Consequences (Are Here.)

It's back! In case you were wondering whatever happened to the patient dumping scandal, Rawson-Neal Psychiatric Hospital is back in the news. Why? Oh, the scandal plagued hospital finally earned its long awaited federal demerit.

 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?

Consequences

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.

Finally, No More Patient Dumping?

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!

FOX5 Vegas - KVVU

"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.

Problem Solved? (Hell, No!)

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.

FOX5 Vegas - KVVU

"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.