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    Public Citizen | Publications - Hospital Emergency Rooms and Patient Dumping




     

    Hospital Emergency Rooms and Patient Dumping

       
     

    Since 1991, Public Citizen's Health Research Group has tracked the Department of Health and Human Services' (HHS) record in enforcing the federal "patient dumping" law. In a report released in December 1997, we named 256 hospitals reported to HHS between April 1, 1995 and September 30, 1996 for violating the law (and later confirmed by HHS as having done so), and 26 hospitals and eight physicians who paid fines in 1995 and 1996 to settle alleged patient dumping violations. The report updates four earlier reports on this topic published in 1991, 1993, 1994, and 1996. The addition of these hospitals brings the total number that have violated the patient dumping law during its first ten years (Sept. 86 to Sept. 96) to almost 700 hospitals, or more than one in ten acute-care hospitals in the United States. The actual number of violations is much higher, since many cases are not reported to the government.

    In addition to naming 256 hospitals found to have violated the law, the report includes for the first time patient-specific clinical information from the reports of government inspectors who investigated dumping complaints. Examples of violations from 31 of these government inspection reports include:

    A 2-year-old child with a fever and history of vomiting and diarrhea earlier that day was brought to the hospital's emergency room by her mother, but instead of being medically screened, was referred to a physician's private practice. Seven hours later, the child was taken to the emergency department by ambulance, but was unresponsive, and died that evening.

    A 16-year-old patient with history of fetal alcohol syndrome and suicide attempts, was brought to the emergency room by his father who stated that the patient had threatened to kill him. The patient was allowed to be transferred by car with his father to a facility with an adolescent psychiatric unit despite the risk of the patient becoming violent and harming others.

    A 28-year-old woman went to the emergency department with severe abdominal pain. Although the medical screening exam included a positive pregnancy test, she was discharged without her severe abdominal pain being adequately investigated. Three days later, she was admitted to the hospital in shock with a ruptured ectopic pregnancy.

    In 1986, Congress passed the Emergency Medical Treatment and Labor Act, which forbids the practice known as patient dumping--denial of treatment to emergency patients or women in labor, or transferring them to another hospital in an unstable condition. Patients are usually "dumped" because they are poor or uninsured, but in recent years, there have been reports of patients with health insurance through health maintenance organizations (HMOs), or other forms of managed care, finding themselves the victims of patient dumping as well.

    Patients in managed care may find themselves having their treatment delayed while the hospital seeks authorization for payment, having treatment denied if the authorization is refused, or being shuffled from one hospital to another in a dangerously unstable condition because their HMO has a contract with the second hospital.

    The Act requires hospitals to screen all patients seeking emergency care and to provide treatment to stabilize emergency conditions. Unstabilized patients may not be transferred to another facility unless the medical benefits of the transfer outweigh its risks. The law applies to all hospitals participating in Medicare and offering emergency services, and it protects all patients seen by those hospitals, not just Medicare beneficiaries.

    Hospitals that violate the Act may be banned from Medicare--a serious penalty since most hospitals rely on Medicare funds for a significant part of their revenues. Hospitals and doctors responsible for patient dumping may also be fined up to $50,000 for each offense. However, these penalties have seldom been used. From 1986 through March 1995, (the period covered by our earlier reports), HHS cited 503 hospitals for violations, but only 41 (8 percent) were penalized. Thirty-two hospitals and four doctors were fined, and nine hospitals were dropped from Medicare. Thus, for the vast majority of violators there is no penalty of any sort imposed. Given the increasing number of dumping complaints reported each year, HHS should use its authority more frequently to fine hospitals that violate the Act, and to send a message that such actions will not be tolerated.

    Between April 1, 1995 and September 30, 1996 (the latest data obtained by Health Research Group), HHS identified 256 hospitals responsible for 264 dumping violations. Twenty-three of these hospitals (9 percent) had been cited for prior violations. In addition, in 1995 and 1996, the Office of Inspector General, (OIG), the agency within HHS with the authority to impose fines for patient dumping violations, concluded settlements with 26 hospitals and eight doctors, where the hospitals or doctors paid a fine to resolve a complaint of patient dumping. The agreements state that the hospital or doctor does not admit to having violated the law but agrees to pay a specified sum to the government in order to avoid litigation. Twenty-five of the twenty-six hospital agreements include "community outreach" provisions, describing steps the hospital promises to take to publicize its availability to treat emergency patients, regardless of their ability to pay. (The table following this text shows the 26 hospitals that paid settlement fines between $2,500 and $55,000 for alleged patient dumping violations.)

    In spite of the fact that it has been against the law for over ten years to "dump" a patient, the ever-increasing numbers of EMTALA violations each year demonstrate that it is still a concern. To deal with this problem, the government must step up its enforcement of the Act, and especially should seek to impose monetary penalties in many more cases. In addition, as the government's experience with enforcing the Act grows, and more data on the various hospitals involved in violations are available, the government should incorporate a centralized review of the violation history of hospitals to ensure that those hospitals with recurring violations are dealt with in a firmer manner than is now the case.

    However, government vigilance alone will not end "patient dumping" as long as more than 40 million people remain uninsured and clinical decisions are driven by concerns about who pays the bills. The recent problems that patients insured through managed care organizations have had in emergency rooms have emphasized how economic, rather than medical, considerations are still playing a major role in many emergency room decisions. Patients in life-threatening condition will continue to be denied care until access to health care is recognized and provided as a basic right. Patient dumping from American hospital emergency rooms is a dangerous, disgraceful but predictable accompaniment to the market-driven health care system in the richest nation in the world. True health care reform -- including universal coverage -- is needed to put a stop to this unconscionable and deadly practice.

    What You Can Do
    Patient dumping is a vastly under-reported violation of the law. If you, or someone you know, suspect that you have been the victim of patient dumping, contact your regional office of the Health Care Financing Administration (HCFA), within the Department of Health and Human Services.

    Boston (617) 565-2689 Dallas (214) 767-8406
    New York (212) 264-1691 Kansas City (816) 426-5959
    Philadelphia (205) 596-6743 Denver (303) 844-2121
    Atlanta (404) 562-7603 San Francisco (415) 437-7961
    Chicago (312) 353-2740 Seattle (206) 615-2306

     

    Hospitals That Paid Fines to Settle Alleged Patient Dumping Violations
    (Settlements Completed in 1995 and 1996)

    State

    Hospital

    City

    Status
    P=For-Profit
    N=Not-for-
    Profit

    Provision(s) Allegedly Violated/Year

    Year of Settlement

    Settlement Amount

    Alabama

    Mizell Memorial Hospital

    Opp

    N

    Screening (1993)

    1996

    $15,000

    California

    Fountain Valley Regional

    Fountain Valley

    P

    Screening, Treatment, Transfer (1994)

    1995

    $10,000

    Fremont Medical Center

    Yuba City

    N

    Screening (1991)

    1995

    $23,000

    Glendale Memorial Hospital

    Glendale

    N

    Screening, Treatment, Transfer (1990)

    1995

    $45,000

    Greater El Monte Community

    South El Monte

    P

    Screening, Treatment, Transfer (1994)

    1996

    $20,000

    Valley Presbyterian Hospital

    Van Nuys

    N

    Non-discrimination
    (refusal to accept patient transfer)

    1996

    $40,000

    Florida

    Aventura Hospital & Medical Center

    Miami

    P

    Screening, Treatment
    (1990)

    1995

    $15,000

    Columbia Blake Medical Center

    Bradenton

    P

    Screening (1995)

    1996

    $55,000

    John F. Kennedy Medical Center

    Atlantis

    N

    Screening (1995)

    1996

    $10,000

    Northridge Medical Center

    Fort Lauderdale

    P

    Screening (1994)

    1996

    $23,500

    Georgia

    Calhoun Memorial Hospital

    Arlington

    N

    Screening (1992)

    1996

    $ 5,000

    Early Memorial Hospital

    Blakely

    N

    Screening, Treatment,
    Transfer (1992)

    1995

    $ 5,000

    Iowa

    Hegg Memorial Hospital

    Rock Valley

    N

    Screening, Treatment,
    Transfer (1992)

    1996

    $ 5,000

    Madison County Memorial

    Winterset

    N

    Screening, Treatment (1993)

    1996

    $ 9,000

    Kansas

    Ashland District

    Ashland

    N

    Transfer (1993)

    1995

    $ 5,000

    Missouri

    Breech Medical Center

    Lebanon

    N

    Screening (1993)

    1995

    $ 2,500

    New York

    Canton-Potsdam

    Potsdam

    N

    [Provision violated unavailable] (1992)

    1996

    $15,000

    Interfaith Medical Center

    Brooklyn

    N

    Screening (1991)

    1995

    $45,000

    Massena Memorial

    Massena

    N

    Screening, Treatment (1995)

    1996

    $10,000

    New York Eye & Ear Infirmary

    New York

    N

    Screening (1992)

    1996

    $22,500

    Our Lady of Lourdes Memorial

    Binghamton

    N

    Screening, Treatment, Transfer (1994)

    1996

    $ 5,000

    Tennessee

    Middle Tennessee Medical Center

    Murfreesboro

    N

    Screening, Transfer (1993)

    1995

    $25,000

    Virginia

    Clinch Valley Medical Center

    Richlands

    P

    Screening (1995)

    1996

    $25,000

    West Virginia

    Princeton Community

    Princeton

    N

    Screening, Transfer (1994)

    1996

    $15,000

    St. Joseph's

    Buckhannon

    N

    Non-discrimination
    (refusal to accept patient transfer)(1995)

    1996

    $10,000

    Welch Emergency

    Welch

    U

    Screening (1995)

    1996

    $ 5,000

    TOTALS:

    26 hospitals

     

    $465,500

    Source: Office of Inspector General, U.S. Department of Health and Human Services

    Hospital Emergency Rooms and Patient Dumping
    Published: December 1997
    Cost: $20

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