10 % US ER's Accused of 'Patient Dumping'

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Thursday July 12 6:18 PM ET

US Hospitals Accused of 'Patient Dumping'

By Karen Pallarito


NEW YORK (Reuters Health) - A troubling number of US hospitals continue to ``dump'' patients who come to the emergency department despite federal legislation barring the practice, according to findings released Thursday by Public Citizen.

For-profit hospitals were nearly twice as likely as not-for-profit hospitals to violate the anti-dumping law, the report indicates.

Confirmed violations of the Emergency Medical Treatment and Active Labor Act (EMTALA) occurred at 527 hospitals--roughly 10% of US hospitals. More than 90% of those violators breached the law's screening, treatment and transfer provisions, which are ``the most serious categories of EMTALA violations,'' Public Citizen said.

The report covers violations confirmed by the Health Care Financing Administration (now the Centers for Medicare and Medicaid Services) from 1997 to 1999. A few confirmed violations between 1996 and 2000 are also included.

``It's distressing that this law has been in place for 15 years, and hospitals are still flaunting 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 toimpose fines on most hospitals violating the law amounts to an invitation to dump sick patients.''

EMTALA requires hospitals to screen every patient who comes to the emergency department to determine if urgent care is needed. If the patient has an emergency condition, the hospital must provide necessary treatment or arrange for the patient's ''appropriate transfer'' to another facility.

The Act also prohibits hospitals from delaying screening or treatment to determine whether the patient is insured or how the patient intends to pay for care.

While some violations represent only minor infractions, ''others are dramatic illustrations of the very practices Congress sought to prohibit,'' Dr. Wolfe and colleague Kaija Blalock caution.

Their report discloses the names of violating hospitals and highlights the most egregious examples of EMTALA violations.

In one 1998 case, a 9-month-old infant who suffered two seizure-like episodes was taken to Santa Clara Valley Medical Center in San Jose, California. The hospital's triage nurse referred the parents and child to an outpatient clinic several miles away without doing a medical screening or taking vital signs. The child, who had a temperature of 104 degrees at the clinic, was returned to the hospital by ambulance after having a seizure that lasted 4 minutes.

As of April 2001, the hospital had not paid a civil monetary penalty in connection with that case, the report notes. However, the number of hospitals nationally that have agreed to pay fines to resolve alleged EMTALA violations rose to 59 in 1998--a fourfold increase over the previous year.

Public Citizen concludes that some violations, particularly those involving on-call specialist panels, may be related to individual hospital practices and deficiencies. It also points to the need for legislation or regulation to force insurers to cover screening and stabilization treatment without prior authorization.

Chip Kahn, president of the Federation of American Hospitals, attempted to refute Public Citizen's contention that for-profits are 1.7 times more likely to violate EMTALA.

``Their own data does not support that conclusion,'' he said in a statement. ``In fact, in two states with the highest concentration of investor-owned hospitals, the report finds no statistically significant difference between the violation numbers of investor-owned hospitals and others.''

Hi. I no longer work in a hospital so I'm curious. When is it okay to send a patient to another hospital before screening? Is it when the hospital is on deferral status d/t a crises in staff and beds such as may occur with a major catastrophe involving many people. What is the primary reason that for profit hospitals dump patients? Don't these hospitals get government funding via Medicare? Seems that dumping would go against their hospital philosophy and policy. I know that concerns about whether insurance will pay is an issue. So is market driven concerns. Can a universal health program funded by an entity (government or etc.) help reduce this occurrence of patient dumping?

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