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San Francisco sues Nevada over alleged patient dumping


By Joe Carlson
Posted: September 10, 2013 - 7:00 pm ET
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In a class-action lawsuit, the city of San Francisco claims Nevada state-hospital officials secretly bused hundreds of homeless patients from a psychiatric hospital to California, sometimes with little more than a few days' worth of pills and instructions to call 911 on arrival.

The lawsuit, filed in superior court in San Francisco (PDF), says officials at Nevada's Rawson-Neal Psychiatric Hospital in Las Vegas bused more than 1,500 patients to hospitals around the country, including 500 who were sent to California even though they were not California residents. Nevada officials failed to tell anyone in California that the patients were coming via Greyhound bus, or arrange for their future care, the suit claims. And some quickly landed at hospitals in California.

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The CMS investigated the Rawson-Neal transportation program and concluded in May that there was evidence the hospital had violated federal law on how patients can be discharged from the hospital, the lawsuit and published reports say.

But Nevada officials claim that many of Rawson-Neal's patients were California residents, and that Nevada taxpayers were picking up costs that should have been shouldered by California.

Between 2008 and 2013, San Francisco received 20 patients from Rawson-Neal who required medical care shortly after arrival. The city spent about $500,000 on the patients at its hospitals and clinics, and is seeking repayment of that amount plus a permanent injunction against similar patient dumping, on the legal theory that the cities are being harmed financially by the alleged patient dumping.

In one case, according to the suit, an unnamed patient with a history of psychosis, schizophrenia and suicidal/homicidal ideation was sent from Rawson-Neal to the Greyhound bus terminal in San Francisco three times within 13 months. The lawsuit says the patient told officials at San Francisco General Hospital that he tried to get a gun with the intention of killing himself and others, but decided to seek mental health instead after failing to secure a firearm.

A spokeswoman for the Nevada attorney general's office said the lawsuit had not yet been served, so state officials could not directly respond.

But a Sept. 9 letter from the Nevada attorney general's office to San Francisco City Attorney Dennis Herrera defended Rawson-Neal's patient transfers as legitimate, according to files provided to the city by HHS: “We believe that the records that DHHS provided demonstrate that the policies are appropriate and that proper discharges were made.”

In its suit, the city asked to be certified as the lead plaintiff in a proposed class-action lawsuit on behalf of other California cities with similar grievances involving Rawson-Neal patients. That would require a judge to certify that other members of the class of cities had substantially similar claims as San Francisco's.

“It's my hope 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,” Herrera said in a news release.

According to the CMS investigation, 445 of Rawson-Neal's 2,402 out-of-state discharges were California residents who spent an average of 18 days each in inpatient care in Las Vegas since 2008.

“Therefore, it could be argued that using the average cost of services in the Rawson-Neal Hospital of $653 per day, the taxpayers of the state of Nevada have subsidized the state of California over $6.2 million during the same period,” says Nevada's Sept. 9 letter from Chief Deputy Attorney General Linda Anderson. “Both California and Nevada are financially impacted by the travel of individuals with mental illness between our states.”

Follow Joe Carlson on Twitter: @MHJCarlson


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