CMS: 40% of Nevada Mental Health Patients Bused to Other States
In a new review of a Nevada mental health hospital, CMS found that about 40% of patients were discharged and bused to California and other states in recent years without adequate plans for follow-up care or shelter, the Sacramento Bee reports (Reese, Sacramento Bee, 8/27).
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 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 (California Healthline, 8/22).
Details of CMS Findings
For the report released Monday, CMS analyzed a sample group of 41 patient charts from Rawson-Neal and found 16 cases in which patients were discharged without arrangements for follow-up care, shelter or support. According to CMS, the majority of such patients were put on buses and sent to other states, including California.
The agency said that Rawson-Neal's actions violate the Emergency Medical Treatment and Labor Act and that the facility could face fines.
The report assumes that Rawson-Neal meets legal standards for being an "emergency" services provider.
Chelsea Szklany -- an administrator at Southern Nevada Adult Mental Health Services -- said EMTALA does not apply to Rawson-Neal because the facility does not have an emergency department.
"The Psychiatric Observation Unit is licensed as an inpatient unit to serve individuals with acute behavioral needs," Szklany wrote, adding, "Individuals cannot walk into the POU for treatment."
However, Nevada officials still argue that Rawson-Neal meets EMTALA requirements.
Szklany said the state will appeal CMS' findings.
Reaction From Mental Health Advocates
DJ Jaffe -- executive director of the Mental Illness Policy Organization -- said the so-called "patient dumping" that took place at Rawson-Neal is a prevalent practice throughout the U.S.
"It's profitable for hospitals to get rid of homeless patients," Jaffe said, adding, "These discharges were not mistakes. It's policy."
In related news, a second CMS investigation found that Rawson-Neal failed to meet requirements for participating in Medicare.
The probe found that the hospital:
- Did not have a process for notifying doctors about the status of requested consultations with medical specialists;
- Did not properly evaluate contract nursing staff; and
- Gave patients medication without having them sign a consent form.
CMS will review Rawson-Neal's plan to correct the problems and conduct another unannounced visit before determining whether to continue the hospital's Medicare reimbursements (Sacramento Bee, 8/27).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.