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Well Sourced: Find out when patients have been kicked to the curb

Well Sourced: Find out when patients have been kicked to the curb

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Note: Portions of this post were adapted from a tipsheet created with input – and in some cases exact phrasing – from Charles Ornstein when he was at the Los Angeles Times. Thank you, Charlie!

If you run a business, usually you can show a patron the door without fear of repercussions. Bars throw out the inebriated and unruly. Restaurants run out the shoeless. And airlines land to let off Whitney Houston impersonators.

But if you’re a hospital and you take federal funds, you are not allowed to simply kick your patients to the curb. That’s called patient dumping. And there’s a law — the Emergency Medical Treatment & Labor Act of 1986 — that says hospitals must treat patients who arrive at their emergency rooms, even if the patients aren’t in a position to pay.

SOURCE: U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS)

WHAT IT DOES: CMS certifies that hospitals and nursing homes meet standards to receive Medicare and Medicaid funding. Typically, it uses state health inspectors to investigate more substantive complaints. It also investigates whether hospitals illegally dump uninsured emergency room patients on other hospitals – or on the street – before they’re stabilized. These are called EMTALA violations, named after the Emergency Medical Treatment & Labor Act. If CMS finds a hospital out of compliance, it can threaten to withhold funding. Note that it is very rare for that to happen.

WHAT IT DOES NOT DO: Examine the quality of care provided by doctors and hospitals.

RECORDS: Reports of EMTALA violations. Threats to cut off Medicare funding. You may need to file a Freedom of Information request to the regional CMS office that encompasses your facility. If a hospital has been fined for patient dumping, that information can be found at the HHS Office of Inspector General.

DRAWBACKS: CMS inspections are rare and often are done in conjunction with the state inspections. Sometimes the state will investigate violations of its own EMTALA laws at the same time it investigates federal EMTALA violations.

SUGGESTION: Once a year, put in a request with CMS for all EMTALA violations and look for patterns. Does one particular hospital stand out? Is patient dumping on the rise?

EXAMPLE: When Phil Galewitz was at the Palm Beach Post, he wrote numerous articles about hospitals caught dumping patients on other hospitals, including one about a hospital that failed to adequately treat a child who had suffered a brain injury.

TESTIMONIAL: Galewitz, a veteran health care reporter now working for Kaiser Health News, told me several years ago that while he was at the Post, he made patient dumping a regular part of his beat.

“Patient dumping has been a big issue in Palm Beach for the past five years as hospitals here struggle to get specialists to cover their ERs,” Galewitz said.

Galewitz got a tip in 2004 about a patient dumping case involving St. Mary's Medical Center in West Palm Beach. He followed it up by contacting the state, which does the EMTALA investigations on behalf of the federal government.

“The inspection documents were usually quite detailed, though they do not include any patient names because the state redacts the names,” Galewitz said. “You don’t just want to get the inspection reports but any correspondence between the state agency and the hospital.”

To get the actual warning letters that CMS sends the hospitals and the fines that they give them later, you probably will have to go through CMS, though. Here’s the catch: “I found going through CMS quite difficult and time consuming. You basically have to call their regional FOIA person almost every day to get documents.”

Galewitz suggested that reporters make it a habit to collect hospital inspection reports from the state at least every four months.

Photo by Leonard Bentley via Flickr.

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