Drop-in mental health clinic at Rawson-Neal to close Friday

By Andrew Doughman

Published Thursday, Jan. 23, 2014 | 12:42 p.m.

Updated Thursday, Jan. 23, 2014 | 6:30 p.m.

State officials will close a clinic at Rawson-Neal Psychiatric Hospital in Las Vegas on Friday after federal officials cited the facility for violations.

The state health department said it was “extremely disappointed” the federal Centers for Medicare & Medicaid Services told the state that its Behavioral Health Clinic was out of compliance with a law governing emergency rooms.

The federal agency claims the clinic falls under requirements of the Emergency Medical Treatment and Labor Act, but the state “continues to disagree” with the federal agency’s classification of the clinic as an emergency room, said Mary Woods, spokeswoman for Nevada's health department.

“This clinic was never designed nor operated as medical emergency room,” Woods said. "But, if we had continued to operate the Behavioral Health Clinic, CMS would require it to be transformed into a medical ER ready to respond to any medical condition ranging from a heart attack to a broken arm. This facility does not have capacity to function as a full spectrum ER.”

Nonetheless, officials at Southern Nevada Adult Mental Health Services will shutter the clinic on Friday because they see no other way to comply with federal regulators' demands.

Woods said the mental health drop-in center served about 16 people per day in January.

Although state policymakers intended for the facility to reduce the number of mental health patients going to local hospital emergency rooms, the clinic did not have a great effect because Rawson-Neal still lacked available inpatient beds for patients who walked into the drop-in center and needed further care, said Tracey Green, chief medical officer for the Nevada Division of Public and Behavioral Health.

The closure of the facility is setback for state policymakers, who opened the facility in July after Gov. Brian Sandoval and a legislative committee set aside money to open it.

The center was one of several new programs state officials started at the troubled psychiatric hospital, which was heavily criticized last year after revelations it routinely bused patients out-of-state. Investigations resulted in the revocation of accreditation from a third-party quality control agency.

The drop-in clinic was supposed to lessen the burden on Las Vegas Valley emergency rooms, where hospital administrators have reported an increased number of mental health patients arriving on involuntary legal hold orders from law enforcement.

When a legislative committee set aside money for the clinic, Nevada health department chief Mike Willden called it part of “our future” in community-driven mental health care.

But Green said the clinic had become what federal regulators determined was an emergency room. Although it was not the state’s intent, at least one third of the people who walked into the clinic without an appointment also required subsequent inpatient care, thus qualifying the hospital as an emergency care provider under federal regulations, Green said.

Mental health stakeholders were disappointed with the news.

But although the Rawson-Neal clinic was supposed to be the solution to reduce the numbers of mentally ill patients inappropriately going to Las Vegas Valley emergency rooms for psychiatric treatment, there are now more mentally ill patients in area emergency rooms, said Erik Pappa, spokesman for Clark County government, which operates University Medical Center in Las Vegas.

Pappa said that number has grown from 164 per day last July to 183 today.

"So we're concerned," he said. "Something has to be done to get the mentally ill the services they need while keeping our emergency rooms clear for true emergencies."

Woods said in a news release that no Rawson-Neal employees will lose their jobs when the clinic closes.

The closure comes as part of plan the state had to submit to CMS to show the federal agency that the hospital will be in compliance with federal regulations.

Federal inspectors have twice found Rawson-Neal to be out of compliance with those regulations, which endangers the hospital’s ability to receive taxpayer support in the form of federal Medicare dollars.

In the latest report, federal inspectors from the Centers for Medicare & Medicaid Services said there were no fire sprinkler systems in many of the buildings, and exit signs for patients were “not readily apparent to occupants.”

The report said the hospital failed to ensure smokers use only ashtrays of safe design. The inspection done in November found no written policy for handling emergencies in the hospital laboratory and no regular inspection of generators as required.

The report further said the executives of the hospital don’t monitor the contract nursing staff. It documented 24 instances from July to October in which contract nurses made errors in patient prescriptions.

The report said the “director of nursing confirmed nurses were counseled” and action taken to correct the medication errors as soon as possible after they occurred. The hospital said it has taken action to correct many of these shortcomings.

Sun reporter Cy Ryan contributed to this story.