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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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