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Greyhound Healthcare?

While many observers, both inside The Great Orange Satan and without, are gleefully eying the Nevada patient-dumping scandal because of its political ramifications to a Republican governor, the problem is greater than one hospital and it has been going on for a long time.

Out of sight, out of mind?
For those who think that this is only a Nevada and California problem, I suggest you check out this nifty interactive map from the Sacramento Bee that details where Southern Nevada Adult Mental Health Services in Las Vegas has sent over 1,500 patients in the last 5 years. That's right, 40 states and the District of Columbia. The most affected city by far was Los Angeles with San Diego, Phoenix, Salt Lake City, and Denver rounding out the top five.

Hell, this isn't even the first time that patient dumping has been a scandal in Las Vegas.

In 2004 in Southern Nevada, the state Health Division, which administers the federal law, investigated 14 complaints that the act had been violated and substantiated eight, said Lisa Jones of the division's Bureau of Licensure and Certification.
That was an increase from 2003, in which six complaints were investigated and three were substantiated, Jones said.
Rawson-Neal Psychiatric Hospital isn't even the only reported abuser in the past month. The problem affects the entire healthcare system in the United States. I'm sure it affects the healthcare systems of other nations as well but I am only one diarist with only so much time to research, write, and post.

Fortunately, in this case, the Centers for Medicare & Medicaid Services gave Nevada 10 days to correct problems at Rawson-Neal Psychiatric Hospital. The notice came in the form of a letter addressed to state of Nevada.

"If we do not receive an acceptable, timely submission, or if a resurvey finds that the hospital is not complying with any [conditions of participation], we will notify you that we are initiating action to terminate the facility’s Medicare provider agreement.”
So, one symptom of the greater problem has been addressed without taking any steps to cure the larger disease. How long until the story loses it's "legs" and patient dumping is relegated to our national blind spot? Will any politicians man the barricades for the mentally ill?

The First Study (1997)

Harvard University released a study in 1997 that examined "the interaction of the health care environment on hospital practices with regard to economically motivated transfers of psychiatric patients" based on "a national analysis of data from community health centers, hospitals and health care competition in various U.S. regions." The study found that two-thirds of the hospitals in the survey engaged in some form of patient dumping.

Some of you may see a hospital bed,
some of you may see a
revenue-generating device
rates of dumping "were higher in areas with higher competition among hospitals, more for-profit hospitals and relatively smaller public sector in-patient capacity. Such transfers involved psychiatric patients who were non-emergency, medically stable individuals."
Let's unpack that a bit: More patients get dumped when multiple hospitals are vying for a limited number of patient-dollars AND the public hospitals have a limited number of beds.
"Transfers disrupt continuity of care and creates (sic) a situation where patients are more likely to "fall through the cracks" of the treatment system," comments Dr. Dorwart [author of the study].
And there lies the rub. Sure the patients who were transferred or released were in stable, non-emergent condition. But what happens to those patients when they leave the hospital, whether or not they enter a public facility? Do they enter another hospital, see another physician, continue their medication, get any kind of assistance at all? Or, do they end up with a few days-worth of medication and a bus ticket out of state?

Los Angeles, CA Has Seen This Before


The area contains one of the largest stable
populations of homeless persons
in the United States.
In 2008, Steven Davis entered College Hospital in Costa Mesa, CA. He was diagnosed with schizophrenia, bipolar disorder, and schizoaffective disorder. Doctors prescribed him medication and the hospital then placed him in a van that drove 40 miles north to downtown Los Angeles.

Davis was left in front of the Union Recue Mission. After the Mission complained to the hospital, the van returned and left Davis in front of the New Mission Shelter. 

Davis never entered the facility but did make his way to California Hospital Medical Center. CHMC was able to track down his relatives and find a place for him in a "board and care" facility designed to accomodate mentally ill patients. Davis' journey prompted an investigation by the city attorney's office that lasted over a year and uncovered an alleged 150 cases of the College Hospital chain dumping mentally ill patients on "skid row" over a two year period.

One result of the investigation was the passage of an ordinance proposed by LA City Councilwoman Jan Perry. The ordinance requires that hospitals obtain written permission from a patient to deliver them to a location other than their home. Violation could result in a fine of up to $1,000 or three years probation or both.

As I mentioned above, LA is by far the most popular destination for the Nevada deportees. Watch this city closely as the current story unfolds.

"It's one of those things that resurfaces from time to time and you just have to be aware of it"

(Herb Smith, President of the Los Angeles Mission

NAMI, National Alliance on Mental Illness

National Coalition for the Homeless

Treatment Advocacy Center

Originally posted to Salted and Cured on Thu May 02, 2013 at 01:26 PM PDT.

Also republished by Community Spotlight.

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Comment Preferences

  •  Patient dumping is very illegal. (15+ / 0-)

    The loopholes some try to exploit to do it should be closed, and of course, as you point out, releasing patients without proper aftercare is a criminal reality of our for-profit health care system.

    What is truth? -- Pontius Pilate

    by commonmass on Thu May 02, 2013 at 01:41:51 PM PDT

    •  It's not illegal in every state (3+ / 0-)
      Recommended by:
      doinaheckuvanutjob, susanala, viral

      After Michael Moore's film "SiCKO" came out, I asked the N.C. insurance commissioner's office about the practice of patient dumping. They researched the issue and found there are no laws on the books here in North Carolina that prohibit care facilities from sending patients to other locations if the patients cannot afford in-patient care at that facility. Certainly the facilities are "expected" to find alternative care facilities to take the patients, but there's no state law that requires them to do so. And definitely no will on the part of many, many state governments to provide oversight.

  •  political ramifications to a Republican governor.. (2+ / 0-)
    Recommended by:
    gravlax, third Party please

    Puh-leeze.  Nevada is a libertarian paradise, and its attempts to dump the homeless out of state probably go over quite well with many of its residents.  

    And it's not just Republicans who are into outsourcing to Greyhound.  Rahm Emmanuel's doing his darnedest to expel people who are poor or of color from his city by letting their neighborhoods become unlivable from crime; every city within 120 miles of Chicago has their contingent of former Chicagoansl.  Gary, Indiana had an ingenious welfare program administered by Greyhound during the 80s -- they gave clients tickets to St. Paul, Minnesota.  New York City's exporting homeless, but being NYC it shows a measure of class by giving them airline tickets.  All of these cities have many claims to being of the Left.  Only Emmanuel faces/faced any sort of electoral consequence from these acts, and that only if his opposition doesn't fragment along angry lines of class, orientation and race.  

    "Politics should be the part-time profession of every citizen who would protect the rights and privileges of free people and who would preserve what is good and fruitful in our national heritage." -- Lucille Ball

    by Yamaneko2 on Thu May 02, 2013 at 03:30:15 PM PDT

    •  sorry I wasn't bi-partisan enough for you (5+ / 0-)

      Thank you for helping to make my point that it is a systemic problem, not a partisan one. Although, I'm not sure where I claimed that no Democrats were culpable.

      I chose that link, from your quote, very carefully to show that politicians were looking at this mostly as a political football. My point was that the issues here are larger than partisan politics.

      This issue, to me, is about a hell of a lot more than politics and that is what I was trying to write about.

      "when the going gets weird, the weird turn pro"

      by gravlax on Thu May 02, 2013 at 04:00:14 PM PDT

      [ Parent ]

      •  You are right (1+ / 0-)
        Recommended by:
        gravlax

        The Sacramento Bee is definitely continuing with their reporting on how the Nevada Governor has not wanted to deal with it until it blew up. And it will be a big issue when the elections happen. So it does have ramifications for him as Governor who just happens to be Republican.

      •  Your article was excellent. (1+ / 0-)
        Recommended by:
        gravlax

        My point was that even politicians who call themselves Democrats or even Progressives have few qualms about booting the homeless or poor over the state line.  

        This may not prove to be a scandal for the Governor of Nevada.  It may prove to be a viable strategy for re-election.

        "Politics should be the part-time profession of every citizen who would protect the rights and privileges of free people and who would preserve what is good and fruitful in our national heritage." -- Lucille Ball

        by Yamaneko2 on Thu May 02, 2013 at 11:07:01 PM PDT

        [ Parent ]

  •  This is a freaking STATE GOVERNMENT agency!? (2+ / 0-)
    Recommended by:
    gravlax, Flying Goat

    Helping the corporate owned "mental health" facilities while messing with citizens' lives???

    WTF?!?

    And the poeple bowed and prayed To the neon god they made...

    by third Party please on Thu May 02, 2013 at 05:00:19 PM PDT

  •  Well, a for-profit long-term facility in Arizona (5+ / 0-)

    effectively killed my husband's dad when his Medicare ran out...they finally got him transferred to a different facility where he died within days of pneumonia.  He had a huge bedsore and various other serious problems too.  And they have the gall to go after the estate for tens of thousands of dollars (more than the estate is worth).

    Republican threats amount to destroying the present if we don't allow them to destroy the future too. -MinistryOfTruth, 1/1/2013

    by sleipner on Thu May 02, 2013 at 05:03:03 PM PDT

  •  The news story reminded me of what I heard when (5+ / 0-)

    I was younger, about how different cities and counties in Southern Calif. would have homeless people taken across the city or county boarder and dumped. Sometimes by police.

    Now this was some time ago and I do not have the sources for that info but given that a number of homeless are also mentally ill this dumping of people has been going on for some time. The really insane part of the Nevada problem is the fact that some of these people have family who were not notified.

    Which takes it a step further than just someone who is insane and alone.

    None of it should be happening but it's one of those things that gets passed off as someone else's problem. Let someone else deal with it.

    Also kind of scary that Grayhound had no problem with doing it. Just wonder what it could have cost them if a patient lost it on one of their buses.

    I wish there was more of an emphasis of helping each other in our society instead of "money is the most important thing in the world, more important than people" attitude.

  •  This type of thing has been going on for decades, (0+ / 0-)

    unfortunately.  I remember hearing years ago that people with mental issues out east would be given bus tickets to Iowa City, Iowa because of the State Hospital there.  There was/is some law/licensing thing in the State of Iowa that made it very difficult to 'return' the patients and therefore due to their indigent status, had to be cared for.  How true this is, I've no idea, it's something that I've heard some of the 'older' nurses at that hospital say.

  •  Treat em and street em. (5+ / 0-)

    Actually, this is largely a direct result of the extent of the current laws on the minimum amount of care hospitals are required to give under the Emergency Medical Treatment and Labor Act (EMTALA).

    Most hospitals (not VA or Shriners or a few others) are required to provide emergency care only under the law, and once they've stabilized you, can essentially kick you to the curb, even if they know that with the little they've done, you might be likely to destabilize again almost immediately.  And because it's more work and less money for them to provide even that little amount of service, it's essentially incentivized to try and position indigents they've 'streeted' where they're more likely to end up 'SEP' - somebody else's problem.

    There really is a simple solution.  Universal single payer healthcare, including health treatments aimed towards improving chronic problems, not just emergency healthcare.

    •  Followup care is minimal. There are, here and (0+ / 0-)

      there, some institutions for that or provisions, far and few between.

    •  How we will ever as a society arrive at SPUHC (0+ / 0-)

      I have no idea.

      We did elect a man who gave us hope, and he had a mandate. But he quickly learned that the only way his bread will be buttered was if he teamed up with the likes of Rahm Emanuel. And that folks, was the end of "Health Care Reform."

      By the middle of August 2009, Rahm had Obama sputtering such nonsense as "The public option is only one tool in a whole tool box of options." And then Obama would go on to say that due to how "The United States has an uniquely American approach to health care, that involves including the insurance companies int eh equation," and Blah Blah Blah, so  we cannot actually eliminate the health care insurers from the equation because Blah Blah Blah.

      In other words, the element in our society that was the main obstacle to having decent health care, the Big Insurers, had to be included in the "reform."

      Offer your heart some Joy every day of your life, and spread it along to others.

      by Truedelphi on Fri May 10, 2013 at 05:24:49 PM PDT

      [ Parent ]

  •  When I lived in CT (& likely still) (0+ / 0-)

    police from the surrounding towns would drive homeless people to downtown New Haven and leave them there.  The "explanation" was that New Haven had the facilities to help them while Guilford, etc., did  not.  

    “If you can't be a good example, then you'll just have to be a horrible warning.” - state motto of Fitzwalkerstan

    by non acquiescer on Fri May 03, 2013 at 12:31:14 PM PDT

  •  Homeless due mostly to mental illness? (1+ / 0-)
    Recommended by:
    gravlax

    Aren't mentally ill a subset of the homeless?  Or, are most homeless also mentally ill?  

    This is an excellent article and breaks my heart.  Where are the resources and networks to help folks when they are old, sick or mentally ill?  If support services don't exist, how do we design them for our cities and communities?  What does it take?

    Once I tried to make a difference by giving a homeless guy a job.  The experience made me realize just what a snobby, priviledged, entitled group of people I am surrounded by.  After several weeks he stopped coming to work but he told me he really appreciated the opportunity.  It is difficult to bridge the gap of different life choices, different mental health and how we can make a real difference.

  •  But while Calif cities are opposed to the fact (0+ / 0-)

    That Las Vegas hospitals are bussing their indigent patients into their city, they have nothing against letting hospitals dump the person who insurance is running out  onto the sidewalks of LA, IV bags and wheelchairs and all.

    An individual has more regulations they must conform to when building a small white picket fence around their property than the average hospital has in terms of dealing with patients.

    (Actually there are laws aplenty, but no one seems to be enforcing those laws.)

    Offer your heart some Joy every day of your life, and spread it along to others.

    by Truedelphi on Fri May 10, 2013 at 05:28:39 PM PDT

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