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September 1, 2014

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Man’s journey to California casts a pall on Nevada’s mental health system

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Renee C. Byer / Sacramento Bee

James Flavy Coy Brown, 48, is addicted to smoking his pipe and consistently asks over and over for more tobacco as he waits for his morning medicine to be delivered. He now lives at the Home Sweet Home boarding house in Sacramento after a harrowing journey from a mental hospital in Las Vegas.

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James Flavy Coy Brown loves the leather couch where he often watches TV at the Home Sweet Home boarding house in Sacramento. He was released from a Nevada state psychiatric hospital in February, with only three days medication and a one way bus ticket to Sacramento, where he knew no one.

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James Flavy Coy Brown, left, begs Home Sweet Home boarding house owner Joy Ubungen, right, for more sugar in his cereal.

SACRAMENTO — By the time his Greyhound bus hissed to a stop on Richards Boulevard in Sacramento on the morning of Feb. 12, James Flavy Coy Brown was in a mild panic.

It was 6:30 a.m., 15 hours and 11 stops after a taxi had scooped him up in front of Rawson-Neal Psychiatric Hospital in Las Vegas, where he had spent the previous 72 hours, and deposited him at a bus station.

During the long ride to Northern California, Brown had rationed the peanut butter crackers and Ensure nutritional supplements that a staff member at the mental hospital had given him, along with his discharge papers and a bus ticket to Sacramento. His food was gone, and he was nearly out of the medication to treat his array of mood disorders, including schizophrenia, depression and anxiety.

As the bus door opened in Sacramento, Brown, 48, stepped out into the pre-dawn gloom. It was 30 degrees, and his windbreaker was no match for the chill.

Brown, a native of the American South with a distinct accent and a healthy head of salt-and-pepper hair, had arrived in the capital city with no concrete plan for survival. He had no friends or relatives in Sacramento. He had lost his ID, Social Security and insurance cards somewhere in Las Vegas. He had no idea how to fill the prescriptions that helped tame the voices and anxiety that clouded his mind.

He wondered if he was destined to die on the streets of this strange new city.

Scanning the landscape, he spotted a nearby police station. Desperation drove him inside.

“Can you help me?” he asked.

Brown’s odyssey to Sacramento has raised questions about Nevada’s treatment of mentally ill people.

Advocates for the mentally ill in California, including state Senate President Pro Tem Darrell Steinberg, call it a disturbing case of patient dumping. The federal government and Nevada authorities are investigating whether the incident is part of a broader pattern of abuse.

Preliminary reports suggest that Nevada has made a habit of discharging mental patients by bus to other states. Rawson-Neal, the state’s primary hospital for mentally ill people, bused about 100 state psychiatric patients to California between July 1, 2012, and the end of February, and scores more to other states, according to data provided by Nevada health authorities.

Nevada officials admit busing Brown to California with no arrangements for his housing or care but contend it is not common practice.

“I don’t think you’re going to see discharges like that again,” said Michael Willden, Nevada’s chief of Health and Human Services. “It’s an embarrassment to us.”

They also acknowledge that, as budget cuts have shrunk and shuttered government mental health programs across the country, it is becoming increasingly difficult to find housing and supervision for severely mentally ill men and women.

The Sacramento Bee first wrote about Brown last month, based on interviews with homeless services workers who tried to help him before he disappeared into Sacramento’s streets. Recently he contacted the Bee and agreed to an interview at the boarding home.

Brown was soft-spoken and polite as he sat on a patio, sipping bottled water and answering questions about the latest chapter of his lifelong struggle with mental illness. He repeatedly referred to a reporter as “Ma’am” and occasionally burst into childlike giggles when discussing the troubles that have followed him since childhood.

“Maybe my story will help someone else,” he said.

Brown’s memory can be faulty, and details of some portions of his life are fuzzy. Some of the stories he tells about his background are fantasy, a product of his illness, according to relatives the Bee tracked down. But several hospital and social services officials have confirmed what he recounted about what has happened to him since he landed in Sacramento.

Brown’s experience starkly underscores gaps in the public health care system that plague mental patients across the country, advocates say, including a lack of suitable housing and crisis intervention care.

His Sacramento saga began in early February shortly after he landed in Rawson-Neal. Although his hospital discharge papers list his place of residence as Catholic Charities of Las Vegas, Brown said his last real home was a small group facility that shut down.

According to a state investigation, he spent 72 hours in the hospital’s observation unit before a doctor discharged him to a Greyhound bus to Sacramento. The discharge orders noted he should be given a three-day supply of Thorazine, Klonopin and Cymbalta to treat his schizophrenia, anxiety disorder and depression, plus “Ensure and snacks for a 15-hour bus ride.”

Brown said a doctor at Rawson-Neal told him to dial 911 when he reached Sacramento.

“But I don’t want to go anywhere,” Brown recalled telling the doctor. “Is this the only option I’ve got?”

He said the physician told him that Nevada had no place for him.

“Pick a state,” he said the doctor told him. “How about sunny California? They have excellent health care and more benefits than you could ever get in Nevada.”

The doctor, Brown said, then shook his hand and wished him luck in Sacramento.

His sense of the situation, Brown said, was: “If I hadn’t left then, I might have had to stay in that hospital for a long time. At least I got my freedom.”

Willden declined to discuss Brown’s case in detail because of patient privacy laws. But in general, he said, Brown’s account does not reflect hospital policy.

“I don’t think we would ever tell a patient, ‘There is no room at the inn and you’re getting on a bus,’” he said.

Brown’s discharge notes included that he had mentioned a desire to go to California, according to the state investigation.

Upon his discharge to the bus station, Brown said, he spotted four other people with whom he had lived at his former group home. All had been sent to Rawson-Neal when the home closed, he said.

“Hey, Ralph,” Brown recalled calling out to one of the people. “What are you doing here?”

“He told me, ‘I’m going to California.’

“I said, ‘Gee, they just put us all in separate cabs to send us to California? What’s going on here?’”

•••

The Greyhound discharge, Brown said, was not the first time he had been cast adrift. He said he has felt that way most of his life.

He was born in Anderson, Ind., to parents unable to care for him, according to family. A couple adopted him when he was a toddler and he spent his early life in Seneca, S.C.

There, when he was about 20 and working as a cook at a local hamburger joint, he met and married a cashier at the restaurant. Her name was Sandy. She called him Jamie.

“I was young and naive, and I didn’t realize the problems he had,” said the former Sandra Brown. Remarried with the last name Bandy now, she spoke by telephone from her home in Virginia.

Shortly after she married Brown, she said, she started to become concerned about his mental state. She learned that he heard voices and that animals told him to do bad things. He once killed a family cat he believed to be evil. He began drinking heavily.

“He had been in a mental health facility before, and in jail,” Bandy said. “He had a temper.”

She said she helped sign him up for Social Security disability benefits, “and they accepted him right away.”

When their daughter, Shotzy Faith Brown, was about 3, Sandy took the girl to Virginia, where her parents lived, and filed for divorce. The next time James Brown saw his daughter, she was 14.

Brown said he worked in coal mines and odd jobs over the years but that his mental illness was difficult to control and he repeatedly landed in jail for disorderly conduct and stealing food. In recent years, he has been homeless for long periods, he said.

“When I’m without my medications, look out!” Brown said with a nervous laugh. “I get into trouble.”

Brown left the South a few years ago, he said, at the suggestion of a psychiatrist who said budget cuts were decimating programs there.

“He said things were way better out West,” Brown said.

So, he said, he jumped on a bus, eventually getting off in Las Vegas.

Brown stayed in shelters, group homes and missions, he said, wherever he could find a bed. Often, he got picked up by police as he wandered aimlessly.

“I’ve been bounced around quite a bit along the way,” he said. “That’s what happens when you are mentally ill.

“I guess that’s why they sent me to Sacramento. I guess the people in Las Vegas thought I was some kind of a threat.”

•••

Brown felt more like a victim than a threat when he walked into the police station on Richards Boulevard in the early hours of Feb. 12.

“I was scared,” he said. “Really, I just wanted to find a hospital or somewhere to be.”

He met a friendly officer, he said, and handed him his hospital paperwork.

“He told me they would take me to a place where there would be a meal, shelter, showers,” Brown said. “He was real nice to me.”

Brown climbed into the back of a cruiser and within minutes arrived at the sprawling Loaves & Fishes homeless complex on North C Street on the industrial outskirts of Sacramento’s downtown. Someone gave him a cup of coffee while the officers talked to a staff member about his situation, he said.

But the agency, which provides a variety of services for homeless people, would be closing in the early afternoon and does not operate a shelter. So after awhile he followed a line of people looking for a place to sleep.

Keeping to himself during his stroll, he said, he first went to the Salvation Army on North B Street, but a receptionist told him it was full. He walked until he reached the Union Gospel Mission on Bannon Street. There, he found a bed.

The next morning, he ambled four blocks back to Loaves & Fishes, where he met with a young staffer named Molly Simones.

By that time, Brown had been off his medications for more than a day, he said. He was confused and agitated, and told Simones he was thinking about throwing himself off a bridge or in front of a car.

“I had to somehow get him to a hospital,” Simones said. “But in our experience, that is not an easy thing to do.”

Simones said she was unable to transport him herself because of legal issues. Someone at the agency could fill out papers to place a legal “hold” on him until police could take him to the hospital, but Simones decided that process would take too long.

She asked Brown whether he could make it to UC Davis Medical Center if she gave him directions and a bus pass.

“He was more than willing, and I felt he could make it on his own,” she said.

She made copies of his discharge papers from Rawson-Neal and wrote an account of his journey from Las Vegas. She told him to give the papers to nurses when he arrived at UC Davis.

After lunch, Brown recalled, he walked to a light-rail station. He can’t recall where he got off the light-rail train. He remembers only concrete, horns and clanging bells. Again, an officer came to his rescue.

He said he approached the first uniformed person he saw and handed him the note from Simones. The note said Brown was “suicidal and unable to care for himself” and should go to the hospital.

Brown walked into UC Davis Medical Center at around 4:30 p.m. Feb. 13 with a police escort, joining a growing legion of mental patients seeking refuge in Sacramento’s emergency rooms.

Brown was upset but fairly calm when he showed up, said Dr. Peter Yellowlees, a psychiatrist on duty that day.

A triage nurse greeted Brown, who handed her his paperwork. She and others took his blood, measured his vital signs and conducted other tests to make sure he was stable, Yellowlees said. A resident psychiatrist, Dr. Jamie Ng, asked him about his mental state and medications.

That night, Brown slept restlessly on a gurney as the ER chaos swirled around him.

In the meantime, UC Davis social workers began calling area mental facilities, trying to find a bed. The task is difficult under the best of circumstances, Yellowlees said, but even more challenging when the patient is from out of state and has neither an ID nor an insurance card.

So for the next two nights and part of a third day, the UC Davis emergency room was Brown’s home. He had daily visits with a psychiatrist, ate hospital meals and watched Netflix movies on Ng’s computer. His panic began to subside, Brown said, as his medications kicked in.

“I felt like I had been rescued,” he said.

•••

Other rescuers would surface after Brown departed UC Davis.

From the medical center, he got a bed at Heritage Oaks, a private mental hospital on Auburn Boulevard. Brown recalls staying there for a couple of weeks before getting moved to Green Pasture, an assisted living facility, where he stayed until he was transferred to a boarding home in early March.

Now he lives in a mint-green house in south Sacramento with three other residents and a rotation of caregivers. He has his own small room, with a single bed and a shelf where he props his pipe and tobacco.

Turning Point Community Programs, which contracts with the county to provide supportive services to mentally ill people, is overseeing Brown’s care.

A staff member brings his medications every morning, watching to make sure he swallows them. The organization has provided him with clothing and psychiatric care, said Carolin Funderburg, program director for the group’s integrated services agency.

Whether the programs will be fully reimbursed for Brown’s care is unclear. As of last week, his insurance and Social Security benefits had yet to be transferred from Nevada to California.

As word of Brown’s experience has spread, other avenues have opened.

Sacramento civil rights lawyer Mark Merin said he is planning to pursue a lawsuit on behalf of Brown and others like him.

“There is something really wrong here,” Merin said. “I have to believe there is a constitutional issue.”

And on April 3, the telephone rang at Brown’s boarding home. Another resident told him the call was for him.

“Hello?” Brown answered.

Shotzy Faith Harrison recognized her father’s soft drawl, a voice she had heard only a few times in the past two decades.

“Daddy! Daddy! It’s me!” said Harrison, now 25 and a nurse. “It’s Shotzy. I want to bring you home with me to North Carolina.”

Brown just smiled, he said, as he listened to his daughter talk “a mile a minute” about her plans for him. It was not the first time she had offered to take him in, he said. But this time, he planned to take her up on her offer.

“I never wanted to be a burden,” Brown said. “But I guess I’m not. Not to my daughter, anyway.”

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  1. What's the problem? CA is full of nut-cases (we see it in their politics) and, seemingly, welcomes them with open arms and open wallets, so let's continue doing them a favor and send them more. I'm sure there are plenty of vacant bedrooms in the homes of leftist Hollywood "stars" such as Alec Baldwin, Susan Sarandon, Sean Penn, etal, that are avaiable to house them and, being the bleeding-hearts they are, will gladly take them in.

  2. Just the way some of you have responded is indicative of of WHY our mental health services are so appalling. What is wrong with you people? (rhetorical question).

    Those of you willing to dump people like yesterday's trash, should thank your God or lucky stars it's not YOU or a family member. Mental disorders are real, just as is any other medical condition such as heart disease or diabetes.

    While this country can spend trillions of dollars waging bogus wars, killing and maiming our young people and other innocents, is the macrocosm of the proplem with our society; the case with Mr, Brown, is the microcosm version of the same mindset. People are expendable where money and profits are concerned.

    Greed is this country's downfall and NOTHING will change, except for the worse, as long as the wealth is controlled by the greediest, vilest people with power...the likes of Cheney, Rove, Bush, Adelson, Wynn, Trump, Boehner, Ryan, and the right wing extremists pounding on their Bibles, instead of reading them.

    A nation that turns its back on its sick, its children, its elderly, and its poor will fail. And, unlike the wealthy, greedmongering banks, this country is NOT TO BIG to fail. You fail your people, your people will fail you.

    When we have had enough of the wealthy squeezing every last dime from us, destroying our health, taking away our homes and neglecting help for the weakest, including the veterans that have been so damaged, then maybe we can all converge on the steps of Capitol Hill and tell THEM to "eat cake" and "drink tea" as we throw everyone out of the building. Starting with the hypocritical "religious right."

    When Jesus was asked what He thought was true religion, He responded by saying, "taking care of the widows and orphans (the poor) among you."

    Shame on the state of Nevada. Shame on this nation.

  3. Nevada's current inadequate mental health system is putting us at risk for lawsuits. Patrick Coolican's 4/10 column warned about some other false economy: "Our jails and prisons have become de facto mental health facilities....we end up paying anyway, through emergency room care or jail beds."

    Americans also pay dearly when massacres result from the tiny fraction of the mentally ill -- recently from males in their 20s* -- whom we have chosen to ignore.

    Besides improved treatment, national mental health reform should include a national gun registry. A registry is currently the most likely "start" for gun safety reform.

    * See the Sun's 4/10/13 "Other Voices" editorial by Anne Michaud, "Treat these young men before they kill."

  4. Actually, in my comment above I meant to write universal background check, NOT national gun registry. Right now the most likely compromise is a background check (that also includes felons). I currently am not in favor of a national registry.

    The Sun printed two Sacramento Bee articles by Cynthia Hubert, this one and one on March 4th, entitled "'Patient dumping' affecting shelters, hospitals." The articles illustrate the extraordinary challenges that people with mental disorders must deal with, just to maintain their stability. The articles also detail California's exemplary mental health care integrated network.

  5. I agree, mikki.

    Have you noticed how little commentary there is about this issue in this forum compared to the other articles?

    There is little value placed on mental health education, let alone care, or the development of an integrated system. Not until this state is sued and made to pay HUGE settlements will people take notice.

    It's always about money.