Tradition

Sacramento Bee reports on Nevada mental health practices have sparked a series of probes.

The U.S. Centers for Medicare and Medicaid Services, Los Angeles and San Francisco city attorney offices, and an Illinois-based hospital accreditation body known only as the Joint Commission have all opened inquiries.

In a package of reports, the Bee found that Rawson-Neal in Las Vegas, Nevada’s leading psychiatric hospital that previously enjoyed a sterling reputation, had been putting patients—1,500 of them over a five-year period—on buses and sending them out of state. The Bee investigation was prompted by the case of James Flavy Coy Brown, a patient who was sent to Sacramento on a bus with a three-day supply of medication, four bottles of Ensure and some crackers. Brown had no connection with Sacramento and knew no one there.

“In recent years, as Nevada has slashed funding for mental health services, the number of mentally ill patients being bused out of southern Nevada has steadily risen, growing 66 percent from 2009 to 2012,” the Bee reported. “During that same period, the hospital has dispersed those patients to an ever-increasing number of states. By last year, Rawson-Neal bused out patients at a pace of well over one per day, shipping nearly 400 patients to a total of 176 cities and 45 states across the nation.”

Former state assemblymember and senator Sheila Leslie (now a columnist for this newspaper), who watched many of the fights over mental health funding, said when she first heard of the Bee series, she reserved comment until she could get more information on numbers and the rate of the problem.

“I think it’s shocking, actually, that apparently the protocol’s deteriorated to—we don’t really know the extent. I’d want to know more about how many there were.”

Now, having obtained more information, she said she’s dismayed by what is going on—but less than surprised.

“Now that I’ve read the whole story, that makes it pretty apparent that there’s a significant problem. I understand the desperation that some of the state mental health workers have, given the resources they have to work with. It is inexcusable, but I understand it.”

She added that the problem is not just in Las Vegas: “There’s nothing for these people in Reno.”

The news of the patient exodus is in keeping with three Nevada traditions—the low priority of mental health in state budgeting, the practice of moving human problems out of jurisdictions, and of acknowledging problems that were exposed by sources outside the state.

Mental health has long been a sort of flexible joint in the state government budget, reduced when needed to accommodate other purposes. During the 1991-1992 recession, Gov. Robert Miller cut mental health sharply, to the point that some critics blamed him for specific violent incidents involving the mentally ill.

Although Nevada became a state in 1864, not until the 1880s was an asylum built and put into operation. Instead the state housed patients at a facility in Woodbridge, Calif., for $7 a week.

In 1955, Colliers magazine reported, “Nevada hasn’t a single mental health clinic, although the mental illness rate there is probably at least as high as in the rest of the country. … It wasn’t until two years ago that the state belatedly inaugurated some kind of mental health program.” The state employed only two psychologists, one of whom told the magazine, “It is pitiable to see so many cases, especially of emotionally disturbed children, and not be able to offer them effective help.”

In 2001, the New York Times reported on its front page, “Pick almost any index of social well-being, and Nevada ranks at or near the very bottom of the 50 states, though it ranks near the top in personal wealth. Besides having the highest suicide rate … a long legacy of low-tax, libertarian government, rural isolation and a steely tradition of self-reliance have combined with a population growth of more than 60 percent in the last decade that has left little sense of community to create a huge range of challenges to the state’s mental and physical health.”

Moreover, there have been unspoken policies of dealing with problems through avoidance. When he was mayor of Sparks, Bruce Breslow said his town should not have to participate in creating an area homeless shelter because Sparks dealt with its homeless by driving them to Reno, confirming a long-rumored practice. In 1988, Reno police officers Guy McKillip and Milton Perry were arrested for allegedly taking a blind, intoxicated man 30 miles out of town and abandoning him alongside Interstate 80.

But then, in 1999, Kenny Guinn became governor and recommended substantial increases in mental health funding, eventually achieving an increase in excess of 300 percent. It was the only period of robust treatment for the mentally ill in state history. But it did not last. The period described by the Bee corresponds more or less to two relevant developments. One is the recession. The other is the governorship of Jim Gibbons,who slashed mental health funding and whose fiscal policies were then embraced by his successor, Brian Sandoval. Gibbons recommended severe cuts, with the small counties particularly hard hit. Lawmakers resisted some of Gibbons’ recommendations, but he still had plenty of impact. Nevada appeared to be back in its traditional mode of minimal involvement in the problem.

The Sacramento Bee has long covered “greater Sierra” news not directly connected with Sacramento itself. In 1935, the Bee received the first Nevada Pulitzer Prize for a series of reports by Arthur Waugh on political influence in the selection of two Nevada federal judges. The Reno Evening Gazette buried the story on page 7 and then—18 days later—denounced the award in an editorial. It was not the first or last time locals trivialized state problems because they were described by outsiders.

Some in-state mental health critics held their fire after the busing reports were published because state health and human services director Mike Willden is widely respected. “Policies were not followed,” Willden told a legislative committee. “We own it in this case. We blew it. We’re taking corrective action.”

A statement by his department was released: “When the Department of Health and Human Services became aware of an incident where policies were not followed, we immediately initiated an investigation. As a direct result of the investigation, a more rigorous review and approval process for patient discharge is now in place.”

The critics were more inclined to criticize state lawmakers who went along with some of Gibbons’ cuts, knowing that the current Legislature is unlikely to be able to do much to solve the situation this late in the 2013 legislative session. Las Vegas columnist J. Patrick Coolican called on Gov. Brian Sandoval to call “a special session of the Legislature this fall to address mental health.”

But others, including some former state mental health officials, excoriated the state for the scandal. And for those not impressed by the ethics at issue, there were other reminders of the consequences of Nevada’s reputation.

“When you’re trying to relocate businesses into the state, I mean, normally the lifestyle issues are important in terms of persuading their employees, their top level management to come, and that has been an issue for us for a long time,” said former Gov. Richard Bryan.

Just as information reported by Colliers and the New York Times helped build Nevada’s reputation for a poor quality of life, the Bee reports are now seeping into the nation’s bloodstream. They have been picked up by Fox News, USA Today, Equities.com, LiveScience.com, ThinkProgress, GOPUSA, Allgov.com, and innumerable newspapers and broadcasts served by the Associated Press. The original stories, distributed by McClatchy News, have appeared in newspapers from Boise to Green Bay.

State officials laid low and did not encourage additional news coverage. Neither the governor’s office or the state Health and Human Resources Department posted statements reacting to the situation on the news release pages of their websites, and Gov. Brian Sandoval had little to say except through a spokesperson. When a Las Vegas television station got an interview with him and asked him about a “policy” of busing patients, he said, “I disagree with the premise of the question. … If there is a problem, we’re going to correct it.”