Las Vegas CBS KXNT- The city of San Francisco says Nevada owes it half a million dollars for the care it’s given to homeless patients who were improperly sent packing from the Rawson-Neal Psychiatric facility in las Vegas.

San Francisco Spokesman Gabriel Zitrin says the city arrived at the figure after an extensive investigation involving shelters, nonprofit center, hospitals, and residency hotels. Zitrin says investigators gathered information over a four-month period, trying to build a picture of when people arrived, how long they’ve been there, and what services they’ve received.

The search uncovered 24 patients San Francico claims were sent from Nevada. Zitrin says San Francisco wants a response from Nevada Attorney General Catherine Cortez Masto by September 9, or it will file a lawsuit to recover the money. Masto’s office says it has received the demand letter, but does not comment on pending litigation.

The letter was accompanied by the set of protocols for patient care repoduced below, which Zitrin says Nevada should adopt.

Placement Coordination for Interstate Discharges By Nevada State Health Facilities
1. Prepare a discharge plan for each patient for whom interstate transfer is contemplated.
a. The discharge plan must include an evaluation of the likelihood of a patient’s
capacity for self-care or of the possibility of the patient being cared for in the
environment to which the patient is being transferred.
b. If the patient is not able to provide some or all of the required self-care, the
evaluation must also address whether the patient has family or friends available
who are willing and able to provide the required care at the times it will be
needed, or who could, if willing, be trained by the hospital sufficiently to provide
the required care.
c. The discharging hospital will take reasonable steps to identify the medical and/or
mental health services that will be available to the patient at the destination city or
d. The discharge plan must include an evaluation of the patient’s ability to payout
of pocket for services, insurance coverage, or reliance on community services or
public assistance (including Medicare, Medicaid, or 551).
2. Assess appropriateness of discharge destination.
a. Determine and confirm that patient has at least one of the following connections
to destination city or location:
i. destination city or location was patient’s place of residence at time client
entered medical facility and at time of discharge;
ii. patient has family in destination city or location who are willing and able to
care for patient;
iii. non-family member responsible adult who is willing and able to care for
patient resides in the destination city or location, and has agreed to care for
b. Confirm availability of appropriate mental health treatment services within or near
the destination city or location.
3. Coordinate Mental Health/Medical Care as Clinically Indicated.
a. The hospital must transfer or refer the patient, along with necessary medical
information, to appropriate facilities, agencies, or outpatient services, as needed,
for follow-up or ancillary care.
b. For both patients being transferred to a health care facility and those being
discharged to their homes, the hospital must provide the following necessary
medical information in writing to the facility and to the patient, as applicable:
• Brief reason for hospitalization and principal diagnosis;
• Brief description of hospital course of treatment;
• Patient’s condition at discharge, including cognitive and functional
status and social supports needed;
• List of medications needed by patient;
• List of allergies, and
• Contact information for transferring medical facility.
c. Communicate with the local mental health agency and, to the extent possible,
the patient, to identify a new treatment provider or coordinator within the
destination city or location.
d. Document in patient’s medical record and discharge plan the date and substance
of communication with the person (family member, responsible adult) or entity
receiving patient regarding their willingness and ability to manage the patient’s
e. Provide medical records of prior treatment directly to new treatment provider or
coordinator. Obtain necessary consents to provide these records.
f. Notify new treatment provider or coordinator of date of transfer at least three (3)
business prior to date of transfer. Ensure new treatment provider or coordinator
is given the patient’s new contact information if the patient will be receiving
treatment as an outpatient.
g. If patient can live independently provide patient with information on the below:
• Mental Health Clinic, Medical appointment(s),
• Substance Abuse Treatment,
• Case Management.
h. Complete transfer summary, if needed.
4. Clinically Assess Patient’s Ability to Travel. Determine whether an escort is
necessary due to patient’s physical and/or mental conditions. Coordinate with
Psychiatric/Medical Team and patient for safe travel, i.e.; determine best escort: male
vs. female, 1 vs. 2 escorts, nurse vs. social worker, non-medical ambulance staff, or
non-professional (family, friend).
a. Determine if durable medical equipment is needed during patient’s transport or
upon arrival, i.e., wheelchair, oxygen.
b. Determine if medication supply is needed during patient’s transport or upon
arrival, and provide patient with appropriate supply,
c. Determine any public safety issue(s) presented by patient on basis of history or
current condition.
5. Coordinate Transportation.
a. Coordinate where the patient will be received:
• Family/responsible adult/care manager to meet patient in destination
city or location, at airport/bus station/or other;
• For patient being transferred to a medical or mental health facility,
delivery to doorstep of agency, clinic, or hospital.
b. Arrange transport for escort if one is needed. Most returns are accomplished by
flying, non-medical ambulance, bus, or car (driving the patient to destination).
c. Select mode of transport for safe travel and if possible, include client in planning
to make sure s/he is comfortable with mode (i.e., not afraid of flying):
• Fly,
• Non-medical ambulance,
• Car,
• Bus.
d. If patient has the ability to travel independently, call receiving family/responsible
adult/care manager to advise time of arrival and coordinate who is meeting
patient at destination. Confirm safe arrival if possible.
6. Post-Return. Remain available if family or friends have questions or need further
assistance with service referrals.


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