There is a big difference between a hospital dumping a patient and simply suggesting a patient leave by giving them a bus ticket and encouraging their departure.

Armed with that knowledge, U.S. District Judge James C. Mahan tossed a federal class-action lawsuit last week brought on behalf of a patient in a Las Vegas psychiatric hospital who was bused to Sacramento, where he knew no one and had no place to stay. The lawsuit also covers others similarly situated.

Rawson-Neal Psychiatric Hospital discharged 48-year-old James Flavy Coy Brown and facilitated his access to a Greyhound bus last February. But the “coercive power of the state was not imposed on (Brown),” Mahan wrote in his decision. “There was no direct command from an individual bearing state coercive authority, nor threat of punishment if (Brown) did not travel to Sacramento.” 

Brown was not the only patient who took the hospital’s gentle suggestion to heart. The Sacramento Bee reported that the psychiatric hospital treated 6,000 patients a year since 2008 and, on average, bused 295 of them out of town during each of the five years. An estimated 500 patients ended up in California.

The Bee told Brown’s story in March 2013. He was given a one-way ticket and three days worth of meds for his schizophrenia, depression and anxiety. He was told to call 911 upon arriving at his destination, a bit of advice that, according to another class-action lawsuit filed by the city of San Francisco, was not given to a substantial number cut loose by the hospital. 

Brown did not call 911 and ended up at a homeless services complex. They helped get him to the University of California, Davis Medical Center, where he spent a couple of nights in the emergency room before ending up in a boarding home. He remained there until the Bee contacted his daughter, who took him to her home in North Carolina.

In a series of stories that followed, the Bee determined that many of the patients were sent to cities that lacked support for them, ending up homeless and/or committing crimes in their new locale. Rawson-Neal lost its accreditation, is in danger of losing its Medicare funding and is under investigation by state and federal authorities.

ACLU attorney Allen Lichtenstein told the Associated Press that they will refile the lawsuit after Mahan suggested that a rewrite might help their cause. The lawsuit argued that the hospital violated the Eighth Amendment’s prohibition against cruel and unusual punishment, and the Fourth Amendment’s protection against unreasonable seizures. Mahan called those arguments “nonsensical.”

The American Civil Liberties Union (ACLU) of Nevada and California attorney Mark Merin, who brought the suit, could also appeal to a higher court or file in state court.

Last September, San Francisco City Attorney Dennis Herrera filed a class-action lawsuit on behalf of other local governments visited by the reluctant travelers, seeking an injunction against Nevada facilities inclined to follow Rawson-Neal’s example. That suit, still pending in San Francisco County Superior Court, also seeks reimbursement for costs incurred by the host cities.

Herrera estimated that the 24 patients sent to San Francisco over the years cost the city $500,000. Twenty of the 24 sought and received emergency care upon arrival. Herrera argued in the suit that patient dumping “cruelly victimizes a defenseless population and punishes jurisdictions for providing health and human services that others won’t provide.”

But Judge Mahan might also point that the bus tours gave the patients an opportunity to travel expense free, pursue new adventures and see new places.

–Ken Broder

To Learn More:

Federal Judge Dismisses Patient-Dumping Lawsuit; Plaintiffs Plan to Keep Issue Alive (by Yesenia Amaro, Las Vegas Review-Journal)

Federal Judge Dismisses Lawsuit in Nevada “Patient Dumping” Case (by Ken Ritter, Associated Press)

Federal Judge Dismisses Nevada “Patient Dumping” Lawsuit (by Phillip Reese and Cynthia Hubert, Sacramento Bee)

San Francisco Sues Nevada over Dumping of Mentally Ill (by Noel Brinkerhoff, AllGov California)

Complaint against Rawson-Neal Psychiatric Hospital et al (U.S. District Court for the District of Nevada) (pdf)

Brown v. Rawson-Neal Psychiatric Hospital et al (U.S. District Court for the District of Nevada)