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Las Vegas patient busing controversy prompts policy changes

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Updated: 10/31/2013 11:18 am

CARSON CITY, Nev. (AP) — The governor's office says Nevada will now require chaperones for all state psychiatric patients who are bused out of state.

A spokeswoman for Gov. Brian Sandoval tells the Las Vegas Sun that the move is part of new strengthened procedures.

They come in the wake of reports that Rawson-Neal Psychiatric Hospital in Las Vegas sent 1,500 discharged mental health patients alone on one-way bus trips in recent years.

A review of Nevada's policies was prompted by a series of stories in the Sacramento Bee about Nevada patients being given bus tickets and sent to other states. Officials in California have called for an investigation.

The Sun reports Nevada also will require two physicians instead of one to sign a discharge. A hospital administrator must approve the decision.

At least two Rawson-Neal hospital staff members have been disciplined following allegations that the psychiatric hospital was practicing patient dumping, according to the Las Vegas Sun. But state officials say the policy was a way to provide discharged patients a way to get back to their hometowns.

However, after reviewing its records of patients being shipped out of Nevada, the state says as many as six cases were found where policy was not followed. Now, everything from patients being accompanied to their final destination, to nixing the busing policy altogether is on the table for the Department of Health and Human Services as they figure out their next step.

Rawson Neal Hospital is accused of shipping discharged patients out of state with no help waiting to meet them. It's a concern Dr. Robert Horne of the Nevada Psychiatric Society says is still present as he reviews the Rawson Neal Psychiatric Hospital busing policy.

“We can't guarantee the patient discharged from the hospital will take their medication,” Horne said.

Many patients who leave the hospital comply with their discharge plan which usually includes taking their medication and heading back to their final destination. But others don't, and if no one is waiting for that discharged patient at their final destination, it could mean significant problems.

“[Patients could be] arrested and spend months in our jails and prisons, or they'll re-hospitalized,” Horne said.

That's what started this whole controversy: the hospital bussed a patient to Sacramento with no help waiting to meet him. This instance is why Horne says it makes sense the department of health and human services would consider requiring escorts for discharged patients who are sent back to their destination.

Several investigations are underway of more than 1,500 cases of patients shipped out of Nevada to all parts of the country since 2008.

Gov. Sandoval put out a statement saying additional oversight of discharge policy was put into place. The policy requires two doctors must sign off on a discharge, and a hospital administrator must approve the decision.

Dr. Horne offered another suggestion for state health officials:

“Have the patient sign a release of information so health facilities homeless shelters might be contacted,” Horne said. “Under HIPAA law, they can't be contacted unless patient gives permission”

That permission may ensure every single patient will have the help and support they need once they get to their destination from Rawson-Neal hospital.

This isn't the first time the hospital staff was caught in controversy. Last year an audit of the hospital revealed doctors did not work their full shifts back in 2009, costing taxpayers $2 million.

“The ethical thing to do of course is to stay and work all the time that you've committed to working and you're paid to work,” Horne said, adding that quality of care requires doctors actually present and policy followed correctly.


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