Patients on a Midnight Bus to Anywhere

Abstract

The policy is called Nevada’s Client Transportation Back to Home Communities. Despite its name, which implies good intent and compassion for the patient being transported, this policy has recently found itself at the center of a lawsuit brought forth by the City of San Francisco against the State of Nevada. An investigation led by the San Francisco Attorney’s Office has revealed that since 2008, over 1,500 mentally ill patients have been bused out of the Rawson-Neal Psychiatric Hospital in Las Vegas and essentially “dumped” on other cities. The lawsuit asserts that 24 of these patients were left to their own devices upon their arrival in San Francisco, given only a small amount of food, and told to call 911 or find a shelter for help. These patients most certainly required further treatment, costing the city and its taxpayers $500,000.

What the lawsuit is describing is a case of “patient dumping”, which occurs when a hospital capable of providing the necessary medical care transfers the patient to another facility or simply discharges the patient because of their inability to pay for the required services. Not surprisingly, there are federal regulations prohibiting this kind of behavior by hospitals, and violators are punished with stiff monetary penalties and their Medicare provider agreements are suspended. What is surprising, however, is that some hospitals are indifferent to the policy or find creative ways to “dump” patients while claiming to have offered necessary care. Regardless of their excuses, hospitals have a social duty to ensure that patients who walk through their doors – whether insured or not – are treated justly and discharged with dignity. The matter of expenses should come second.

It is not hard to find the glaring bioethical issues that are a part of this developing case, and the story serves to shed a necessary light on a type of practice more prevalent than people think. If the allegations outlined in the lawsuit are true, then the Rawson-Neal Psychiatric Hospital has clearly victimized members of a vulnerable population who deserve nothing less than respect and compassionate treatment. Those afflicted with mental illness have been the target of abhorrent and cruel treatment throughout history, mostly at the hands of physicians and a society ignorant of the delicacy of their disorder. However, as a modern society learning from the mistakes of the past, we have come to realize that the mentally ill are not a people to be feared or cast out, but nurtured and provided with respectful care. The fact that the staff members in this Las Vegas psychiatric institution would disregard their professional and moral duty to these patients – regardless of their ability to pay for expenses – shows a lack of understanding and empathy, and one that should be met with swift punishment.

This case illustrates that some institutions will forego good judgment and “dump” vulnerable patients in a foreign city, without so much as a hand to guide them to safe care. Although the lawsuit brought forth by San Francisco did bring this issue to the forefront, it does not seem that any monetary compensation will fix the issue long-term. What the mental health system needs is a better form of communication across state lines and between psychiatric institutions and hospitals in order to ensure that these patients do not get left out in the cold, or alone at a bus stop.

For more reading:

San Francisco Sues Nevada Over “Patient Dumping”

http://abcnews.go.com/Health/san-francisco-sues-nevada-patient-dumping/story?id=20350308

Vanderbilt University Medical Center Accused of Patient Dumping

http://www.tennessean.com/article/20130924/NEWS07/309240015/Vanderbilt-University-Medical-Center-accused-patient-dumping

Proposal Would Create Tougher Penalties for Patient Dumping

http://www.ktnv.com/news/local/Bill-proposal-would-create-tougher-penalties-for-patient-dumping-225103922.html