SAN FRANCISCO (News Release From The City of San Francisco) - San Francisco City Attorney Dennis Herrera today filed a class action against the State of Nevada on behalf of California local governments to which indigent patients were improperly bused from the state-run Rawson-Neal Hospital in Las Vegas. The lawsuit filed in San Francisco Superior Court this morning seeks a court-ordered injunction barring Nevada from similar patient discharge practices in the future, and reimbursement for San Francisco's costs to provide care to the patients bused there.
The litigation makes good on Herrera's legal threat in a formal demand letter to Nevada Attorney General Catherine Cortez Masto last month, alleging that Rawson-Neal improperly discharged and unsafely transported at least two-dozen patients by Greyhound bus to San Francisco between 2008 and 2013. Herrera's investigation established that patients were transported without adequate food, water or medication, and without instructions or arrangements for their continued care when they reached their destination. Twenty of the patients required medical care shortly after their arrival in San Francisco--some within hours of getting off the bus--at a cost of approximately $500,000 to City taxpayers for medical care, shelter, and basic necessities. Herrera said he hoped the suit would be a "wake-up call" to similarly errant medical institutions nationwide that they risk being held accountable for mistreating indigent and mentally ill patients.
"Homeless psychiatric patients are especially vulnerable to the kind of practices Nevada engaged in, and the lawsuit I've filed today is about more than just compensation--it's about accountability," said Herrera. "What the defendants have been doing for years is horribly wrong on two levels: it cruelly victimizes a defenseless population, and punishes jurisdictions for providing health and human services that others won't provide. It's my hope that the class action we're pursuing against Nevada will be a wake-up call to facilities nationwide that they, too, risk being held to account if they engage in similarly unlawful conduct."
If successful, San Francisco's claim for reimbursement of the amounts it expended to care for indigent patients Nevada bused here would benefit all California jurisdictions by establishing a precedent for award of restitution to all jurisdictions able to demonstrate claims for damages and restitution substantially similar to San Francisco's. Herrera's suit additionally seeks injunctive relief that would apply statewide to prohibit Nevada from continuing to transfer non-residents into California without prior arrangements for patients' care, or in a manner that violates state or federal standards governing patient discharges.
In March, the Sacramento Bee first reported the story of 48-year-old James Flavy Coy Brown, a former Rawson-Neal patient who was sent on a 15-hour bus ride to Sacramento--despite having never before visited there, having no friends or family members in the area, and with no prior arrangements for his care, housing or medical treatment. The Nevada-run hospital had discharged Brown in a taxicab to the Greyhound bus station with a one-way ticket to Sacramento, snacks, and a three-day supply of medication to treat his schizophrenia, depression and anxiety. Brown was instructed to call 911 when he arrived. A Rawson-Neal physician reportedly recommended "sunny California" to Brown as a destination, according to the Sacramento Bee, because they "have excellent health care and more benefits than you could ever get in Nevada."
The following month, in response to news reports that Nevada's Rawson-Neal Psychiatric Hospital in Las Vegas had questionably bused more than 1,500 psychiatric patients to locations throughout the nation, the San Francisco City Attorney's office launched an investigation to determine whether any of the 31 Greyhound bus tickets Rawson-Neal purchased for trips to San Francisco conveyed improperly discharged patients. The initial conclusion of Herrera's investigation is that among 24 patients bused to San Francisco (including some who made multiple trips), 20 sought and were provided emergency medical care, some shortly after their arrival.
Those findings led Herrera to issue the formal demand letter on August 20, giving Silver State officials until yesterday to respond, and threatening legal action if they did not do so satisfactorily. The Nevada Attorney General's reply letter, dated yesterday, recounted its efforts to cooperate with Herrera's investigation, but proposed better collaboration between officials in both states "rather than trying to allocate financial responsibility through litigation."
The Nevada Department of Health and Human Services has released this statement:
Nevada’s Client Transportation Back to Home Communities policy was created to help people return home, or to another supportive destination. The policy requires staff confirm housing/shelter and a support system is available to meet the individual at his/her destination.
The discharge practice is similar to San Francisco’s Homeward Bound Program to provide transportation home to those who are stable to travel to locations where staff has confirmed a support system is available. http://www.sfhsa.org/79.htm
When the Nevada Department of Health and Human Services first became aware of a single situation where staff did not follow policy, it immediately initiated several inspections and reviews. A review of all out-of-state transportation assistance was conducted which showed from July 1, 2008 through March 31, 2013, the hospital discharged 31,043 patients, of those 8% were non-Nevada residents. The facility purchased out-of-state bus tickets for 4.74% of its discharged population. Rawson Neal Psychiatric Hospital is located in Las Vegas which is reported to attract nearly 40 million visitors a year.
An in-depth review was conducted of all 1,473 (4.74% of all discharges) bus tickets purchased to determine if staff followed policy requirements. The findings show there were 10 instances in the course of 5 years where there was not enough documentation to know for certain if staff confirmed there was housing/shelter and supportive services at the destination. The hospital has since terminated medical staff. It has also strengthened its policy to require thorough documentation and require additional medical staff approval, as well as, approval from the hospital administrator. Furthermore, the policy now requires a chaperone accompany the client to his/her destination.
To date, Nevada Governor Brian Sandoval recommended and the Legislature approved an additional $30.4 million for the mental health budget. This funding will be used for such things as a new 24/7 psychiatric urgent care facility on the Southern Nevada Adult Mental Health Services campus, 22 additional inpatient psychiatric hospital beds on the SNAMHS campus, a new drop-in center for those in need of shelter, food, and treatment services during the day, and funds a mobile crisis team to tend to psychiatric patients seeking treatment in Vegas area hospital ERs.