The Nevada Supreme Court on Thursday upheld a lower court’s decision to impose fines against the state agency responsible for delays in providing treatment to criminal defendants found mentally unfit to stand trial.

The state’s Division of Public and Behavioral Health (DPBH) for years has struggled to provide timely mental health treatment for criminal defendants found to be mentally incompetent. The state has two psychiatric facilities for criminal defendants — the Stein Hospital in Las Vegas and Lake’s Crossing Center in Sparks — but they lack sufficient staff and capacity.

Last year, the Eighth Judicial Court in Las Vegas held DPBH in contempt for the delays, charging the agency $500 for every day each defendant had not been transported to a treatment facility. The department is supposed to transfer inmates for treatment within seven days of receiving a court order, but defendants generally have had to wait between 90 and 120 days to be transferred to a psychiatric facility. As of this week, there are 139 criminal defendants awaiting transfer to a psychiatric facility, which combined have 199 beds, according to DPBH.

Attorneys for DPBH asked the state’s highest court to intervene, claiming the district court lacked jurisdiction to issue the contempt orders and abused its power because the fines would be “impossible” for the agency to meet.

In its unanimous ruling, authored by Justice Linda Bell, the Supreme Court refuted those arguments.

“We conclude that DPBH failed to meet its burden of demonstrating the need for extraordinary relief. The district court had jurisdiction to hold DPBH in contempt and did not manifestly or capriciously abuse its discretion in doing so,” the ruling reads.

Darin Imlay, the Clark County public defender, said after the ruling he is “hoping that going forward, that those in competency court can be transported in a timely fashion.”

The case centered around contempt orders involving 11 criminal defendants who were deemed incompetent to stand trial and set to be transported to psychiatric facilities for treatment. None of them are still waiting to be transferred for treatment. As of court filings from last October, one defendant, Dana Gee, had waited at Clark County Detention Center for more than 116 days to be transferred. Another defendant, Carlos Guzman, waited more than 101 days. 

The state in legal filings said these court-ordered fines exacerbate the problem. They argued the district court abused its power by imposing the civil contempt orders because the department could not accommodate all defendants given its financial constraints and limited capacity and staffing.

“The result of the district court’s monetary sanctions is the equivalent of putting the Department on a debt treadmill,” the state said last year in a legal filing. “The ultimate result of the monetary sanctions is to exacerbate conditions that will lead to further delays across the entire state, not to coerce compliance, because the fines will further deplete the Department’s already limited resources.”

The defendants’ lawyers argued that the district court was within its rights to issue contempt orders, and that the DBPH’s financial situation does not shield it from fines.

“While the Department’s financial resources may be limited, these sanctions are not excessive in light of the egregious harms incurred,” the public defender’s office said in a November filing with the Supreme Court. “As a result of these delays, their trials are indefinitely postponed and no meaningful preparation of their defense can be facilitated, depriving them of their due process rights.”

The Supreme Court’s ruling ultimately refuted the state’s arguments.

“The record shows that DPBH can and does comply with competency orders once a civil contempt order with sanctions is issued,” the opinion said. “Therefore, DPBH's arguments that compliance is impossible and that sanctions undermine its ability to comply with the competency orders lack merit.”

DPBH has for years struggled to accommodate all criminal defendants in need of psychiatric treatment. In 2005, a man sued the department after not being transported to a treatment center despite being considered incompetent to stand trial. That lawsuit resulted in a settlement, in which the department agreed to provide treatment within one week of receiving a court order.

In 2013, three men sued the department after they alleged they had remained at the Clark County Detention Center even after the department ordered them to receive treatment at a psychiatric center. That dispute resulted in a consent decree — a legally binding agreement — where the department had to move incompetent defendants to treatment facilities within one week of receiving a competency order. That agreement expired in 2020, and the delays soon picked up again.

The Legislature's Interim Finance Committee last year allocated more than $55 million in American Rescue Plan Act funds to add 45 more treatment beds and 115 new staff members for treatment facilities. The Las Vegas City Jail also has plans to convert unused units into psychiatric beds, but that plan has faced delays and could be years away from completion, The Nevada Current reported.

The initial contempt orders against DPBH appeared to lead to quicker treatment, according to court documents. Of the first 15 defendants that were subject of the orders, 11 were transferred to a treatment facility one day before the contempt hearing.

The long waits reflect a nationwide problem. Other states also have psychiatric facility waitlists in the hundreds, with Texas last year having a backlog of more than 2,000.

The issue has concerned mental health experts.

“Jail is the worst place because it's scary, because they're vulnerable to attack from other prisoners,” Philip Fornaci, who has worked as an attorney with the National Disability Rights Network, said in an interview. “You hear a lot of stories about people just sort of decompensating after a few weeks, ending up huddled in a corner and set back severely.”

However, Fornaci said he would not envision the fines being enough to alleviate the problem.

“What you're doing in that situation is the court is telling them ‘I know how to run your jail better than you do.’ And this might very well be true, but not necessarily,” Fornaci said. “I feel like because it's such a negative approach, it's not ever going to work.”