Independent review finds nothing ‘inappropriate’ at Rawson-Neal but details needed improvements

By Conor Shine

Thursday, May 23, 2013 | 5:45 p.m.

An outside review of Rawson-Neal Psychiatric Hospital, which has been scrutinized in past months for its practice of busing mentally ill patients out of state, found room for improvement and flaws in the facility’s discharge procedures, but didn’t uncover any wrongdoing or negligence by hospital staff.

Multiple investigations were launched into the hospital after the plight of a mentally ill man from Las Vegas who turned up on a Greyhound Bus in Sacramento disoriented and lacking his proper medication came to light in April.

A state review examined nearly 1,500 cases in which patients were bused to other states since 2008 and found only 10 instances where proper procedure was not followed.

The new independent report released Thursday outlines 10 recommendations to improve care at the facility, in areas including treatment services, suicide prevention, staffing and documentation.

The most pertinent part dealt with the hospital’s discharge practices, which involve a “complex set of circumstances that defy simple conclusions.”

Because Las Vegas attracts visitors from all over the country, many of the patients who were bused to other states were sent there because they had family or other ties outside of Nevada.

“We found nothing per se inappropriate with discharge plans that included state-funded arrangements to return these individuals to their places of primary residence,” the report said.

In some instances, however, staff failed to make proper aftercare arrangements for discharged patients, the report said, hinting that overcrowding at the hospital may have played a role.

“At almost all times, the (psychiatric observation unit) and inpatient units run at full capacity. This reality creates a tension between the benefit of longer inpatient stays and the need to open up beds for those who require admission,” the report said.

The report recommended more comprehensive discharge planning that includes specific goals for patients and detailed information about aftercare arrangements, including the patient’s capacity to safely follow through on those arrangements.

Another area of criticism dealt with the over-reliance on medications to treat patients, though there were no allegations of over-medicating, and recommended increasing group, individual and behavioral therapy offerings at the hospital.

The outside review of Rawson-Neal, which was released to the public Thursday, was conducted by University of Massachusetts Medical School professor Dr. Kenneth Appelbaum and Dr. Joel Dvoskin, a clinical psychologist and faculty member at the University of Arizona College of Medicine.

The two spent five days at the hospital in early May interviewing patients and staff and reviewing records, discharge plans and policies.

In a statement, Gov. Brian Sandoval said he was committed to implementing the recommendations included in the report.

“I am confident doing so will help improve the services the state of Nevada provides to the mentally ill,” he said. “As this process moves forward, I will continue to receive regular briefings on Rawson-Neal to ensure our state is providing the best care possible to those who need it most.”