Although Nevada says its hospitals no longer bus their mentally-ill patients out of state, it agreed to pay California $400,000 to settle a class-action lawsuit over the matter after a hard-fought battle.

Nevada claimed the events were isolated and not systemic, but the Sacramento Bee, in a series of stories beginning in April 2013, claimed as many as 1,500 patients were given bus tickets to go from the state-run Rawson-Neal Psychiatric Hospital in Las Vegas to other cities between 2008 and 2013. Five hundred were said to end up in California.

San Francisco City Attorney Dennis Herrera filed the lawsuit in September 2013, claiming 24 patients had been sent to his city and 20 of them needed immediate medical care. He sought to bar Nevada from such practices and recover expenses for handling Rawson-Neal’s patients, like 48-year-old James Flavy Coy Brown.

Nevada argued that the hospital merely discharged the patient and facilitated his access to a Greyhound bus. Brown was given a one-way ticket and sent to Sacramento, where he knew no one. He said he was told to call 911 when he arrived, but did not.

Brown wound up in a homeless services center, then spent a couple of nights in the emergency room at the University of California, Davis Medical Center, 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. 

Lawyers filed a lawsuit on behalf of Brown, but he lost when U.S. District Judge James C. Mahan tossed the case (pdf). The “coercive power of the state was not imposed on (Brown),” Judge 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.”

Still, it didn’t look good. Nevada Governor Brian Sandoval vowed to clean up the state’s mental health care system by spending an additional $30 million, according to the Bee, and a few bad apples were fired.

The agreement still needs to be approved by the Nevada Board of Examiners and a similar panel in California.

–Ken Broder

To Learn More:

Nevada to Pay San Francisco $400,000 to Settle Patient-Busing Scandal (by Jackie Valley, Las Vegas Sun)

S.F., Nevada Reach Tentative Settlement in Patient-Dumping Case (by Bob Egelko, San Francisco Chronicle)

Nevada, San Francisco Agree to Settle Patient Dumping Suit (by Michelle Rindels, Associated Press)

What a Dump: A Primer on Nevada’s Patient Dumping Scandal (by Andrew Davey, Let’s Talk Nevada)

Nevada Agrees to Pay San Francisco $400,000 over Patient Dumping (by Curtis Skinner, Reuters)

Nevada Still Hopes to Have Patient-Dumping Case Dismissed (by Jackie Valley, Las Vegas Sun)

Judge Rules Nevada Patient-Dumping Bus Ticket Was Only a Suggestion to Leave (by Ken Broder, AllGov California)