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July 6, 2015

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Sun Editorial:

An outrageous case

Nevada needs to clean up its act after claims of patient dumping

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A damning series of stories published this year in the Sacramento Bee accuses Nevada of systematically dumping mental health patients on other states, particularly California. According to the Bee’s analysis, the Rawson-Neal Psychiatric Hospital in Las Vegas over the past five years discharged more than 1,500 patients to the Greyhound bus station with one-way tickets out of state.

The details of some of the cases are awful. Consider what happened to James Flavy Coy Brown, who had spent three days in the Las Vegas hospital being treated for schizophrenia and other mood disorders. He says he was told there was no place for him in Nevada and sent by taxi to the bus station.

Brown had a ticket to Sacramento, a few days’ worth of medication, some crackers, bottles of Ensure and not much else. He didn’t have identification, had never been to Sacramento and didn’t have any friends or family there. He had no follow-up treatment plan besides a verbal instruction to call 911 when he arrived.

He was set up to fail. He told the Bee that he wondered whether he was destined to die in Sacramento. Thankfully, people in California were able to help Brown, and he eventually found a place in a halfway home.

Good for California.

Nevada, however, should be appalled and ashamed.

A state investigation into the allegations is ongoing, and so far state officials admit they “blew it” in Brown’s case, but they don’t think this is widespread. The state has given people one-way bus tickets and sent them packing, but state officials say the idea has been to reunite people with families and support networks back home.

As Mike Willden, director of Nevada Health and Human Services, puts it, Las Vegas is a “mental health magnet,” and people from all over the world end up here without the support they need. Willden said 2,400 of the 31,000 people admitted to the Rawson-Neal hospital over the past five years had out-of state addresses.

Logically, it would make sense to reunite people with their families, assuming the patients will find support when they arrive. But that’s not what happened in Brown’s case — his daughter lives on the East Coast — and there was nothing in place to help him. Brown’s case is the picture of patient dumping.

State officials this past week said they have tightened procedures to make sure that anyone bused out of state has an escort, but the question still remains about how other cases were handled.

Perhaps Brown’s case is an anomaly, and as proud Nevadans, we would like it to be so. Still, it’s not difficult to understand why people would accuse Nevada of dumping mental health patients. The state, as a whole, has been negligent when it comes to mental health care, much less social services. Mental health budgets have been sparse and have repeatedly been targeted for cuts. Given that, were one-way bus tickets the best the state could do? Was “Greyhound therapy” a way to ease an overcrowded system?

That would be a crass and cynical view that we hope isn’t true, but Nevada’s attitude toward the mentally ill has been awful. At best, it’s an attitude of benign neglect; at worst, it’s cold-hearted and mean. There’s a prevailing belief that people should pull themselves up by their bootstraps, and the taxpayers aren’t responsible.

But what about the people who don’t have the ability, means or support to pull themselves up? People such as James Flavy Coy Brown.

It has been said that a society is measured by the way it treats its weakest members, and Brown’s case speaks volumes. It’s not acceptable that even one person was treated this way.

Nevadans need to do some soul searching. Brown’s case and the allegations of patient dumping are symptoms of a state that has ignored problems and left the most vulnerable in jeopardy. That has to change.

The Bee’s stories have left a deserved black eye on the state. Improving social services and mental health care are issues that won’t win much applause, much less elections, but political and civic leaders have to take on the task. Nevada has to be better than this.

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  1. As a society, we are only as strong as our weakest link. We have social safety nets in place to assist those who need it, in their time of need. Clearly, there is something very wrong with those in charge of creating policies and making decisions, when we begin to discard our fellow human beings as trash to be dumped. It is immoral and unethical, and it starts at the top, because people follow orders in any organization.

    Those with mental health issues are doomed in this country. There are only a precious few who truly have comprehensive access to mental health care providers, treatment facilities, and medical treatment plans. If you are not amongst those few, then you will discover it is a hit or miss experience in obtaining quality services, and in reality, unless you are able to afford follow up appointments and numerous trials of medication until one is found that works, your mental state will only continue to deteriorate to the point of self-implosion or self-destruction. Most Americans lack proper mental health assess and care.

    As our nation's servicemen and servicewomen return home to assume civilian lives, many come back requiring some sort of transitional services, including mental health services. Too many of these fine Americans, now line the back allies and streets in make-shift shelters as a part of the homeless population, because Citizens have failed to insure our American Lawmakers were watching out for them and us. The politics in this country has overshadowed decency, goodwill, duty, and commonsense. It is a national disgrace and shame.

    Politics has also marginalized our school children, many who come to school lacking care, including mental health care. In any given classroom, there is a third of that class of children who require mental health care and are neglected until they find themselves in the criminal justice system, or as a pregnant minor on social services. That is hardly proactive.

    Children with mental health problems underachive, perform poorly in school, and typically are behavioral problems where ever they are. Moving to another school (as many parents will do to avoid addressing the problem), will not help or fix that child's mental health issues.

    Mental health begins early in life for most, unless they are involved in traumatic circumstances, as war, or domestic abuse. Americans must require and expect those in charge of policies and laws to do better, as they have our public trust. It starts now. Thank you.

    Blessings and Peace,

  2. How would they notice in California?

  3. Mr. Chapline is correct. This stuff goes on all over. The money that is spent on healthcare in this country is spent on cancer, diabetes, obesity, and heart disease. Those four diseases cost us trillions. There is no money for mental health services anywhere in the United States.

    I was a policeman in California for decades. We used to use section 5150 of the Health & Safety Code to detain mentally ill people that were a danger to themselves or others. For the most part it was hard to keep someone in the system for six hours. They would be given pills and released.

  4. BChap...should that policy be applied across the board? Here in Washington we have a better system of public supports than our neighbors. At a meeting on implementation of the Affordable Care Act and expansion of Medicaid the question was asked "If poor people from other states that do not expand Medicaid move here for medical care can we refuse, ship them home or bill their home state?" The Fed rep said that no and you can't even establish a residency or waiting period. It would appear that your approach is contrary to Federal regs as mental health services for the indigent usually fall under some sort of Medicaid or other federal funding.

  5. "How would they notice in California?"

    Bob: California has an acute sense of smell for nauseating habits; Nevada is only motivated when the Federal Courts step in. For the same reason, technology doesn't come to this state. What we get are tax dodgers who immigrate to set up server networks in rented garages with the intent to FTW.

    Know what I mean Vern?

  6. @BCChap Clearly you don't get the issue here. Otherwise you would never advise, "the state administrators of the Rawson-Neal Psychiatric Hospital; stand your ground. You have the Nevada Revised Statutes on your side...DO NOT admit anyone who is not a Nevada resident for any reason in the future..." because if anyone who has read the Nevada Revised Statute's definition of resident would see what useless advice that is.

    Anyone denied services based on non-residency need only invoke NRS 483.141 1.(d) which defines a resident as, "a person:"Who declares that he or she is a resident of this State to obtain privileges not ordinarily extended to nonresidents of this State."

    So upon such denial of services a patient may then simply declare themselves a resident to obtain those services they were just denied.

  7. To a point, I agree with, or maybe understand, what you are saying Bradley. Your point: Where does all the money for services come from to pay for all these services? As a public servant, I get it. Health care services costs money, and it is scarce and fought over in government service programs.

    What has happened, is that now our country has MORE people than it can afford. Compare it to a private person having a family that they can be responsible for and afford for the duration. Somewhere along the lines of opening up our borders to allow any and everybody, our government lost sight of the fact that each person allowed in has a price tag. We hope that they are more productive than a liability, but, as we are witnessing, that may not be the case.

    Charity begins at home, and the United States government has been negligent caring for its own native citizens for decades. Again, poilicies, laws, decisions, are in the hands of those at the top, who seem to be serving two masters: corporate interests and their constituents. Ultimately, only one master trumps the other and wins final vote. Judging by the financial reports, it ain't the constituents.

    Caring for our citizens is a national disgrace, and we all assume a part in it being that way, whether we stood at the sidelines and said nothing, or hired illegals "under the table", or abandoned a needy relative or friend in their time of need. Might I add, that there is exacted a hefty price for doing the "right" thing, and personal satisfaction is usually the only reward for doing the right thing, besides seeing someone restored to some form of wholeness as a person.

    Our country needs to examine whether or not the policies we have in place or are negotiating are sustainable for the population. These decisions originate at the top, who have the facts to guide their decision, and are accountable to us, the taxpaying Citizen.

    From where I stand, from the cradle to the grave, we are neglecting the mental health and wellness of our people. Daily, I interact and watch children growing up with their needs neglected. These neglected or poorly cared for children mature into individuals who are a burden, rather than a blessing, in our society until they die. Mental health access and care are virtually nonexistent for children. Our country is evolving into the status of a third world country, and there is little we, as Citizens, can do.

    Not liking those kind of apples. Policy makers need to focus on sustainable policies and quit politicizing these issues.

    Blessings and Peace,

  8. While I'm not condoning..., when we dump every last dollar into "education" there just is nothing left for a safety net for American citizens with issues--mental health issues, senior/fixed/limited income. We "must" use State revenue to match federal funding of the endless programs for teen moms and dads, for the career-indigent (Medicaid, some of the EBT SNAP), and for the illegals who get SNAP food snaps, housing vouchers, Medicaid, LIHEA free utilities, child care, tax refunds without paying anything in. We need to reassess our priorities: sustaining our lives and way of life must be the top priority. If there is anything left over (not likely), we can consider teen moms and dads, illegal "needs", supplementary K-12 programs, tuition for foreign students, scholarships for illegals.

  9. BChap....Despite your attempts to back peddle here, I did understand what your post stated. It was you who seems not to have understood mine.

    First let's just remind readers that despite your current claim that you "..never said that ["claim "no bed space" to non-Nevada residents] would be allowed by state statute or the federal government."

    You said just that here:

    "You have the Nevada Revised Statutes on your side. No more charity; no more "Mister Nice Guy". DO NOT admit anyone who is not a Nevada resident for any reason in the future."

    This wasn't even the central point of my post. I was trying to tell you that you clearly don't have any concept of how the Nevada Revised Statute defines a Nevada resident.

    Had you bothered to read the NRS 483.141 you woull have learned that simply being in the state and showing up to request services defines a person as a Nevada resident, with the exception of only
    "actual tourist, an out-of-state student, a foreign exchange student, a border state employee or a seasonal resident."

    Unless all those shipped out of state met those exceptions then administrators of the Rawson-Neal Psychiatric Hospital, rather than provide mandated services, shipped Nevada residents out of state.

  10. This discussion thread very clearly points out the dilemma facing large sparsely populated western states. We do not have the population necessary to support a tax base which provides the public services which we expect and demand a modern state to provide. Arguments range widely on these threads about raising revenue. Potential revenue exists but prevailing political sentiment suggests that those sources, primarily hard rock mining and gaming, will not be touched. The opposing view appears to be that if we only better manage public services and get rid of "waste, fraud and abuse" then all services are possible. The latter view never suggests that we simply cannot afford some services and that the public sector should not offer them. Why, for example, does a low population state need two universities when one would suffice? Why have state parks? Why participate in Medicaid or any other Federal program which requires a match? Cost saving suggestions never seem to involve reducing the scope of government. Take the university system. Would Nevada be better off paying the tuition differential between in and out-of-state for our better students to attend schools in, say, Utah or Arizona, and close the u-system completely. Maybe the folks who live in Tonopah or Ely should pay the costs associated with maintaining highways in and out....toll roads perhaps.

  11. Still to be shameful and outrageous, or not to be, that is the question for Nevada --

    I was happy to read today on that Nevada Representative Dina Titus sent a letter to Michael Willden (director of NV Health and Human Services) to please keep her informed about the steps that DHHS is taking. The more legislators, state and federal, who show sincere involvement, the better.

    It is too easy for many agencies, such as DHHS, to hide behind privacy laws. It appears that the pending federal investigation will determine that Rawson-Neal's policy changes satisfy funding regulations. However, reporters, legislators, and others must resort to legal means to be able to verify DHHS's statements.

    "A shameful policy that sets state apart," by Sacremento Bee editor Dan Morain (reprinted in the Sun on 4/17/13), reported that "Nevada authorities were cavalier in their care of James Brown. But they are strict about privacy laws, careful not to release any names. That leaves questions."

    Early on the San Francisco city attorney's office opened an investigation in order to uncover facts. The Los Angeles city attorney's office is also investigating. The Sacremento Bee broke the story. They are keeping readers posted.

    How did we find out about the mental health system challenges? It took caregivers at Loaves and Fishes, the California agency that first helped James F. Brown; they secured his permission to disseminate his "story." (That was before he disappeared for a while.) It also took the Sacremento Bee investigating and reporting the story. Then add federal and state investigations and the threat of class action civil lawsuits. That momentum gives me hope that the story of reform has actually be continued by Nevada's excellent investigative media.

  12. Maybe California should get even. They could give Steven Brooks a couple of pills and throw him on a Greyhound back to Nevada.

  13. Bussing the indigent and mentally impaired out to other states is the ESSENCE of Libertarianism and limited Government. Turning charity and civil welfare over to the goodwill of private parties and churches is an important function in reducing the size of Government. This was Sharron Angle's main theme.

    "People ask me, 'What are you going to do to develop jobs in your state?' Well, that's not my job as a U.S. senator." --Sharron Angle, May 14, 2010. Of course not - that is Governmental interference with the free market economy.

    These people are welcomed as Americans when they bring money and bussed out as 'Californians' when they loose. i.e 'Welcome Padner' when their pockets jingle and 'don't Californicate me' when their luck runs out.

    Libertarianism is embodied in the current theme of the NDA by having another state pay for the person's education, then come to Nevada and make money by reducing taxes', i.e. through limited education.

    Libertarianism is having the freedom to take with little or no civil obligation...except maintaining police, prison and limited judicial functions. Yet this is the profile of a Police State, not a Democracy, but there is no contradiction. Libertarianism disappears quickly and a Republic, or police state appears.

  14. To my fellow bloggers,

    Patient Dumping? So that is what it is called now. Being a cop in this community for over 34 years, this type of activity was tolerated, condoned and even ordered by municipal judges back in the day, when we had vagrancy laws to help keep the city streets clean and safe. The involuntary transportation of undesirable persons was even condoned by the big boys between cities in Clark County. If that special person was especially undesirable they got transported to the County Line or even to the State Border. By the way, California did the same thing to us and dropped off their undesirables at former State Line now Primm. This exchange program has been going on for years and is an excepted and condoned unsavery practice, except when somebody complains and the media is starving for some kind of story to fill up the columns. Stay Safe. Just an old cop reflecting,