San Francisco wants to take Nevada to court.
That's after the U.S. Supreme Court declined to hear Nevada's appeal of a lawsuit over what's known as patient dumping.
San Francisco had sued, wanting the state to reimburse it for bussing indigent psychiatric patients from Rawson-Neal Psychiatric Hospital to the Bay Area.
Nevada filed the appeal of that suit.
Cynthia Hubert with the Sacramento Bee, along with her colleague Phillip Reese, broke the patient dumping stories.
The newspaper heard about the issue when a man named James Brown was sent to Sacramento from Rawson-Neal. He didn't know anyone in Sacramento and did not have a treatment plan.
According to Hubert, Brown ended up being found by police and taken to a homeless services agency. That agency called the newspaper.
While that case brought the most attention, Hubert said patients were bussed from Las Vegas to every part of the country.
"They were dumped into every state across the continental United States. All 50 states over a period of five years," Hubert said.
In all, 1,500 people received bus tickets. The hospital said they were sending people to their 'home' communities, where they had requested to go.
Hubert said there were some people who did have family or friends on the other side of the Greyhound Bus ride, but some ties were tenuous.
"They ended up becoming homeless in those communities," Hubert said. "Some of them committed crimes in those communities and many, many ended up in psychiatric hospitals and emergency rooms in those communities."
However, specific numbers for patients that were 'improperly discharged' remain difficult to fully calculate because reporters haven't been given complete access to records, according to Hubert.
Hubert said that the state's own policy required patients be discharged with a treatment plan with either someone at the other end of the bus ride or with a chaperone to make sure they arrive at their destination.
But, that was not the case at Rawson-Neal, Hubert said.
"This process of discharging patients by Greyhound Bus is not isolated," she said. "It was policy."
Money was one of the biggest problems, Hubert explained.
"It was certainly a cost savings to put them on a bus versus putting them in a hospital room for days, or weeks or months," she said.
The patient dumping scandal cost Rawson-Neal its accreditation for a period but the hospital was able to get it back. It has also changed its transportation policy.
Rawson-Neal also received more money from the state, which could help it with indigent patients.
Despite the changes since the scandal first broke in 2013, San Francisco is still suing.
According to Hubert, San Francisco found that Rawson-Neal sent about three dozen patients its way and the vast majority of those patients ended up needing emergency treatment.
"The city attorney Dennis Herrera believed that was improper that Nevada was foisting the cost of caring for these indigent mentally ill people onto California cities and counties and they want their money back," Hubert explained.
The city is looking for $500,000 in reimbursement.
If San Francisco ends up winning the lawsuit, Hubert believes it will force psychiatric hospitals to change their discharge policies, and it could open the door for more lawsuits against Nevada from other jurisdictions.
The whole case has opened a discussion about to properly discharge and transport psychiatric patients.
"What this has done has caused psychiatric hospitals around the country to examine their policies for discharging patients and make sure that those patients are safe," Hubert said, adding a need to make sure "the people on the buses they're being transported in are safe and that the communities they end up in are safe."
She believes it has ultimately made life better for some seriously ill people.
Cynthia Hubert, Sacramento Bee
