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Some Losing Jobs Amid Alleged Nevada Patient Dumping

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From the Office of Governor Brian Sandoval

Governor Brian Sandoval today issued the following statement on further disciplinary action taken at Rawson-Neal based upon internal investigations of patient discharges.  Late last week, the Nevada Department of Health and Human Services concluded a review of all out of state transports between July 2008 and March 2013:

"Over the weekend, I reviewed the results of the investigation into patients transported out of state.  All individuals who violated release policies have been or will be disciplined.  These disciplinary actions include terminations effective today.  While the investigation showed the vast majority of patient releases were done correctly, it also revealed policies were not followed by certain individuals.  I will continue to evaluate the need for further action if necessary.

"In addition, we have obtained proposals from national experts in the mental health field to provide an objective and comprehensive analysis of our state facilities to ensure that best practices are being implemented and followed.  As I have stated before, improperly discharging one patient is one patient too many.  It is important to me and all Nevadans that we treat our most vulnerable members of society with dignity and care." 

BACKGROUND:
Today's action comes after a full review of the roughly 1500 patients who were transported out of state since July 2008. In addition to the actions taken today, state-wide discharge policies for patients transported out of state have been strengthened, and a formalized chaperone policy has been instituted.

From the Office of Governor Brian Sandoval

State Democrats released their own statement that said, "given that almost every assertion made by the Sandoval Administration on patient dumping has later proven to be false, this self-policed 'report' has as much credibility as Rawson-Neal does on the proper discharge of patients."

The Sacramento Bee newspaper recently reported that Nevada's primary state psychiatric hospital has transported more than 1,500 patients by Greyhound bus over a 5-year period to various cities nationwide.

The issue has been under scrutiny since February when one Rawson-Neal patient turned up suicidal and confused at a homeless complex in Sacramento, where he knew no one and had never been before.

Nevada Department of Health and Human Services Director Mike Willden categorically denies the state of Nevada is "patient dumping" due to budget cuts and said he's offended by that characterization.

From the Nevada Department of Health and Human Services

As has been previously made public, the transportation policy at Rawson-Neal Psychiatric Hospital has been strengthened to now require multiple medical staff and hospital administrator review and approval prior to granting out of state transportation for clients which require tickets purchased for transportation out of state. Furthermore, the transportation policy has been formalized and chaperones are now required to accompany each discharged client receiving transportation ticket assistance out of state.

Of the 1,473 unduplicated instances of clients receiving ticket purchased for out of state transportation, there are 10 instances where insufficient documentation makes it difficult to know for certain that staff confirmed there was a support system/family/friends/housing at the destination. This information indicates that more than 99% of the time staff followed the discharge policy and documentation was accurate and complete.

In the 10 cases identified, 9 were admitted with substance abuse issues as their primary diagnosis and discharged directly from the Patient Observation Unit without the need for inpatient hospital admission.

Upon identifying these 10 cases, the following actions have occurred:
• There were 9 Rawson Neal medical staff responsible for discharge plans with insufficient documentation.
• Of the 9 medical staff, 4 are no longer employed with Rawson Neal Hospital. 
• Of the remaining 5, 2 have been terminated and 3 will receive further disciplinary action as indicated.

Here is supplemental information to the news released today by the Governor's office:

• During a period of five years, 31,043 people were admitted to the Rawson Neal Psychiatric Observation Unit.
• Of the 31,043 individuals, 92% were Nevadan.
• Of the 31,043, we initially identified 1,508 instances of individuals who received tickets purchased for out of state travel.

After a review of each of the 1,508 instances, our findings show:
• There were duplicates in the initial number so the final total of individuals who received tickets purchased for out of state travel is 1,473.

In each of these cases we reviewed the following:
• Did staff follow the "Client Transfer Back to Home Communities" policy? (Current and previous policies are available upon request).
• What was this person's diagnosis at the time of admit?
• What was this person's diagnosis at the time of discharge?
• Was this person discharged from the Psychiatric Observation Unit or discharged from the inpatient services of Rawson Neal Hospital?

Regarding how much federal funding Rawson Neal Psychiatric Hospital receives – FY12 Actual Revenue from Medicare was $3,818,082; Revenue from General Fund was $32,522,017.

From the Nevada Department of Health and Human Services

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