Audit seeks sweeping changes to state’s psychiatric hospitals

Executive branch auditors called for a laundry list of changes they say will save money in the state’s psychiatric hospitals. But both Health and Human Services Director Mike Willden and Gov. Brian Sandoval made it clear those recommendations, at least for now, are going nowhere.

The list includes providing some services to inmates in county jails instead of Lake’s Crossing Center hospital, closing down some of the beds there and moving them to Stein Hospital in Las Vegas, moving patients into private facilities around the state and bringing patients now send out of state back to Nevada.

Auditor Warren Lowman said those and other changes could save the state millions.

But Willden and Sandoval both pointed out that amid accreditation problems for both state psych hospitals, allegations of patient dumping by Rawson Neal officials and the burgeoning number of judicial commitments overcrowding the system, now is not the time.

Willden said the system needs both the added civil psychiatric beds and additional forensic beds for criminal defendants who have mental issues.

Sandoval said during the meeting that judicial commitments have tripled in the past six months.

“I don’t want to limit the number of beds when we have tripled commitments,” he said.

He said auditors prepared those recommendations before all that happened.

“The audit is well-intended, but there have been a lot of changes in the meantime,” he said after the audit committee meeting.

While Willden said generally the recommendations are worth considering, “the devil’s in the details.”

First, he said, the added beds in the Stein Hospital won’t be ready for patients for two years and that, with both the existing southern hospital and Lake’s overcrowded, it wouldn’t make sense to shut down any beds north or south until then. He said the expansion at Lake’s is designed to add forensic beds and is needed to handle a waiting list of more than 30 people still stuck in county jails.

Willden said the recommendation to move patients into private psych hospitals is also problematic because federal law denies Medicaid benefits to anyone between 21 and 64 unless the hospital has 16 beds or fewer. He said there are 14 freestanding psychiatric hospitals in Nevada and that all of them have more than 16 beds, so they can’t bill Medicaid.

Further, he said, private hospitals in the state don’t take inpatients for Medicaid rates.

Auditors also called for creating specialized programs and centers so the state can bring patients it now sends out of state back to Nevada and serve them at much lower cost.

“Part of the problem is there aren’t enough patients to justify those programs in Nevada,” Sandoval said.

Willden agreed, saying that for a specific type of illness, there may be only four or five patients in Nevada, making it impossible to justify a program for them here.

Willden said jail-based treatment for some patients instead of housing them at the hospitals is a possibility, but that it depends on getting legislation to set up the program and setting rates to pay the counties for providing services.