Report Says Nevada Mental Health Hospital Should Make Changes

Rawson-Neal Psychiatric Hospital in Las Vegas should hire more staff and strengthen discharge protocols to curb practices such as busing patients with mental illnesses to California and other states, according to a report released Thursday by two consultants, the Sacramento Bee reports (Reese, Sacramento Bee, 5/24).

Background on 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 month, the Joint Commission -- an independent, not-for-profit firm that accredits hospitals -- 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, 5/20).

Details of New Report

Nevada hired two consultants to examine the hospital's practices:

• Kenneth Appelbaum, a professor of psychiatry at the University of Massachusetts Medical School; and
• Joel Dvoskin, a clinical psychologist and faculty member at the University of Arizona College of Medicine.

Earlier this month, the consultants spent a week at the hospital.

They found that Rawson-Neal staffers often feel pressure to discharge patients quickly to make room for more.

According to the consultants, staffing levels are not adequate for the large volume of patients at the hospital.

In addition, they found that the hospital relies too heavily on treatments that involve the use of medications and not enough on psychotherapy or behavioral therapy.

However, the consultants also said that the hospital often acted appropriately when busing patients to other states. "In many cases, helping people to get home safely is a kindness to them and to their families," the report states.

Report Recommendations

The consultants recommended that Nevada increase the number of staff positions at the hospital by about 5% and that the facility "increase the amount of high-quality, evidence-based treatments beyond the provision of psychotropic medication."

State Response

State officials said they already have adopted many of the recommendations in the report and would work to implement other changes.