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October 2, 2014

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Feds cite failures in Rawson-Neal hospital’s patient-discharge procedures

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Sam Morris

This is the front sign for the Rawson Neal Psychiatric Hospital Tuesday, May 7, 2013.

A federal inspection says the Rawson-Neal Psychiatric Hospital in Las Vegas failed to provide safe plans for patients to access further services and shelter when they were discharged and placed on a bus to another state.

The examination, released Wednesday, found problems in eight of the 30 psychiatric cases reviewed by the federal audit.

“The facility failed to identify patients who were likely to suffer adverse health consequences upon discharge without an adequate discharge plan,” said the inspection team of the federal Centers for Medicare and Medicaid Services.

There have been charges the hospital adopted a “Greyhound dumping” policy by shipping patients out of state. The audit said the patients sampled were not provided adequate medication and nutrition upon for their bus trip nor information about whom to contact when they reached their destination.

Gov. Brian Sandoval says there have been firings and other discipline and the hospital will now provide a chaperone on the bus trips out of state, most of them to California cities. Two physicians must now review the discharge plan instead of one.

The report by the federal center said there was a failure by the hospital to conduct a full evaluation that should have included “the likelihood of patients needing post-hospital services and the availability of the services.”

The hospital says all medical staff has since been educated on updated policies and procedures on discharges.

The center, which decides if a hospital gets federal money for treatment of these patients, is expected to send another team to the hospital to see if these reported corrective actions have been taken.

The examination said that in two cases the patients were put on a bus to Sacramento and Oklahoma without adequate instructions.

In the case of the patient bused to Sacramento, the man received three days of medication, plus Ensure and snacks for the 15-hour ride.

Ensure is a nutritional drink that contains vitamins and protein.

The center said, “There was no documented evidence that indicated how the patient could access mental health services, narcotics anonymous meetings, medication clinic, name of a psychiatrist and medical physician for follow up and a list of housing or shelters where the patient could stay.”

In another case, the patient was put on a bus to Tulsa, Okla., but there were no documents to show the individual was given enough Ensure for the two-day trip. The center said the patient should not have been given Ensure because he was diabetic. In addition, it was confirmed a doctor had not seen the female patient since she was admitted.

In another case, the patient wanted to return to Boston and was put on a bus. But there was no record he received any Ensure for the trip. In other cases, there was a lack of evidence that the patients received needed medications or Ensure for the bus ride.

These patients were admitted to the hospital for a variety of reasons, including bipolar disorders, drug use and other mental problems.

The state maintains these patients were not a threat to themselves or others upon discharge. Sandoval said, “Rawson-Neal is a safe, modern and has a five-star accreditation.”

There have been an estimated 1,500 patients bused out of state since July 2008.

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