Calif. Lawmakers Seek Federal Probe of Nevada Discharge Policies

On Tuesday, 21 California lawmakers sent a letter urging HHS Secretary Kathleen Sebelius and U.S. Attorney General Eric Holder (D) to launch a federal investigation into Nevada's practice of busing patients with mental illnesses to California and other states, the Sacramento Bee reports.

The letter -- which was initiated by California Rep. Ami Bera (D-Elk Grove) -- cites a Bee review of the practice at Rawson-Neal Psychiatric Hospital in Las Vegas (Reese [1], Sacramento Bee, 4/30).

Details of Rawson-Neal's 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 the psychiatric hospital 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.

Last week, city attorneys for Los Angeles and San Francisco announced formal investigations into Rawson-Neal's practices.

Meanwhile, CMS sent a letter to the mental health facility urging officials to correct "serious deficiencies" or potentially lose millions of dollars in federal Medicare funding.

Nevada's Response

Nevada Gov. Brian Sandoval (D) said that state officials have implemented a new policy to strengthen oversight of the patient discharge process.

According to state officials, regulations now require two physicians instead of one to approve a discharge order for a patient. In addition, the discharge of a patient now must be approved by a hospital administrator.

Nevada officials also said that, effective immediately, a chaperone must accompany any patient with a mental illness discharged from state facilities and sent to locations outside of Nevada (California Healthline, 4/30).

On Monday, Nevada officials 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 (Reese [2], Sacramento Bee, 4/30).

Details of Letter

In the letter, California lawmakers said that if the practice of improperly busing patients to other states is occurring, "it would not only be unethical and disgraceful, but would also be an illegal attempt by Nevada to evict members of the state's most vulnerable population to benefit its bottom line."

According to the lawmakers, the practice might violate a number of laws, including federal mandates that hospitals must stabilize patients before discharging them and meet certain criteria before receiving Medicaid and Medicare funding.