In a statement issued this afternoon, Carson Tahoe Health President & CEO Ed Epperson said that the Nevada Department of Corrections has been subjecting the hospital “to several egregious cases where prisoners were virtually left at Carson Tahoe ER for no physical reason,” incurring expenses that have not been paid back by the state. The complete statement, plus two supporting cases sent by the hospital, are republished below in their entirety.
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Carson Tahoe Health Statement
Carson Tahoe has been providing care to Nevada’s inmate population for many years. Previously the Nevada Department of Corrections (NDOC) covered the care of these prisoners through a private, third party insurer – Hometown Health Plan (HHP). With the advent of the ACA, NDOC decided to do away with private insurance for its prisoners needing inpatient services. Instead they have advised Nevada hospitals that each time an inmate checks in for hospitalization they much be enroll in Medicaid in order to receive reimbursement for services. This has resulted in payments changing from hospitals receiving reimbursement through private Insurance, already established, to a reimbursement of approximately 10 cents on the dollar by Medicaid, pending approval. Again, the prison system does not carry inpatient insurance on their inmates nor does NDOC provide its own inpatient services, therefore it relies heavily on local hospitals. This change over to Medicaid from private insurance was reported earlier this year by NDOC as a budget savings of 5 million dollars for the State. In reality it was shifting the cost of inmate health care to hospitals and the Federal Government. Our small community cannot bear the medical care cost of the State’s Prison System, only receiving reimbursement for a mere 10% of charges.
According to NDOC’s report on inmate admissions by hospital, Carson Tahoe Health provides care for the largest percentage of inmates (37.2%) in Nevada while Carson City prisons provide care for only 17.5% of the entire state inmates. This disproportionate share is especially true for the most medically complex patients, who are transferred to Carson City from all over the state. *Note Renown see 7%, Saint Mary’s sees 4% and UMC sees 19.4% of the state’s total inmates.
Recently, in conjunction with the transference to Medicaid, Carson Tahoe has been subject to several egregious cases where prisoners were virtually left at Carson Tahoe ER for no physical reason. (See attached case studies of two such instances which have costs CTH close to $270,000 with a reimbursement of approximately $36,000)
The volume of inmates admitted to Carson Tahoe Regional Medical Center has nearly doubled year to date compared to same last year. No person, including prisoners, are turned away from Emergency services. Carson Tahoe is currently working cooperatively with Governor Sandoval and his Chief of Staff to provide solutions to this issue.
Ed Epperson
President & CEO
Carson Tahoe Health
Case #1
NEVADA DEPARTMENT OF CORRECTIONS (NDOC)
INMATE RELEASE WHILE CTRH INPATIENT
CASE STUDY: PATIENT R001R*
Date of Admission: 11/07/2014
Date of Discharge: 11/19/2014
Diagnosis: Septic Shock, Rectal Bleed
Length of Stay: 12 days
Medically Necessary Days: 11 days
Patient Charges: $98,071
Medicaid reimbursement: $17,148
Narrative of Events:
Patient R001R* was brought to the CTRH emergency department on 11/07/2014 via ambulance, and was subsequently admitted to intensive care for septic shock and rectal bleeding. He was transferred to the medical unit on 11/09/2014. The following day, at approximately 11am, prison guards informed the patient and staff that RR had been released from prison, and the guards left.
The discharge plan included admission to an extended care facility. The patient was eligible for discharge on 11/10/2014 but placement proved challenging due to his prison record. His physical condition deteriorated and discharge was delayed for several days. R001R was subsequently discharged from CTRH and admitted to Carson Nursing and Rehabiltation. CTRH is paying for physical and occupational therapy provided at the extended care facility as a condition of admission.
Commentary:
Patient RR was an emergency admission due to his medical issues, which were addressed such that he was ready for discharge after four days. However placing him in an extended care facility proved problematic due to his prison background. Prison guards informed CTRH on the third day post-admission that RR had been released. The patient’s family state they had been informed of RR’s impending release two months earlier. CTRH is paying for PT and OT for him since Medicaid does not.
*inmates initials, full name to be released only as necessary and appropriate
Case #2
NEVADA DEPARTMENT OF CORRECTIONS (NDOC)
INAPPROPRIATE ADMISSION TO CARSON TAHOE REGIONAL HEALTH (CTRH)
CASE STUDY: PATIENT W002SS*
Date of Admission: 08/16/2014
Date of Discharge: 10/31/2014
Diagnosis: Inability to Care for Self (per NDOC)
Social Admission (per CTRH physician)
Length of Stay: 75 days
Medically Necessary Days: 0 days
Patient Charges: $168,577
Medicaid Reimbursement: $19,204**
Narrative of Events:
Patient W002SS* was brought by prison guards to the CTRH emergency department at a.m. on Saturday, August 16, 2014. The guards stated that SSW had been released from NDOC, despite the fact that he was dressed in prison garb.
NDOC staff produced a Legal 2000 written by a registered nurse at NDOC, and the document stated a diagnosis of “inability to care for self”; it also states inmate has severe brain damage due to PCP intake and past trauma. Guards stated that attempts to notify W002SS’s mother about his release were unsuccessful. NDOC did not, and has not, documentation of prison discharge, medical history, physical or psychological evaluation, or medication lists.
Over the subsequent few days numerous calls were made to the warden and others at NDOC without response. Eventually CTRH staff learned that NDOC had tried to place SSH at Mountain View extended care facility, but was rejected. NDOC stated it was unable to enroll W002SS into Medicaid while he remained incarcerated.
Guardianship is necessary for Medicaid enrollment and it was discovered there was no guardianship known. CTRH contacted W002SS’s mother who stated NDOC originally intended to release W002SS on 07/31/2013l; she had not been informed of the release on 08/16/2014. CTRH at its expense flew legal counsel to Las Vegas to meet with the mother; and subsequently underwrote the expenses of the mother coming to Carson City to sign guardianship documents.
Ongoing efforts to obtain Medicaid for SSH continued without success. Multiple phone calls requesting status update by the state were not returned. The application had not been acted upon, for reasons unknown. October 10, 2014, CTRH staff learned the name provided for the patient is incorrect, and apparently was incorrect throughout his incarceration. It became necessary at that point to obtain a copy of W002SS’s birth certificate and to resubmit an application for Medicaid. The patient at this time had been at CTRH for more than 60 days.
Medicaid was obtained on behalf of SSW on 10/25/201 . The patient was discharged to an extended care facility on 10/31/2014.
Commentary:
Inmate SSW was inappropriately left at the CTRH emergency department following NDOC’s attempt to place him at an extended care facility. W002SS was not a patient within the prison and there was no medical need for him being left at the emergency department. NDOC did not attempt to enroll the inmate in Medicaid, and despite comments otherwise, NDOC routinely makes no attempt to do so on behalf of inmates.
The Legal 2000 form provided by NDOC appears inappropriate given no findings of mental illness by either NDOC or CTRH physicians.
Attempts by CTRH staff to obtain Medicaid status for W002SS was necessary for placement of him in an extended care facility. This process was severely hindered by the fact NDOC provided an incorrect name, as well as multiple delays and non-response from the Medicaid office.
This admission was medically unnecessary and occurred as an apparent cost saving event by NDOC. CTRH expended significant resources to support W002SS and hospital charges are $168,577. Additionally CTRH paid the costs to bring his mother into the case, as well as to establish the patient’s accurate name.
*inmates CTH identification, full name to be released only as necessary and appropriate
**pending Medicaid authorization and subsequent payment
