Into the Wrong Hands

It happened again. This time, it was Isla Vista, California, which is home to UC Santa Barbara. Seven people are now dead, including the suspected shooter, Elliot Rodger.



Once again, we saw the brutal reality of gun violence. Even though Elliot Rodger had obtained his semiautomatic pistols legally, friends & family had seen evidence showing that Rodger was preparing to commit a very heinous crime. Even local police ran into the warning signs (but seemed to miss them).

Make no mistake. These weapons are designed to kill. And when these weapons fall into the wrong hands, tragedy ensues.

Earlier this month, the NRA made a splash over its own "rebranding" campaign, complete with a brand new online TV network. Try as it might, but the NRA can't "rebrand" reality away. Over the weekend, Richard Martinez made that point very clear. He should know, as his son was one of the victims of the Isla Vista massacre.



Once again, we've seen the recipe for disaster executed. Someone didn't receive the treatment and care he needed. Instead, he was able to access deadly firearms. And we're once more witnessing the results of allowing lethal weapons to fall into the wrong hands.

Already, "TEA" fueled media pundits are trying to deflect blame onto someone else. "It's the feminazis' fault! It's the homosexuals' fault! It's a false flag government conspiracy!"

But of course, these "TEA" powered media personalities will never blame those who boast about being "what stood in the way" between this nation and better gun safety laws. Because of course, free-dumb isn't free. And it's best for us not to worry our little heads over dangerous weapons falling into the wrong hands.

Bloody Juice

We just saw another one unfold. It's easy to lose count of how many we've witnessed in the past few years. However, it's never easy to witness such a brutal and cruel loss of innocent lives.

This time, it happened at Fort Hood, Texas... Again. On November 5, 2009, Major Nidal Malik Hasan opened fire at Fort Hood. He killed 13 people and wounded at least 30 others.



On April 2, 2014, Ivan Lopez opened fire at Fort Hood. He killed 3 people and wounded 16 others before shooting himself dead. Lopez was under evaluation for Post-traumatic Stress Disorder (PTSD) just before he picked up his .45 caliber pistol and opened fire.

Once again, we're reminded of the serious public health, national security, and civil rights threats posed by unfettered gun violence. And once again, we're left wondering why this keeps happening. Once again, we're left wondering why we haven't taken more action to curb this senseless loss of lives.

Ironically enough, The White House had scheduled a "Champions of Change" event today to honor those who have been working hard on gun violence prevention. One of those honored today was Nevada's own Teresa Crawford. The event went on as planned this morning, but it certainly had a more somber tone in light of yesterday's tragic event at Fort Hood.

It also felt (even) more poignant. Think about it. Fort Hood has just endured another mass shooting. The perpetrator had mental health struggles. And yet, he successfully accessed and discharged a .45 caliber Smith & Wesson pistol. How could this happen again? And why are we letting this happen over & over again?



At today's event, Teresa discussed the campaign gun violence prevention activists have used to hold politicians like Senator Dean Heller (R-NRA), Rep. Joe Heck (R-NRA), and Governor Brian Sandoval (R-NRA) accountable for serving as "what stood in the way" between us and better gun safety standards. She and the other panelists shared stories of their own experience with gun violence, and how they've been able to turn their stories of tragedy into opportunities to build community and work on positive action to improve their communities. And yes, they also shared stories of how they're still working to overcome the immense political juice the NRA & gun industry still hold locally & nationally.

What we're now realizing is that the juice the NRA & gun industry produce is a rather bloody juice. They keep peddling fantasies of deregulation heaven. Yet when we follow their orders, we only end up with hell is nightmares. Something must change. We can't afford to continue drinking this bloody juice.

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.

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?

How Does This Make Any Sense?

Ever since the Nevada Legislature adjourned sine die, we've been keeping a close eye on what Governor Brian Sandoval (R) may soon do to SB 221, the background checks gun safety bill. The Governor's Office quickly set up a hot line for NRA members to freep to gauge support for SB 221. And now, the Mayors Against Illegal Guns Demand Action campaign is responding with this.

‏@RalstonReports: Mayors Against Illegal Guns using patient-dumping controversy in web ads to pressure @GovSandoval on gun bill. Wow

Oh, yes. That's right. They just went there.

While Rawson-Neal Psychiatric Hospital is on track to regain accreditation, several California municipalities are still threatening law suits over recent "dumps" of Nevada mental health patients into their communities. And the State of Nevada is still not investing what's needed to fix our public health infrastructure so that this never happens again. And on top of all this, the fact remains that it's easier for the severely mentally ill to access dangerous weapons in this state than access the health care they need.



Think about that. It's easier here in Nevada to buy guns than it is to access the health care one needs. And while Governor Sandoval and Republican legislators claim to care about mental health care, they've (again) failed to properly fund it.

So now, a bill that simply expands background checks on gun sales to gun shows, online sales, and other "private, back room" sales sits on Governor Sandoval's desk. If he vetoes it, then the seriously mentally ill, along with dangerous criminals, can continue to easily access dangerous firearms. We'll let them have dangerous guns, but not health care.

How does this make any sense?

The Buck Stops There ( @GovSandoval's Office, That Is).

Wow. That was fast. Just this morning, we witnessed the Assembly Judiciary Committee hearing for SB 221, Senator Justin Jones' (D-Enterprise) gun safety bill. And not too long after the hearing, some Carson City gossip hounds and pot stirrers were already declaring the bill "dead on arrival". It also didn't help that Governor Brian Sandoval (R-NRA) began hinting at "The V Word".

Then, all of a sudden, we saw this.

.@GovSandoval on GOP gun alternative: "I want to commend Senator Roberson for his attention to this important issue..." #nvleg #choreography

Remember when Senator Michael Roberson (R-NRA) pulled this stunt last week?

We even saw poison pill amendments, including one from Senate Minority Leader Michael Roberson making the background checks provision voluntary instead of mandatory. Ummm, hello... Will anyone trying to purchase firearms and ammunition for nefarious, criminal purposes voluntarily submit to a background check? File that in the "Totally Defeats the Purpose" Department.

What was once Senator Roberson's proposed poison pill amendment to SB 221 now has its own bill number: SB 520. And seriously, Senator Roberson and Governor Sandoval may be inhaling a bit too much 420 (without even waiting to pass SB 374 into law!) if they think this act of political convenience can magically make Nevada's gun violence problems go away.

Funny enough, several of the 21st Century Know Nothings who testified against SB 221 this morning railed against the mental health portion of the bill along with the universal background checks provision. And that's not the first time this has occurred. (Thanks for the reminder, Senator Debbie Smith [D-Sparks].) Yet all of a sudden, Senator Roberson and Governor Sandoval are champions of better mental health care? I wonder what James Flavy Coy Brown, Monica, and/or any other mental health patient dumping victims have to say about that!

We all know what this is truly about: Governor Sandoval wants to remain in the gun lobby's good graces, yet he also wants the appearance of "doing something on gun safety". So all of a sudden, his "new old BFF" Senator Roberson has all too conveniently dropped SB 520 at the very last minute. Governor Sandoval can (once again) have his political cake and eat it, too!

Or can he? Senator Jones refuses to let his bill go down without a fight.

.@Jones4Nevada says he won't strip out background checks provision to get bill passed. Says leadership in Assem. will move it. #nvleg

And as long as the Assembly passes SB 221 within the next six days, the bill will still reach Governor Sandoval's desk. And ultimately, the buck will stop with him. So is there any wonder as to why he and Senator Roberson are desperately trying to pass the buck now? And would they really be doing this if they didn't believe 86% of Nevadans support Senator Jones' bill?

Costly Status Quo

We've been warning of this for some time. And now, we are beginning to see the consequences. Nevada's largest psychiatric hospital, Rawson-Neal in Las Vegas, has faced disturbing allegations of mental health patient dumping since April. And today, an independent investigation of Rawson-Neal concluded that while many of the discharges were proper, quite a few were not.

The state hired Dr. Kenneth Appelbaum, a professor of psychiatry at the University of Massachusetts Medical School, and Joel Dvoskin, a clinical psychologist and faculty member at the University of Arizona College of Medicine, to examine the hospital's practices.

The two spent a week at the hospital earlier this month. Among their findings:

• Hospital staff often feel pressure to discharge patients quickly to make room for more.

• The hospital relies too heavily on treatment with medications and not enough on psychotherapy or behavioral therapy.

• Staffing levels are not adequate for the large volume of patients seen at the hospital.

The consultants recommended that the state increase the number of staff positions at the hospital by about 5 percent. They also recommended that the hospital "increase the amount of high-quality, evidence-based treatments beyond the provision of psychotropic medication."

Boosting staff levels, along with ensuring each patient has a clear treatment plan upon discharge, may reduce the number of patients improperly bused out of state without housing or treatment waiting at their destination.

"Every single state has seen massive budget cuts in their mental health system," Dvorkin said in an interview. "Billions of dollars nationally. It isn't just Nevada. In my opinion, we are starting to see the impact."

Surprise! Chronic underfunding of our state's social safety net is leading to ghastly consequences. Who could have guessed this?

As we've explained before, Nevada is finally experiencing a rude awakening. We can no longer afford lulls of complacency. The strained economy and tattered social safety net won't allow for any more.

At least Governor Brian Sandoval (R) has finally agreed to address the problems with Nevada mental health care. Yet with that said, is he ready to truly fix the systemic ills behind this latest scandal? His latest actions cast doubt. And it's not as if the Legislature now has the appetite to do something.

So for now, we're mostly stuck with the status quo. Look at how much it's already costing us. How much more can we afford?

Sounding the Alarms

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.

Back to Basics

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.

The Rude Awakening for #NVLeg

Last Monday, we were warning everyone not to get too caught up in all the pomp & circumstance of the latest rumors of sweeping tax reform to hit Carson City. After all, the bulk of the tax plans floating around the Nevada Legislature don't even come close to fixing the major holes in our public infrastructure and social safety net. Nevada now faces potential law suits for mental health patient dumping.

Just yesterday, The Sacramento Bee released interviews with former Rawson-Neal who opened up on the origins of "Greyhound Therapy".

Though the employees offered different perspectives on the wisdom of sending psychiatric patients alone on bus trips across state lines, most described increased pressure in recent years to move patients out. And budget cuts, they said, were a driving factor.

"There is so much pressure now to get people out as soon as possible," said one longtime Rawson-Neal nurse, who requested anonymity for fear of losing her job.

"The administration has a meeting every week to talk about length of stay," she said. "Doctors are told, 'You need to get these patients out of the hospital.' " [...]

Nevada cut mental health spending 28 percent between 2009 and 2012, cuts that brought furlough days, staffing shortages and widespread reductions in outpatient services and housing for the mentally ill, according to employees and area social services workers. [...]

Bryan Peralta worked as a mental health technician at Rawson-Neal for eight months, ending in November of last year. One of the reasons he left the hospital was its discharge of patients "who were not ready" to be released, he said.

Peralta recalled one young woman who was sent to the Greyhound station while "she was still foaming" at the mouth and talking to herself. She had a ticket to California, but was sent back to Rawson-Neal by a bus driver before she crossed the state border, he said.

Yep, that's really been the state of mental health care here in Nevada. And no, sweeping this under the rug won't make it go away. And neither will dumping it onto a Greyhound bus.

But wait, there's more. Nevada is also facing potential law suits over K-12 public education. Here too, schools are being shortchanged. And the shortchanging is especially horrific in Clark County, where 72% of the population resides and the student body is far more diverse. For years, the Clark County School District (CCSD) has suffered overcrowded classroom and lack of programs students need. Now, CCSD and the Clark County Education Association (CCEA) have released a $1.2 billion plan to address overcrowding.

In total, the district and union's plan calls for hiring 4,115 new teachers, for a total of $271.7 million. The average teacher's salary with benefits is $66,000.

The additional teachers would be on top of an estimated 2,000 new educators being hired for next school year as a result of the School District's arbitration win against the Clark County Education Association in February. If all goes according to plan, the School District could have upward of 23,000 teachers by 2017.

That would lower average class sizes significantly in kindergarten, and fourth and fifth grades. Average class sizes in kindergarten would drop to 16 students. Fourth and fifth grades would see a drop to 26 students.

To accommodate the 6,000 new teachers and a growing student enrollment, the district also would have to build 37 new schools at a cost of $931.7 million. The average elementary school costs $25 million to construct.

In total, the new teachers and schools would cost the district $1.2 billion.

OK, that sounds nice. But wait, where will the funding come from? Right now, that's the key $1.2 billion question.

We know Governor Brian Sandoval's (R-Denial) oh so "sunny" budget fails to shine enough resources for public schools or mental health care. And while Senator Michael Roberson's (R-Lone Wolf) proposed IP 1 mining tax alternative initiative raises half of what CCSD is now requesting, it's still unclear whether "The Senate GOP Mod Squad" gambit is actually legally and/or politically viable.

So where does that leave us? Take it away, (Assembly) Speaker Marilyn Kirkpatrick (D-Seriously?).

Speaker Marilyn Kirkpatrick this morning informed folks that her long-awaited admissions tax is finally drafted, setting a rate of 8 percent for all major venues.

The current Live Entertainment Tax has a two-tiered rate, with some venues taxed at 10 percent and others at 5 percent, depending on capacity. I'm told the bill draft exempts only small venues under 50 seats, nonprofits and some government sites.

The Live Entertainment Tax would go away and be replaced by the Nevada Entertainment and Admissions Tax.

Well, I guess something is better than nothing. And this does look preferable to the revenue-neutral regressive sales tax clusterf**k she and Republican leaders were considering earlier this session. But ultimately, this only offers a few drops in the bucket when we need that bucket as full as possible to take care of our own people.

It often seems like many politicians and pundits in Carson City don't understand why We the People decided to take tax reform into our own hands with The Education Initiative. Well, this is why! Nevadans are looking for solutions. And if the Governor and Legislature can't agree on a real solution by June, then We the People will have to provide it for them next year.

We can't take any more of the status quo. It's already costing us dearly. Something must change. And if we don't see that change coming out of Carson City soon, then it will be facing a very rude awakening come November 2014.

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.

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.

How Congress Fits into Mental Health Patient Dumping Scandal

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.