Nevada Mental Health Facility Could Lose Accreditation

The Joint Commission has issued a preliminary denial of accreditation for a psychiatric hospital in Nevada that bused patients with mental illnesses to California and other states, the Sacramento Bee reports (Reese/Hubert, Sacramento Bee, 7/25).

Background on Busing Practices

According to a Bee review of bus receipts kept by the Nevada Division of Mental Health and Developmental Services, the number of patients with mental illnesses sent by Rawson-Neal Psychiatric Hospital in Las Vegas to other cities via Greyhound bus increased by 66% from 2009 to 2012.

The Bee found that Rawson-Neal has sent more than 1,500 patients to other cities since July 2008.

According to the review, about one-third of such individuals traveled to California, including:

• 200 who arrived in Los Angeles County;
• 70 who arrived in San Diego County; and
• 19 who arrived in Sacramento.

In April, the Joint Commission launched an investigation of the hospital. CMS also has launched multiple investigations of Rawson-Neal's patient discharge practices. In addition, San Francisco has launched a formal inquiry into the matter, while Los Angeles is pursuing a criminal investigation of the hospital.

In response to the investigations, Nevada Gov. Brian Sandoval (D) said that state officials have implemented a new policy that requires two physicians instead of one and a hospital administrator to approve a discharge order for a patient. In addition, a chaperone must accompany any patient with a mental illness discharged from state facilities and sent to locations outside of Nevada, hospital officials said.

Nevada officials also said that two employees at Rawson-Neal have been fired and another three were disciplined following an internal investigation that found 10 cases in which patients might have been placed on buses without family or treatment contacts at their destination (California Healthline, 6/7).

Details of Joint Commission's Decision

Joint Commission spokesperson Elizabeth Eaken Zhani said that the group issued the preliminary denial of accreditation "due to the hospital placing patients at risk for a serious adverse outcome."

During a routine inspection of the Rawson-Neal facility in May, the commission found that the hospital failed to meet 35 standards, including many related to patient safety, according to the Bee.

In a subsequent inspection, the commission found that the hospital failed to meet 23 standards, including:

• Ensuring the competency of staff;
• Educating patients during discharge about follow-up care; and
• Providing adequate information to other health care providers who will care for patients after discharge.

Implications of Denial

Steven Hirsch of health care consulting firm Steven Hirsch and Associates said the hospital would not automatically be ineligible for federal funding if it loses its accreditation. However, many private insurers might not reimburse an unaccredited facility, according to Hirsch.

In addition, he said the loss of accreditation would result in greater federal oversight of the facility.

To appeal the commission's decision, the hospital would have to prove that it was in compliance "based on what they [were] doing at the time of the survey," Hirsch said.

State Reaction

Mike Willden -- director of the Nevada Department of Health and Human Services -- said that the agency is "disappointed by the Joint Commission's decision" and that the denial "appears to be based on outdated survey information and is not an accurate reflection of the hospital's current practices and policies."

Mary Woods -- spokesperson for Nevada HHS -- said the state is deciding whether to appeal the commission's decision. The appeals process would take four to six months, during which the hospital would retain its accreditation (Sacramento Bee, 7/25).

Nevada Gov. Takes Action

Following the commission's decision, Mary-Sarah Kinner -- a spokesperson for Sandoval -- said the governor called for a special legislative action to accelerate funding for mental health care services.

She said Sandoval has formally requested that the Interim Finance Committee hold a meeting about such funding "in the very near future."

According to Kinner, Sandoval hopes a mental health funding boost will help "address any outstanding concerns with" Rawson-Neal (Rindels, AP/U-T San Diego, 7/24).