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May 6, 2015

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Policy change in 2009 prompted increase in busing mentally ill patients



A Greyhound bus whizzes down Highway 97 south of Goldendale, Wash.

Nevada health officials are delving into allegations that mental health clinicians in Las Vegas have sent mentally ill patients on buses across the country with little to no plan or regard for their welfare.

Click to enlarge photo

James Flavy Coy Brown, 48, is addicted to smoking his pipe and consistently asks over and over for more tobacco as he waits for his morning medicine to be delivered. He now lives at the Home Sweet Home boarding house in Sacramento after a harrowing journey from a mental hospital in Las Vegas.

Since a mentally ill man from Las Vegas turned up in Sacramento on a Greyhound bus earlier this year, the state’s health department has disciplined employees involved in the man’s release, changed hospital policy and asked for a federal review of their practices.

The state Department of Health and Human Services has also begun a review of the circumstances surrounding each of the 1,500 patients it has bused out of state over the past five years — a trend uncovered by the Sacramento Bee.

According to an initial review, the state’s mental health agency removed administrative oversight of busing patients with a policy change in 2009, prompting an increase in the number of patients bused out of state, said Mike Willden, director of the state Health and Human Services Department.

The agency has subsequently added back that level of oversight following two internal investigations sparked by the Sacramento Bee reporting.

“We’ve taken action to date. We’ve disciplined staff, referred to the licensing boards. We’ve done several policy changes. Additional training has been done to ensure going forward that this can’t happen again,” Willden said. “Zero tolerance is our goal.

“We need to finish our 1,500 case review. We are working with our national partners on whether we should or should not make additional policy changes. So there may be more things coming down the road.”

While changes have already been implemented, Willden repeated in an interview with the Sun what he told state lawmakers in March — that he believes the Sacramento case is an isolated incident and that improper busing is not a systemic problem.

Willden said of the 31,000 patients admitted to the Rawson Neal Psychiatric hospital in Las Vegas in the past five years, 2,400 had out-of-state addresses. Of those out-of-state patients, 770 came from California.

As state health officials react to the Sacramento Bee reporting, Nevada’s elected leaders have taken a wait-and-see approach.

Nevada Gov. Brian Sandoval delivers the State of the State address at the Legislature in Carson City on Wednesday, Jan. 16, 2013.

Nevada Gov. Brian Sandoval delivers the State of the State address at the Legislature in Carson City on Wednesday, Jan. 16, 2013.

Gov. Brian Sandoval has largely kept quiet when various news agencies have asked him about the practice of inappropriately busing patients from Rawson Neal to other states.

His press secretary has emailed multiple news organizations a brief statement that “the governor has been briefed throughout the investigation process and has asked for more information.”

“I think there is a good quality of care there,” Sandoval told KSNV News Channel 3 when a reporter talked to the governor an event he attended in Las Vegas earlier this week. “If there’s a problem, we are going to correct it.”

Willden said he’s been meeting with Sandoval at least weekly to keep the governor apprised of ongoing investigations.

State legislators, however, have largely been preoccupied with other matters in Carson City. Some aren’t aware of the new stories detailing the investigations into Rawson Neal’s practices and policies.

Other says they’ve met with Willden but don’t want to jump to conclusions before federal investigations conclude.

“Until we can get that information in the next couple weeks, we will have to see if any policy changes need to be made,” said Assembly Speaker Marilyn Kirkpatrick, D-North Las Vegas.

Assemblywoman Lucy Flores, D-Las Vegas, called the revelations in the Sacramento Bee stories “shameful” but also said that legislators don’t yet have enough information about the hospital’s policies or the details of the investigations.

Assemblywoman Maggie Carlton, D-Las Vegas, said she’s spoken with Willden but also needs to see more detail.

“What we have to separate is dumping versus sending home,” she said. “We need to figure out what this is really about.”

Even with federal-level investigations pending completion, the state Democratic Party has seized upon the so-called “Greyhound therapy” scandal as a chance to pummel Sandoval -- who is up for re-election next year -- for his defending of the health department.

“It is a clear demonstration of where the governor’s priorities are that his administration has now gone from throwing mental health patients under the bus last session to putting them on a bus and shipping them to other states,” said party spokesman Zach Hudson.

Willden, however, said previous state budget cuts to the state’s Southern Nevada Adult Mental Health agency haven’t caused the uptick in out-of-state busing. Instead, it was the 2009 policy change that may have led to an increase in discharges via Greyhound and created a situation in which “mistakes could be made,” Willden said.

State officials have since reinstated that second level of administrative review when travel plans are approved for patients.

Health officials have reviewed about 500 of the 1,500 Greyhound trips patients took following discharge, and a few appear not to follow discharge policies, Willden said.

Most patients did make it to their destinations with someone to meet them upon arrival, he said.

“The idea is to have a safe discharge and confirmation of receipt of our patient in the other jurisdiction,” Willden said. “That’s the goal.”

Noting that Las Vegas is a “mental health magnet city” like Hollywood, Washington D.C., or New Orleans, Willden said it’s not unusual that the local mental health agency sends so many people back to other states.

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  1. Something stinks here, it's good that people were disciplined for doing this but someone higher up knew about this and approved it. It wouldn't surprise me how high up the ladder the knowledge of these practices were known.

  2. I first learned about California's investigation of James F. Brown's transfer to California as possible patient dumping from "'Patient dumping' affecting shelters, hospitals," the Sun's 3/4/13 reprinting of a Sacramento Bee article by Cynthia Hubert. A follow-up Sacramento Bee article was reprinted in the Sun on April 16th and entitled "State official defends practice of moving psychiatric patients."

    A third Sacremento Bee article by editor Dan Morain was printed in the Sun on April 17th. All of these articles explain California's "analysis."

    I appreciate Anjeanette's story, which gives the Nevada authorities' perspective.

    Today's Review-Journal has an important article entitled "Dumping allegations spur detailed review" by Laura Myers. Pertaining to that article I hope that Nevada officials will separate the readmissions from the Rawson-Neal "Inpatient admissions" figure of 14,397 from 7/1/2008-3/31/13. A readmissions number will indicate whether there is a "revolving-door" problem.

    Laura's article states that out-of-state Nevada admissions were 8% of total admissions. California patients admissions were 2.5% of Nevada admissions. That disputes an official's statement that Nevada not only transfers patients out-of-state but equally treats out-of-state patients.

    I have read that Nevada has received a D Grade on its mental health system. Millions of dollars have been cut from it. I cringed when I recently read that an official remarked that since Southern Nevada will get more education money from the new funding formula, he certainly hoped there would be additional funds for northern Nevada, so it would not have to go backwards. That hasn't stopped the severe cutting of the mental health budget....What about the projected loss of $87 Million for 2014 for UMC, our hospital for the uninsured.

    Anjeanette's article says that some legislators have been unaware of the mental health system's challenges. I am relieved that the time has arrived for its review and remedy.

  3. The quotation below gives validity to my concerns that Nevada, along with other states, has serious room for improvement of its mental health system (and not JUST regarding releasing patients by bus to other states). The quote shows that services have been slashed. However, legislators have proposed improvements. After this crucial newspaper story quotation, I reference information from yesterday's Jon Ralston's Channel 3 7:30 PM "Ralston Reports." (Note: I will have to BREAK UP my online comment, because it is over the 3,000 character limit.)

    I looked up the source for my comment that "Nevada has received a 'D' grade." The source was the Las Vegas Review-Journal, 4/8/13, "Won't somebody please help?," by Joan Patterson (part of their "mental illness" multi-day coverage). It reported, "In 2009 the National Alliance on Mental Illness gave the country an overall "D" grade for delivery of mental health care. Since then states have cut their mental health budgets further because of the recession.

    "Nevada cut 28 percent of its general fund mental health budget from 2009 to 2012, placing it among the handful of states that have made the most 'devastating' cutbacks, an alliance report shows.

    State Sen. Justin Jones, chairman of the Senate Health and Human Services Committee, noted that the reductions have meant, for example, a 19 percent drop in mental health staffing and a loss of 100 beds at the Rawson-Neal Psychiatric Hospital in Las Vegas. All of this during tough economic times, when the need for services usually rises, he said. Continued....

  4. This is the rest of my online comment from above. (Immediately below is continuation of a long quotation from Joan Patterson's story in the Review-Journal.):

    "Despite the cuts, there have been rumblings about proposed changes in Nevada's mental health services. One proposal is for a 24-hour urgent care center in Las Vegas for the mentally ill, many of whom now have to seek health during a crisis at hospital emergency rooms. There's also discussion of an outpatient commitment law that would help keep the mentally ill from continually revolving in and out of community jails by requiring them to receive treatment."

    Last night Jon Ralston interviewed Mike Willden, director of the state Health and Human Services Department. Jon mentioned that $80 million dollars has been cut from the mental health budget. Mike Willden echoed the "NV message" that money is not the problem. He said that there was
    about $2 million unspent in their budget last year, and this year will probably be the same.

    I hope Mr. Willden gives us details about this unfathomable statement.

    Jon Ralston also mentioned that TODAY is the day that is SUPPOSED TO end mental health bill discussion. However, Jon hinted that there is an option called an emergency bill.

    My editorial comment is that it is too bad that the reason we have arrived at this emergency/"REVIEW" stage is only because of a caregiver who cared enough to get James F. Brown to sign a patient release of information form (before he "disappeared" for a long time), the Sacramento Bee's investigation, bad publicity, and threats of lawsuits/judgments against Nevada. (Some of the officials mentioned over a week ago that not many of their constituents had expressed concern--as opposed to concern for other Nevada needs, such as education.)

    Another very PERTINENT article is "Jail detains, doesn't treat," by Laura Myers, in the Review-Journal, 4/15/13.

  5. This bus ticket dumping issue has been going on for decades, including those who are on probation in the criminal justice system. Our society needs to rethink, reform, and sustainably fund our mental health and criminal justice systems.

    We should look to other countries for models on how we can encourage functional behaviors and lives. Instituting individuals is not the answer for ALL who find themselves in the system. With the incredible amount of residualism shown in statistics, we can be doing much, much better than doing the same thing and hoping for different outcomes or results. Now that citizens understand that there is a problem, Lawmakers need to gather the courage and address it. Thank you.

    Blessings and Peace,