June 25, 2007
Patient Dumping: Another Dark Side of Health Care
By Michael D. Shaw
Politicians of all stripes love to talk about the crisis in health care, but all you hear about is access and financing. No one ever seems to be concerned with quality and outcomes. But, here is a story where access and financing—of an indigent patient—were no problem, until she had to be discharged.
Rumors had been circulating for years about a practice called “patient dumping,” whereby hapless patients—largely homeless individuals—are dropped off in Skid Row, upon discharge. The theory is that this part of town would have an abundance of services for these unfortunates, and the hot potato could simply be passed along.
The health care industry tried to relegate these rumors to the status of alien abduction tales, until one of these incidents was caught on tape in March, 2006.
Carol Ann Reyes, a 63-year-old homeless woman, was found wandering in the street near Los Angeles’ Skid Row. Reyes had just been discharged from Kaiser Permanente Bellflower hospital where, after taking a fall, she had been treated for three days. Wearing little more than a hospital gown and a diaper—the hospital lost her clothes and even left her without pants or shoes—Reyes was put in a taxi and dumped on Skid Row, a 50 square-block area that is the last stop for approximately 11,000 people.
According to Rev. Andy Bales, who runs Union Rescue Mission, the biggest shelter in Skid Row:
“The cab came this way. He did a u-turn, pulled around, and stopped. The driver didn’t even get out of the car. The back door opened and this little lady got out in her hospital gown.”
LA City Attorney Rocky Delgadillo chimed in:
“They’re dumping a 62-year-old woman with dementia in the heart of Skid Row? That’s what’s going on. And it’s shocking and it’s criminal.”
For its part, Kaiser admitted the wrongdoing, but stressed that it was certainly not its policy to do such things, and emphasized its many good works benefiting the homeless, pointing to an investment of more than $1.5 million over the past three years in programs to strengthen the homeless health care system in Los Angeles County alone. Kaiser reached a settlement with the city that involves fines, establishment of new programs, and court oversight of its homeless policies.
Back in 1986, as part of COBRA, the Consolidated Omnibus Budget Reconciliation Act, a provision called EMTALA (Emergency Medical Treatment and Active Labor Act) was introduced, which governs when and how a patient may be (1) refused treatment or (2) transferred from one hospital to another when he is in an unstable medical condition.
A person found to be in an “emergency medical condition” or “active labor” must either be provided with medical treatment or transferred. However, if such a person has not been “stabilized,” or is in “active labor,” the hospital is not permitted to transfer the patient except in certain limited circumstances. Once “stabilized,” a person with an “emergency medical condition,” but not a person in “active labor,” may be transferred without restriction. Both hospitals and physicians may be held liable for EMTALA violations. A hospital’s or physician’s violation of the Act can result in civil monetary penalties of up to $50,000.00 for each incident.
The above terms are placed in quotation marks since they are quite specifically defined in the statute. More information is available here. Upon visiting that site, you will see that the legal/enforcement situation is far from clear-cut.
Many hold that the only answer to such abuses is some sort of Federal single-payer system, akin to the programs in Canada and Europe. However, no matter who pays, the simple fact is that rationing still goes on. In Europe, for example, the elderly, smokers, and overweight individuals are routinely denied certain care. In Canada, rationing takes place by extending the wait for various procedures to a point that has caused death in more than a few instances.
Michael Moore publicizes American fatalities based on denial of treatment in his latest film, but the situation is hardly limited to our shores. Patient dumping is just one more method of health care rationing, and even with draconian laws in place, I doubt that it can be completely curtailed.