San Francisco Files Lawsuit Over Nevada Patient Busing Practices

On Tuesday, the city of San Francisco filed a class-action lawsuit against the state of Nevada over the improper busing of patients with mental illnesses to California, Modern Healthcare reports (Carlson, Modern Healthcare, 9/10).

Background on Busing Practices

According to a Sacramento 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.

Investigations, Rawson-Neal's Response

In April, the Joint Commission launched an investigation of the hospital and then in July issued a preliminary denial of accreditation, which the hospital declined to appeal. CMS also has launched multiple investigations of Rawson-Neal's patient discharge practices.

In addition, Los Angeles is pursuing a criminal investigation of the hospital.

In response to the investigations, Nevada Gov. Brian Sandoval (R) said that state officials have implemented new policies at the facility. Nevada officials also said that two employees at Rawson-Neal have been fired and another three were disciplined following an internal investigation.

City Seeks Compensation

In August, Dennis Herrera -- city attorney for San Francisco -- sent a letter to Nevada Attorney General Catherine Cortez Masto (D) threatening to file a lawsuit if the state did not reimburse the city for treating patients who were bused from Rawson-Neal.

In the letter, Herrera wrote that San Francisco's months-long investigation determined that several patients from Rawson-Neal have been sent to San Francisco since April 2008. Of those patients, 20 individuals sought emergency medical care within a short time after they arrived in the city.

Herrera wrote that the psychiatric hospital's staff "were well aware" that the patients sent to San Francisco were "indigent and homeless, suffering from mental illnesses requiring ongoing medical care and medication, and in most cases were non-residents of San Francisco with no family members here to care for them."

Herrera wrote that the city was seeking at least $500,000 in reimbursements for the care and housing of such patients provided by the city. He also requested that Nevada agree to "an enforceable contract" to regulate the future transfer of patients with mental illnesses to California (California Healthline, 8/22).

Details of Lawsuit

The lawsuit filed by the city seeks:

• Compensation for the care of patients with mental health problems who were sent from Nevada; and
• A permanent injunction against the practice of sending patients to states where they are not residents, do not have family members who are residents or do not have follow-up care arrangements (Hubert/Reese, Sacramento Bee, 9/10).

San Francisco requested that it be named the lead plaintiff in the class-action suit.

In a release about the lawsuit, Herrera said, "It's my hope the class action we're pursuing against Nevada will be a wake-up call to facilities nationwide that they too risk being held to account if they engage in similarly unlawful conduct" (Modern Healthcare, 9/10).

Herrera added that the lawsuit is "about more than just compensation -- it's about accountability" (Romney, "L.A. Now," Los Angeles Times, 9/10).

He also said that the suit could pave the way for other California cities and counties to "demonstrate claims for damages" from the improper transfer of patients with mental illnesses to the state (Sacramento Bee, 9/10).

The lawsuit has not yet been certified by the court as a class-action case (Kearney, Reuters, 9/10).

Nevada's Response

The Nevada attorney general's office has not yet been served with the lawsuit, so officials have declined to comment.

However, Linda Anderson -- chief deputy attorney general of Nevada -- sent a letter to Herrera on Monday saying that the patient transfers were "appropriate."

She also said that Nevada might have paid more for the care of California residents, citing a CMS investigation that found 2,402 California residents have received an average of 18 days each of inpatient care in Las Vegas since 2008.

"[I]t could be argued that using the average cost of services in the Rawson-Neal Hospital of $653 per day, the taxpayers of the state of Nevada have subsidized the state of California over $6.2 million during the same period" of the busing practices noted in the lawsuit, she said (Modern Healthcare, 9/10).

Anderson added, "Since both California and Nevada are financially impacted by the travel of individuals with mental illness between our states, we believe that government officials would benefit from better communication and collaboration ... rather than trying to allocate financial responsibility through litigation" ("L.A. Now," Los Angeles Times, 9/10).