CMS Investigation Finds 'Systemic' Problems at Nevada Mental Hospital

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On Wednesday, CMS reported "systemic" problems that compromise the safety of discharged patients at Rawson-Neal Psychiatric Hospital in Las Vegas, which has been accused of busing patients with mental illnesses to cities in California and other states, the Sacramento Bee reports (Resse, Sacramento Bee, 5/9).

Details of Rawson-Neal's Practices

According to a 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 the psychiatric hospital 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, including:

  • 200 who arrived in Los Angeles County;
  • 70 who arrived in San Diego County; and
  • 19 who arrived in Sacramento.

Last month, city attorneys for Los Angeles and San Francisco announced formal investigations into Rawson-Neal's practices. In addition, the Joint Commission -- an independent, not-for-profit firm that accredits hospitals -- also launched an investigation of the hospital.

Nevada's Response to Criticisms

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 to approve a discharge order for a patient. In addition, the discharge of a patient now must be approved by a hospital administrator.

Nevada officials also said that, effective immediately, a chaperone must accompany any patient with a mental illness discharged from state facilities and sent to locations outside of Nevada.

In addition, Nevada officials said that two employees at Rawson-Neal have been fired and another three were disciplined following an internal investigation that found 10 cases in which patients might have been placed on buses without family or treatment contacts at their destination (California Healthline, 5/1).

Details of CMS Investigation

The CMS investigation stemmed from a complaint that Rawson-Neal in February discharged a homeless man with schizophrenia and depression and sent him via bus to Sacramento without making arrangements for treatment or housing.

CMS conducted a survey based on a sampling of 30 patient records and found multiple instances in which the hospital did not meet patient safety benchmarks required for receiving federal Medicare funding.

The agency said, "The cumulative effect of these systemic practices resulted in the failure of the facility to deliver statutory mandated care to patients."

In its formal response to CMS, Rawson-Neal submitted a detailed corrective action plan. According to the plan, the hospital has implemented a "100% review" of every patient discharge to locations in other states. Hospital officials also said that they have reviewed and updated all discharge and medication consent policies.

CMS Launches Second Investigation

Rufus Arther -- director of hospital operations for CMS' western region -- said that, considering the concerns raised about Rawson-Neal, the agency has launched a second investigation of the hospital's policies and practices.

According to officials, the ongoing investigation will determine whether Rawson-Neal has violated the federal Emergency Medical Treatment and Active Labor Act, which restricts hospitals from refusing treatment to a patient during an emergency because of the possibility of high costs (Sacramento Bee, 5/9).

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