Hospitals Turn Away Patients for Inability to Pay

or lack of proof of insurance, or having a condition they are not getting reimbursed well for

This is completely legal, unless the patient isn't stable. At this time, legally most hospitals have to stabilize patients. Then they can turn them away, or transfer them somewhere else. They do not have to provide any necessary further treatment or care. However, the law requiring hospitals to stabilize patients before turning them away is extremely poorly enforced.

Alot of people don't know this, and don't realize how bad things are in our healthcare system.

Most people don't understand that in the USA, healthcare is a private, for profit business.

For example, most Americans believe doctors and hospitals have to treat sick people, whether they can afford the bill or not. This is completely untrue.

While the Hippocratic Oath requires all doctors to treat those in need, in the USA doctors break that Oath all day every day, in multitude ways, anyways.

By law in the USA no doctor has to treat any patient, they can refuse service to any customer. Requiring doctors to treat patients is conscription, which is illegal in the U.S. except in times of war.

To the point, most Americans have no idea how EMTALA law works.

EMTALA was enacted in 1986. Before EMTALA, private hospitals were turning away so many poor patients from their Emergency Departments and sending them or transferring them to public hospitals, that the public hospitals were over flowing, and wait times were horrible. Under extreme pressure to take action, Congres decided to use the power of the purse to change things. They used CMS (Centers for Medicare & Medicaid Services) powers.

EMTALA requires any hospital participating in Medicare / Medicaid insurance networks, or receiving reimbursment through Medicare / Medicaid insurance policies, to screen every patient that comes to their ER, insured or not, to check if they are medically stable. If they are not stable, they are required to stabilize them. If they are stable, or once they are stabilized, they may refuse further care, and turn them away, or have them transfered elsewhere.

This law is extremely poorly enforced. In fact, most people don't even know about it, and don't know to report EMTALA violations to the federal government. Even long standing ER doctors often have never heard of it. Without reporting, there is no enforcement. Even with reporting, it can be hard to investigate, as the accused party (the hospital) usually has the majority of the evidence, and may not be interested in providing it, or even not destroying it.

EMTALA is just one glaring example of the extreme failures in our system, with bad design structures, and also a lack of ethics and morality, and massive financial conflicts of interest ruling practice and outcomes, often with deadly harm.

Every year people die because of EMTALA violations. No one knows how many, because it has never been substancially investigated. Estimates are based are reporting which in known to be extremely underreported, due to lack of awareness of the law, education, and training. Also, as described below, hospital staff report living in fear of retaliation from the hospital for reporting. It is known that there are, on average, multiple EMTALA violations everyday. It is not know exactly how much harm and death is resulting, but the risks are extremely high.

Here are some notes on the subject, and some documents and info to help spread the word:

“EMTALA, signed into law by President Ronald Reagan in 1986, was designed to prevent the practice of so-called wallet biopsies — where hospitals would turn away patients who couldn’t prove they had financial resources like health insurance to pay for their care. Those patients ended up at public hospitals, often in unstable conditions. They died about three times more often than patients who were not transferred this way, according to an influential 1986 study on the practice.

...Under the law enacted in 1986, emergency departments must:

Offer patients a timely and appropriate medical screening exam.

This exam is different from triage, in which a nurse or other provider takes vital signs to decide the order in which to see patients.

Unlike with triage, a health care professional with a certain level of expertise — typically a doctor, advanced practice nurse, or physician assistant — must do the medical screening.

Medical screening exams are done to find out the cause of a patient’s symptoms. They cannot be delayed or denied in order to ask about a patient’s ability to pay.

Medical screening exams must make use of all the hospital’s relevant resources, for example, lab tests or CT scans.

Over the last 10 years, the most frequent EMTALA violation by hospitals was the failure to do an adequate medical screening exam.

Stabilize patients who have emergency medical conditions.

Failure to offer stabilizing treatment was the fourth most common EMTALA violation over the last 10 years.

If a hospital can’t stabilize a patient, it is required to arrange an appropriate transfer to another facility, including:

Treatment to lessen the risks of transfer

Getting consent from the receiving hospital to accept the transfer

Ensuring the transfer involves qualified personnel and transportation (an ambulance)

Failure to do an appropriate transfer was the second most common way hospitals have violated EMTALA over the last 10 years.”

https://www.georgiahealthnews.com/2018/11/investigation-finds-lives-lost-er-violations/

‘It’s like I’m worthless’: Troubleshooters investigate patient dumping allegations

Hospital discharged a seriously ill man, left him on the street — now police want answers | WSB-TV

"Patient dumping" outside hospitals caught on tape

Patient dumping complaints persist: Troubleshooters investigate the gap in services

Arizona hospital accused of neglecting quadriplegic man

911 Call From A Hospital ER

"If you were to ask most emergency physicians, they would tell you they were aware of patients who died in the waiting room or who got a lot sicker," says Ramon Johnson, MD, director of pediatric emergency medicine at Mission Hospital Regional Medical Center in Mission Viejo, CA, and a member of the board of trustees of the American College of Emergency Physicians (ACEP). It was in that capacity that Johnson testified before Congress recently that "the recent death of a patient in the waiting room of the emergency department at Martin Luther King Jr. — Harbor Hospital in Los Angeles is the latest illustration of a problem that has tragically become all too common in emergency departments across the country."

https://www.reliasmedia.com/articles/105643-woman-dies-in-ed-waiting-room-experts-say-this-happens-too-often

He went to the hospital for help. He left on his hands and knees.

Patient Dumping ..wearing little more than a hospital gown because the hospital admits they've lost her clothes and sent her away without pants or even shoes

Inappropriately releasing homeless or indigent patients

"...in the hospital world, we call it "dispo to street." Disposition to street. We send them out of the hospital to the street, because they don't have a place to live, they don't have followup, they don't want followup, whatever it is. Not our problem anymore."

Patient Patient Dumping: A Historical Perspective

"The impetus behind EMTALA legislation was concern about treatment of indigent and uninsured people during the 1980s, and courts have long noted problems with access to adequate care for those groups.9 During the drafts of World War I and World War II, Selective Service physical examinations revealed an astonishing problem in the nation’s health care system. Large numbers of American men were medically unfit for military service.1

Before the enactment of EMTALA, most hospitals enjoyed the common-law “no duty” rule, which allowed them to refuse treatment to anyone.11 Hospitals believed indigent patients should receive care through charitable organizations or through uncompensated care provided by hospitals.12 The common-law no duty rule was partly to blame for the poor state of the American health care system, and by extension, the poor health of the aforementioned men in the draft.

After World War II, President Truman expressed concern with America’s health care system, and worked with Congress to pass the Hill-Burton Act (Hill-Burton) of 1946.13 Hill-Burton Act provided federal funds to states for construction and modernization of hospitals. Further, the federal funding stipulated that for 20 years, hospitals must make their services available to all people in the territorial area of the facility and provide a “reasonable volume of free or below-cost care to any person unable to pay.”14

However, Hill-Burton did not succeed in ending patient dumping because it was not properly enforced. 15 For example, Hill-Burton failed to define “emergency.” Its regulations did not require states to develop their own regulations, to set-up monitoring and oversight, or to enforce the law. Finally, from a federal stance, HHS repeatedly failed to enforce Hill-Burton. 16 Specifically, HHS did not create regulations to accompany Hill-Burton until 1979, after litigation forced the Department’s hand. 17 Another criticism of Hill-Burton was that it represented a limited, piecemeal effort at reforming the health care system. 18 In proposing Hill-Burton, President Truman envisioned the beginning of a larger overhaul of the nation’s health care system. 19 Funding of new hospitals and modernization of existing hospitals was only the beginning of the reforms he sought.20

Congress quickly passed Hill-Burton but failed to act on Truman’s other proposals; most significant among them was a national health insurance plan. Recognizing that the real problem facing the health care industry was the inability of people to pay for services, President Truman noted Hill-Burton’s limitations and repeatedly pressed Congress to enact further reforms.21 He was unsuccessful. Understood in the context of President Truman’s broader goals, Hill-Burton was only a preliminary effort to improve health care delivery, and was not intended as a national program to provide health care to the indigent.22

The government did not enforce the Hill-Burton requirements until decades later when people began suing for required administrative oversight and regulations.23 Almost two decades after Congress enacted Hill-Burton, it enacted the Medicare and Medicaid programs. These programs were an attempt to alleviate the financial burden of medical expenses on vulnerable American populations—namely the elderly and the poor. However, the combination of Hill-Burton, Medicare, and Medicaid still did not resolve the underlying problems of lack of access to health care because of inability to pay. Millions of uninsured Americans fell within the gaps of coverage that these federal programs left open, and they did not have adequate ability to pay for hospital services.

It was not until the early 1980s that the problem of patient dumping began to receive national attention. It was reported that hospitals refused medical care to an estimated 250,000 patients annually because they were uninsured or lacked the ability to pay.24 Although 22 states had passed anti-dumping statutes, private hospitals still denied patients emergency care in a majority of states.25 In fact, several studies of hospitals in major cities revealed a spike in the number of patients being denied emergency medical attention in the mid-1980s.26 Courts across the United States recognized the lack of adequate state remedies for harms resulting from patientdumping. 27 The dramatic increase observed in patients being refused emergency medical attention, coupled with the lack of state protection in a majority of the country, contributed to the passage of federal legislation. Congress sought to address it through EMTALA.

The Passage of EMTALA

Congress passed EMTALA as part of the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). President Reagan signed EMTALA into law on April 7, 1986. Since then, Congress has amended the statute multiple times.28

Courts have interpreted the legislation’s text as applying to any individual regardless of insurance status.29 Congress’s overriding purpose in enacting EMTALA was to address “the increasing number of reports that hospital emergency rooms are refusing to accept or treat patients with emergency conditions if the patient does not have medical insurance.”30 EMTALA was enacted to ensure that patients received an “adequate first response to a medical crisis . . . regardless of wealth or status.”31 Specifically, Congress was concerned that “medically unstable patients [were] not being treated appropriately” and “patients in an unstable condition have been transferred improperly, sometimes without the consent of the receiving hospital.”32 In drafting EMTALA, Congress created two statutory rights of action:

1. The first right of action is that of a patient against a Medicare-participating hospital.33

2. The second is a right of action of a medical facility that received an improperly

transferred emergency patient or woman in labor against the transferring hospital.34 Congress did not intend for EMTALA to be a “substitute for state law on medical malpractice.”35 Congress further deferred to state law in adopting EMTALA’s damages provision, stating that the damages in any suit are subject to the personal injury law of the state in which the hospital is located.36

Medicare-participating hospitals that violate any EMTALA requirements are subject to a maximum fine of $50,000 for each violation.37 They are also subject to having their participation in Medicare and Medicaid terminated if they fail to correct EMTALA violations for which CMS has cited them. The statute imposes penalties for EMTALA violations by any physician responsible for the examination, treatment, or transfer of an individual in a participating hospital. 38 Hospitals and physicians are also subject to civil suits from patients who suffer personal injuries resulting from an EMTALA violation.39 Finally, facilities may also bring suit against sending hospitals for costs incurred while treating patients who were improperly transferred to them.40

Currently in the United States, there are 6,181 hospitals participating in Medicare and/or Medicaid. Of this total number, 549 represent psychiatric hospitals and 1,605 represent short-term acute care hospitals that have a psychiatric inpatient unit.41 Very few hospitals can elect to not participate in either federal program. 42 EMTALA applies to all Medicare-participating hospitals that operate a “dedicated emergency department,” and/or has specialized capabilities. The law imposes the four basic statutory obligations highlighted in Table 1 below.43

Further, EMTALA prohibits hospitals from delaying medical screening exams or providing stabilizing treatment in order to inquire about the patient’s method of payment or insurance status.44 Recipient hospitals must report any inappropriate transfers.45 In addition to several other administrative requirements, EMTALA also contains strict enforcement provisions.46

Patient Dumping, September 2014

U.S. Commission on Civil Rights

https://www.usccr.gov/files/pubs/docs/2014PATDUMPOSD_9282014-1.pdf

30% of hospitals have violated EMTALA, investigation finds

“Nearly one-third of U.S. hospitals have violated emergency department care standards set by the Emergency Medical Treatment and Labor Act in the last decade, according to an investigative report from WebMD and Georgia Health News."

Reporters found 4,341 EMTALA violations occurred at 1,682 hospitals nationwide between 2008-18.

The three most common violations were failing to conduct thorough medical screenings (1,353 violations), not transferring patients properly (701) and not following ED log standards (607).”

https://www.beckershospitalreview.com/uncategorized/30-of-hospitals-have-violated-emtala-investigation-finds/

“One in ten EMTALA citations events are associated with patient death (10.43%).”

https://schaeffer.usc.edu/research/108-characteristics-of-emergency-medical-treatment-and-labor-act-citations-and-their-association-with-patient-death/

Deprived of Care: When ERs Break the Law,

“WebMD and Georgia Health News analyzed 10 years of EMTALA violations by hospitals around the United States from March 2008 to March 2018. The records, obtained under a Freedom of Information Act request, show cases where complaints were substantiated by investigators for the federal Centers for Medicare and Medicaid Services, meaning the hospital was found to be at fault. Our investigation found:

** More than 4,300 violations from 1,682 hospitals in total over 10 years.

** Violators represent about a third of the nation’s approximately 5,500 hospitals, according to statistics from the American Hospital Association.

** Hospitals in the Southeast accounted for 1,175 violations over 10 years, more than any other region.

** Florida was the worst state in the nation for the number of violations, followed by Texas, Pennsylvania, New York, California, and Georgia.

** Smaller hospitals — those with fewer than 100 beds — accounted for the largest number of violations — 1,488, or 34% of the total.

** Failure to do a thorough medical screening exam was the most common violation committed by hospitals, accounting for more than 1,300 citations, nearly twice as many as the second most common violation: transferring patients inappropriately.

** In a deeper analysis of investigation reports from January 2016 to March 2018, at least 34 patients died during that period after emergency departments violated the law.

Yet experts say the raw numbers belie both the scope and severity of the problems they see. That’s because enforcement of the law depends on someone filing a complaint. Although anyone can file a complaint, it’s most often a doctor, nurse, or hospital administrator.

Howie Mell, MD, an emergency doctor in Chicago and a spokesman for the American College of Emergency Physicians, says that when someone from a hospital makes a complaint about what happened at another hospital, both hospitals are investigated. While complaints are anonymous, investigations can be rigorous, and they often catch smaller violations — like failing to post signs about patient rights in an emergency room — along with larger ones that directly affect patient care.

“That system of going after both sides really discourages people from complaining,” says Mell.

Given that fact, he says, when you do see an EMTALA violation recorded in the system, it’s usually because something really serious happened.

“They were either really egregious, or what you’re seeing is the tip of the iceberg” for that hospital, Mell says.

EMTALA, signed into law by President Ronald Reagan in 1986, was designed to prevent the practice of so-called wallet biopsies — where hospitals would turn away patients who couldn’t prove they had financial resources like health insurance to pay for their care. Those patients ended up at public hospitals, often in unstable conditions. They died about three times more often than patients who were not transferred this way, according to an influential 1986 study on the practice.

Federal investigators cited Piedmont Newton for failing to stabilize Theresa and for transferring her to another hospital even though it wasn’t safe to move her. In their report on the case, investigators determined the surgeon who transferred Theresa had the skill and resources to perform the needed operation. In an interview with investigators, the surgeon says in her 34 years of practice, she’d never heard of EMTALA and wasn’t familiar with the law, records show

“The delay in treatment was just shocking to us,” she says.

The clerk at the front desk had told James, Randy’s son, that they couldn’t take Randy back because they were attending to a priority patient.

But Phillips, who left North Metro in December 2017, says his investigation found that there was no priority patient.

The nurse on duty had left early — about a half-hour before the end of her shift — without telling anyone, Phillips says.

The ER clerk and another woman who was staffing the reception desk had failed to recognize how sick Randy was.

The ER doctor did not know the situation because Randy was not sent to a room in the back to be seen.

After Randy’s case, Phillips says he changed ER triage procedures so that patients with low blood pressures or rapid heart rates were brought straight back to see a doctor.

“They just didn’t bring the guy back. They didn’t think he was that sick,” Phillips says.

“There was a mistake made,” he says. “That should never, ever, ever have happened. Ever.”

...Under the law enacted in 1986, emergency departments must:

Offer patients a timely and appropriate medical screening exam.

This exam is different from triage, in which a nurse or other provider takes vital signs to decide the order in which to see patients.

Unlike with triage, a health care professional with a certain level of expertise — typically a doctor, advanced practice nurse, or physician assistant — must do the medical screening.

Medical screening exams are done to find out the cause of a patient’s symptoms. They cannot be delayed or denied in order to ask about a patient’s ability to pay.

Medical screening exams must make use of all the hospital’s relevant resources, for example, lab tests or CT scans.

Over the last 10 years, the most frequent EMTALA violation by hospitals was the failure to do an adequate medical screening exam.

Stabilize patients who have emergency medical conditions.

Failure to offer stabilizing treatment was the fourth most common EMTALA violation over the last 10 years.

If a hospital can’t stabilize a patient, it is required to arrange an appropriate transfer to another facility, including:

Treatment to lessen the risks of transfer

Getting consent from the receiving hospital to accept the transfer

Ensuring the transfer involves qualified personnel and transportation (an ambulance)

Failure to do an appropriate transfer was the second most common way hospitals have violated EMTALA over the last 10 years.

Keep appropriate records on patients, including a central log of who came to the ER and what happened to them.

Failure to keep this log was the third most common EMTALA violation over the last 10 years.

Post signs in the ER letting people know about these rights.

Keep a list of on-call doctors who can see patients in case of an emergency.

Accept appropriate transfers from other hospitals if the receiving facility has special abilities or is able to care for an incoming patient.

Not punish any hospital employee who reports a violation.

Report any improperly transferred patients it receives within 72 hours.

How we reported this story

For this 8-month investigation, WebMD and Georgia Health News filed a Freedom of Information Act request to the Centers for Medicare & Medicaid Services for a list of all EMTALA violations by hospitals across the U.S. between January 2008 and March 2018.”

https://www.georgiahealthnews.com/2018/11/investigation-finds-lives-lost-er-violations/

“EMTALA violations in the Centers for Medicare and Medicaid Services publicly available hospital violations database from 2011 to 2018 were evaluated for vascular-related issues. Details recorded were case type, hospital type, hospital region, reasons for violation, disposition, and mortality.

Results

There were 7001 patients identified with any EMTALA violation and 98 (1.4%) were deemed vascular related. The majority (82.7%) of EMTALA violations occurred at urban/suburban hospitals. Based on the Association of American Medical Colleges United States region, vascular-related EMTALA violations occurred in the Northeast (7.1%), Southern (56.1%), Central (18.4%), and Western (18.4%) United States.

...The Emergency Medical Treatment and Labor Act (EMTALA) is a US federal law enacted in 1986 in response to “patient dumping” after certain institutions in the 1980s refused to treat patients who required emergency care owing to low reimbursements.1-4 At the time, uninsured or Medicaid patients evaluated at private hospitals were often transferred to public hospitals for care without any medical treatment or stabilization before transfer.4

EMTALA ensures that any patient who presents within 250 yards of an emergency department (ED) of a Medicare-participating hospital and has an emergency medical condition will receive medical care regardless of demographics, ethnicity, or insurance status.5,6 EMTALA defines an emergency medical condition as “a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in placing the individual [or unborn child's] health in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of bodily organs.”5

EMTALA also addresses “reverse-dumping” by mandating Medicare-participating hospitals with the required medical specialty/facilities and capacity to accept transfers from institutions that are unable to treat unstable emergency medical conditions as well as “stabilize” patients “within reasonable medical probability [that] no material deterioration of the condition is likely to result.”3,5 Additionally, hospitals are obligated to report to the Centers for Medicare and Medicaid Services (CMS) or their state survey agency within 72 hours whenever it is believed that they received a patient in an unstable emergency medical condition from another hospital.6 To enforce EMTALA, CMS conducts unannounced surveys of CMS-accredited hospitals in response to complaints filed by patients, physician/staff, or hospitals.7”

https://www.jvascsurg.org/article/S0741-5214(21)00176-2/fulltext

“Patient dumping violates the federal Emergency Medical Treatment and Active Labor Act (EMTALA). Enacted in 1986, EMTALA seeks to prevent any refusal of care for patients who are unable to pay [2]. It imposes three requirements on any Medicare-participating hospital and enforces monetary sanctions against physicians or hospitals that do not comply [3]. Participating hospitals must: (1) conduct medical-screening examinations, (2) provide necessary stabilizing treatment to any patient seeking emergency medical care in an emergency department, and (3) hospitals that are unable to do (1) and (2) may transfer the patient to a facility that can provide those services in a manner that accords with EMTALA guidelines [4].

To establish a violation of EMTALA, “a plaintiff must demonstrate that (1) the hospital is a Medicare-participating hospital covered by EMTALA that operates an emergency department (or an equivalent treatment facility); (2) the patient arrived at the facility seeking treatment; and (3) the hospital either (a) did not afford the patient an appropriate screening to determine whether he or she had an emergency medical condition, or (b) bade farewell to the patient (whether by turning away, discharging, or improvidently transferring him or her) without first stabilizing the emergency medical condition” [5]. Forty-three of the 50 states have adopted statutes similar to the federal requirements [6-9].

Despite these statutes and penalties, hospitals have continued turning patients away. From 1996 to 2000, the watchdog organization Public Citizen confirmed violations from 527 hospitals in 46 states, as well as the District of Columbia and Puerto Rico [10]. Of the 527 hospitals, 117 had violated the act more than once, and for-profit hospitals were significantly more likely to do so [10].

EMTALA's inability to curb denial of treatment has been attributed to the ambiguity of the statutory provisions, poor enforcement mechanisms, and divergent judicial interpretations of the statutory provisions. A 2001 Office of the Inspector General (OIG) study revealed that emergency-care personnel and hospital staff are often unaware of EMTALA provisions and policy changes, and, even when they are aware, there is uncertainty about the proper interpretation and application of the provisions [11]. Furthermore, most emergency personnel do not receive EMTALA guidelines [11].

Lack of uniformity in enforcing the provisions also contributes to their ineffectiveness. Some hospitals have a greater chance of being investigated than others, not because they are more prone to violate EMTALA terms, but because they are geographically closer to Centers for Medicare & Medicaid Services (CMS) regional offices [11]. The EMTALA enforcement process fails to notify hospitals that are at risk for violating the proper standard of care, and regional CMS offices often don't inform state survey agencies, hospitals, and peer-review organizations about their decisions [11]. Thus, statistics on violations are often inconsistent and incomplete.

Judicial decisions have also produced conflicting interpretations of what emergency personnel must do to comply with EMTALA. The EMTALA requirement that emergency personnel provide appropriate medical screening within the capability of the emergency department, for example, can be interpreted under an objectively reasonable standard, subjective standard, or burden-shifting standard [12-14]. There is discrepancy about whether physicians should be held to the negligence standard of care customary in the medical field, or whether EMTALA is governed by a strict liability standard [15]. Finally, disagreement persists over whether the three duties imposed on medical personnel—to provide an appropriate medical screening examination, to stabilize, and to appropriately transfer patients—are separate duties that should be considered individual causes of action under law or whether they should be viewed conjunctively [16, 17]. The divergent standards of judicial interpretation further hamper EMTALA's effectiveness by creating inconsistent standards of compliance. Emergency personnel are not able to comply with EMTALA provisions because it is not clear what exactly is required of them, and case law has only exacerbated the problem.

Despite EMTALA's shortcomings, the statute is not without bite. The OIG recorded eight violations of EMTALA in November 2008 [18]. Baptist Hospital, Inc., in Florida, agreed to pay $22,500 to settle allegations that it failed to perform a medical screening on a suicidal man. After informing the registrar that his suicidal thoughts were growing stronger, the patient was informed that he would have to continue to wait—he then proceeded outside and lacerated his right arm [18]. Cumberland County Hospital System, Inc., in North Carolina, agreed to pay $42,500 to settle claims that it unsuccessfully provided appropriate medical screening or stabilized a suicidal 13-year-old girl. The physician saw the patient for 5 minutes before releasing her. Fifty minutes later, the patient jumped out of a car traveling approximately 40 miles per hour and fractured her skull [18].

Recent cases in Los Angeles demonstrate that the threat of large fines might deter the practice of patient dumping under state law. The Los Angeles City attorney secured a settlement with Methodist Hospital amid allegations of patient dumping that required the hospital to implement detailed protocols for the discharge of homeless patients. The hospital will also contribute $215,000 to fund recuperative care beds for homeless individuals at the Salvation Army's Bell Shelter and pay $5,000 in civil penalties and $20,000 in investigative costs [19]. Kaiser Hospital reached a similar agreement in May 2007, resulting in court-ordered protocols for the proper discharge of homeless patients, as well as $500,000 in donations to a charitable foundation that offers services to the homeless and $5,000 in civil penalties [19].

In response to recent incidents in California, Los Angeles passed a city ordinance that prohibits transporting or arranging for the transport of patients to somewhere other than their home without their written consent [20]. A violation of the ordinance warrants a $25,000 penalty for the misdemeanor and the suspension of the hospital's Medicare finding for at least 5 years [20].

The underfunded health care system in the United States drives the practices of patient dumping and refusal of care. Caring for patients who do not have insurance is costly, and much of the treatment often goes without reimbursement. From 1994 to 2005, the number of emergency department visits increased 18 percent from 93.4 million to 110.2 million annually, a rate that coincided with the rising costs of care and lower reimbursement by managed-care organizations and other payers, including Medicare and Medicaid [21]. The trend disproportionately affects low-income patients, who generally do not have access to health care and often seek it in emergency rooms. In response to the rising costs of medical care, states have implemented a series of measures directed at lowering costs, including reductions in Medicaid eligibility, benefits, and provider payments [22]. As Clay Mickel, spokesman for the American Hospital Association, stated, “The real problem is that the government has not acknowledged that caring for the indigent is its responsibility” [23]. The solution to patient dumping may lie in addressing its root causes rather than strengthening the enforcement mechanisms in EMTALA and similar state statutes.”

https://journalofethics.ama-assn.org/article/refusal-emergency-care-and-patient-dumping/2009-01

EMTALA 1395dd Examination and treatment for emergency medical conditions

govinfo.gov/content/pkg/USCODE-2010-title42/pdf/USCODE-2010-title42-chap7-subchapXVIII-partE-sec1395dd.pdf

“... patient dumping, ... about hospitals now are turning patients away, or taking patients in doing an initial diagnosis and when they find that the thing that's wrong with the patient is really going to require a lot of procedures that they're not getting reimbursed well for, the patient is shoved out the door in one form or another... twelve different instances... the main point to this is in [these] cases these companies these hospitals were fined, but you know most of the fines aren't very big compared to what they would have lost if they had treated the patient in the first place because the complications with the patient were going to overwhelm their ability to get reimbursed...

...so it's patient dumping is a big problem... there's a couple [examples] that I think we want to take note of... Kaiser Bellflower a few years ago... in big trouble but they only paid a $250,000 fine they dumped a patient now on skid row, I think more than one I'm not exactly sure... and the other big one was Garden Regional Hospital... both in Los Angeles, they did the exact same thing, they paid a $450,000 fine. so you know $450,000 fine to a hospital that, that's peanuts in most cases when it comes to cash flow to be honest... about things that have been done to stop this behavior but unfortunately in some cases it still occurs...

...they look at the patient as soon as possible and if they they'll tell people in the in the ambulance not to come. ambulances call in and say they've got this thing coming in sometimes hospitals say we're full we can't take anybody else, even though they may not be full, but that kind of patient coming in the door is gonna cost them money.”

S2E8: Healthcare is Hostile part 1

HealthReform 2.0: Beyond the Partisan Divide

“if you walk in the hospital today and the hospital treats you because they have to by law and you can't pay don't think for a minute the hospital doesn't have some recourse number one to go after you but number two is if they can't get it collected they do get reimbursement through Medicare from the federal government so it is a dollar-for-dollar billed but as we've said to you many times in the past the dollar for dollar is not what's being paid it's 20 cents on the dollar on average so they get reimbursed pretty well for those patients compared to what their normal reimbursement rate most they do

and that's going to show up in what is considered the community service aspect of their P&L where they show that the money that they made they basically give away they don't give it away”

“...there's a whole lot of hospitals that today are just violating EMTALA and throwing patients out the door letting them out on the street transferring them to other hospitals because they're not getting reimbursed adequately for even insurance coverage patients from any of the critical care items that they're coming in with so hospitals are starting to be very good at selecting the patient mix that's coming in the door and when they see a disease state that's not going to give them a good reimbursement some of the hospitals out there now are rejecting those patients one way or another

...it comes down to not only the reimbursement for the disease state, hospitals reserve beds for specific illnesses and issues that pay a very high rate, and if they have a bed set aside aside for something that's going to have a higher rate of reimbursement, and you come in with let's say pneumonia, you're not going to get that bed. I can give you a case, it happened in the Pacific Northwest, where a woman that was turned away she had pneumonia, she died two days later and that institution is paying dearly for that mistake. I'll give you another one where the same institution transferred a patient to the Harbor view who died on the way in the ambulance because they hadn't stabilized the individual nor screened them prior to sticking them in the ambulance to move them over to Harbor view. Harbor view is a trauma center in Seattle.

...some larger statistics 30% of Hospital of the United States a violated EMTALA”

S2E9 Healthcare is Hostile Part 2

Please help spread the word.

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- Thomas Jefferson