Still Far from Over

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.

Deadly Consequences

They're at it again. And Governor Brian Sandoval (R-Denial) must again confront an issue he keeps trying to sweep under the rug in the Governor's Mansion. Oh, yes. That's right. We're talking about the mental health patient dumping scandal. And the Sacramento Bee released another explosive article yesterday chronicling even more victims of this horrifying scandal.

This year, Rawson-Neal Psychiatric Hospital has been embroiled in scandal over a growing dossier of incidents where the hospital had mental health patients bused out of state without accounting for the patients' continuing treatment needs. It's led two major California cities (Los Angeles & San Francisco) to draft law suits against the State of Nevada, and it prodded the federal government to review both accreditation and funding for Southern Nevada's largest public mental health treatment facility. And on top of all that, it's renewed investigations into incredibly long waiting lists and inadequate treatment at Lake's Crossing Psychiatric Hospital in Sparks.

Clearly, Nevada has a patient dumping problem. The state was looking for a "cheap way out", but it's instead leading to very costly consequences. Those consequences have especially been costly for the victims profiled in the Sacramento Bee article on Rawson-Neal patients bused out of state... Only to fall (back) into a life of crime.

Consider the case of Mark Hesselgrave. He was convicted of second degree murder in 1993 for strangling his wife in Arizona. Shortly after being released from prison in October 2012, he moved to Southern Nevada. And after attempting suicide, he landed at Rawson-Neal. Here's what followed.

On Feb. 2, two days after he was admitted, Rawson-Neal deemed Hesselgrave fit for bus travel, the records state, and discharged him with a bus ticket, psychiatric medications for the ride and a recommendation to seek out Narcotics Anonymous meetings in Phoenix. After a bus ride that he described as “crazy,” Hesselgrave said he arrived at the Phoenix terminal with no one waiting for him. Without money or a place to live, he said, he ended up walking about 20 miles to a friend’s house in the suburbs.

From Arizona, Hesselgrave migrated to North Dakota to pursue a job in the oil fields. He quickly found work. Things were going pretty well, he said, until May 12, when he stabbed his roommate repeatedly. Eddie Bergeson survived, but suffered stab wounds in his face, stomach and back, according to a police affidavit.

“I hope he’s dead, I think he’s dead, I’m glad he’s dead,” Hesselgrave said as he stood over Bergeson, according to the affidavit.

Hesselgrave remains jailed in North Dakota, awaiting trial on charges of attempted murder. Police say he planned the attack; Hesselgrave contends they were drinking and got in a fight. He said he wonders whether things would have turned out differently had he received more treatment after his release from prison.

Rawson-Neal “didn’t try to treat me or nothing,” he said. “They could have kept me for 21 days. They could have ... got my depression in check.”

Mark Hesselgrave is just one of several stories of patients who needed help, but couldn't find it at Rawson-Neal. Instead, they were sent elsewhere. And others were ultimately harmed. At least one was killed. And a patient may have succeeded in committing suicide.

Of course, Governor Brian Sandoval('s spokesperson) said he was "appalled" by this report. However, it remains to be seen what (if anything) will be done about it.

Again, this is what happens when we try to provide health care "on the cheap". We ultimately haven't saved money. And we certainly haven't saved lives. Something must change.

Over the course of this year, we've been witnessing the consequences of neglecting people in serious need of treatment. We've been learning the hard way that providing proper mental health care is not just "bleeding heart liberalism", but also the most efficient way to save lives. How many more lives must be harmed and/or lost before we finally learn this lesson and end this deadly scandal?

The Consequences of Foolishness

Remember, it was all supposed to be over by now. Governor Brian Sandoval (R-Denial) was supposed to have fixed all the problems at Rawson-Neal Psychiatric Hospital. And there's supposed to be no more patient dumping.

Last month, news broke of incredibly long wait lists at Lake's Crossing Psychiatric Hospital in Sparks. And after all the revelations of mental health patient dumping (into other states) from Rawson-Neal Psychiatric Hospital in Las Vegas, someone is now stepping forward to demand justice. Yep, San Francisco is taking the state to court.

San Francisco City Attorney Dennis Herrera filed the class-action lawsuit against Nevada, Rawson-Neal Psychiatric Hospital in Las Vegas and state mental health administrators, seeking reimbursement for the care of indigent patients he said the system “dumped” onto California in an effort to save money.

“What the defendants have been doing for years is horribly wrong on two levels,” Herrera said in a written statement announcing the lawsuit. “It cruelly victimizes a defenseless population, and punishes jurisdictions for providing health and human services that others won’t provide.”

In addition to unspecified financial damages, the suit asks for a permanent injunction preventing Nevada from dispatching psychiatric patients to California unless they are residents of the destination city or county, are being sent to family members who have agreed to care for them, or are being sent to a medical facility where arrangements have been made for their treatment.

Ever since The Sacramento Bee first uncovered the horrific story of James Flavy Coy Brown's bus ride to Northern California, media from across California began investigating the matter. Pretty soon, other states began reporting patient dumping incidents. Then, federal health officials began investigating Nevada's broken mental health care system.

And now, federal investigators are confirming what many had suspected all along.

The U.S. Centers for Medicare and Medicaid Servicesassessed a sample group of 41 charts for patients at Rawson-Neal Psychiatric Hospital in Las Vegas and found that in 16 cases, patients were discharged without evidence the hospital had made even basic arrangements for their shelter, support or follow-up care.

The majority of those patients were discharged directly to Greyhound buses bound for other states, without documentation of specific instructions about how to find housing or mental health treatment.

Most had been living in Las Vegas shelters or on the streets before being transported to other cities. A few were sent by bus to homeless shelters in the area.

CMS officials said the hospital's handling of the cases violated the Emergency Medical Treatment and Labor Act or EMTALA, sometimes known as the "anti-dumping" law, requiring hospitals to either stabilize emergency patients or, at the patient's request, to transfer them somewhere else. Rawson-Neal, which already has lost its accreditation following investigations into its discharge practices, could face further sanctions for violating the act.

So is anyone still wondering why San Francisco is suing the state? And why are we left to wonder when our state will finally invest in fixing our languishing public infrastructure?

These are the consequences we are now paying. Southern Nevada's only public hospital dedicated to mental health care is losing federal accreditation, at risk of losing federal funding, and now faces a law suit in federal court. And why? Oh, it's just because our state government has had a knack for penny wise and pound foolish bullshit.

These are the consequences of failure to invest in our own people. Can we afford to continue making this same mistake? Can we afford to continue being so foolish?

Falling Through the Cracks

Over time, it's become a familiar story. We've become all too familiar with the many tragic stories from Rawson-Neal Psychiatric Hospital. And now, Nevada is beginning to pay the price of allowing all the patient dumping from there.

But now, we're finding out Rawson-Neal may not be alone. Today, we learned of Clark County public defenders' law suit against the Lake's Crossing Psychiatric Hospital in Sparks.

The Clark County public defender’s office filed the lawsuit in June against Lake’s Crossing Center in Sparks, saying inmates on the waiting list are spending an average of 80 days in jails without proper treatment and with their legal cases on hold.

“Incompetent detainees have routinely spent weeks and, in most cases, months, at detention facilities where the conditions are punitive and no prompt restorative treatment is available,” the lawsuit alleges.

The state must respond to the lawsuit by Aug. 26, according to Nevada Health and Human Services spokeswoman Mary Woods. In the meantime, the state is working to meet demand by adding 10 beds to the Dini-Townsend building — on the same campus as Lake’s Crossing — by November.

Mentally ill inmates are waiting 11 times longer for admission than they're supposed to. And as a result, their criminal cases are stuck in legal limbo. And to make matters worse, this is a problem that should have been resolved when the state settled another law suit in 2008.

Yet again, the State of Nevada decided to be penny wise and pound foolish. By not investing in basic mental health care and public infrastructure, the state is now in a world of constant legal trouble. Rawson-Neal is already being pummeled with law suits as the federal government continues to investigate the troubled mental health treatment hospital in Las Vegas. Even accreditation is now at stake there.

And now, it's not just Rawson-Neal. Cracks are appearing throughout the system. And far too many people are falling through those cracks. There's a financial toll to pay. And of course, there's a real human toll as well.

When will the powers that be (in Carson City) learn?

Saving Face v. Saving Lives

Last week, we checked in on the very critical condition of Rawson-Neal Psychiatric Hospital. The hospital was losing federal accreditation, and state mental health officials seemed resigned to accepting this fate. However, they've also been insisting that Rawson-Neal truly is cleaning up its act.

Ralston recently penned a blog on the forlorn state of Nevada mental health care. He spread blame all over the place. But ultimately, he did acknowledge these facts.

►You have heard the figure of $80 million being cut from the already spare mental health budget since 2007. That’s real. The number actually is $498.3 million, with a 19 percent reduction in force (364 positions).

►In 2009, 94 positions were eliminated at Rawson-Neal. In the 2010 special session, one of two satellite inpatient facilities in Southern Nevada was shuttered. In 2011, the other one was shut down, leaving Rawson-Neal as the only state-operated inpatient facility in the state. (All of this came amid declines in funding for medications and capital projects, too.)

►If you include all the money, including federal dollars, Southern Nevada Asdult Mental Health Services spent $173 million in the 2010-2011 biennium -- $13 million more than in the fiscal year just ending. Overall state mental health spending declined by about $34 million during the same period. (The good news: It is slated to increase by close to $30 million, if the administration request is approved, in the next biennium.)

You know what makes this sad story even sadder? That $30 million raise for mental health doesn't even reach 2009 levels. And Rawson-Neal was likely busing patients out of state then.

Last week, The Sacramento Bee (the paper that broke this scandal) released an editorial commenting on the sorry state of Nevada mental health care. Oh, and the paper had some choice words for Governor Brian Sandoval (R-Denial) and the Nevada Legislature.

As the story unfolded, Sandoval made much of Rawson-Neal's accreditation, proclaiming in April that "Rawson-Neal is safe, modern, and has a five-star accreditation."

However, Rawson-Neal received that accreditation in 2010, at a time when the hospital routinely bused patients. That raises questions about whether inspectors studied discharge plans or inquired what became of patients who were sent on their way with bus tickets and a few bottles of Ensure.

The Bee's Cynthia Hubert and Phillip Reese found eight former patients. Seven had no one waiting for them at bus depots when they arrived, and none had discharge treatment plans. One patient never made it to his destination. His whereabouts remain unknown.

Sandoval, Nevada's Legislature, and voters should be haunted by the question of what became of the other 1,492 patients. If Sandoval is uninterested in reconciliation, Democrats who control the Legislature should exercise oversight authority to determine the patients' fate.

This is the real tragedy. Whatever happened to those 1,492 other patients? Where did they go? Where are they now? And why are our state's "leaders" only trying to save face now?

Here's the problem. They're trying to save face. How about saving lives? That actually would have saved us all this money and time as well. That's the glaring irony of being penny wise and pound foolish.