Tuesday, June 25, 2013 | 2 a.m.
LA PLATA, Md. — If you happened to be riding an eastbound Greyhound bus in late February, you might have encountered Nicholas Attilio Caroleo.
You probably would remember him.
Caroleo, a former light-heavyweight professional boxer with a nose that is slightly off-kilter, had just been released from Rawson-Neal Psychiatric Hospital in Las Vegas, one of hundreds of mentally ill people the facility has discharged to buses headed out of Nevada in recent years.
With a history of schizophrenia and bipolar disorder, a long rap sheet of misdemeanor offenses and a roiling anger in his gut, Caroleo had a one-way ticket to Fort Lauderdale, Fla., courtesy of Nevada's largest state psychiatric hospital.
It is unclear whether Caroleo, 32, ever made it to his destination, where relatives said he had no family or friends but has lived on the streets.
Before he left Las Vegas, he let a former girlfriend know he was on the move, sending a text message and photo of himself sitting at the Greyhound station. Shaggy and bearded, he is showing off his bus schedule and discharge papers from Southern Nevada Adult Mental Health Services, the state agency that oversees Rawson-Neal.
"You will repent!!!" his text warns. "I gotta ticket."
Alarmed, the girlfriend forwarded the message to Caroleo's parents, Pat and Robert, in Maryland. Within hours, they sought a court order barring their son from contacting them.
"Nicholas has threatened to kill myself, my husband, himself and my grandchildren," Pat Caroleo told the court in a written statement. "He is en route from Las Vegas by bus."
Asked whether he had access to a firearm, she answered, "Do not have any idea."
The Charles County court granted the protective order.
A few days later Nicholas' parents, who live in a quaint southern Maryland town of about 9,000 people, got a call from an Atlanta mental hospital where he had been admitted. Later, they received a series of chilling phone and text messages from him. "You'll be dead by summer," one of them said.
Now, with summer upon them and armed only with court papers, the Caroleos are not letting down their guard.
Every day, his mother said in a recent interview, she braces for the possibility of Nicholas showing up at the family's pristine colonial-style home, which is perched on a street of towering oaks and manicured lawns studded with American flags.
"They put people like him on a bus?" asked Pat Caroleo, a petite, no-nonsense retired schoolteacher.
"He is 200 percent unstable. He's angry. He's psychotic. He's a boxer. His fists are weapons."
Nicholas Caroleo is one of about 1,500 patients in the past five years who were discharged from the Nevada state mental hospital to Greyhound buses bound for cities across the country, according to a Bee review of receipts for bus tickets purchased by the state. The patients traveled alone, typically with a small supply of psychiatric medications and liquid nutritional supplements for their journeys.
Between July 2008 and March this year, according to the Bee's review, the hospital shipped patients to every state in the continental United States, at a pace that steadily increased and last year hit more than one patient per day. About a third of the patients were sent to California.
Since mid-February, when Rawson-Neal bused a mentally ill homeless man to Sacramento without making arrangements for his treatment or housing, officials in California and across the nation have questioned whether Nevada has been "dumping" mentally ill patients into other states. Earlier this 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.
After a series of Bee reports, Rawson-Neal revised its policy and no longer discharges people to buses without an escort.
But questions still loom about the fate of the hundreds of mentally ill patients sent off alone over the past five years.
Administrators defend the hospital's long-standing policy as safe and humane, arguing that the vast majority of patients transported out of state were mentally stable and wanted to leave. They insist that in all but a handful of cases, staff members confirmed before discharge that patients had relatives and treatment arrangements waiting for them at the other end of their bus trips.
They acknowledge, however, that they have done no follow-up checks to determine whether patients actually made it to their destinations.
During the past two months, through a painstaking process of tracking down former patients whose records are protected by privacy laws, the Bee sought firsthand accounts of patient treatment at Rawson-Neal and how the aggressive cross-state busing policy played out. The newspaper was able to identify and obtain the stories of eight people placed on buses by the hospital in recent years.
In none of those cases, according to the patients and their families, did staff members fully adhere to the discharge policies outlined by administrators.
Only one passenger completed his bus journey at the scheduled time, with a friend or relative waiting at the bus station. None of the patients had firm treatment plans in place at their destinations. At least two were bused to cities where, according to family, they had no personal ties.
Three of the eight described their mental and housing situations today as healthy and stable.
One of the patients was a vacationer who had a mental breakdown while in Las Vegas. The others were living in the city, in some cases for years, and without jobs or stable housing. They were drawn by the balmy weather and the promise of a better life.
All ended up at Rawson-Neal in despair.
'Let's send him home'
"People are trying to kill me," Joshua Soules told a social worker after he arrived at Rawson-Neal Psychiatric Hospital in May 2011. "I see invisible people that you can't see."
Two weeks later, Soules was discharged via Greyhound to Sacramento, near the home of his mother, Sharon, in Elk Grove. The trip should have taken about 15 hours. Instead, it turned into a three-day odyssey.
Contrary to Rawson-Neal's stated policy, Soules' mother said she never received a call from staffers before his bus trip. If she had, she said, she would have advised against allowing Joshua to take a long bus ride alone.
"He's got a heart of gold when he's stable and sober, but how do you know that he's going to stay that way?" she said. "It's absolutely not safe."
Instead, it was Joshua who called his mother in early June and asked her to meet him at the bus station the next day. But he was nowhere to be found when she arrived to pick him up at the Greyhound depot in downtown Sacramento.
More than two days later, he showed up on her doorstep, dirty, disheveled and soaked with perspiration.
Soules, in a recent interview, said he is unsure why he and his mother never connected at the bus station. But once he realized he had missed her, he said, he started walking to her home in Elk Grove, a journey of more than 20 miles.
"I had no money or ID or phone," he said, standing in the backyard of the dingy boarding home where he now lives. "I left the hospital with nothing but the clothes on my back."
Joshua, 25, was adopted by Sharon Soules as a toddler and diagnosed in his teens as bipolar. In the winter of 2010, he drove to Las Vegas with a girlfriend on a whim and spent about eight months drifting around the city.
Unemployed, homeless and off his medication, Soules entered Rawson-Neal voluntarily in May 2011, he said. He was in the throes of a romantic breakup and recently had been mugged in the streets. "I knew I needed help."
His medical records, which the Bee reviewed with his permission, show Soules was admitted to Rawson-Neal with "active paranoia" and auditory and visual hallucinations of people following him and wanting to kill him.
After two weeks of treatment, according to the records, he was discharged in "stable but guarded" condition. "They offered me a bus ticket, and I grabbed it," he said. "I'm a Cali boy, and I wanted to go home."
The staff offered him the name and number of a "recovery house" where they said he could seek care when he got home. But Soules said he never had an appointment and had no intention of going there.
Once released from Rawson-Neal, Soules got into a waiting taxi and headed to the bus station. He had no cash, no identification other than his Medicare card, and none of the liquid nourishment that hospital policy mandates for such trips, he said. He did have a supply of anti-psychotic medications, but "I threw them away," Soules said, believing they were spiked with heroin.
The bus ride, Soules recalled, "was strange. I remember someone in the back of the bus staring at me, trying to mess with me." But he said he made it to Sacramento without incident.
Sharon Soules said she was reluctant to take her son into her home, on a quiet street where she lives with her disabled adult daughter. She agreed, she said, after he promised for the umpteenth time to stay away from drugs and alcohol and take his medications.
Instead, she said, he resumed his drug habit and started getting into trouble.
"He was flailing around, not making sense, yelling and screaming," she said. "He broke furniture; he broke the door. He was sweet one minute and out of control the next."
Since returning from Las Vegas, Soules has been detained by Elk Grove police at least eight times for minor offenses ranging from public intoxication to disorderly conduct, records show.
In the most recent case, on April 30, officers took him in after reports that he was "yelling and cursing at people in the streets" in Old Town, police spokesman Christopher Trim said. "Officers determined he was off of his meds and unable to care for himself," Trim said.
He ended up at Heritage Oaks, a private psychiatric hospital, and now lives in a boarding home in south Sacramento where he is struggling to remain sober and stay on his psychiatric medications.
Sharon Soules speaks with her son by phone almost every day but has taken out a restraining order that bars him from coming to her home.
Tall and solidly built, with piercing blue eyes, elaborate tattoos on both biceps and a black loop earring in his left lobe, Joshua spoke of his life in a recent interview at the sparsely furnished boarding home he shares with four other people.
During a rambling, disjointed discussion, he ranted about crooked police officers and others he believes have wronged him. He disclosed that people on TV spy on him, and that the wind whispers messages. In the course of a 90-minute interview, he rapped and danced to an Eminem tune, burst into tears over the loss of a friend, and laughed hysterically at the absurdity of his situation.
Still, he said, he is happy to be back in Sacramento and believes the hospital treated him fairly.
"What are they going to do with me?" he asked. "They can't keep me forever. So they said, 'Let's get this guy out of here. Let's send him home.' I was fine with that."
Dazed and disoriented
Matt Hartford barely remembers his Greyhound trip from Las Vegas to Portland, Maine, a distance of 2,411 miles.
When he boarded the bus, he said, he was "completely disoriented" by medications for a mental illness he insists he does not have.
"I was so doped up when I left there that I was drooling on myself," said Hartford, 26. "It was scary."
Hartford wound up at Rawson-Neal in November 2011 after an altercation with a police officer, he said.
He had moved to Las Vegas about 18 months earlier, with high hopes of finding a job and living with a cousin. "But Vegas wasn't what I thought it would be," he said.
One day he was "walking down the street asking people for change" when an officer confronted him. "The next thing I knew I was in the mental hospital with a needle of Haldol in my arm, being told I had a severe illness and that I was hearing voices," he said.
After a few days, he said, staffers asked him whether he wanted to leave Las Vegas, and he opted for a bus ticket to Maine, where his parents live. He said he got no referrals for counseling or treatment.
He remembers asking if he could stay in the hospital another day "to get the drugs out of my system," he said, but he got a Greyhound ticket instead.
"They wanted to kick me out because I didn't have money," Hartford said. "They doped me up with meds, gave me a big plastic bag of Ensure and some saltines, and they put me on a bus."
Hartford's cross-country trip "is a blur," he said. He remembers little about it other than "waking up in places like Pittsburgh and Ohio and Boston" for transfers.
Although a Rawson-Neal social worker told him that his father would be waiting at the bus station, he said, his dad never got a call and no one was there when he arrived.
Nevertheless, Hartford said, he made it and now is healthy and stable.
"I was so out of it when I left," he said. "I can't believe I made it home."
'Full despair and misery'
Ryan Weatherman said he received neither medications nor therapy when he found himself at Rawson-Neal last year after an episode of severe depression while he was visiting the city.
After a brief stay, "a doctor asked me if I wanted to go home" to Indiana, he said. He did. He endured a "long, boring" ride, and his mother was waiting for him upon his return.
But he is bitter, he said, that the hospital seemed more concerned with "passing me off to someone else" than offering him treatment.
"I was in full despair and misery," he said, and had threatened suicide.
"All they did was give me a place to sleep for the night," he said. "No food, no medicine, no psychiatry, no referrals, no follow-up. Just four bottles of Ensure" and a hefty bill.
Weatherman, 34, said he sought help after arriving home and is doing well.
'Never going back to Vegas'
Life is more precarious for another former Rawson-Neal patient, Tommy Veith of Lake County.
Veith, 34, who has a history of disabling depression, moved to Las Vegas in 2000 hoping to become a musician. But it never worked out, he said.
He said he worked odd jobs and mostly lived with his father. Earlier this year, he wound up at Rawson-Neal after a fight with his dad.
Veith was at the hospital for "three or four days," he said, and received medication for his depression but no counseling. When the hospital was ready to discharge him, he told doctors that he wanted to move back in with his dad.
Within minutes, he said, a staffer took him outside and pointed him to a bus stop.
"I was in flip-flops from the hospital," Veith said. "I didn't have a cellphone or wallet or anything. But I wanted out of there. So I walked across Vegas for 24 miles."
After a short stay with his dad, he said he ended up in a low-rent motel, where he lived until relatives from Long Beach, Calif., found him in late April. Shortly after that, Veith decided to move in with a sister in Lake County.
"I'm never going back to Vegas," he said.
'Of course I am afraid'
By the time she learned that her son Nicholas had been dispatched out of Las Vegas by bus in early February, Pat Caroleo had lost track of him.
She had not seen him in years, she said, since he had adopted a transient lifestyle and begun lashing out at his family for his failures and disappointments.
"This mental illness, it's terrible," Caroleo said. "We tried everything to help him, but nothing worked.
"I've cried and cried and cried for 12 years," she said, shaking her head. "I don't cry anymore."
Since she learned of her son's discharge from Rawson-Neal, Caroleo said, she and her family have been living on a razor's edge.
The simple act of picking up the phone is a source of stress. Bills from mental facilities across the country arrive on a regular basis. Collection agencies call morning and night. Pat Caroleo cannot step outside without a pang of worry that Nicholas might be waiting.
"Of course I am afraid," she said during a lengthy interview in an elegant home decorated with photos of children and grandchildren. "I believe that he wants to hurt us."
Nicholas Caroleo was "a sweet kid" with athletic potential, his mother said. Family photos show him romping with his sisters on the beach, riding ponies, posing in a Superman costume. He was a standout pitcher in youth baseball. A quarterback. A boxer who turned pro and has three technical knockouts to his credit.
"He was a natural athlete like you wouldn't believe," Pat Caroleo said, "and we went to every one of his games and practices."
But somewhere along the line, Nicholas' mind began to falter. After he attempted suicide at 16, Pat said, her son entered a mental facility for the first time. He has been diagnosed by various doctors as having bipolar disorder, depression and schizophrenia, she said.
Between periods of stability, Nicholas Caroleo has been in and out of jails and hospitals, his mother said. He had been living off and on in Las Vegas, where he hoped to make a living as a boxer, for the past seven years.
In February, Nicholas was arrested for ignoring traffic signals as he wandered around the city, according to police records. He was sent to Rawson-Neal.
On Feb. 27, unknown to his family, the hospital discharged him with a Greyhound ticket to Fort Lauderdale, where he once lived on the streets but where his mother said he has no family or friends.
Pat Caroleo learned of his bus trip when she received the text message from Nicholas' former girlfriend. The news sent a shudder of fear through her, she said, both for her son and the people he might encounter on his trip.
"Nicholas thinks he's the son of God, the prince of peace," she said. "We don't know what he might be capable of."
After reading her son's text message, the Caroleos contacted a relative who is a police officer, filed for a protection order and discussed exit routes from the house should Nicholas show up without warning.
The last time they heard from him, about three weeks ago in a phone call from somewhere in Florida, Nicholas ranted at his father and demanded money.
The next day, Robert Caroleo suffered a heart attack.
"I can't say that Nick's call was the reason," Pat said. "But it sure didn't help."
Policy called humane
The man whose story sparked the recent scrutiny of Nevada's state psychiatric hospital was homeless and psychotic when he landed in the facility earlier this year.
Seventy-two hours later, James Flavy Coy Brown was discharged via Greyhound to Sacramento. He arrived 15 hours later, on a cold February morning, at the downtown bus station.
Brown, 48, who has schizophrenia, said he had never been to California, and had not a single friend or relative in the capital city. After police delivered him to a homeless services complex in an industrial section of the city, he told a social worker he was terrified and was thinking about killing himself.
According to his records from the Nevada hospital, Brown wanted to go to California. But he told the Bee that it was his doctors who suggested he travel to "sunny California" and that he had no ties to the state. "They put me on a bus and sent me to a place I didn't know anything about," he said.
After spending time in the UC Davis Medical Center emergency room and a Sacramento boarding home, Brown was reunited with his daughter in North Carolina. He now lives in her family's home and is faring well, she said recently.
Brown's case prompted the Bee's investigation of Rawson-Neal's busing practices, as well as internal reviews by the state of Nevada, ongoing probes by the cities of San Francisco and Los Angeles, and investigations by the independent agency that accredits hospitals nationwide.
Two staff members were fired in response to the controversy, and the hospital has added a layer of oversight to oversee files of patients to be bused to other cities. Under the new policy, any patients bused out are to be accompanied by a chaperone.
Officials have admitted that they "blew it" by sending Brown to Sacramento, but say a limited review of patient files found only a few cases in which discharge policies were clearly violated.
"That means the essence of the policy was followed, and the real difficulty in a small number of cases was a lack of documentation," said Nevada's state health officer, Dr. Tracey Green.
Green and other state officials have explained the busing policy in part by noting Las Vegas is a destination city that draws people from around the globe, including transients and mentally ill people.
"If they want to go back to their home cities," Green said, "we think it is humane to send them home. We really believe this is a compassionate program."
Green would speak specifically only about Brown and Soules, both of whom signed off on release of their records.
Brown's treatment was unacceptable, she said.
As for Soules, "I don't see any problems," Green said. "He was stabilized and on medication. He wanted to go to California. When treated, people who are mentally ill do have resolution of their symptoms and can perform normal functions, including taking a bus ride."
John Kurtz, a professor of psychology at Vanderbilt University in Pennsylvania and a specialist in assessing mentally ill people, agreed with her general philosophy, as long as proper arrangements for treatment and care are made on the other end.
"If that person is OK to be discharged and is not a danger to themselves or others, putting them on a bus is better than just turning them loose in Las Vegas," he said. "On the face of it, it's not a bad idea."
But the large number of patients who received bus tickets from Rawson-Neal give reason for pause, he said.
"I suspect that a lot of these people had no place to go in Las Vegas and the hospital wanted to send them as far away as possible so they didn't come back."
Merin, the attorney suing Nevada over the busing policy, said he is convinced that the state, in the midst of a budget crisis, sacrificed the care of mentally ill people to save money.
"Rawson-Neal's policy was, 'Get 'em out as soon as possible, and send them as far away as possible,'" Merin said. "That's why the busing program works for them. If you get sent to Maine or Michigan, it's not likely you're going to end up back in a hospital in Las Vegas."