S.F. City Attorney Threatens Lawsuit Over Nevada Patient Busing

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 a Nevada mental health facility, AP/U-T San Diego reports (AP/U-T San Diego, 8/20).

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. 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.

In July, the Joint Commission issued a preliminary denial of accreditation for the Nevada psychiatric hospital (California Healthline, 7/25).

Shortly thereafter, officials at Rawson-Neal said the facility would waive its right to appeal a preliminary denial of accreditation by a Joint Commission panel. The decision means that the facility and its affiliated programs are no longer accredited (California Healthline, 7/30).

Details of the Letter

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."

The letter adds that hospital staff "understood and expected that the bused patients would rely on San Francisco's public health resources for continuing medical care" and that they "specifically directed some of the bused patients to seek care at San Francisco public health clinics and San Francisco-supported shelter and housing upon their arrival."

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 (Reese, Sacramento Bee, 8/21).

Nevada AG's Response

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" (O'Neill, "KPCC News," KPC, 8/20).