Sacramento Joins S.F. in Seeking Compensation for Nev. Patient Care

Jim Sanchez -- city attorney for Sacramento -- has joined San Francisco city attorneys in an effort to seek compensation for the care and housing of patients with mental illnesses who were bused to California from a Nevada psychiatric hospital, the Reno Gazette-Journal/USA Today reports (Bellisle, Reno Gazette-Journal/USA Today, 8/21).

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, 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.

Cities Seek Compensation

On Tuesday, Dennis Herrera -- city attorney for San Francisco -- sent a letter to Nevada's attorney general threatening to file a lawsuit if the state does not reimburse the city for treating patients who were bused from Rawson-Neal.

In the letter to Nevada AG Catherine Cortez Masto (D), Herrera wrote that San Francisco's months-long investigation has 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 is 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.

Herrera said that if Nevada does not agree to such terms within 20 days, he would file a class-action lawsuit over the matter.

Jennifer Lopez -- a spokesperson for Cortez Masto -- said the AG's office has "received the letter, and we are working with our clients on this matter" (California Healthline, 8/21).

This week, Sanchez said that the Sacramento city attorney's office has been working with Herrera on the issue because Rawson-Neal bused several patients to the capital city, the Gazette-Journal/USA Today reports.

Sanchez said, "Everybody recognizes there needs to be humane treatment of these individuals."

He added that Sacramento officials also will pursue legal action if Nevada does not reimburse the city (Reno Gazette-Journal/USA Today, 8/21).

Second Nev. Hospital Accused of Patient Busing

Meanwhile, a second Nevada mental psychiatric hospital improperly transferred patients to California, according to a CMS notice issued last week, AP/U-T San Diego reports.

The notice states that Dini-Townsend Inpatient Facility in Sparks, Nev., improperly sent patients to other states, including seven patients who were transferred to California between December 2007 and March 2012.

The facility also was cited for violating the Emergency Medical Treatment & Labor Act by:

• Failing to report and keep appropriate medical records;
• Delaying examinations; and
• Failing to provide appropriate medical screening and stabilizing treatment.

Mary Woods -- a spokesperson for the Nevada Department of Health and Human Services -- said that the department questions the allegations, adding that it might be inappropriate to require "a psychiatric facility to adhere to regulations for a medical emergency room."

She also said that the patients who were transferred to California all "identified California as his or her previous place of residence and had a support system" in the state (AP/U-T San Diego, 8/21).