Nevada Psychiatric Hospital’s “Patient Dumping” Prompts Suit by San Francisco and Scrutiny from CMS

On September 10, 2013, the San Francisco city attorney, Dennis Herrera, filed a class action suit against the state of Nevada and Rawson-Neal Psychiatric Hospital (Rawson-Neal), accusing them of intentionally dumping 500 psychiatric patients in California. The suit seeks a court order from the San Francisco Superior Court that prohibits Nevada’s mental health facilities from sending patients to California unless (1) they are California residents or (2) their care has been prearranged.  The suit also calls for $500,000 to reimburse the city for expenditures made to care for 20 patients bused to San Francisco from Nevada’s primary state mental health facility, Rawson-Neal.

Rawson-Neal has been under investigation by CMS since the Sacramento Bee reported in April 2013, that the hospital bused approximately 1,500 psychiatric patients to cities all over the country during the past five years.  According to the Sacramento Bee, almost 500 psychiatric patients have been sent to California alone, with Los Angeles, San Diego, and San Francisco receiving the most patients. According to a recent article, CMS is working on terminating the hospital’s Medicare funding and Rawson-Neal recently lost it accreditation from the Joint Commission, an independent agency that evaluates medical facilities.

One heartbreaking example of a patient dump was reported by the San Francisco Chronicle. It is the story of Timothy Martin, a deaf, blind, mute, and homeless man who was found crying on the street outside of a local bar. Martin recounted how he ended up in San Francisco, “The doctor in Reno wanted me to leave the hospital. … He told me to come here to San Francisco.” Martin, who in addition to being deaf and blind cannot speak, said through an interpreter. “They bought my ticket.” However, once in San Francisco he did not know where to go, so he entered a bar.  “The doorman wanted me to leave, and it made me cry, so I just sat outside and cried,” Martin said. “Then an ambulance came and took me to San Francisco General Hospital.” An investigation conducted by San Francisco city officials has prompted them to suspect that Martin’s case is an example of “Greyhound therapy,”  the alleged practice by medical officials in Nevada of dumping indigent or homeless patients on the city.

CMS released the results of its noncompliance complaint investigation survey on Rawson-Neal. Among the deficiencies cited by CMS against Rawson-Neal were the hospital’s failure to comply with  42 CFR sec. 482.43,  which requires hospitals to ensure a comprehensive discharge plan is implemented for patients; and 42 CFR sec. 482.12(a),  the requirement that the governing body hold the medical staff accountable for the quality of care provided to patient, including discharge planning. In response to CMS’ findings the hospital submitted a plan of correction.  The Nevada Department of Health and Human Services also implemented a new policy that requires that chaperones accompany each discharged patient to his or her destination when he or she receives a transportation ticket.

The Las Vegas Review Journal reported that, Linda C. Anderson, Nevada Chief Deputy Attorney General, responded to the demand letter from Herrera. Ms. Anderson wrote that the documents requested by Herrera’s office and provided by the Nevada Department of Health and Human Services, “demonstrate that the policies are appropriate and that proper discharges were made.”  She further wrote, “You made a demand for approximately $500,000 but you fail to provide details to support your claim including how you identified the 20 patients.“ Anderson also questioned Herrera’s legal theory and the standing of the city to sue on behalf of other affected California cities and counties.

The next legal maneuvers are still to come and updates will be posted as they develop.