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Hospitals in California Violated Federal Patient Dumping Law More Than Any Other State, Study Shows

July 12, 2001

Hospitals in California Violated Federal Patient Dumping Law More Than Any Other State, Study Shows

California Tops List With 77 Hospitals Violating Law Regarding Screening, Treating ER Patients

WASHINGTON, D.C. ? More hospitals in California in recent years have violated a federal law prohibiting them from dumping patients than any other state, leading to people with medical emergencies being improperly screened or refused treatment altogether, a new report from the consumer advocacy group Public Citizen has found.

In its sixth in a series of reports on patient dumping, Public Citizen found that 527 hospitals in the United States have violated the 1986 Emergency Medical Treatment and Active Labor Act (EMTALA), with 77 hospitals in California having confirmed violations. That law contains rules that virtually all hospitals in the United States must follow regarding the provision of emergency medical services. When a hospital emergency department denies medical screening or stabilizing treatment, or if it inappropriately transfers an individual whose condition is not stable, the hospital is “dumping” the patient. Taking data from all six reports into account, more than one in five hospitals throughout the country have violated the law since it was passed. The report concludes that most hospital staff are familiar with the law but break it anyway.

“It?s distressing that this law has been in place for 15 years, and hospitals are still flouting it,” said Dr. Sidney Wolfe, director of Public Citizen?s Health Research Group. “The government needs to do more to force hospitals to comply. People shouldn?t be denied desperately needed emergency medical care when they go to a hospital. Failing to impose fines on most hospitals violating the law amounts to an invitation to dump sick patients.”

Most of the violations cited in the current report were confirmed in 1997, 1998 and 1999, although a few were confirmed in 1996 and 2000. Not all the hospitals violating the act actually dumped patients; some violations were administrative in nature, involving such things as omitting documentation or failing to post signs spelling out patients? rights. The report lists the name of each hospital, the nature of the violation and any fines assessed against the hospital. Of the 500 hospitals that had confirmed violations in 1997, 1998 and 1999 and were eligible to be fined, only 85 (17 percent) had been fined as of April 2001.

In California, 72 hospitals violated the screening, stabilizing treatment or transfer provisions of the Act ? the most serious types of violations. Forty-seven of the 77 total violating hospitals are non-profit, 24 are for-profit and the status of six is unknown. California for-profit hospitals appear more likely (1.37 times more likely) than not-for-profit hospitals to violate the law, the study found. Eleven hospitals were listed in previous Public Citizen reports as having confirmed violations.

The California hospitals with confirmed violations are located in Anaheim, Arcata, Bakersfield, Bellflower, Big Bear Lake, Burbank, Carmichael, Encinitas, Encino, Eureka, Fortuna, Fresno, Garden Grove, Harbor City, Hayward, Huntington Beach, Huntington Park, Indio, Irvine, Lakeport, Lancaster, Loma Linda, Long Beach, Los Angeles, Los Banos, Martinez, Merced, Monrovia, Montclair, Monterey Park, Norwalk, Oakland, Paramount, Porterville, Redlands, Redwood, Redwood City, Reedley, Riverside, Sacramento, San Diego, San Francisco, San Jose, San Pablo, Santa Ana, Santa Clara, Santa Rosa, Sonora, Stockton, Taft, Torrance, Turlock, Vallejo, Victorville, Visalia, Walnut Creek, Watsonville, Whittier, Wildomar and Yosemite,

Some of the more egregious examples of patient dumping in California include:

  • A man involved in a skiing accident went to Fresno Community Hospital. After X-rays showed a pulverized leg bone, the staff gave him pain medication and splinted his leg, but the emergency room orthopedist refused to admit him and told the man to come to his office two days later. When the patient followed up, the doctor said them man had to come up with $15,000 to $20,000 for surgery. The patient went to a different hospital, where he was evaluated, admitted and operated on. The medical record from the second hospital documents that the patient was unable to receive followup care from Fresno?s on-call orthopedist because of his insurance status. As of April 2001, the hospital had not been fined.

  • In Bellflower, a man brought to Kaiser Foundation Hospital after being involved in a motor vehicle crash was asked to pay $75 before being screened or receiving treatment. Because he didn?t have the money, he was denied care. Kaiser agreed to pay a $15,000 fine.

  • A Spanish-speaking man went to the emergency room of Coastal Communities Hospital in Santa Ana, where he was told that he would have to go elsewhere because the hospital didn?t have a contract with his HMO. He went to another hospital, where he was admitted after doctors determined he had suffered a heart attack. As of April 2001, the hospital had not been fined.

According to records reviewed by Public Citizen, hospitals in 46 states as well as the District of Columbia and Puerto Rico were cited for violations during the years analyzed. States with no confirmed violations listed in this report were Delaware, Hawaii, New Mexico and Wyoming. Consumers wishing to find out which hospitals in their state violated the law can visit www.citizen.org after 1 p.m. EDT (10 a.m. PDT), go to “Questionable Hospitals,” click on a map of the United States and select their state. A copy of the report is also posted there, as is a supplemental report on the California findings.

Among the report?s key findings:

  • Nationwide, for-profit hospitals had a significantly higher rate of violation (1.7 times higher) than not-for-profit hospitals.
  • Up to a third of surveyed emergency room registration staff recently told the U.S. Department of Health and Human Services Office of Inspector General that patients might be asked for insurance information before a screening is provided or while it is taking place, and 35 percent said they contact health plans for authorization of screening exams at some point. These actions violate the law if they delay treatment.
  • Hospitals are being fined more than in previous years. Civil money penalties increased from $130,000 in fiscal 1988 to?? more than $1 million in each of 1998, 1999 and 2000. However, the amounts paid are still paltry compared to a hospital?s overall budget and do nothing to discourage hospitals from turning needy patients into the streets. Worse, most hospitals with confirmed violations are not fined.

“The sad truth is that it?s cheaper for a hospital to break the law and pay a fine than to treat an uninsured patient,” Wolfe said. “Hospitals know that the risk of getting caught is low, and even if they are caught, the risk of being fined is even lower and the fines are minuscule compared to hospitals? operating budgets.”

While the records reviewed by Public Citizen generally don?t reflect the reason a patient was dumped, often it is because the patient was uninsured, Wolfe said. The law prohibits emergency room personnel from delaying screening or treatment to ask whether a patient has insurance, but personnel still do. Further, some HMOs require pre-authorization for exams or treatment, and some HMOs refuse to pay for emergency room treatment later if the patient is found not to have a condition that constitutes an emergency. This often means the hospital gets stuck with the bill, providing hospitals with a deadly incentive to dump uninsured or poor patients.

Federal legislation or new federal regulations could help, Wolfe said. The EMTALA could be amended to create liability for insurers that require pre-authorization or that refuse to reimburse hospitals for emergency screening and treatment.