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.

With AB 484 Dead, UMC Plan Reignites Clark County Controversy

Back in January, we looked at the stark divide that was beginning to emerge on the Clark County Commission. On a host of critical issues, there's seemed to be a persistent 4-3 split. Perhaps the one issue this has most often been manifesting itself has been the ongoing struggle over UMC, Southern Nevada's only public hospital.

Earlier this week, the Assembly Health & Human Services Committee heard testimony on AB 484. This bill calls for a new governing board for UMC, but opponents fear it threatens the hospital's mission as a critical health care provider for those who can't access care anywhere else. And opponents fear this bill may actually be a back door route to privatizing UMC.

Yet what truly surprised nearly everyone this week was the appearance of three County Commissioners... To testify against AB 484! No one saw this coming.

“This is a slippery slope. We have a moral obligation to make sure we take care of the needy people in our community,” [County Commissioner Chris] Giunchigliani said. “I would caution that no matter what happens with this bill, which I hope does not pass, that we be very cautious about unintended consequences.” [...]

[Commissioners] Giunchigliani, [Tom] Collins, and [Lawrence] Weekly told legislators that changing UMC’s governance structure wouldn’t address underlying revenue issues that cost the county tens of millions of dollars per year.

Collins called the proposed changes “unproven” and said it was an instance of “government trying to pass the buck.”

Weekly said the proposed legislation wasn’t “genuine” and was being fueled by special interests. He said commissioners should spend more time working on hospital issues before offloading those responsibilities to an independent board.

“If you move forward with this … what you’re going to see down the line is a whole bunch of special interest folks coming out of the woodwork and UMC won’t be that safety net hospital anymore,” Weekly said. “I don’t think enough time has been spent as a board caring for this hospital like we should.”

Giunchigliani said county commissioners need to have the “courage” to take serious action to fix UMC’s financial situation, including possibly creating a countywide tax to help pay for hospital operations.

“We have to clean up our own house to some extent and we don’t need AB484 to do that,” she said. “This bill diverts us from that discussion. We’re not dealing with how do we fund the hospital or add to our payer mix.”

Yes, that actually happened this week. What was supposed to a "Clark County backed bill" drew opposition from three sitting Clark County Commissioners. And yes, the Nevada Legislature took notice.

And as a result, another surprise occurred. AB 484 died in committee yesterday. Remember that yesterday was the deadline for bills to pass from their originating committees. So because the Assembly Health & Human Services Committee took no action yesterday, AB 484 will likely go nowhere this session.

Assembly Speaker Marilyn Kirkpatrick [D-North Las Vegas] said part of the reason the bill failed was legislators were reluctant to get involved in an issue that could be solved at the county level.

“Anytime that any county comes before us and they have a split vote, we try to send things back to them so they can work on them,” she said. “It's really their issue that they need to resolve amongst themselves.”

So it's back to the drawing board for the Clark County Commission on charting the future of UMC. And going forward, UMC will likely remain a county issue for some time. Since AB 484 is no more, the county will probably have to give up any plans to privatize the hospital for now.

Now, it's just a matter of whether the Clark County Commission can overcome this 4-3 divide and come together for a holistic solution for UMC. Again, this is Southern Nevada's only public hospital. And it's the only source for health care for many in Clark County who have the legal right to access health care somewhere in the county.

So what happens next? For now, that big question moves out of Carson City and back to Clark County HQ in Downtown Las Vegas. Good luck with that.

NV-Sen: The Truth Behind Berkley's New Ads (& Heller's Complaints About Them)

So the pundits are not liking this.



Why? It completely obliterates their previously prepared narrative of, "ZOMG!!! Democrats are running away from Shelley Berkley and her SCANDALS!!!!" They're having such a hard time realizing that somehow her campaign has been able to scoot past Dean Heller's manufactured "controversy" and turn the "scandalous" spotlight back onto Dean Heller and his actual record.

In particular, a handful of pundits are screaming out Berkley calling out Heller for his support of Paul Ryan's Medicare busting plan. While they're arguing over semantics, they're ignoring the fact that "Ryan-care" would indeed end the traditional Medicare system and dramatically raise health care costs for seniors if enacted.

Even a REPUBLICAN member of Congress recently admitted the truth behind Paul Ryan's spin. He even sent a flier to his constituents late last month highlighting his opposition to "Ryan-care"!

House Republicans approved a budget in April that would drive up Medicare costs for seniors, and Mitt Romney has embraced the plan crafted by Rep. Paul Ryan (R-WI). But not all in the party are in agreement. Ten Republicans voted against Ryan’s budget in April, and now, Rep. David McKinley (R-WV) is campaigning on his opposition to it. [...]

The GOP plan that McKinley opposes would give seniors the option of enrolling in traditional Medicare or taking a stipend to buy their own health care policy on the private market. Republicans have argued it would slow the federal government’s rising costs for Medicare, but the Congressional Budget Office says the plan would increase seniors’ out-of-pocket costs by privatizing Medicare.

In the flier, McKinley says Congress “must balance the budget,” but not on the backs of seniors. McKinley spokesman Jim Forbes told the Los Angeles Times that the congressman “is standing for what he believes in,” but in an election cycle dominated by health care and budget issues, McKinley’s stance is out of step with the rest of his party.

And this is exactly what Shelley Berkley has been saying. Unlike the manufactured "Kidney-gate SCANDAL!!!" about nothing, Heller actually voted for "Ryan-care". And if it's really not as frightening as Berkley's ad suggests, why won't Heller run on it? Why won't he just come out and defend his BFF Paul Ryan? What could he possibly be afraid of?

So keep this in mind as you hear media pundits console Dean Heller's campaign as they whine and complain about Shelley Berkley's new ads.

NV-Sen: When Saving Lives Is "Corrupt"

Is this stupid or is this stupid?

Democratic Rep. Shelley Berkley's efforts to influence federal reimbursement rates for dialysis providers and to save a kidney transplant program in her home state of Nevada have raised questions about an appearance of a conflict of interest with her husband's medical practice.

But an ethics watchdog group said Tuesday the efforts are unlikely to generate further investigation because her work helped a large swath of health providers, not just her husband.

Berkley, who is running for the Senate, was the focus of a New York Times report that examined her role in staving off the closure of the state's only kidney transplant center. Her husband, Dr. Larry Lehrner, has a nephrology practice that administers kidney care at the University Medical Center in Las Vegas.

Federal regulators had moved three years ago to shut the kidney transplant program because kidney transplants were failing at unusually high rates, but Berkley and other members of Nevada's congressional delegation intervened and succeeded in gaining a reprieve.

The department's closure would have required Nevadans to go out of state for a kidney transplant. “I think going to bat for the hospital, it's really hard for me to see that as a big conflict,” said Melanie Sloan, executive director of Citizens for Responsibility and Ethics in Washington. “The concept of closing the only transplant center in the entire state, that seems like a big deal, and it seems like any member of Congress would have to be involved, plus she didn't initiate it, so it just doesn't bother me very much.”

OMG, Shelley Berkley's husband is a doctor! And OMG, Shelley Berkley saved the state's only kidney transplant center! OMG, what a conflict of interest! (snark)

I know "The Grey Lady of Journalism" has been letting its journalistic standards lapse for some time (case in point, Jayson Blair and Judith Miller being allowed to make up their own "facts" as they wrote along), but this may be a new low for The New York Times. In trying to make a big story that could tip our US Senate election, The Times missed some key details of the actual story.

Reacting to the story, Berkley issued a statement accusing the Times of ignoring important contextual elements, such as the fact Nevada’s entire delegation, including then-U.S. Reps. Jon Porter and Dean Heller, both R-Nev., urged regulators to save the transplant center.

Berkley has also been a fierce advocate for funding for treatment of cancer, hepatitis and osteoporosis — a disease she suffers from.

“While The New York Times may not care about the health care needs of my fellow Nevadans, I do,” she said in a written statement. “I will never stop fighting on behalf of my constituents just because my husband is a doctor.” [...]

But political scientist Eric Herzik said Berkley is well positioned to withstand the scrutiny.

“So she happens to be married to a doctor,” he said. “She saved a transplant clinic. If I were her, I would be out there right now spinning it that way. ‘Yes, it was flawed, and I helped fix it.’ ”

I don't always agree with UNR's registered Republican political scientist, but I think both he and The Sun's editorial this morning are onto something. If this is "scandalous", then I want more "scandal", dammit! This is the only kidney transplant program in the state. And if Dean Heller and his DC Republican cohorts now want to claim we would have been better off allowing UMC to close it so Nevada patients in need would be forced to fly out of state to get the health care they need, then I can't wait to see their pretzel twists of "logic".

NV-Gov: Is Rory Reid Becoming Viable... Or Losing His Own Base? And Is He Even Doing What's Right for Clark County?

So Rory Reid released his "county rescue plan"... Just as the political chatter has been about whether he has any chance of becoming Nevada's next Governor and just as the federal courthouse shooting was rocking all of us in Las Vegas yesterday.

So what exactly did Rory Reid propose? Steve Sebelius explains the policy.

Toward the end of Clark County Commission Chairman Rory Reid’s news conference today — the one where he announced several government reforms — he allowed that the political fallout could cut either way. “I think it’s impossible to measure the political impact [of the reforms],” he said. “It might help me, it might hurt me.” But, he said definitively, “I was elected to do a job.”
Indeed, he was. And, if nothing else, you’ve got to give Reid credit for speaking up when he did, when staying silent might have been the more politically prudent course.
As for the substance of his proposals, it’s a quick list when one boils it down to specifics:
Transform University Medical Center into a non-profit, or a teaching hospital, “…or another financially viable model.” Since the county ran a deficit at UMC of $140 million in the last fiscal year, the number of “financially viable models” appear fairly limited.
Re-open public employee union contract negotiations. This is the most politically perilous of Reid’s suggestions, although it’s not something new. (He asked for concessions last year, too.) Of this year’s move, he said that “our labor agreements are not sustainable in the long term” and that “everything’s on the table.” For unions that have won good contracts during boom times, that’s not so good. And for Reid, running for governor and needing all the help he can get, it’s not exactly the way to win an endorsement.
Put about $300 million in public works infrastructure projects out to bid as soon as possible to create jobs.
Consolidate some IT, finance and human resources employees. (Apparently, many county departments each have their own IT, HR and finance employees.)
Past that, there were some semi-vacuous sound bites, things about “public-private partnerships” to create jobs, or “partner with the private sector to create jobs.” (Hey, that’s a great idea! Why, if only somebody said that a year ago, we’d probably all be rolling in cash right now!) But there was enough of substance to make it worthwhile for Reid to hold the news conference the day before he’ll bring these ideas before his colleagues.

Now of course, this isn't just about policy. It's also about the politics of the Governor's race. Rory Reid obviously thinks this is how to convince those skeptical-yet-still-undecided "fiscal conservatives" that he isn't some "evil lib'rul SOCIALIST union pawn!!111!!!1111!" And who knows, maybe this will work out for him.

But last I checked, labor unions are typically among Democrats' strongest supporters and partners. How will they feel about being dumped upon like this? Sure, it's not like Oscar Goodman, Brian Sandoval, or (especially!) "Luv-Guv" Gibbons is more likely to do anything to help working families. However, Reid, Jr., may be risking turning what should be his political base apathetic and more willing to stay home or vote "None of the Above" than vote for anyone at all.

And turning back to policy, I'm not totally convinced that turning UMC private will be helpful to anyone at all. After all, no matter what happens to UMC, Clark County still has the obligation of providing emergency care to the indigent.

Now regarding the county workforce, there certainly are redundant positions and departments (and especially management!) that can be streamlined and consolidated. However, there's no reason to demonize so many hard-working public servants and strip away their very livelihood. It's easy to bash "the evil, corrupt UNIONS!!!!11111!!!111!", but it takes real courage to be rational and strike a deal that's fair to these public servants while also preserving the services that Clark County residents rely upon.

So politically, I think there are risks. And policy wise, I think there are risks. But if Rory Reid somehow pulls it off while not gutting county government and/or throwing thousands more people into the unemployment lines, maybe this will all work out. And whatever happens next, this most certainly will be a game changer in the race for the state house.