LAS VEGAS -- State leaders say they were surprised to discover federal guidelines would force them to shut down Las Vegas' walk-in mental health clinic. But as the I-Team has uncovered, state health officials knew about those federal guidelines several years ago.
Closing the clinic leaves a large hole in Nevada's mental health treatment facilities. Federal regulators say the rules are strict. If there is a walk-in clinic inside a hospital campus, it needs to accept all emergencies which includes everything from broken bones to childbirth.
State health leaders and Governor Brian Sandoval say they were shocked to learn the rules would apply to their new walk-in mental health clinic. But former hospital administrators speak out - claiming state health officials knew the clinic would be shut down years ago.
Rawson-Neal Psychiatric Hospital is only one part of southern Nevada's mental health treatment. Until late January, there was a walk-in clinic on the hospital grounds where people could receive outpatient mental health treatment. It was meant to keep the mentally-ill from flooding hospital emergency rooms. The state had to close the facility because it wasn't in federal compliance with guidelines governing emergency rooms.
Under federal guidelines, the clinic is viewed the same as an emergency room and must deal with emergency medical conditions.
Nevada's health director Mike Willden reacted with surprise on Jan. 23, the day the clinic's closure was announced.
"I feel like almost sometimes we're being held to a different standard than the local psychiatric hospitals," he said.
Governor Brian Sandoval pushed for the walk-in clinic to be moved to Rawson-Neal only to watch it shut down a few months after opening.
"We hope to meet with them and sort this thing out because this is a new standard that we weren't aware of that they suddenly administered in this instance," Sandoval said in an interview on Jan. 23.
"I was quite surprised to hear the state was unaware that if you set up an outpatient clinic inside the hospital and it wasn't either free-standing or somehow distinct from that hospital, that it would be evaluated, certified or reviewed under any other criteria other than hospital criteria," said Dr. Stuart Ghertner, the former director of Southern Nevada Adult Mental Health Services.
Ghertner, who was the director from 2006 to 2012, says as far back as 2008 he was aware of the problem. He set up the downtown mental health clinic on 7th Street in 2008.
Nathan baca: dr. Ghertner recalls lines forming every weekday morning with dozens of homeless seeking mental health treatment. The state closed this clinic last year, saying it was more efficient to move the clinic several miles from where many of Las Vegas' homeless live.
RTC buses became the lifeline for the mentally ill seeking help.
"Emergency room numbers have gone up significantly because a lot of those people have to get out to west Charleston. The clinic out there, according to the state, was seeing 16 people a day. The downtown clinic used to see 60 to 80 people a day," Ghertner said.
Doctor Jonna Triggs spoke to the I-team by phone. She led Southern Nevada Adult Mental Health Services from 2002 to 2006. As Rawson-Neal hospital was under construction, she recalls a conversation state health leaders had with federal regulators.
"It was made very clear to us that if you took money from CMS, Medicare or Medicaid money, you had to serve all emergencies. You could not carve out psychiatric emergencies," she said.
The state health department disputes the claims and qualifications of both former directors saying they have no evidence to back up what they're saying. A spokesperson tells the I-Team, while the state knew the federal requirements, the state still believed their new clinic didn't violate them.
Also, according to the state, numbers show when the downtown clinic closed, it was only seeing a few patients a day, not dozens. Whether it was a surprise or a mistake, it will prove to be costly. The governor's budget spent $300,000 to move the downtown clinic to the Rawson-Neal campus. The closure of the clinic leaves dozens of mentally ill people with even fewer options.
"I find it concerning that somebody who's in charge of monitoring the appropriate use of federal money doesn't know the rules," Triggs said.
State health officials point to the federal guideline known as the "one third rule." If a clinic doesn't provide full emergency services, the clinic can't send more than one-third of it's patients to the psychiatric hospital next door.
Federal regulators tell the I-Team it was clear the state violated that rule. Even after the clinic's closure, the state continues to disagree. This will be a topic for the governor's new mental health task force meeting next Wednesday