City Attorney Dennis Herrera filed a class action against the State of Nevada on behalf of California local governments to which indigent psychiatric patients were improperly bused from the state-run Rawson-Neal Hospital in Las Vegas. The lawsuit filed on Sept. 10, 2013 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's Attorney General 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.
In filing the suit, Herrera said: "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. 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."
Because of the widespread public interest and large number of public records requests from members of the news media and public about this case, the City Attorney's Office has created this page to aggregate available public records related to the case.
S.F. City Attorney presskits and documents
(In reverse chronological order)
- PDF presskit for: "Herrera files class action suit against Nevada over 'patient dumping' practices, expenses; City Attorney follows through on litigation threat to seek statewide injunction, restitution for S.F.'s costs for care of improperly bused non-residents" (Sept. 10, 2013)
- PDF presskit for: Herrera vows class action lawsuit over Nevada 'patient dumping' scandal; Silver State can avoid litigation, according to demand letter, with commitment to reimburse California localities for costs, adopt strict mental health protocols (Aug. 20, 2013)
- PDF presskit for: Herrera launches investigation into Nevada's psychiatric 'patient dumping'; S.F. health and homeless services providers invited to assist in gathering evidence from others victimized by practice, which bused 1,500 patients out of Nevada in five years (April 22, 2013)
U.S. Centers for Medicare & Medicaid Services records
(In reverse chronological order)
- PDF of U.S. CMS letter to Southern Nevada Adult Mental Health Services re: Survey Report on Special Conditions for Psychiatric Hospitals, concluding that provider "is not in compliance with the applicable Conditions of Participation for a provider of psychiatric hospital services in the Medicare program..." (Sept. 5, 2013)
- PDF of U.S. CMS letter to Southern Nevada Adult Mental Health Services re: EMTALA (Emergency Medical Treatment & Labor Act) enforcement, notifying Nevada of multiple violations and serving notice that "[i]f the cited deficiencies are not corrected, we may terminate your participation in the Medicare program." (Aug. 8, 2013)
- PDF of U.S. CMS letter to Southern Nevada Adult Mental Health Services re: Full Validation revisit survey, which "demonstrated instead that the hospital remains out of compliance" with conditions for Medicare participation, and that the facility "was also found not in compliance with the provisions of the National Fire Protection Association's Life Safety Code." (Aug. 8, 2013)
- PDF of U.S. CMS Survey Report on Special Conditions for Psychiatric Hospitals, noting a pattern of failures in "treatment plans that do not identify individualized expected patient outcomes in a manner that can be utilized by the treatment team to measure the effectiveness of treatment and or progress towards discharge." (July 26, 2013)
- PDF of U.S. CMS Full Validation Revisit Survey, which identifies multiple clinical and procedural deficiencies dealing with psychiatric patients, together with provider's plans for corrective actions and Nevada's Aug. 16, 2013 response. (June 20, 2013)
- PDF of U.S. CMS Medicare Life Safety Code Survey identifying deficiencies together with provider's plans for corrective actions. (June 14, 2013)
- PDF of U.S. CMS EMTALA (Emergency Medical Treatment & Labor Act) Survey and Statement of Deficiencies, which found that the facility failed to ensure that numerous "sampled patients received the necessary discharge instructions to secure aftercare services identified by the treatment team to prevent worsening of the psychiatric condition" and other deficiencies. Includes response from Southern Nevada Adult Mental Health Services (May 9, 2013)
- PDF of U.S. CMS Complaint survey and statement of deficiencies cover letter, noting that Southern Nevada Adult Mental Health Services did "not comply with...Conditions of Participation" that include discharge planning. (April 25, 2013)
- PDF of U.S. CMS Complaint survey and statement of deficiencies finding that allegations of "unsafe discharge of patients was substantiated through observation, document review, clinical record review and interviews with facility staff." Includes Nevada's plans for corrective actions. (March 20, 2013)
State of Nevada records
(In reverse chronological order)
- Independent Consultant's Report, performed for the Nevada Department of Health and Human Services, which notes that: “Many hospital staff persons told us that they have long felt under pressure to move patients out of the hospital as quickly as possible to free up beds for other individuals in need of admission.” (May 23, 2013)
- Nevada Department of Health and Human Services Director’s press release on Independent Consultant's Report, characterizing the “doctors’ positive findings and meaningful recommendations.” (May 23, 2013)
- Nevada Department of Health and Human Services, Internal Review of Out of State Travel: Summary of Findings, noting improvements in Rawson-Neal's transportation policy. (April 29, 2013)
- Nevada Bureau of Health Care Quality and Compliance (NBHCQC) report, finding that “the allegation regarding unsafe discharge of patients was substantiated through document review, clinical record review and interviews with facility staff.” Includes Rawson-Neal's stated plan of correction. (March 20, 2013)
Many of the following documents were obtained through City Attorney Herrera's public records requests as part of his office's investigation, including his office's initial public records request of April 22, 2013.)
- Response from Office of the Attorney General, State of Nevada. (April 25, 2013)
- All Greyhound Bus receipts for Rawson-Neal's discharged patients to out-of-state locations since July 2008.
- Documentation responsive to San Francisco's request for information about discharged patients from psychiatric and mental health services facilities under Nevada's control since July 2008 (redacting personal information on patients or clients as required by law). Copies of citations imposed by state or federal regulatory bodies on mental health, psychiatric, psychosocial rehabilitation, substance abuse, and co-occurring disorders programs and facilities under the control of the Nevada Division of Mental Health and Developmental Services, including appeal documentation and Plans of Correction submitted in response to such citations since July 2008 (redacting personal information on patients or clients as required by law).
- State of Nevada, Office of the Controller, Budget Status Reports: FY 2009-2013
- Copies of current licenses to operate for mental health, psychiatric, psychosocial rehabilitation, substance abuse, and co-occurring disorders programs and facilities under the control of the Division of Mental Health and Developmental Services.
San Francisco requests for which Nevada had no responsive documents
The following requests from City Attorney Herrera's letter of April 22, 2013 produced no responsive records from the State of Nevada.
- Copies of any reciprocal agreements from July 2008 to date between the Administrator of the Nevada Division of Mental Health and Developmental Services on the one hand, and any board; commissioners or officers of the State of California, on the other hand, for the mutual exchange of consumers confined in, admitted or committed to a mental health or mental retardation facility in one state whose legal residence is in the other, as authorized by Nevada Revised Statutes § 433.444.
- Copies of records of written permission given by any board, commissioners or officers of the State of California for the return to California of any consumer confined in, admitted or committed to a mental health or mental retardation facility in the State of Nevada, from July 2008 to date (redacting personal information on patients or clients as required by law).
- Copies of any records of approval of the Administrator of the Nevada Division of Mental Health and Developmental Services of the transfer of any non-resident of Nevada confined or admitted to a Division facility to the State of California pursuant to Nevada Revised Statutes § 433.444, from July 2008 to date (redacting personal information on patients or clients as required by law).
ACLU of Nevada litigation against Rawson-Neal Psychiatric Hospital
The American Civil Liberties Union of Nevada and Sacramento civil rights attorney Mark Merin filed a class action lawsuit against Rawson-Neal on June 11, 2013. The named plaintiff in that litigation is James Flavoy Brown, whose busing to Sacramento was exposed in a series of reports by the Sacramento Bee.