Leave the patients to us: Is Nevada unloading its mentally ill in Oregon?

From Street Roots, October 10, 2013

They were given a bus ticket along with a few days worth of medication and food. They traveled long distances to cities in California where they arrived as strangers. Their journeys have sparked outrage and lawsuits. Now there are calls to find out if it happened in Oregon.

Following allegations that a psychiatric facility in Nevada improperly “dumped” patients in cities throughout California where they had no family and had no connections, the Mental Health Association of Portland is calling on the Oregon attorney general to conduct an investigation to determine if the Beaver State has also received improper discharges from the embattled hospital.

Earlier this year, The Sacramento Bee published a series of articles that alleges that the Rawson-Neal Psychiatric Hospital, a state-run institution located in Las Vegas, systematically engaged in “patient dumping” — euphemistically known as “Greyhound therapy” — for some of its indigent patients, shoveling the costs and responsibility of caring for these individuals onto another state. It’s the subject of two lawsuits, including the American Civil Liberties Union of Nevada, which claim that the hospital involuntarily discharged the patients, bought them bus tickets to cities in California and sent them off with a supply of food and medications for several days. Some were instructed to access social services available in the city, according to The Bee.

Key evidence in the case are 1,500, one-way bus tickets to send patients to other cities. Street Roots has received copies of the tickets and found they include 29 one-way tickets to Oregon between 2008 and 2012 — 20 of them to Portland. The names of the passengers have been redacted to protect their identity, nor is there any information attached regarding the circumstances surrounding their trip.

“For a price of a bus ticket, hospitals can get rid of a difficult patient,” says Jason Renaud, spokesperson for the Mental Health Association of Portland, of the practice of patient dumping. The Mental Health Association has formally requested that Oregon Attorney General Ellen Rosenblum investigate whether there were any cases of patient dumping here in Oregon stemming from the Nevada case.

California’s class action lawsuit focuses on the case of James Flavy Coy Brown, who arrived in Sacramento after a 15-hour bus ride from Las Vegas, confused as to why he had been sent to a city where he had no contacts, according to The Bee. The paper’s report says Brown had been given instructions from the staff at Rawson-Neal to call 9-1-1 when he reached his destination. San Francisco City Attorney Dennis Herrera filed the lawsuit earlier this month against the State of Nevada and administrators at Rawson-Neal on behalf of local governments in California.

An investigation by Herrera’s office found that Rawson-Neal bused at least two-dozen patients to San Francisco without adequate food, water or medication and without arrangements for continued care when they reached the city. Twenty of these patients required medical care shortly after arriving in San Francisco, the investigation found. The suit seeks $500,000 to recoup the costs associated with providing shelter, medical care and other necessities for individuals bused to the city.

The suit alleges that Rawson-Neal administrators imperiled the safety of 500 patients bused to California, as well their fellow passengers on the bus rides and the residents of their destinations. It also alleges that Rawson-Neal administrators deliberately appropriated resources California had set aside for its indigent population.

“Rawson-Neal understood and expected that the bused patients would rely on San Francisco’s public health resources for continuing medical care, and specifically directed some of the patients to seek care at San Francisco public health clinics and shelter at San Francisco-supported shelter and care programs,” Herrera states in the complaint.

The American Civil Liberties Union of Nevada and Sacramento civil rights attorney Mark Merin filed a suit in June against administrators at Rawson-Neal on behalf of Brown and other patients wrongfully bused to California.

The suit alleges that patients’ constitutional rights were violated when the hospital involuntarily discharged them from the facility and sent them across state lines. The suit claims that patients were medicated before their discharge, forcing them to make the journey in drugged states, incapable of giving informed consent to what was happening to them.

Mary Woods, spokesperson for the Nevada Department of Health and Human Services, says that while there have been problems with the state’s Transportation Back to Home Communities program, they have been overblown.

According to Woods, when the department became aware that staff did not follow program policies, it immediately initiated a review. Between July 1, 2008 and March 31, 2013, the hospital purchased bus tickets for nearly 1,500 patients, or 4.7 percent of all discharges. An analysis of those discharges found only 10 instances over this time period where there was not enough documentation to know for certain if staff had confirmed that there was housing and other supportive services waiting for patients at their destination.

Woods also says that the hospital has terminated medical staff. It has also revised policies to require more thorough oversight of travel arrangements and for a chaperone to accompany the client to their destination, according to Woods. Additionally, she points out that the state has increased funding for mental health services, and a recent outside review of the Rawson-Neal facility was generally positive.

However, Gabriel Zitrin, spokesperson for the San Francisco city attorney, told Street Roots that the problems with Rawson-Neal really are that dire.

“Our suit represents the very tip of the iceberg,” he says, pointing out that 24 patients being sent to one municipality over the course over a five-year span suggests that there was a widespread problem at Rawson-Neal. He also says that those are just the instances uncovered by the city attorney’s investigation.

In August, a review of Rawson-Neal by the U.S. Centers for Medicare & Medicaid Services found evidence that there were significant problems with how the hospital discharged patients.

David Austin, spokesperson for Multnomah County, says that county staff handling social services haven’t seen any indication that Rawson-Neal was sending patients their way.

Renaud, of the Mental Health Association of Portland, says that the analysis from the Nevada Department of Health and Human Services can’t be trusted to provide an objective assessment of patient dumping practices by the Rawson-Neal hospital. He says that the Oregon attorney general, which didn’t respond to a request for comment by press time, needs to look into the matter to determine if any Rawson-Neal patients, or patients from other facilities, were improperly sent to Oregon and to take legal action if necessary.

Patient dumping was once a fairly routine practice that has abated in recent years, says Renaud. Today, he says, it’s more likely to occur in small towns, which don’t have the resources to properly address mental health issues, where a local sheriff might take a mentally ill person to the edge of town and tell them to keep walking.

“That’s what people want to have happen to people with mental health and addiction problems. They want them to go away,” he says.

Renaud says that there are some mentally ill individuals who will improve with the right treatment, and there are some that simply won’t get better. Reduced budgets for hospital administrators have made some of their already-tough choices even tougher.

“So as a hospital administrator, are you going to spend money on people who are going to benefit, or are you going to spend money on people who are not going to benefit?” says Renaud. “It’s a real problem. It’s not just mean people or lazy people, but when you stress the system by underfunding it and undermanaging it you get these kind of problems.”