Nevada Governor Brian Sandoval has acknowledged that the state-run psychiatric hospital improperly discharged at least one mentally ill man but said a new discharge policy put in place in recent weeks would prevent future missteps. A formalized chaperone policy has also been instituted. Sandoval stated, "All individuals who violated release policies have been or will be disciplined. These disciplinary actions include terminations effective today."

The governor issued a statement that he is planning on taking further action against the state-run Las Vegas psychiatric hospital accused of dumping patients in other states. "Over the weekend, I reviewed the results of the investigation into patients transported out of state," stated Sandoval.

Following accusations of improper patient discharge, Nevada's Department of Health and Human Services reviewed all out-of-state transfers made by the Rawson-Neal Psychiatric Hospital between July 2008 and March 2013. Roughly 1,500 patients have been transported out of the state since July 2008.

Built at a cost of $35.5 million, Rawson-Neal opened in 2006 with 190 beds. According to a state website, the hospital is charged with providing acute psychiatric inpatient treatment for adults with serious mental disorders. With a multi-disciplinary assessment as the basis of each individual treatment plan, the hospital also supplies intensive and comprehensive treatment and after-care recommendations.

In March, the Sacramento Bee reported that Rawson-Neal gave bus tickets to as many as 1,500 patients without adequate provisions for food, medication, housing or medical treatment in a practice dating back to July 2008.

The Bee described how a patient, James Flavy Coy Brown, 48, disappeared onto Sacramento's streets last month, a day after he arrived by bus from Las Vegas. According to staffers who spoke to him at Loaves & Fishes homeless services, Brown was frightened and confused, and said he had no family in Sacramento and had never visited the city. He carried his discharge papers from the Southern Nevada Adult Mental Health Services psychiatric hospital and a schedule detailing his 15-hour bus ride from Las Vegas.

The medical discharge papers, obtained by The Bee, ordered that Brown be taken "to the Greyhound bus station by taxi with a 3 day supply of medication," including one drug to treat schizophrenia and another for depression.

Sandoval said in a statement that when he learned that "discharge policies and procedures were not followed" in at least one instance at the hospital, his administration began an inquiry. The governor's statement notes that proposals have been received from national experts for a comprehensive analysis of Nevada's state facilities.

The Emergency Medical Treatment and Active Labor Act (EMTALA), passed by Congress in 1986, is intended to protect Medicare and indigent patients against premature discharge from hospitals for economic reasons.

Under EMTALA, hospitals are required to advise Medicare patients of their right to challenge what they consider as premature discharge after treatment. The regulation was adopted after initiation of another Medicare policy whereby hospitals would be paid according to a particular illness, regardless of the length of hospitalization. The latter policy was meant as an incentive for hospitals to reduce the period of inpatient care. EMTALA is part of the Consolidated Omnibus Reconciliation Act, commonly referred to as COBRA.

San Francisco City Attorney Dennis Herrera, who requested public records from Nevada, said that his office's investigation will continue. San Francisco health director Barbara Garcia said outreach workers identified two psychiatric patients who arrived in the city on buses after being discharged from Rawson-Neal with neither relatives nor treatment plans awaiting them in San Francisco.

Although the Nevada Bureau of Health Care Quality and Compliance completed its probe, the Centers for Medicare and Medicaid Services are continuing to investigate procedures at Rawson-Neal, said Mary Woods, a Nevada Department of Health and Human Services spokeswoman. An ongoing investigation by the hospital has found only four or five of its discharges were made in violation of hospital policy, said Woods.