why doesn't it feel like it's over?
Last week, a federal district judge dismissed the law suit against the State of Nevada filed by James Flavy Coy Brown. Governor Brian Sandoval's (R-Denial) media spinners spokespeople quickly declared "victory" and resumed sweeping this inconvenient scandal under the rug. And ACLU Nevada (who sued alongside Brown) has yet to decide where to take this case next.
So why doesn't it seem like this case is over? Perhaps that's because it's not. Even if this specific law suit doesn't proceed further, the State of Nevada nonetheless faces more consequences for its mental health patient dumping.
But how so? San Francisco's separate federal suit against Nevada is still pending. Rawson-Neal Psychiatric Hospital has already lost federal accreditation and is now at risk of losing federal funding. And the scandal has spread beyond Rawson-Neal & Southern Nevada as increased scrutiny of Nevada's failing mental health care system exposed overcrowding woes at Lake's Crossing Psychiatric Hospital in Sparks.
That's why it came as no surprise that the US Civil Rights Commission held a hearing on Nevada patient dumping last week. That's also why it came as no surprise that we're still seeing growing demands in California and here in Nevada (and perhaps in other states where Rawson-Neal dumped patients) to mend Nevada's tattered social safety net. This case is still far from over.
And it will remain so as long as the political powers that be in Carson City continue their attempts to sweep matters like this under the rug and the corporate powers that be in Las Vegas continue erecting straw men meant to distract us from the real problems that plague our state. Oh, and let's not forget that Las Vegas federal district judges don't have that great of a record when it comes to their rulings surviving appeal. So yes, this case is still far from over.
State officials say they won't appeal an accrediting agency's low marks of a Las Vegas psychiatric hospital, saying they'd rather wait for the organization to take a fresh look at the much-scrutinized hospital.
Nevada health and human services chief Mike Willden says he's disappointed by the Joint Commission's decision last week to give Rawson-Neal a "preliminary denial of accreditation." The mark can be appealed, but indicates problems that would lead to loss of accreditation.
The designation was based on a May inspection that found the hospital out of compliance with standards including ones dealing with patient discharge procedures.
At least for now, the hospital will remain open and continue receiving federal Medicaid dollars. However, the hospital's future relationship with the feds will be in doubt without accreditation. And this may only be the beginning.
"It's a very big deal," said Troy Lair, CEO and president of The Compliance Doctor, a Los Angeles-based firm that consults with health organizations across the country on accreditation.
Private insurance companies generally will not pay for patient care in a hospital that is not accredited, Lair said. "They will not be able to see any type of private insurance patient," he said.
In a best case scenario, Lair said, it generally takes a hospital up to a year to regain accreditation. Many hospitals that lose accreditation end up closing. [...]
The hospital remains the subject of several outside probes. The city attorneys in Los Angeles and San Francisco are investigating whether Rawson-Neal has been systematically dumping patients across state lines for years. Last month, Sacramento civil rights lawyer Mark Merin filed a lawsuit seeking class-action status against Nevada and Rawson-Neal, contending the busing policy violated patients' constitutional rights.
Ouch. This is a big f**king deal. So why aren't we seeing more state "leaders" treat it as such?
Gov. Brian Sandoval (R-Denial) had to be shamed into even acknowledging the woes of Rawson-Neal. And he, along with quite a few others in Carson City, continues to ignore the consequences of failure to keep in place Nevada's social safety net.
We're now just beginning to pay the price. I just wonder what it will take for this state to fully change course. Can we truly afford more of the same?
For some time, we've been sounding the alarms on Nevada's patient dumping scandal. We've been warning everyone that trouble was brewing. And we sensed that trouble was about to spill all over our fine state.
Today may be the first day of reckoning. And we can't say we didn't see it coming. Los Angeles and San Francisco launched their own respective criminal probes last month into the numerous discharges from Rawson-Neal Psychiatric Hospital who ended up in their cities, in other parts of California, and even in other parts of the country without any support system and/or treatment plans waiting for them. And now, the City of Los Angeles looks ready to sue Nevada.
Los Angeles is able to take a hard line because it has an ordinance that defines patient-dumping explicitly and lays out criminal penalties for violations. Other agencies are making use of state and federal laws that apply more broadly to hospital discharge practices – often targeting emergency rooms – or that don't list specific penalties.
"Doesn't this represent to you a crime?" asked Los Angeles City Attorney Carmen Trutanich, soon after the investigation was launched.
Rawson-Neal bused about 150 patients to the Greyhound bus station near Los Angeles' Skid Row in the past five years, far more than were sent to any other city.
To build their case, Trutanich's investigators are searching for former Rawson-Neal patients to learn if the circumstances of their discharges violated the city's ordinance against patient-dumping. That ordinance says patients cannot be transported from hospitals to anywhere but their homes, or the location they give as their home, without written consent.
Uh oh. But wait, there's more. Again, Nevada may soon face some very serious consequences for neglecting many of our state's most vulnerable.
If the investigation ends like several others, the hospital could settle with the city, be forced to adopt stringent discharge protocols and pay a fine.
Alternatively, the case could go to court, potentially leading to a misdemeanor criminal conviction for the hospital or some of its employees, Trutanich said.
"This is 150 people allegedly on the streets of L.A.," Trutanich said. "We're already stretched as it is."
And that's not all. The City & County of San Francisco is looking at the federal Emergency Medical Treatment and Active Labor Act and investigating whether Rawson-Neal violated this federal law. If so, San Francisco will sue in federal court. In addition, the federal Centers for Medicare & Medicaid Services are conducting their own investigation to determine whether Nevada's mental health patient dumps violated federal law.
Again, we've been sounding the alarms. And after decades of letting our social safety net fall apart, we're now beginning to feel the consequences. The supposedly wise sages in Carson City thought they were being so penny wise in shortchanging investment in our community's health care, but they're now just being revealed to be incredibly pound foolish. And we may all soon pay the price for their pound foolishness.
So Former Assembly Member Steven Brooks is back in the news today. Brooks was supposed to be at a court hearing in Las Vegas today. He couldn't make it... Because he was at a court hearing in San Bernardino County, California.
Here's what's happened so far.
The lawyer for a former Nevada lawmaker charged in a car chase and a police confrontation is asking that his client go through a mental health court program.
Ex-Assemblyman Steven Brooks appeared in a San Bernardino County, Calif., court Tuesday after pleading not guilty to charges stemming from his arrest March 28. Prosecutors say there could be a decision Friday on whether he's eligible for mental health court.
Mental health courts divert people into treatment programs and hold them accountable along the way.
Late in March, Steven Brooks was arrested in Victorville following a dispute with a tow truck driver in Barstow and a dramatic car chase with police. His attorney is now requesting for the California case to be transferred to mental health court. This way, he can finally obtain the treatment he needs.
At least there's a chance of Brooks obtaining the treatment he needs in California. Just before his latest arrest, Brooks sounded eerily prophetic in his final interview with Jon Ralston.
In four brief, surreal conversations, alternately heart-wrenching and frightening, shortly after he was expelled from the Assembly, Steven Brooks said he is "the assemblyman of sorrow," wondered why his colleagues "hate me so much" and declared he was going to "break the state" with a lawsuit worth at least $10 million.
Brooks was alternately angry, with expletive-filled rants directed at Speaker Marilyn Kirkpatrick and Majority Leader William Horne, despondent, weeping and saying he was checking himself into Seven Hills, a Southern Nevada treatment facility, and suicidal, saying he had no other recourse. [...]
"I'm the assemblyman of sorrow," he declared. "Why do they hate me so much? Fill in the blank: I'm so angry I could (blank) myself."
Brooks told me he was "on my way to Seven Hills to check myself into the hospital. He began weeping when I asked why, adding, "I have no other resort. I'm going to kill myself if they keep this up. I have nowhere to go. I'm the assemblyman of sorrow." [...]
"You know why they hate me? You know why want to kill me because I know all of their secrets."
No one expected what was coming next, probably not even Steven Brooks himself. Yet in an incredibly bizarre way, he warned us. Just days after Brooks was sent to jail in San Bernardino County, another former Nevadan emerged in California.
After The Sacramento Bee began investigating the mysterious Greyhound bus trip that landed James Flavy Coy Brown in Sacramento, the Nevada patient dumping scandal steadily grew. Now, there's a strong chance of Nevada facing law suits soon over improper discharge of mental health patients and transport of them out of state.
And now, outrage is spreading to a new state. Last weekend, ABC 15 Phoenix looked into the 100 cases of Rawson-Neal mental health patients bussed into Arizona. And while investigating, they may have uncovered yet another horrifying scandal in the making.
Mark Holleran, CEO of Central Arizona Shelter Services, says it's hard to track those patients down. He says "patient dumping" happens more than you might think.
"It just shows you how it's very easy to do this, and it's sort of under the radar. It's hard to detect," he said.
Holleran says a few years ago, former prisoners from Nevada got dumped at the shelter.
"They had been provided a bus ticket, a small amount of cash, a print out of a Mapquest that showed them how to get to CASS. And written on it was, 'ask for Howie,'" he said.
Holleran says these cases often end in chronic homelessness. He says that stretches resources in other states, like Arizona. And it passes along the problem, instead of fixing it.
"That might be something we might want to take a look at. Because if we can solve it for one place, I think we solve it for all the places," Holleran said.
So now, Arizona officials are reporting cases of Nevada patient dumping. And not only that, but we may have also dumped former prisoners on them as well! How about that for being a "good neighbor"?
One would think this would light a fire under the behinds of the Governor and legislators to fix this glaring crisis. Come on, we're now facing law suits and loss of federal funding! But no, they were too busy kissing the behind of Nicholas Cage. No, I'm not even making this up. And Ralston was downright revolted by today's lurid display of misplaced priorities.
James Flavy Brown can be shipped out of Las Vegas, leaving with barely his wits about him, some meds and peanut butter crackers. But the star of “Leaving Las Vegas” can be treated like royalty, with the mayor of Las Vegas as his sidekick, and an offer pending of enough taxpayer money to buy a peanut butter cracker factory.
These are the Legislature’s priorities – cut mental health funding, ignore English Language Learner money but give tax breaks to those who need them least. Brown gets a bus ticket to anywhere while Cage gets a national treasure trove worth of goodies and Apple gets a 90 percent tax break negotiated by the governor. That is tax policy in Nevada.
This is the state we are in.
I wonder if anyone stops to think: We may get Cage ghost-riding on the Strip, with his production company soaring and a Vegas backdrop for movies. But what does it say if that fake scene is juxtaposed a few miles off-camera in either direction with real tableaus of packed emergency rooms, overcrowded classrooms and jammed thoroughfares.
If this is part of a master plan, I’d like to see the drawing because it seems like a blueprint for disaster to me. What exactly is the policy articulated by this approach that allows $80 million to be cut from mental health services in five years but in one bill lawmakers are willing to give half of that amount [$35 million] to prospective Nevada-based filmmakers?
Lest you think my heart’s bleeding cuts off circulation to my brain, I get the job-creating argument, the economic diversification argument, the image-changing argument. But why is it a good idea for government to give incentives to anyone – movie producers, renewable energy companies – if offcials don’t provide incentives for people to really want to live here by supporting the quality of life, a culture that values higher and lower education, a political class that leads rather than follows?
He's right about this. It simply doesn't make sense.
Honestly, there may be some merit to encouraging more film production here in Nevada. But when we can't even take care of our own, who wants to risk shooting a movie here? Think about it.
Why is it that we always hear that "we can't afford" proper mental health care, decent schools, and repaired roads, yet our Governor and Legislature always seem to be able to afford corporate welfare to shower upon multinational corporations like Apple that neither need the help nor deserve it? Think about that as well. How on earth does this lead to a stable economy for our state? And how on earth does neglecting the most vulnerable in our society lead to a healthy economy?
It doesn't. That's precisely the problem. Our "leaders" in Carson City keep chasing after mythical economic unicorns while failing to provide the most fundamental building blocks of a sound economy.
Sure, luring Hollywood to Las Vegas sounds sexy. But ultimately, that won't mean shit for economic development if our schools keep bursting at the seams, our hospitals keep stuffing patients onto Greyhound buses heading out of state, and our roads are clogged with commuters while paved with just as many potholes. We seriously need to pay attention to the rude awakening we're now receiving. We must get back to basics, and we must do so before it's too late.
What else can be said? We told them so. Nevada has been rocked by the mental health patient dumping scandal for the past month. And so far, it only looks to be worsening.
Just moments ago, San Francisco City Attorney Dennis Herrera tweeted this.
Yikes. Is anyone here not thinking San Francisco is not gearing up to sue Nevada? Oh, and by the way, Los Angeles is considering suing as well.
Rawson-Neal Psychiatric Hospital has been under fire since last month, after a Sacramento Bee investigative series reported that hospital staff gave as many as 1,500 patients one-way Greyhound bus tickets from Las Vegas to California and 46 other states over the past five years.
"If the conduct is true as alleged, it's no less than human trafficking," Los Angeles City Attorney Carmen Trutanich told Reuters, adding he was working with San Francisco City Attorney Dennis Herrera, who last month opened an investigation into the practice.
"We have to find the individuals who were dumped. We're working on it. It's like finding a needle in a haystack," Trutanich said.
Oh, yes. That's right. They're going there. And Nevada is facing even more legal trouble over Rawson-Neal's now infamous patient dumping habit.
But wait, there's more. For the first time since The Sacramento Bee originally uncovered his harrowing true tale of "Greyhound Therapy", James Flavy Coy Brown just began telling his own side of the story. Brown explained to ABC News today how he landed at a Sacramento homeless shelter confused and suicidal. Brown also recently spoke with KSNV/News 3 (Las Vegas).
"I said, 'I don't want to leave Nevada,'" Brown told ABC News. "[His doctor at Rawson-Neal] said, 'California sounds like a really nice state. I think you'll be happy there.'"
Although Brown had never been to Sacramento, he says he was told he would get better mental health care there. Brown was driven to a Greyhound bus station with a $306 one-way bus ticket, six Ensure nutrition shake bottles and just a three-day supply of psychiatric medications. [...]
After a 16-hour overnight Greyhound bus trip, James arrived in Sacramento, but he didn't call 911. So instead, a confused Brown walked to a nearby police station- the police took him to a homeless shelter. By then, he was feeling the symptoms of medication withdrawal: a headache, profuse sweating and confusion.
He had no Social Security card, no food stamp card and no Medicaid card.
The Sacramento Bee first broke Brown's story last month, finding Nevada has purchased nearly 1,500 bus tickets since 2008, sending patients by bus to every state in the continental United States, mostly California.
With Brown's permission, ABC News obtained and reviewed his entire Rawson-Neal medical record. Documentation in the medical record shows his most clear wish regarding his discharge from Rawson-Neal was to go to a local group home.
At that Sacramento homeless shelter, Brown nearly killed himself. He soon had to be taken to the emergency room at UC Davis Medical Center. After three days in the ER, he was found temporary housing. And eventually, authorities there were able to reach Brown's daughter in North Carolina. And he's now staying with her there.
This is the kind of help Rawson-Neal should have provided. Instead, he, Orange County Monica, and possibly many more were unceremoniously tossed onto Greyhound buses and dumped into other states. Most were dumped into California, and local health agencies there were then forced to figure out what to do with these patients.
And now, those local governments want payback. While the separate federal investigation of Rawson-Neal continues, the Sacramento City Attorney is also considering legal action against Nevada. And on top of that, Alameda & Santa Clara Counties (in the SF Bay Area) are in the mix as well.
Meanwhile, Sacramento City Attorney James Sanchez has joined legal authorities in Los Angeles and the Bay Area in pressing for details about the cases of hundreds of mentally ill patients from Rawson-Neal who were given one-way Greyhound tickets to cities in California over the past five years.
"From our standpoint, this apparently was not a single instance of someone being bused somewhere without services," said Sanchez. "We feel it could be a significant number of cases, but we won't know for sure until we get into the files." [...]
The cities of San Francisco and Los Angeles have launched criminal probes to determine whether Nevada was systematically dumping indigent patients across state lines. The hospital's practices are also under scrutiny by the Center for Medicare and Medicaid Services, which oversees federal funding for health facilities, and the Joint Commission.
Elizabeth Eaken Zhani, spokeswoman for the Joint Commission, confirmed that the agency sent surveyors to the hospital Thursday. Their inspection was a response to possible violations of standards that cover "provision of care" as well as "rights and responsibilities" of patients, Zhani said. [...]
The survey played out as the Sacramento city attorney, along with city attorneys from San Francisco and Los Angeles, and county counsels representing Alameda and Santa Clara, waited for a response to their request for a joint meeting with Nevada Attorney General Catherine Cortez Masto to discuss Rawson-Neal's discharge practices.
In a letter dated Monday, the attorneys said they also want to find out "how Nevada may best assist us" in identifying patients who were dispatched to their jurisdictions "so we may ensure that they receive necessary medical care or medications."
Ouch. Even more California municipalities are expressing outrage over #DumpGate. And while Governor Brian Sandoval (R-Denial) has been doing some damage control lately, he still seems to be in denial of the larger problem.
But at this point, Nevada can no longer afford denial. While Governor Sandoval and his political consultants continue to present to us their "sunny" spin, reality is crashing down on us. Because of the EPIC FAIL of our mental health system (that is, what little we have to offer and slap with this label), this happened. Because we've chronically underfunded our social safety net and public infrastructure for so many decades, we're now just starting to feel the consequences.
We truly can't afford any more denial. Something must change. And legislators must recognize reality, even if a certain someone else in Carson City continues to deny it.
Over the past month, we've been digging deep into Nevada's burgeoning mental health patient dumping scandal. Initially, Governor Brian Sandoval (R-Denial) and Nevada mental health officials denied any widespread wrongdoing. But as cases continued piling up, they eventually began to promise solutions. Yet even with Sandoval and the Nevada Department of Health & Human Services claiming responsibility for 10 cases of patient dumping and promising that it will never happen again, several elected leaders in California are still calling for further investigation.
Oh, yes. That's right. 21 of California's Members of Congress are sending a letter to US Health & Human Services Secretary Kathleen Sebelius and US Attorney General Eric Holder demanding federal action.
The letter, initiated by Rep. Ami Bera, an Elk Grove Democrat, states that "if this practice of shipping patients with a history of mental illness to other states, known colloquially as 'Greyhound Therapy,' is occurring, it would not only be unethical and disgraceful, but would also be an illegal attempt by Nevada to evict members of the state's most vulnerable population to benefit its bottom line."
The letter cites a Bee investigation that found that Rawson-Neal Psychiatric Hospital in Las Vegas, Nevada's primary hospital for the mentally ill, has bused about 1,500 patients out of southern Nevada since 2008, sending people to every state in the continental United States. [...]
The congressional letter says busing patients to other states may violate several laws, including federal requirements that hospitals must stabilize patients before discharging them and requirements that hospitals meet certain conditions before receiving Medicare and Medicaid funding.
The letter also states that involuntary placement of a psychiatric patient on a bus to another state "may constitute interstate kidnapping."
The letter asks Health and Human Services Secretary Kathleen Sebelius and Attorney General Eric Holder to report any investigative findings to Congress within 30 days.
"Federal investigation is warranted here, particularly in light of admissions from Nevada officials that their own investigation found 'no pattern of misconduct,' " the letter says.
And that's not all. Late last month, we noted San Francisco's launch of a probe into Nevada patient dumping. A day later, Los Angeles followed suit in launching its own probe. Now, San Francisco City Attorney Dennis Herrera is poring through documents he just received from Nevada Attorney General Catherine Cortez Masto (D).
Late last week, Nevada's Attorney General Catherine Cortex Masto responded to Herrera's public records requests with a trove of documents, including nearly 400 pages of Greyhound Bus invoices and scores more detailing potentially improper discharges dating back to July 2008.
The documents cover five general areas:
The records provided to the Sacramento Bee,which first broke the story about Nevada's practice of "patient dumping." The documents related to "challenged" discharges, "specifically any discharges challenged on the basis of inadequate discharge planning." Copies of licenses for Nevada's mental health facilities. Copies of citations levied against the Nevada's mental health facilities. Documents showing the sources of funding for Nevada's mental health services. Hererra's investigation seeks to discover the extent of Nevada's patient dumping. The Bee's investigation found that Rawson-Neal bought bus tickets for more than 1,500 mentally ill patients over the past five years. Around one-third of those buses went to California, including 36 to San Francisco. But Nevada officials have maintained that nearly all of those discharges were appropriate --Sandoval admits to only one confirmed improper discharge, [then 5, then 10?] for which two hospital employees were fired. [...]
And, as Reuters reported last week, "San Francisco health director Barbara Garcia said outreach workers in the past year identified two psychiatric patients who arrived in the city on buses after being discharged from Rawson-Neal with neither relatives nor treatment plans awaiting them in San Francisco."
Herrera's public records query also included requests for documents showing that California approved to accept any of Nevada's mental health patients or agreed to exchange any patients with Nevada. Masto's response noted that none of those documents existed.
Ouch. Remember, shortly after the harrowing true tale of James Flavy Coy Brown began making headlines in California and Nevada, Governor Sandoval denied any widespread patient dumping. It wasn't until roughly the time when Orange County Supervisors began asking their mental health officials about Monica, just as even more cases were emerging here in Southern Nevada, when Sandoval began backtracking on his earlier blanket denials.
Already, this scandal is proving to be costly. The state is scrambling to head off threats of federal funding cutoffs. The state is also scrambling in a desperate attempt to avoid California law suits. And now, on top of all that, Clark County hospitals are now feeling the strain of Rawson-Neal bursting at the seams in the wake of #DumpGate.
Reports of improper discharges at the Rawson-Neal psychiatric hospital is affecting other local medical facilities.
The “Review-Journal” reports University Medical Center closed its emergency room to adults for 12 hours on Monday, after mentally ill patients filled nearly half of the hospital’s ER beds.
The Southern Nevada Health District says nearly 200 psychiatric patients are currently being held at local hospitals.
Jeez. And UMC was already swirling in controversy before Rawson-Neal fell deep into scandal!
Again, no one can't say we weren't sounding the alarms. We were. The state's social safety net has been woefully inadequate for some time. And in case that wasn't enough, we slashed and burned even more in recent years. And mental health care has especially been hit hard by recent state budget cuts.
And now, it's all coming back to bite us. This is what happens when Nevada won't take care of its own. Think about it.
Well, that didn't take... Actually, it has taken this long. But nonetheless, something is happening. Just minutes ago, Governor Brian Sandoval's office announced this.
RalstonReports: INBOX: "Sandoval Announces Further Action Taken at Rawson-Neal..individuals who violated release policies have been or will be disciplined."
Wow. This looks serious. I wonder if this had something to do with it.
[The federal Centers for Medicare & Medicaid Services] gave the hospital 10 days to submit "evidence of correction." After that, a new survey will likely occur. If corrective action is not adequate, according to the letter, "we will notify you that we are initiating action to terminate the facility's Medicare provider agreement," a vital source of federal funding.
Rawson-Neal and its umbrella agency, Southern Nevada Adult Mental Health Services, have been under fire following a report in The Bee earlier this month showing that the hospital paid to transport about 1,500 patients to other states via Greyhound bus since 2008. About one-third of those patients were dispatched to California, and 19 of them to Sacramento, according to a review of Greyhound bus receipts purchased by the umbrella agency.
One of Rawson-Neal's patients, James Flavy Coy Brown, in February was bused 15 hours to Sacramento, a place he said he had never visited and where he knew no one.
Brown suffers from schizophrenia and depression and had been living in the streets and shelters of Las Vegas for years. Out of food and medication when he arrived in Sacramento, he spent three nights in a hospital emergency room before social workers found him temporary housing.
The Bee's report has touched off criminal probes by the city attorneys of San Francisco and Los Angeles into whether Nevada has engaged in cross-state "patient dumping." Los Angeles received 149 Rawson-Neal patients during the five-year period reviewed by The Bee, while 36 patients were sent to San Francisco.
As we discussed last Friday, CMS is serious about pulling federal funding from Rawson-Neal if its patient dumping fiasco isn't properly resolved. So now, finally, Governor Sandoval and Nevada mental health officials are feeling the heat. It's now just a question of how much change we'll see at Rawson-Neal.
Late last week, KVVU/Fox 5 interviewed a former Rawson-Neal nurse who shed some light on past practices there. She confirmed earlier accounts of patient dumping happening even before 2009. And on top of that, she added a new charge. Apparently before Rawson-Neal began stuffing mental health patients onto Greyhound buses, the hospital would simply give the patients Greyhound tickets upon discharge and leave them in Downtown Las Vegas!
"Finding out, ‘Oh, he is originally from California. Do they have family there? We do not know. Give [him or her] a bus ticket.' So the patient is discharged from the hospital to make the bed available," a former Rawson-Neal nurse who wished to remain anonymous explained to FOX5.
Originally, this nurse said patients were given a bus ticket and discharged on their own, but many of the patients wound up back at Rawson-Neal.
"The patient, they found out, is making money out of the ticket. They sell it out there [Las Vegas Greyhound bus station]. Then the patient gets to buy their drugs or alcohol," the former nurse said.
So to fix that problem, FOX5's source said the patients were put in a state vehicle and driven to the downtown Greyhound Bus station, where a hospital employee made sure they actually got on the bus.
Over the weekend, the Las Vegas Sun's Andrew Doughman reminded everyone, and in particular the California media, of Governor Sandoval's habit of playing coy to the media and trying to avoid big actions on big issues. We saw him do this in the first few days after the story of James Flavy Coy Brown and his "Greyhound Therapy" from Rawson-Neal to Sacramento, California, began to make headlines. It really took continued ugly patient dumping headlines, threats of lawsuits from California municipalities, and now the threat of loss of federal funding for Rawson-Neal, for Sandoval to realize how serious this is and begin implementing solutions.
Again, we now must wait and see how serious Governor Sandoval and the Nevada Legislature are about solving this problem. It will clearly take more than just window dressing. It will certainly mean more funding for mental health care here in Nevada.
While The Sacramento Bee praised Governor Sandoval's recent steps to address the patient dumping scandal, it also noted that Nevada will actually have to restore funding for mental health services to truly fix the problem. So will he and the Legislature finally do it? That looks to be the $25 million question there.
Earlier this week, we learned of even more Nevada patient dumping stories. One involved a woman named Monica. She had been receiving mental health treatment at Rawson-Neal Psychiatric Hospital in Las Vegas. But of course, she was dumped onto a Greyhound bus bound for Orange County, California, despite (or because?!) needing more treatment. Monica was just dumped onto a Greyhound bus and into Orange County with no home and no treatment plan. And now, Orange County health officials are on a desperate search for Monica.
And she's not alone. Also this week, KVVU/Fox 5 uncovered the story of a former Rawson-Neal patient who was dumped into California. She described herself what happened when she was first admitted to Rawson-Neal in 2004... And when she was admitted again in 2008.
"They don't realize we're people too," said [Tina] Schmidt. "We have a heart. It hurts because we feel like we are being thrown away like trash."
Schmidt got emotional recalling her treatment at Rawson-Neal. She was admitted in 2004 for attempted suicide and depression. Schmidt said the hospital bused and left her in San Diego because it didn't have enough resources. She didn't know anyone there.
"They act like they just don't care," said Schmidt. "It's like 'You're not my problem. I don't want to deal with you. Let's just send you someplace else.'"
Schmidt said it happened again when she returned in 2008. Last month, the Sacramento Bee revealed as many as 1,500 patients were improperly discharged from the state-run hospital.
So this has been happening for even longer than some thought. And it sheds even more doubt on Governor Brian Sandoval's (R-Denial) assertion that the improper discharge of James Flavy Coy Brown from Rawson-Neal this past February was a mostly isolated incident. Think about it. Sandoval and Nevada Department of Health & Human Services Director Mike Willden have claimed "only 5 or 6" of the 1,500 patient dumping cases from 2008-2013 were actually improper. Yet despite their assertions, more disturbing cases continue to surface.
Oh, and here's another one. But in the case of Rodrick Hicks, Rawson-Neal didn't even bother to get him a Greyhound ticket. This time, the hospital just threw him a RTC bus pass.
Rodrick Hicks was found by Nevada Highway patrol last week. The 18-year-old was walking barefoot on Interstate 15, near Flamingo Road. He was taken to a hospital, which transferred him to the Rawson-Neal Psychiatric facility. What happened next has his mother outraged.
"My child was out there somewhere," says Shannon Hicks. "Rawson-Neal gave him a city bus pass and said go on your merry way."
Hicks claims administrators at Rawson-Neal gave Rodrick two prescriptions and a bus ticket to get home.
Hospital paperwork shows he was admitted to Rawson-Neal on April 17 and stayed through the 24th.
"I didn't get a call, I didn't get nothing," Shannon says. "It's a miracle he made it home safely, because his schizophrenia affects his ability to understand directions. They'll just let a mental patient out the door, without letting a family member know?"
Shannon claims she didn't even know Rodrick was at Rawson-Neal in the first place, despite calling the hospital several times.
"We were looking for him everywhere, and they told me that they had nobody under that name there," she says. "Now it makes me wonder how often this happens. There's probably more people looking for a loved one. It's scary."
Wow. And this happened just this month! Oh, and it happened just as Rawson-Neal was supposedly "fixing" its patient dumping policy! So is this the new policy? Instead of "Greyhound Therapy", Rawson-Neal patients will be subjected to "RTC Therapy"?
Clearly, the problem is far from solved. In fact, evidence is surfacing that patient dumping may actually still be occurring at Rawson-Neal. And yes, just releasing patients with RTC bus passes and without a treatment plan going forward is just as repugnant as out-of-state "Greyhound Therapy".
This also looks to be the verdict of the federal investigation of Rawson-Neal. If Nevada does not take appropriate "corrective action", Rawson-Neal will lose a significant amount of federal funding.
The federal Centers for Medicare and Medicaid Services on Thursday sent a letter to Nevada health officials telling them that, due to "serious deficiencies," the state's primary psychiatric hospital "may be subject to termination of its Medicare provider agreement," according to a copy of the letter obtained by The Bee.
The federal agency, in concert with state officials, conducted a survey March 20 of Rawson-Neal Psychiatric Hospital in Las Vegas after The Bee first reported that one of the facility's patients was discharged improperly to Sacramento with no arrangement for housing or care.
According to the letter, the survey results showed that the hospital was out of compliance with federal regulations for discharge procedures and governance.
CMS gave the hospital 10 days to submit "evidence of correction." After that, a new survey will likely occur. If corrective action is not adequate, according to the letter, "we will notify you that we are initiating action to terminate the facility's Medicare provider agreement," a vital source of federal funding.
And that's not all. On top of this latest news, a Member of Congress is stepping forward to demand a new investigation into Nevada patient dumping.
Despite the policy change, Rep. Doris Matsui, a Sacramento Democrat, on Thursday called for a congressional investigation into Nevada's long-standing practice of shipping patients out of state.
In a letter to ranking members of the House Energy and Commerce Committee, which has jurisdiction over health matters, Matsui asks for investigative and oversight hearings into Rawson-Neal's discharge policies. She said a congressional investigation is warranted to determine if the practices violated federal laws regarding discharge planning and patient rights.
She called for the committee to look into "the scope, severity and consequences of Southern Nevada Adult Mental Health Services' selective disregard for the health and safety of its patients. Someone must be held accountable."
Yesterday, US Senate Majority Leader Harry Reid (D-Here) expressed his own outrage over the growing patient dumping scandal. However with that being said, he did say he did not want to "intertwine himself" with this. Yet whether or not he personally wants to, other Members of Congress (especially ones representing California) may ultimately demand some sort of Congressional action. And perhaps they should, considering the feds may have also had a hand in worsening this problem [by cutting mental health funding].
So this story is far from over. And actually, I'm starting to wonder if this is only just the beginning.
Earlier this month, President Obama released his federal budget proposal. Yet while most pundits initially focused in (perhaps justifiably) on the President's pre-concessions on Social Security, there was another aspect of the White House Budget Plan that's steadily been gaining more attention. Here, take a look at this.
The new budget plan will propose $130 million for programs that train teachers and other adults to help recognize early signs of mental illness, referring them to help when they detect such warnings. That includes $55 million for a new program called Project AWARE (Advancing Wellness and Resilience in Education). That will give states and local school districts grants to administer such programs, while also collecting data on how well they work.
Another $50 million in funds would go toward training masters-level mental health specialists such as psychologists, nurses and counselors who work in schools. The idea is to expand the mental health workforce to prepare for the demands of millions of Americans who will gain health insurance coverage under the Affordable Care Act.
“We can’t take 12 years training doctors and post-docs to meet the need in 2014,” the administration official said. “We’re taking a very promising and practical approach.”
Another $25 million would be put towards helping schools, where violence is pervasive, to address the trauma experienced by children and test violence prevention strategies.
Obama touched briefly on the importance of expanding mental health services in a Monday night speech on gun violence, at the University of Hartford in Connecticut.
“We have to tell Congress it’s time to strengthen school safety and help people struggling with mental health problems get the treatment they need before it’s too late,” he said.
In total, the President is requesting an additional $235 million for mental health care. And especially considering all the recent attention on the intersection of health care policy and gun violence, one would think there's renewed interest in fixing this. And indeed, there is. There's even been talk of legislation in Congress.
But then again, we are talking about the 113th Congress. So of course, that means productive legislation gets sidelined while pointless "tea party" circle jerks become the center of attention. And indeed, that's what may soon be happening again as House Republicans demand even more votes to repeal the Affordable Care Act.
At a Wednesday panel organized by the Heritage Foundation, conservative Republicans lamented that it’s been too long since they had the opportunity to vote to wipe out the Affordable Care Act in its entirety — and that the newest members haven’t had the chance yet.
“We need to get a vote on full repeal, and I’ve asked leadership for this. I’m a cosponsor of Michele Bachmann’s bill … that just goes straight at it for full repeal,” said Rep. Steve Scalise (R-LA), the chairman of the influential and deeply conservative Republican Study Committee. “We need to continue fighting for repeal. We need a clean vote on repeal.”
Rep. Mick Mulvaney (R-SC) urged leadership to hold a repeal vote so freshman members can serve up the same anti-Obamacare talking points for their conservative constituents that more senior Republicans enjoy.
“If you’re a freshman — the guys who’ve been up here the last year, we can go home and say listen, we voted 36 different times to repeal or replace Obamacare. Tell me what the new guys are supposed to say,” he said. “We haven’t had a repeal or replace vote this year.”
“We have not had a chance as freshmen to do that,” said first-term Rep. Trey Radel (R-FL). “Even if it’s just symbolic — and even if we understand that process-wise we are not going to be able to say, okay we want repeal, it’s done, and it’s over. But this is the issue that so many people around the country who love the Republican Party are frustrated with.”
Never mind that the Affordable Care Act (ACA) has already been saving lives and cutting health care costs since implementation began in 2011. And never mind that House Republicans have voted at least 36 times to repeal the ACA since 2011. And never mind that the 112th Congress wasted $50 million in taxpayer money and 88 hours on their many failed ACA repeal attempts.
So how does that fit into this story? ACA actually expands mental health care for 62 million Americans. Pay attention to what Dr. Richard Friedman, Professor of Psychiatry at Weill Cornell Medical College, wrote for The New York Times last July.
One of the health care act’s pillars is to forbid the exclusion of people with pre-existing illness from medical coverage. By definition, a vast majority of adult Americans with a mental illness have a pre-existing disorder. Half of all serious psychiatric illnesses — including major depression, anxiety disorders and substance abuse — start by 14 years of age, and three-fourths are present by 25, according to the National Comorbidity Survey. These people have specifically been denied medical coverage by most commercial insurance companies — until now.
From an epidemiologic and public health perspective, the provision that young people can remain on their parents’ insurance until they turn 26 is a no-brainer: By this age, the bulk of psychiatric illness has already developed, and there is solid evidence that we can positively change the course of psychiatric illness by early treatment.
Mental disorders are chronic lifelong diseases, characterized by remission and relapse for those who respond to treatment, or persistent symptoms for those who do not. In schizophrenia, for example, relapse is common, even with the best treatment. It makes no sense to tell someone with this condition that his lifetime mental health benefit is just 60 days of inpatient hospitalization.
Psychiatric illness is treatable, but it is rarely curable; it may remit for a while, but it doesn’t go away. That is why the current limits on treatment are as irrational as they are cruel — the discriminatory hallmark of commercial medical insurance.
No more. The Affordable Care Act treats psychiatric illness like any other and removes obstacles to fair and rational treatment.
And House Republicans are still hellbent on repealing the Affordable Care Act.
Here in Nevada, we've been rocked by the patient dumping scandal that's been growing since James Flavy Coy Brown was found disoriented and suicidal in a Sacramento, California, homeless shelter. He was discharged from Rawson-Neal Psychiatric Hospital in Las Vegas in February despite needing more treatment. And he was placed onto a Greyhound bus bound for Sacramento with only a three day supply of medicine, some peanut butter crackers, and a few cans of Ensure.
Governor Brian Sandoval (R) insists that this was a mostly isolated incident and it's all better now. However, officials throughout California are viewing Governor Sandoval's recent statements very skeptically. And they're not alone. Today, US Senate Majority Leader Harry Reid (D-Searchlight) finally weighed in. And let's just say he's not pleased.
“I’ve got enough problems back here, trying to take care of issues in the federal government so I am not going to intertwine myself with issues in Nevada as it relates to state government,” Reid said.
“But I think it is unfortunate that people would be given a bus ticket and not given the proper care they need before they leave – not before they leave but before they are sent out of the state.” [...]
When it was suggested that lack of funding was the root of the problem, Reid said Nevada has been cutting back on mental health for decades.
“Since Gov. (Mike) O’Callaghan has been governor (1971-79), there have been cutbacks on mental health services in Nevada, which is unfortunate,” Reid said. “They have had a lot of cuts and that has been too bad.”
Nevada’s issues about funding mental health facilities begin in Congress, Reid said.
“Of course, it spins down,” Reid said. “When we cut back things here, it makes it difficult for the state Legislature, Gov. Sandoval to do their job because we are cutting back here.”
Reid doesn’t see mental-health spending getting any better in Congress.
“I was talking on the floor today and it is going to get worse,” Reid said. “The Republicans are happy where we are. They have one goal in mind and that is to cut spending. Nothing else matters.”
And that gets us back to what's happening in Congress now. For all the talk of preventing gun violence by expanding mental health care, most Republicans in Congress are now pursuing the opposite. And on top of that, they want to repeal the very Affordable Care Act that stands to improve mental health care nationwide.
We've discussed before how state health care budget cuts likely contributed to the patient dumping scandal. Recent federal budgets have probably exacerbated this. And if the "tea party" gets its way in Congress, we can only look forward to even more mental health care headaches in the future.
Earlier today, we examined the growing outrage in California over Nevada's patient dumping scandal. Los Angeles and San Francisco have launched their own respective probes into the matter, and a federal investigation is now underway. However today, a state investigation is wrapping up and there will be some sort of action taken as a result.
Mike Willden, director of the state Department of Health and Human Services, said today a decision will be made soon whether to continue sending discharged patients by bus out of state, to scrap the policy or require a chaperone to accompany the patient.
The majority of patients involved were not considered a “threat to themselves or to others” and expressed a desire to return to their families, friends or to an out-of-state treatment facility, the internal review found.
Two staff members at the Rawson-Neal Psychiatric Hospital were disciplined, but Willden refused to say if they were higher-echelon officials or what penalty they faced.
The review of the 1,500 cases — prompted by a series of stories in the Sacramento Bee — was completed at midnight Tuesday. The Bee first broke the story of Nevada patients being put on a buses and sent to other states, prompting officials in California to call for an investigation.
Nevada officials are still asserting that there were only 5 or 6 cases at Rawson-Neal Psychiatric Hospital in Las Vegas where the hospital's standard discharge policy was not followed. And they're insisting this little hiccup is being fixed. However, doubts remain in California over whether this was truly a little hiccup that only involved 5 or 6 cases. KQED recently posted more of its interview with The Sacramento Bee's Phillip Reese. He's been closely tracking this story, and he isn't so quick to confirm Mike Willden's assertion today.
"San Francisco told us that they've had at least two patients in the last year alone come from this particular facility, Rawson-Neal, without a plan or family members," Reese said. "[They] just showed up, in the way that Mr. Brown did."
According to the Bee's review of bus records, 36 patients took buses to San Francisco. Without talking to those people, it's hard to know what happened once they got to the city. They might have sought help. They might not have. They might be in San Francisco now. They might be elsewhere.
Reese said he and his colleagues are trying to track down patients, as well as Rawson-Neal employees and former employees. […]
One-third of patients bused out of Nevada were shipped to California.
Reese points to "severe" budget cuts in Nevada. The bus trips began to spike in 2009, around the same time a recent round of budget cuts took place.
Plus, he said, "They never had an elaborate safety net for mentally ill patients to begin with."
And even with today's latest development from Carson City, not everyone in Sacramento is satisfied. Oh, and San Francisco's own probe is still definitely happening. And that may not be all, as SF Weekly just learned.
Earlier this week, San Francisco City Attorney Dennis Herrera launched an investigation into Nevada's nefarious patient dumping, asking the state for for public records relating to Sacramento Bee reports which revealed the patient dumping problem. In one case, a patient reported that the Nevada hospital gave him a one-way ticket to California, with some snacks an only a few days worth of medication; his doctor told him to call 911 when he landed and he would received better health care than he would in Nevada.
Herrera told Reuters that he's pleased Nevada's governor has taken measures to stop the patient dumping, but that won't stop him from plunging ahead with his probe.
"Nothing changes my intention to pursue all legal options against the state of Nevada," Herrera said.
And there, we have it. The State of Nevada may be ready to close its books on this matter, but San Francisco certainly is not. Neither is Los Angeles. And we may still see more municipalities across California explore legal action against Nevada for patient dumping.
Governor Sandoval and Rawson-Neal administrators continue to insist the discharge of James Flavy Coy Brown was a mostly isolated incident. However, several throughout California continue to suggest otherwise. I have a feeling we're not finished with this story yet, far from it.
I can understand why Sandoval and Rawson-Neal administrators want this story gone. It doesn't look good. It's threatening federal funding for Southern Nevada's only state run mental health treatment hospital. And now, we may soon see law suits filed over this.
However, this story isn't going away. And at this point, the best thing the state can do is come clean with the truth and make a real effort to fix this problem. We'll see if that ultimately happens. And we'll be waiting to see if this means Nevada will finally fully fund mental health services.
Despite their best attempts at denial, they just can't avoid it any more. Of course, we're talking about Governor Brian Sandoval (R-Denial), his staff handling mental health care in this state, and the burgeoning patient dumping ("DumpGate"?) scandal. San Francisco launched a probe on Monday, followed very closely by Los Angeles (City) yesterday. So of course, Jon Ralston had to follow up his interview with Mike Willden (Nevada's mental health care director) with an interview with Dan Morain. He's The Sacramento Bee's Senior Editor, and he actually personally traveled to Carson City in search of answers as his paper has been conducting a thorough and riveting investigation into the matter.
And now, Orange County officials are chiming in as well.
Health care officials have been looking for the woman, whose first name is Monica, but haven’t had any luck, according to Mary Hale, Orange County’s behavioral health director. At least one Nevada patient has previously been found in Orange County.
“This facility in Nevada is doing Greyhound [bus] therapy,” Hale told county supervisors on Tuesday amid growing outrage over the issue statewide.
And there could be many more patients locally who have yet to be identified.
Nevada’s main psychiatric hospital sent 28 patients to Orange County in recent years, according to data collected by the Sacramento Bee. In many of the so-called “patient dumping” cases examined by the paper, Nevada officials simply sent clients on their way without ensuring they received treatment or housing. [...]
Hale also recalled that a former Nevada patient, diagnosed with schizophrenia, was found in Newport Beach “a couple of years ago” and subsequently received treatment.
Hale emphasized that Orange County officials ensure that family members are contacted and outpatient care is arranged for when patients are discharged.
It’s “extremely rare” to ever send a patient out of state without contacting family, Hale added, saying she couldn’t remember that ever happening in Orange County.
Mary Hale testified yesterday at the Orange County Board of Supervisors meeting. They're OC's version of the Clark County Commission... Except that they're all conservative Republicans. Yet with that being said, they nonetheless unanimously approved a two year, $8.7 million for mental health inpatient services at hospitals in Anaheim and Costa Mesa. Jeez, even Orange County Supervisors know it's better to actually solve their problems than attempt to cut corners by dumping them somewhere else!
Oh, and of course, OC Supervisors are joining the growing chorus of outrage over Nevada's "Greyhound Therapy" scandal. San Francisco City Attorney Dennis Herrera still awaits a response from Nevada officials to his request for documents relating to the allegations swirling around Rawson-Neal. KQED's California Report also provided an update on the scandal. And they're finding even more mental health officials in California who are shocked to learn of what Nevada has been doing.
What started as The Sacramento Bee wondering why James Flavy Coy Brown nearly committed suicide in a Sacramento homeless shelter has become a far-reaching investigation by The Bee and other California media outlets into the 1,500+ incidents of Nevada patient dumping. And we'll find out soon if/when California municipalities begin suing Nevada over this. And on top of all this, federal funding for Rawson-Neal is at risk pending a federal investigation into Nevada patient dumping.
We've said this before, and we must say this again today. This didn't have to happen. Nevada could have fully funded mental health care, properly handled the cases of these patients, and probably saved money (considering the likely forthcoming legal action against Rawson-Neal)! What else will it take for Governor Sandoval to learn this lesson? Hell, what will it take for Governor Sandoval to even admit this problem is real?!
Yesterday, news broke of San Francisco launching a probe into Nevada's habit of dumping mental health patients into other states, most notably California. Today, San Francisco has company. The City of Los Angeles is launching its own probe into Nevada patient dumping.
Los Angeles officials are investigating reports that Nevada’s primary state psychiatric hospital bused indigent mentally ill patients with few or no resources to California cities.
Spokesman Sandy Cooney said the L.A. city attorney's office was “gathering information and ... trying to determine whether what we gather warrants an investigation.”
The Sacramento Bee reported last month that more than 200 Nevada psychiatric patients were given bus tickets and sent to Los Angeles County after their release from hospitals. [...]
Los Angeles’ inquiry follows the San Francisco city attorney office’s announcement Monday that it had launched a formal investigation into the allegations against Nevada’s facility.
The Bee was the first to bring the allegations of so-called "patient dumping" to light. The paper reported that at least 36 of 1,500 patients discharged by Rawson-Neal Psychiatric Hospital in Las Vegas over the last five years had been sent to San Francisco on Greyhound buses.
San Francisco is now requesting documents from Nevada. And pretty soon, Los Angeles will be doing the same. And they may yet have more company. Ever since The Sacramento Bee first noticed the story of James Flavy Coy Brown, this scandal has been steadily growing. And now, it's threatening accreditation and federal funding for Rawson-Neal Psychiatric Hospital, the state's only public mental health treatment hospital in Southern Nevada. Ironically enough, what's likely been clumsy state effort to cut corners and cut costs may end up costing the state far more.
Yesterday, Nevada Mental Health Services Director Mike Willden went on "Ralston Reports" to defend the actions of his staff and Governor Brian Sandoval's (R-Denial) office. Well, he tried. What else could he say?
That's the problem. What else can we say? How is this even defensible? Who can condone the dumping of human beings somewhere else, and do so just because their needed treatment "costs too much"?
Again, the ultimate irony here is that Nevada may very well pay far more now. We didn't have to fall into this mess. We could have just done the right thing, cared for our own, sent those who requested to go to places where care was already lined up... And saved ourselves this lurid legal fiasco.
Ultimately, cutting corners and ripping the social safety net to shreds don't make for good public policy. We're now learning this lesson the hard way. But really, we didn't have to.
Over the course of the month, we've been looking at the tragic case of James Flavy Coy Brown, the Rawson-Neal Psychiatric Hospital patient who was "released" from the hospital, only to be thrown onto a Greyhound bus and dumped into Sacramento, California. Growing outrage over this heinous case of patient dumping resulted in state and federal investigations into Nevada's patient dumping habit. And we now Nevada has busedover 1,500 patients out of state since 2009, sending at least one patient to each and every one of the 48 continental states.
Recently, Governor Brian Sandoval (R-Denial) has been boasting about increasing the state government's budget, and especially education and health care funding, "without raising taxes" (and the accuracy of this statement actually depends on how one categorizes extending "The Sunset Taxes" of 2009 & 2011). Yesterday, The Las Vegas Sun's Andrew Doughman explained how Governor Sandoval has been able to do this. Surprise, surprise, there's a method behind his "magic"!
This month, he found $25 million for education programs and even released a handy slogan: “Increasing funds for education without raising taxes: Check.”
The next day, he said he found yet another $25 million for health programs for the state’s most vulnerable populations. Then, he announced $12 million more for eliminating furloughs for state workers by mid-2015.
How, exactly, did those presents end up under Nevada’s Christmas tree?
The majority of the money comes from regular state accounting adjustments, and it’s not necessarily good news. Nevada gets a portion of this new money because the federal government now projects the average American’s income will grow faster than the average Nevadan’s income. [...]
But in this case, economic growth isn’t fueling increases to the budget.
Besides getting more federal money because it’s getting poorer than other states, Nevada also is benefiting from revisions to the number of state residents enrolled in government health programs and a nationwide trend in lower-than-projected health care costs.
“Those are both pretty standard adjustments we’d make,” said Jeff Mohlenkamp, the state’s budget director. “They just happen to be working in our favor right now.”
So Sandoval has been able to increase the state's budget by claiming poverty and showing the number of Nevadans in need of some sort of federal/state aid. And there's technically nothing wrong with that in and of itself. It just becomes a problem when he and fellow Republicans demand austerity out of one side of their mouths... While simultaneously using the other side to milk the feds for more money!
It's also a problem that Sandoval wants to use these additional federal funds to claim he's "increasing funding without raising taxes"... And silence criticism of the shortcomings of Nevada's social safety net. Even with the additional federal funds, the state's mental health care budget still allocates much less per patient now than in 2007. And even the 2007 budget was not keeping up with 20 years worth of tremendous population growth.
And that leads us back to the patient dumping scandal. Yesterday, The Sacramento Bee published a stinging editorial on Nevada's patient dumping. And they cut right to the heart of this matter.
If they truly had the interests of the patients at heart, Nevada health officials would have contacted mental health authorities in locales that were receiving the patients. No mental health official in any city, county or state contacted by The Bee had heard of Nevada's practice of busing mentally ill patients – unescorted, no less.
Sandoval, thought to be one of the Republican Party's rising stars, has not acquitted himself well. When the Las Vegas television reporter caught up with Sandoval and asked about the "policy" of busing patients, he pushed back by saying, "I disagree with the premise of the question."
Exactly what Sandoval disagrees with is not clear. Nevada long has had a written policy to bus patients to their home states. The policy stated that one of its goals was to relieve the "burden" on Nevada taxpayers of the patients' care, though the state dropped the word "burden" from a revised policy after The Bee quoted from it.
"If there is a problem, we're going to correct it," Sandoval told the reporter.
Mr. Sandoval, you've got a problem. You need to correct it. [US Health & Human Services] Secretary [Kathleen] Sebelius, you need to make sure he does.
Especially since Sandoval is using additional federal funds to plug holes in the state's budget, he needs to come clean on this. After all, if he doesn't, the state may ultimately lose at least some of those federal funds. Accreditation of Rawson-Neal is now at risk. And on top of this, Los Angeles and San Francisco are considering suing Nevada over patient dumping.
So we can't just (mis)use additional federal funds to sweep our problems under the rug and deny their existence. After all, these federal funds are supposed to be used to help people in need! And Nevada will likely pay a heftier price if the state continues to neglect people in need of treatment.
So why live in denial any longer? Let's admit we have a problem. And then, we can truly fix it.
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."
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.
