Make Ends Meet

There's a reason why a number of Southern Nevada's fast food workers took part in #FastFoodGlobal last week. They're working incredibly hard to survive. Yet even as they're working, they're still finding it difficult to survive and make ends meet.

Just look at the numbers Desert Beacon unearthed earlier today. Those numbers tell a sobering story. Even workers who earn slightly more than the minimum wage struggle to make ends meet for their families.

Yet when we've seen Congress debate even a fairly modest increase in the minimum wage, we've heard the usual "job killing" rhetoric from G-O-TEA politicians. Rep. Joe Heck (R-Henderson) tried it at a Henderson town hall in February. And Senator Dean Heller (R) tried it when he voted against raising the minimum wage to $10.10 per hour. (FYI, #FastFoodGlobal strikers last week were demanding $15 per hour because that's what a parent with child needs just to make ends meet.)

What they fail to acknowledge is that Washington has the highest state minimum wage in the nation... And the highest rate of growth for small business employment last year. They also fail to acknowledge is that San Francisco has the highest municipal minimum wage in the nation... And the highest rate of growth for small business employment. Oh, and Seattle is the #2 city for small business growth. It's the largest city in Washington State, and it's now implementing a plan to #RaiseTheWage to $15 per hour citywide by the end of the decade.

We've yet to figure out how businesses would be hurt by guaranteeing workers' ability to make ends meet. To the contrary, workers with higher wages mean consumers with more income to drop back into the economy. And that ultimately means less poverty and more economic growth.

If anything, our current system isn't working. Case in point: McDonald's, the nation's largest fast food chain. McDonald's low wage business model costs US taxpayers an average of $1.2 billion per year due to McDonald's forcing its workers to utilize the social safety net just to make ends meet. And McDonald's executives are wondering why their company's profits have been so weak lately?

Maybe it's because low wage workers are struggling so hard just to make ends meet that they can't afford to buy their kids a lot of "Happy Meals"? Maybe it's because they've contributed to the inequality gap that's threatening to undo the foundation of this very nation? Maybe it's because their short term avarice has harmed their company's (and this nation's) long term success?

Think about it. How are we supposed to succeed as a society if so many of our people are finding it increasingly difficult just to make ends meet? And how can our democracy function if so few can afford to participate? How will America then be able to make ends meet?

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.

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?

Costly Denial

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.

Problem Solved?

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.

California Outrage Grows as Nevada Patient Dumping Scandal Thickens

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.

(The segment starts at 20:05.)



Governor Brian Sandoval continues to deny any widespread wrongdoing on the part of his administration and Rawson-Neal Psychiatric Hospital in Las Vegas. Yet despite Sandoval's continuing denials, questions persist in California. Los Angeles officials continue to ask.



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?!

Learning the Hard Way

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.

View more videos at: http://nbclosangeles.com.

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.

Scent of a Scandal

Earlier today, we were discussing our state's need to admit that we have a problem with our current (non-)treatment of mental health patients. Ever since Californians began to learn the story of James Flavy Coy Brown, outrage has been mounting over Nevada's habit of patient dumping (out of state). And now, Governor Brian Sandoval (R-Denial) and the Nevada Legislature are about to find themselves in even more trouble.

Why? Oh, San Francisco is now launching a probe into our (not so) little patient dumping problem.

San Francisco City Attorney Dennis Herrera today announced a formal investigation into whether the State of Nevada improperly "dumped" psychiatric patients to his city and across California.

In a letter to the director of Nevada's Department of Health and Human Services sent this morning [and copied to Sandoval and Attorney General Catherine Cortez Masto (D)], Herrera demands that the state turn over documents related to its aggressive practice in recent years of discharging mental patients to Greyhound buses and transporting them across the country. [...]

The director of San Francisco's Behavioral Health Services department told The Bee earlier this month that at least two other Rawson-Neal patients had arrived in San Francisco in the last year "without a plan, without a relative."

"Assuming the reports are true, Nevada's practice of psychiatric 'patient dumping' is shockingly inhumane and illegal," Herrera said in a statement. "We intend to investigate these reports thoroughly, and I am inviting input from providers of services to San Francisco's homeless, who may be willing to volunteer evidence and testimony to assist the city in a potential civil action. "

Herrera said the city will seek compensation from Nevada if it determines that "patient dumping" has resulted in the improper transfer of patients to San Francisco.

"We're prepared to litigate aggressively on behalf of San Francisco and its taxpayers to recover whatever costs or damages we're able to identify," he said. "I also intend to pursue injunctive relief, including monitoring of the offending medical facilities, to send a strong message to any other state or locality that would consider similarly irresponsible public health practices."

Oh, yes. That's right. This just happened. And "Governor Sunny" can't say we didn't warn him.

In recent days, the patient dumping scandal has been getting more attention... And more complaints. Los Angeles is also considering legal action against Nevada. A federal investigation is still underway. California legislators have asked the federal government to take action against Nevada soon. And now, even Utah mental health officials have been speaking out against Nevada's patient dumping habit.

Earlier today, Steve Sebelius wondered aloud if this issue has become the opening shot of the 2014 campaign season. While the issue has been slow to "bubble up" on this side of the state line, it's been receiving more attention lately. And every time Governor Sandoval clumsily denies its existence and/or tries to deflect from it, some higher level Democrats have been salivating over this potential opportunity to finally weaken "Governor Sunny's" political position.

So there's that. But more importantly, there's also the actual policy FAIL. Nevada didn't live up to its obligation to care for these real people. And as a result, these people were just disposed of like garbage. They were left in strange places without a home and without the treatment they need.

With today's news, there's finally the chance Nevada will be forced to deal with this problem. And perhaps with the budding scent of scandal sticking to Governor Sandoval, he may ultimately feel the urge to be done with the ugly political optics. We shall see what happens next.