Federal authorities approved a Nevada hospital's proposal on Friday for correcting deficiencies that led to newly discharged psychiatric patients being bused out of state without adequate plans for continued care.
The U.S. Centers for Medicare and Medicaid Services also said it would conduct unannounced inspections of Rawson-Neal Psychiatric Hospital in Las Vegas to ensure that procedures are in place and working to prevent further instances of so-called patient dumping.
Officials at the state-licensed hospital said they have increased oversight of discharge planning to guarantee patients released to other states are enrolled in appropriate after-care programs when they arrive. The hospital also has enlisted chaperones to accompany newly discharged patients on Greyhound Bus rides.
Rawson-Neal came under fire after the Sacramento Bee newspaper reported the hospital gave one-way bus tickets to as many as 1,500 newly released patients for destinations in 47 other states in the past five years. About one-third were sent to neighboring California, the bulk of them arriving in Los Angeles.
Nevada health officials later acknowledged the hospital shipped 10 newly discharged patients out of state without documenting adequate aftercare plans for food, housing, medication and treatment. They said two employees were fired and three others faced disciplinary action.
The U.S. Health and Human Services Department agency warned the hospital in April that it was in violation of Medicare rules governing discharge of patients and gave the facility until May 6 to come up with a remedy.
"We'll continue to inspect the hospital until we're convinced that it's in full compliance with Medicare rules that protect the health and safety of patients," said Jack Cheevers, spokesman for the Medicare and Medicaid Centers. "If the hospital fails to comply, it could lose its federal funding."
Also this week, Rawson-Neal released a hospital-commissioned report that confirmed a lack of follow-up care for some patients bused out of state as well as for some patients released within the Las Vegas area.
The independent report, prepared by a psychiatry professor and a clinical psychologist who spent a week in the facility, commends the hospital staff as "competent, compassionate, respectful and dedicated." But it said the unit was constantly filled to capacity and, as a result, staff members felt pressure to move patients out.
The report also concluded the 190-bed facility was severely understaffed.
Nevada health officials said they already had corrected some of the problems the report cited and were working to correct the remainder.
In one patient-dumping case cited by federal inspectors in March, a psychotic man who entered the hospital hearing voices and talking about worms in his head was put on a bus out of town the same day. The discharge was signed by a staff psychiatrist, and the man was sent to Sacramento, where he knew no one, with little more than cans of nutritional supplements and a three-day supply of medication, the report said.