Transcription
THE SACRAMENTO BEESunday, sacbee.comApril 14, 2013Page A1THE PUBLIC EYEA Bee investigationBusing of patients rife in NevadaLEAVING LAS VEGASGreyhound tickets purchased by the agency,by county of destinationSouthern Nevada Adult Mental Health Services in Las Vegas has discharged andbused more than 1,500 patients across the country during the last five years.Wash.King .Y.Wis.IdahoSaltLake Co.Calif.Nev.SanFranciscoCo.Sacramento Co.S.D.Wyo.LasVegasIowaPa.Ill.Denver Co.Colo.Ind. OhioW. Va.Va.Kan.N.M.Ark.Ariz.Tenn.N.C.S.C.Miss.TexasSan Diego Co.Del.Okla.Maricopa Co.Orange Co.Md.Mo.Ky.LosAngelesCo.N.H.Cook Co.Neb.UtahVt.Mich.Ga.Ala.San Bernardino Co.Fla.A total of395 patientswere busedin 2012.La.Most popular destinationsCountyLos AngelesSan DiegoMaricopaSan BernardinoSan FranciscoKingSalt lif.Wash.UtahColo.Ill.Calif.Tickets since mid-2008213695343363333323028Increasing paceExplore an interactiveversion of this data atsacbee.com/datacenterSource: Southern Nevada Adult Mental Health Services, Bee analysis by Phillip ReeseThe rate the agencyhas bused patientsout of Las Vegas hasrisen over the pastseveral years, withthe monthly averageincreasing to 36.5 inearly 2013.Monthly average4032.936.53021.12019.8100’08**Average based on partial year data’09’10’11’12’13*Sacramento BeeHUNDREDS OF MENTALLY ILL SENT TO CITIES AROUND NATIONIn recent years, as Nevada has slashed fundingfor mental health services, the number of mentallyOver the past five years, Nevada’s primary state ill patients being bused out of southern Nevada haspsychiatric hospital has put hundreds of mentallysteadily risen, growing 66 percent from 2009 toill patients on Greyhound buses and sent them to2012. During that same period, the hospital has dispersed those patients to an ever-increasing numbercities and towns across America.Since July 2008, Rawson-Neal Psychiatric Hos- of states.pital in Las Vegas has transported more than 1,500By last year, Rawson-Neal bused out patients atpatients to other cities via Greyhound bus, sending a pace of well over one per day, shipping nearly 400at least one person to every state in the continenpatients to a total of 176 cities and 45 states acrosstal United States, according to a Bee review of bus the nation.Nevada’s approach to dispatching mentally illreceipts kept by Nevada’s mental health division.About a third of those patients were dispatched patients has come under scrutiny since one of itsto California, including more than 200 to Los Ange- clients turned up suicidal and confused at a Sacles County, about 70 to San Diego County and 19 to ramento homeless services complex. James Flavythe city of Sacramento.Coy Brown, who is 48 and suffers from a variety ofBy Cynthia Hubert, Phillip Reese and Jim Sanderschubert@sacbee.com
“Getting rid of (mentally ill patients) by busing them out of state is, I think, rare. I amshocked by these figures. It seems to be almost routine in Nevada.”DJ JAFFE, executive director of Mental Illness Policy Org.mood disorders including schizophrenia,was discharged in February from RawsonNeal to a Greyhoundbus for Sacramento,a place he had nevervisited and where heknew no one.The hospital senthim on the 15-hourbus ride without making arrangements forhis treatment or housing in California; hearrived in Sacramentoout of medication andwithout identificationor access to his SocialSecurity payments. Hewound up in the UCDavis Medical Center’s emergency room,where he lingered forthree days until socialworkers were able tofind him temporaryhousing.Nevada mentalhealth officials haveacknowledged makingmistakes in Brown’sa.m departure:this morning’s 6:30Itinerarycase, but have madeBut anforinvestigationby theNevada StateStops: 25Travel time: 2 days,no apologies for their policyof busingDivisiondocumented severalother instancHOWLONG patients out Health15 minutes15 hours,Bus transfers: 5of state. Las Vegas is an sinFebruaryinIS THAT TRIP?Standard fare: 263Onewhileof the longestand patients who become illin theGreyhoundcity havewhich the state hospital violated written rules forbus trips routinely booked bya right to return home if theydesire,thestate’ssafely discharging mentally ill patients.Southern Nevada Adulthealth officer, Dr. Tracey Green,told ServicesNevadain lawOther apparent violations surfaced during TheMental HealthLasVegasisthe2,500-milemakers during a hearing last month.Bee’s investigation.Las Vegasjourney to Miami. Over 30She and others insist thatthevastmajorityofAt least two patients from the Nevada systempatients have taken it in thepastfiveyears.patients they are discharging to the Main Streetarrived in San Francisco during the past yearArrive12:55 a.m.Stopbus station are mentally stable and have family“withouta plan, without a relative,” said JoRobintimelocalTransferWednesdaymembers, treatment programs or both waiting forson, director of that city’s Behavioral Health Serthem at the end of their rides.vices department.MiamiSacramento BeeSource: GreyhoundThat was not true in Brown’scase. His papers“We’re fine with taking people if they call andfrom Southern Nevada Adult Mental Health Serwe make arrangements and make sure that everyvices read: “Discharge to Greyhound bus station by thing is OK for the individual,” Robinson said. “Buttaxi with 3 day supply of medication” and provided a bus ticket with no contact, no clinic receptor,a vague suggestion for further treatment: “Followanything, it’s really not appropriate.”up with medical doctor in California.” Brown saidRobinson said she viewed the practice asstaff at Rawson-Neal advised him to call 911 when“patient dumping,” and has reported it to federalhe arrived in Sacramento.authorities. “It’s offensive to me that they wouldNevada Health and Human Services Directorshow this lack of care for a client,” she said.Michael Willden told lawmakers last month thatPractice called riskywhile health officials “blew it” in their handling ofNevada mental health officials did not respondBrown, an internal investigation found no patternto repeated requests for phone interviews for thisof misconduct.GREYHOUND
HOW LONGIS THAT TRIP?One of the longest Greyhoundbus trips routinely booked bySouthern Nevada AdultMental Health Services inLas Vegas is the 2,500-mileLas Vegasjourney to Miami. Over 30patients have taken it in thepast five years.Itinerary for this morning’s 6:30 a.m departure:Stops: 25Travel time: 2 days,15 hours, 15 minutesBus transfers: 5Standard fare: 263GREYHOUNDStopTransferArrive12:55 a.m.local timeWednesdayMiamiSource: Greyhoundstory, nor would they address a list of emailedquestions about the origins of the busing policyand the safety protocols in place.Southern Nevada Adult Mental Health Services,the agency that oversees Rawson-Neal, maintainsdetailed written policies for transporting patients“to their home communities,” with the stated goalof providing more appropriate care by the mosteconomical means possible.The policy includes a special section on “TravelNourishment Protocol,” specifying the numberof bottles of Ensure nutritional supplement thepatient should receive for the bus trip -- essentiallysix per day.Staff members are supposed to fill out a “Client Transportation Request” form, which includesquestions about whether the patient is willing togo, whether housing or shelter has been verified,and the cost of the trip.The written policy calls for staff to confirm thata patient has housing or shelter available “and asupport system to meet client at destination.” Theyare to provide information about “mental healthservices available in the home community.”Interviews with health officials in Californiaand numerous other states indicate Nevada’spractices are unusual. None of the 10 state mentalhealth agencies contacted by The Bee said thatplacing a psychiatric patient on a bus withoutsupport would be permissible. And none recalledbeing contacted by Rawson-Neal to make arrangements for a patient coming from Nevada.In California, where most public mental healthtreatment is overseen at the county level, agenciescontacted by The Bee said they rarely bus patientsand that Nevada’s practices seem out of step withthe standard of care.Several described the practice as risky, even ifpatients have someone waiting for them at the endof their journeys.“Putting someone whose mental illness makesthem unable to care for themselves alone on a busfor a long period of time could be absolutely disastrous,” said Dorian Kittrell, executive director ofthe Sacramento County Mental Health TreatmentSacramento BeeCenter.Patients could suffer relapses during their tripsand potentially harm themselves or other people,said Kittrell and others. They could become lost tothe streets or commit crimes that land them in jail.“The risk is just too great,” said Dr. MaryeThomas, chief of behavioral health for AlamedaCounty.Southern Nevada Adult Mental Health Serviceshas had an ongoing contract with Greyhound sinceJuly 2009, said bus company spokesman TimothyStokes.Stokes said he was unaware of any serious incidents involving mentally ill patients from Nevada.He said Greyhound has contracts with “a number”of hospitals around the country, but declined toidentify them.“We take it on good faith that the organizationis going to make certain that patients are not a riskto themselves or others,” he said.Still, officials in several of California’s largestcounties said they rarely, if ever, bus patients out ofstate.“We don’t do it, we never will do it, and wehaven’t done it in recent memory, meaning at least20 years,” said David Wert, public information officer for San Bernardino County. Rawson-Neal hasbused more than 40 patients to that county sinceJuly 2008.Los Angeles County officials said they have notbused a single patient out of state during the pastyear, and when they have done so in the past theyhave supplied chaperones. In the past five years,L.A. County has received 213 people from the Nevada hospital, according to The Bee’s review, morethan any place in the country.Likewise, in Riverside County, sending patients out of state “happens very infrequently uponrequest of the family,” said Jerry Wengerd, head ofthe county’s Department of Mental Health. “A staffmember accompanies the client and it is usually byair.” Nevada bused 20 patients to Riverside in theperiod reviewed.Sacramento County bought bus tickets forfive patients during the past year, Kittrell said. In
James FlavyCoy Brown, whosuffers frommood disorders, isreunited with hisdaughter ShotzyFaith Harrisonin SacramentoThursday after aNevada psychiatrichospital bused himto the capital withno medication oridentification.Renée C. Byerrbyer@sacbee.comall cases, he said, facility staff confirmed beforepatients departed that a family member or friendwould meet them at their destinations, and provided referrals for treatment.Organizations that advocate for mentally illpeople said Nevada’s busing numbers seem unjustifiably high.DJ Jaffe, executive director of Mental IllnessPolicy Org., a nonprofit think tank, said his groupoften hears anecdotally about patients being“dumped” from one county to another.“Discharging severely mentally ill patientsinappropriately is policy in this country,” Jaffe said.“But getting rid of them altogether by busing themout of state is, I think, rare. I am shocked by thesefigures. It seems to be almost routine in Nevada.”After California, Arizona has received the mostpatients by bus from Nevada, at more than 100over the five years.But Cory Nelson, acting deputy director forthe Arizona Department of Health, cautionedagainst drawing conclusions about Nevada’s practices based solely on number of bus tickets issued.In many cases, Nelson said, relatives could haveagreed to house patients or made treatment arrangements before the clients left Las Vegas.In rare cases, Nelson said, a hospital can finditself in a Catch-22 situation when a patient nolonger needs to be in a hospital but refuses to cooperate with a discharge plan. “It kind of leaves ahospital in a tough situation,” he said.Still, the sheer number of patients bused fromthe Nevada hospital “does seem pretty high,” hesaid.‘A tsunami situation’Several people interviewed said the numbersmight be explained in part by the unusual natureof Las Vegas.“As the whole country no doubt knows, Vegasis a pretty unique place,” said Dr. Lorin Scher, anemergency room psychiatrist with UC Davis HealthSystem.The city’s entertainment and casino culturedraws people from all over the world, Scher noted,including the mentally ill.“Many bipolar patients impulsively fly acrossthe country to Vegas during their manic phasesand go on gambling binges,” he said. “Vegas probably attracts more wandering schizophrenic people”who are attracted to the warm weather, lights andaction, he added.“I am by no means defending their practices,”he said. “It certainly gives cause for concern. Butit’s one possible explanation.”Stuart Ghertner, former director of Southern
Nevada Adult Mental Health Services, cited otherpossible reasons.He said Rawson-Neal has been under siegefor years because of state budget cuts, a steadyincrease in poor people needing mental healthservices in the Las Vegas area and a revolving doorof administrators.He noted the city had a disproportionate number of people displaced by the housing and mortgage meltdown of a few years ago.“The casino boom was over, people were losingtheir jobs and their homes. They were stressed andthey wound up in a mental health crisis,” Ghertnersaid.Between 2009 and 2012, Nevada slashed spending on mental health services by 28 percent toaddress budget deficits, according to data collected by the National Alliance on Mental Illness.Even before those cuts, Nevada fell well below thenational average in spending on mental healthservices: In 2009, it spent 64 per capita on suchservices compared with a national average of about 123, according to the study.“You’re looking at a tsunami situation,” saidGhertner, a psychologist who resigned last yearafter five years as agency director. “There is morepressure to turn patients over faster, and fewerprograms (in which) to place them. Perhaps busingthem became the easier solution.”It also is cheaper, he noted. Southern NevadaAdult Mental Health Services spent a total of 205,000 putting patients on Greyhound busesduring the past five years, according to The Beeanalysis. The state hospital admits about 4,000patients a year to its inpatient unit, and inpatientcare runs around 500 per day per client, Ghertnersaid.He said he was aware during his tenure thatRawson-Neal was busing patients out of state butthat he thought the practice was rare.At the time, “I had 800 employees and a 106million budget,” he said. Ghertner regularly reviewed numbers pertaining to admissions, lengthof stay and other issues at the hospital, but patientbusing was never on his radar, he said.“I’m embarrassed to say that this practice wasgoing on to this degree under my leadership,” hesaid. “I had no idea. It just never came up.”Ghertner said the state mental hospital hasbeen under stress since it opened in 2006, turningover five hospital directors since that time. Thatinstability has taken a toll, he said.“This busing issue is a symptom that reflectsthat the care there is not quality care,” he said.“Things clearly are being missed.”Willden, Nevada’s Health and Human Servicesdirector, said during last month’s legislative hearing that policies have been tightened and disciplinary actions taken to ensure that patients aredischarged only after the hospital confirms careand treatment at their planned destinations. Thehospital administrator, Chelsea Szklany, now mustapprove all bus discharges ordered by medicalstaff, he said.“Southern Nevada Adult Mental Health Services is committed to providing quality mental healthservices to its patients,” said spokeswoman MaryWoods in an emailed statement.But investigations continue into the agency’spractices.Rawson-Neal could lose vital federal fundingpending an ongoing probe by the federal Center forMedicare and Medicaid Services. California stateSenate President Pro Tem Darrell Steinberg haswritten a letter expressing outrage to U.S. Secretaryof Health and Human Services Kathleen Sebelius.The hospital’s discharge practices also haveprompted a call for action by a member of the U.S.Commission on Civil Rights. Commissioner DavidKladney called for a broad investigation by Nevada’s governor and Legislature.“As a Nevadan, I am ashamed that my state isfailing in its duty toward the neediest residents,”Kladney said. Nevada, he said, appears to be“simply hoping that other states will shoulder theresponsibility.”Call The Bee’s Cynthia Hubert, (916)321-1082.Bee researcher Pete Basofin contributed to thisreport.
THE PUBLIC EYE A Bee investigation LEAVING LAS VEGAS Southern Nevada Adult Mental Health Services in Las Vegas has discharged and bused more than 1,500 patients across the country during the last five years. Source: Southern Nevada Adult Mental Health Services, Bee analysis by Phillip Reese *Average based on partial year data Sacramento Bee .
