Health officials reverse policy that allowed for busing mentally ill patients out of state unescorted

By Andrew Doughman, Cy Ryan

Published Wednesday, April 24, 2013 | 4:11 p.m.

Updated Wednesday, April 24, 2013 | 8:25 p.m.

Nevada’s health department today reversed its practice of sending patients discharged from state psychiatric hospitals alone on bus trips out of Nevada.

Gov. Brian Sandoval’s spokeswoman said today that the state will now require escorts to accompany patients who are bused out of state.

“We made a decision to formalize the policy,” Mary-Sarah Kinner, Sandoval’s spokeswoman, said. “This is part of the new strengthened procedures.”

The Rawson Neal psychiatric hospital in Las Vegas has come under fire in recent months for sending 1,500 discharged mental health patients on unescorted, one-way bus journeys to other states. The health department has said most of these trips involve transportation home for patients visiting Las Vegas from other states.

Last week, health department officials said that most patients didn’t need escorts.

“When a patient is discharged, they are considered safe,” said Tracey Green, Nevada state health officer, during an interview last Friday. “So really that wouldn't require the need for an escort. When we look at best standards for care, I think that the safety is really what is supported by the fact that the client is considered safe when they're discharged from our hospitals.”

Prior to today’s announcement, medical personnel made the decision on whether the patient needed a state-provided escort.

Patients discharged from the psychiatric hospital have conditions that run the gamut from "acute intoxication" to "schizophrenia," Green said. Each patient might require a different level of supervision after being discharged.

"So really our policy is to ensure that the system appropriate for our client is set up," Green said of the prior practice.

Green said policy changes happen periodically, but in this case the media stories about this particular policy drove the change.

"Our policy stands that it has been the determination of need, but at this time we are erring on the side of caution," she said. "Given the events in the media, we have determined it's better to err on the side of caution."

The change from discretionary option to mandatory practice allows for a number of chaperones to accompany a discharged patient: state mental health staff, family members of a family-designee, domestic partners, legal guardians, or “other appropriate caregivers,” said Mary Woods, Nevada Department of Health and Human Services spokeswoman.

Woods said she did not have an estimate of what this new policy would cost the state.

The policy change comes on the heels of a review of 1,500 patients shipped out of state from Rawson-Neal, finding five or six cases in which the hospital’s discharge policy was not followed.

Mike Willden, director of the state Department of Health and Human Services, said earlier today that officials were considering whether to continue sending discharged patients by bus out of state, to scrap the policy or require a chaperone to accompany the patient.

Shortly before the announcement, Willden was seen waiting for a meeting in the lobby of the governor’s office.

The health department did not disclose what in the review led to the requirement for a chaperone.

“It's just a part of strengthening our policy,” Woods said.

The initial review found that the majority of patients involved were not considered a “threat to themselves or to others” and expressed a desire to return to their families, friends or to an out-of-state treatment facility.

Two staff members at the Rawson-Neal Psychiatric Hospital were disciplined, but Willden refused to say if they were higher-echelon officials or what penalty they faced.

The review of the 1,500 cases — prompted by a series of stories in the Sacramento Bee — was completed at midnight Tuesday. The Bee first broke the story of Nevada patients being put on a buses and sent to other states, prompting officials in California to call for an investigation.

The policy governing how patients in Nevada are discharged out of state has since been tightened. Now, two physicians instead of one must sign a discharge, and the hospital administrator must approve the decision.