Policy change in 2009 prompted increase in busing mentally ill patients

By Anjeanette Damon, Andrew Doughman

Saturday, April 20, 2013 | 2 a.m.

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.

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.

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.