Jim Wilson/The New York Times
David Theisen, a homeless man at the center of a lawsuit against the State of Nevada, said, "Technically, they shouldn't have been allowed to send me anywhere. They should have put me in a little room until I got better." More Photos »
SAN FRANCISCO — David Theisen keeps his legal papers in a frayed yellow envelope in his tiny transients' hotel room, a toilet down the hall, the covers of his beloved comic books, with titles like "Dark Mysteries" and "Vault of Horror," lining the drab walls.
A lot has changed in the year and a half since Mr. Theisen, 52 and homeless, threatened to kill himself with a butcher knife and ended up in a Las Vegas psychiatric center. After one night, Mr. Theisen found himself on a bus to San Francisco, several sack lunches and a day's worth of medication clutched in his lap.
"Technically, they shouldn't have been allowed to send me anywhere," Mr. Theisen said. "They should have put me in a little room until I got better."
Now, Mr. Theisen is at the center of a class-action lawsuit brought this month by San Francisco's city attorney, Dennis Herrera, against the State of Nevada on behalf of 24 mentally ill and homeless people. They were all, like Mr. Theisen, bused out of Nevada and left on the streets of San Francisco with little or no medication.
But that is just a small sampling, Mr. Herrera says, of the estimated 1,500 people who were bused all over the country in recent years from the state-operated Rawson-Neal Psychiatric Center in Las Vegas and other Nevada institutions, 500 of them to California.
"It's horrifying," Mr. Herrera said. "I think we can all agree that our most vulnerable and at-risk people don't deserve this sort of treatment: no meds, no medical care, a destination where they have no contacts and know no one."
But what makes it "even more tragic," Mr. Herrera said, "is that on top of the inhumane treatment, the State of Nevada was trying to have another jurisdiction shoulder the financial responsibility for caring for these people."
Attorney General Catherine Cortez Masto of Nevada, who has several weeks to respond to Mr. Herrera's lawsuit, has declined to comment in the meantime.
Mary Woods, a spokeswoman for the Nevada Department of Health and Human Services, laid out the state's position in an e-mail. Outside a handful of instances, the state believes that its Client Transportation Back to Home Communities program was operated properly and that it is not dissimilar from programs in other jurisdictions, including San Francisco.
Hospitals in several cities have programs intended to reunite discharged psychiatric patients with their families and hometowns. Where abuses occur, Mr. Herrera and others say, is when patients are shipped off with little or no oversight about where they are going and what will happen once they get there.
Nevada officials say that besides a single, well-documented case, they believe that the Rawson-Neal staff followed proper release procedures in almost all of the remaining cases they have investigated.
That single case, involving a man named James F. Brown who was sent by bus to Sacramento, a city where he knew no one, from the Vegas hospital in February, was the subject of an article in The Sacramento Bee.
That newspaper article not only prompted the San Francisco city attorney's office to look into the Nevada policy, but it also led to a federal investigation.
"This has certainly elevated attention of a practice that, frankly, has probably gone on for many years in a number of states," said Ronald S. Honberg, legal director for the National Alliance on Mental Illness in Washington. "We've never done a study, and I've never seen one anybody else did, but we have certainly heard over the years a number of stories that this sort of practice goes on. It's something we refer to, euphemistically, as Greyhound therapy."
Mr. Theisen's experience began when he and another homeless man tried to hitchhike across the Mojave Desert from Las Vegas to San Diego. They made it about 45 miles to the small town of Primm, little more than a cluster of casinos.
The two men, desperate and hungry, ordered a meal and then ran before the bill arrived. They did not make it. His friend was arrested, but Mr. Theisen went to a pay phone and called the authorities. "I told them I had a knife and was going to kill myself," he said. "After the dine-and-dash, I just gave up."
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