The Department of Health and Human Services said another four people who were involved no longer work at Rawson-Neal Psychiatric Hospital.
Gov. Brian Sandoval earlier in the day announced the firings and said his administration is looking for a national expert in the mental health field to review all the state's facilities "to ensure best practices are being implemented and followed."
The moves come in the wake of an investigative series by the Sacramento Bee after James F. Brown, who suffered from schizophrenia and depression, was given a one-way bus ticket in February to Sacramento, Calif., where he knew no one. The newspaper then reviewed bus ticket receipts dating to 2008 and found that the hospital, part of the Southern Nevada Adult Mental Health Services, had transported about 1,500 patients to other states. Roughly 500 went to California.
Sandoval said that over the weekend, he reviewed the results of an internal investigation on all out-of-state transports between July 2008 and March 2013.
"While the investigation showed the vast majority of patient releases were done correctly, it also revealed policies were not followed by certain individuals," he said in a statement.
The statement also said Sandoval's administration has obtained proposals from mental health field experts to provide an "objective and comprehensive analysis of our state facilities."
According to the agency, 1,473 patients were provided with bus transportation out of state over the last five years. Of those, the state identified 10 cases where documentation was insufficient to determine whether staff had confirmed the patient had family or a support system awaiting them.
"This information indicates that more than 99 percent of the time staff followed the discharge policy and documentation was accurate and complete," the agency said in a statement late Monday. It added that 31,043 people were admitted to the Rawson-Neal Psychiatric Observation Unit during the five-year period, and of those, 92 percent were from Nevada.
New policies were implemented this month to strengthen oversight of patient discharges. The state now requires two physicians instead of one to sign a discharge order for patients. A hospital administrator also must sign off on the decision.
Additionally, Nevada now requires chaperones to accompany all state psychiatric patients who are bused out of state.
Last week, the federal agency that oversees Medicaid and Medicare compliance cited the hospital for "serious deficiencies" and gave the state 10 days to demonstrate corrective action or risk losing federal funding.
Steps Nevada has taken will be included in the state's response.
"We're confident we will be able to respond with corrective action," Richard Whitley, administrator of the Nevada State Health Division, said Monday.
Rawson-Neal is largely funded by the state. In fiscal year 2012, it received $3.8 million from Medicare and $32.5 million from the state general fund.