Anatomy of a scandal: How the patient dumping crisis developed

On March 1, a story in the Sacramento Bee reported a harrowing odyssey of a mentally ill man who had been bused from a Las Vegas facility to the California capital. James Flavy Coy Brown, who could not have known his sad story would ignite fires beneath politicians in two states, had discharge papers that gave his address as: "Greyhound Bus Station to California."

What ensued since that first story appeared in the Bee is not just the exposure of the depraved practice of dumping a mental patient onto a bus with nine stops. Brown's story has led to a newspaper embarking on a worthy crusade and catalyzing expected reactions from California politicians (they are outraged and want investigations!) while providing a window into how a Nevada administration that routinely blocks or deflects media inquiries finally had to initiate a full damage control operation.

Gov. Brian Sandoval’s ability to maintain high approval ratings through the the myth of his bipartisan approach, the radiance of his preternaturally sunny personality and the perfect foils in the Legislative Building may not be threatened by this tempest. But it does reveal how Gov. Sunny’s public face belies a staff/political operation that believes it can keep the media at bay with peremptory replies, a strategy that unraveled once the Bee’s aggressiveness spurred local media players to start asking questions. The duality of the Sandoval Administration – shiny and accommodating on the outside, nasty and ruthless on the inside – is but one phenomenon the sorry tale of Greyhound therapy has illuminated -- a synergy that has served the governor well until now.

It may not cause any long-lasting damage to the presumptive two-termer despite the Democrats’ daily bludgeon, but it may speak to a weakness that could be exploited later if the Democrats get a candidate and if an issue a wide swath of voters actually cares about were to surface. Two very large IFs.

What follows is a timeline of how the story metastasized from that one Bee piece to consuming the Nevada media. The narrative shows just how little concern the administration had before engaging, but it also indicates the Democratic narrative of a dissembling, uncaring governor and his minions is not so solid, either.


The day after its first report, the Bee called for an investigation. I wonder if a capital newspaper calling for a probe could find any politicians who would want to do so….

Four days later, the inevitable occurred -- a federal probe sought by a California legislator. That same day the Review-Journal picked up the story (the “newspaper” has a paywall, so forgive the lack of links). The March 5 report by Laura Myers is exhaustive and quotes state Health Officer Tracey Green explaining the policy: "The reason we're investigating is because this is awful," Green said. "We are saddened by this. We would never want it to be misconstrued that we're doing any dumping. We want to make sure everything was done correctly."

More from the RJ piece: Green said there are two investigations -- an internal one by the Nevada State Health Division and an external one by the Bureau of Health Care Quality and Compliance, which licenses medical facilities. "There is a lot more information" state authorities are learning about Brown's situation, Green said, which will shed more light on the matter once the investigation is completed in two to four weeks. She said the probe will determine whether any policy violations occurred and whether anyone should be disciplined. According to written policy, psychiatric patients are discharged from state care if a doctor determines a patient is no longer a danger to himself or others and can function outside the hospital. A treatment plan that includes the need for medication and continued outpatient services is drawn up. State policy also allows for transportation back to a patient's "home community in order to provide more appropriate care and to remove the burden of treatment from the state of Nevada." But hospital staff must first confirm there is housing or shelter "and a support system available to meet (the) client at destination." Staff also should provide information and an appropriate appointment for mental health services in the home community.

On March 9, state officials pushed back against the Brown story in an RJ piece headlined, “Mentally ill man's tale faces rebuttals.” There even was a subhead that read: “Holes in his story”

Busing patients is rare. Brown was no bumpkin. And so on.

The next day though, senior Bee Opinion Editor Dan Morain wrote an extensive and blistering column on the subject, quantifying the numbers, detailing the budget cuts and wondering:

But without knowing details about the individuals who were bused to California, it's impossible to know whether Nevada employs Greyhound Therapy as a way of solving its problem of mentally ill homeless people. That said, the mental health agency's policies, and the number of people bused to California in one six-month period from a single Nevada hospital, raise serious questions.

By now, the Legislature’s antennae were up and that week a hearing was held. That's where Mike Willden, the respected HHS chief, fell on his sword in a quote widely reported here and in California: "We own it. We blew it, and we are taking corrective action."

And this: State Sen. Justin Jones, D-Las Vegas, the committee's chairman, praised the health authorities for admitting mistakes and for working to fix the problems. "I appreciate that you guys have accepted responsibility and are trying to get out ahead of this," Jones said.

Indeed, for as long as this has gone on, lawmakers have backed up Sandoval – or, maybe I should say Willden, whose immeasurable credibility has helped shield the governor. Willden did, however, give a quote to the Associated Press that, while it may prove true,  Democrats would later exploit: “This is not a widespread issue. This is an isolated, rare incident Where staff did not follow our policies.”


But still not a comment from the Sunny office, nor was one requested that I can see. And for about two weeks, there was silence from the media on the issue.

Then came April. On the 1st, the state released the findings of its first investigation, indicating Brown was not the only case. The Bee was all over it.

A few days later, the Bee published an interview of Brown that the Las Vegas Sun linked to on its site. That was followed quickly by a brutal editorial.

The editorial said Sandoval and lawmakers should “not pay lip service,” but his lips had yet to move. That would soon change, though.

That weekend, the Bee published a story that would alter both the story and the governor’s muteness. “Nevada buses hundreds of mentally ill patients to cities around country," the headline read in the Bee, which devoted many inches to detailing the problem.

There was this, too: "Southern Nevada Adult Mental Health Services is committed to providing quality mental health services to its patients," said spokeswoman Mary Woods in an emailed statement.”

Accompanying the story was a devastating column by Morain that mocked the state’s new slogan and made Sandoval the focus. And it turns out that Morain experienced what every political reporter and commentator in the state has from Team Sandoval:

"We are going to decline to comment," Sandoval's press secretary, Mary-Sarah Kinner, said in a recent email, before she stopped bothering to respond to my requests for comment.

Welcome to our world.

On April 15, my producer, Dana Gentry, tried to get Sandoval to come on “Ralston Reports.” No dice.

A few days later, though, the silence would be broken – and I witnessed it. KSNV’s Marissa Mike approached the governor after a typically feelgood speech to the Keystone Corp. at the Silverton. She began peppering him with questions about the patient dumping stories.

Sandoval looked uncomfortable; Kinner looked like she wanted to kill Mike.

The governor made a few generic comments before saying, “I believe there is a good quality of care” at Rawson-Neal. Thus began the onslaught of Democratic Party releases ridiculing and lambasting the administration for its handling of the incidents.


From April 18 to today, Zach Hudson, the party’s relentless communications specialist, has issued no fewer than 26 releases, linking to stories, posting videos and escalating the rhetoric. “BREAKING: Sandoval Administration Admits to Lying About Last Week’s New Patient Dumping Case,” was this morning’s offering. Not really.

But it’s full campaign mode now for the Democrats, who have seized on two weeks of shakiness by the administration. I raised the issue of the Democrats seizing on the issue to signal they were revving up the machine.

The Sun also got on the story, breaking the news of a 2009 policy change on busing patients. And there was this:

Gov. Brian Sandoval has largely kept quiet when various news agencies have asked him about the practice of inappropriately busing patients from Rawson Neal to other states. His press secretary has emailed multiple news organizations a brief statement that “the governor has been briefed throughout the investigation process and has asked for more information.”

The Bee was not letting up, though. On the 19th, the paper revealed another probe.

And: Nevada Gov. Brian Sandoval has been under pressure to address the busing issue. On Thursday, spokeswoman Mary-Sarah Kinner said Sandoval "takes the concerns regarding Southern Nevada Adult Mental Health Services very seriously," adding, "The governor has been briefed throughout the investigation process and has asked for more information." Through Kinner, Sandoval declined an interview request.

Sound familiar? During the next few days, the trajectory was predictable. California officials called for investigations. The Bee dutifully reported each one. Sandoval kept mum.

Until, without warning, on April 23, apparently after someone awakened the governor's political folks from their slumber or pulled them off the fundraising trail on Las Vegas Boulevard South, Sandoval, through Kinner, released a statementIt didn’t say much, but it was the governor, so all the media, here and in Sacramento, picked it up.

The next day, in a very unusual move for that office, Kinner called media folks and offered the information that the state was reversing the busing policy. She called it “formalizing” a new one.

That Sun story contained a very unfortunate (for Sandoval) and perhaps revealing (for Sandoval) quote from the state health officer:

"Our policy stands that it has been the determination of need, but at this time we are erring on the side of caution," she said. "Given the events in the media, we have determined it's better to err on the side of caution."

What ensued after this was not a stanching of the bleeding, as the Democrats continued their daily knifing. The Bee kept publishing stories, including one a few days later about a federal letter of deficiency. Then, on Monday, Sandoval issued another news release revealing that more cases had been found, people had been fired and that the dumping was not systemic. Later in the day, the HHS folks sent out quantification.

The message: “Can we just end this now?”

I doubt it, at least from California's point of view. I get the sense the Bee is far from done and will not take the state's word for it. Unlike strapped Nevada news outlets, consumed with covering the Legislature and with few resources to spare, the Bee will be able to do investigative work.

The federal HHS still has to weigh in, too. (Maybe Harry Reid, who fears a Sandoval run in '16, can get Kathleen Sebelius to criticize the governor? I kid. I kid. That would never happen.)

Until then, Sandoval will hope no more cases of dumping are found, the media will keep looking for more evidence of Greyhound therapy and the Democrats will parse every word spoken to find ways to assail the governor.

Oh, and mental health services in the state will continue to be underfunded and mostly underreported. I’d ask the governor for a comment on that. But I doubt he has one.


(Image credits: L.A. Times and CMG Digital.)