EMTALA Update

• Hospitals Cited for Patient Dumping
• Many ERs Illegally Refuse to Treat Patients, Consumer Group Says

Hospitals Cited for Patient Dumping
By Chistopher Newton The Associated Press

WASHINGTON (AP) - More than 500 hospitals were cited for illegally sending patients with emergency conditions to other hospitals in the late 1990s, according to a report from a public interest group.

The practice, called patient dumping, is a way for hospital emergency rooms to get rid of poor patients who have no health insurance. Most of the 527 hospitals named in the research project conducted by Public Citizen were cited for breaking a law that guarantees patients the right to be treated at the nearest available hospital.

They were fined by the Health Care Financing Administration between 1997 and 1999, according to the report, which was released Thursday.

``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 to impose fines on most hospitals violating the law amounts to an invitation to dump sick patients.''

About 72 percent of the violating hospitals were not-for-profit hospitals, according to the report. About 19 percent were for profit. The status of 8 percent of the hospitals was not known.

Rick Wade, a spokesman for the American Hospital Association, said the report doesn't indicate a serious problem.

``We have a million visits to the (emergency room) every year,'' Wade said. ``We have 5,000 hospitals in this country. The numbers (Public Citizen) is reporting are not significant and do not reveal any sort of trend. There has never been any evidence that patient dumping is rampant.

'' The report concludes that a patient's insurance status likely influences hospital's compliance with the law.

Citing a case in New York, the report alleges that several uninsured patients in an emergency room were told by doctors that they would have to pay a fee before receiving a screening exam.

In another case, a patient arrived at an emergency room complaining of seizures. The patient's pulse, respiratory rate, blood pressure and temperature were taken. Despite a rapid heart rate, the patient was discharged with prescriptions for anti-seizure medication. He had a heart attack the next day. An autopsy revealed the attack was brought on by a severe case of pneumonia.

It was unclear whether the patient had insurance.

Wade said that many of the violations do not reflect malice by hospital staffs. ``There are all sorts of reasons that a hospital could be cited for breaking the law that do not mean the hospital intentionally turned away a patient,'' Wade said. ``In some cases, the emergency room may misread the seriousness of the illness. This is a human process and there is human error. Hospitals work everyday to reduce the possibility for error.''

Public Citizen also concluded that the fines administered by the federal government are not big enough to make hospitals change their ways. The fine amounts generally do not exceed $50,000 per violation.

``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.''

On The Net: Public Citizen: http://www.citizen.org/

American Hospital Association: http://www.aha.org/index.asp

Many ERs Illegally Refuse to Treat Patients, Consumer Group Says
Government Never Fines Most Hospitals Guilty of the Practice
By Steve Mitchell WebMD Medical News

July 12, 2001 (Washington) -- Hundreds of hospitals across the country are guilty of illegal patient "dumping," or not providing patients with proper emergency room treatment as required by law, the consumer advocacy group Public Citizen charges in a new report.

In its report "Questionable Hospitals," Public Citizen's Health Research Group says that the emergency departments of more than 500 hospitals in 46 states, the District of Columbia, and Puerto Rico illegally denied medical screening, did not provide stabilizing treatment, or improperly transferred patients with unstabilized emergency conditions to other hospitals between 1997 and 1999.

Under the 1986 Emergency Treatment and Labor Act, or EMTALA, all hospitals with emergency rooms are required to provide appropriate medical treatment to every person who enters the ER seeking treatment, regardless of their ability to pay.

The report, available on Public Citizen's web site, is based on a review of confirmed violations from the Centers for Medicare and Medicaid Services, the government agency responsible for making sure hospitals comply with the 1986 act.

One major reason for the illegal patient dumping is financial, Public Citizen charges. This is because many patients coming to ERs have no health insurance, and even if a patient does have insurance, their managed care organization may deny or reduce reimbursement to the hospital if the person is found not to have an emergency medical condition.

So in an attempt to avoid racking up expenses that will not be recouped, hospitals either discourage patients from receiving treatment by asking for payment up front or flat out refuse to treat the patients. Both actions can be construed as illegal, and in more than one case, they have led to the death of a patient, Public Citizen says.

Hospitals violating the 1986 act can be fined, but most never are, Sidney Wolfe, MD, said at a press conference on Thursday. Wolfe is the director of Public Citizen's Health Research Group.

Of the 500 hospitals that committed finable offenses during the study period, only 85, or 17%, were fined, Wolfe noted.

But even if the hospitals are fined, the maximum penalty, which is $50,000, is not much of a deterrent, according to Wolfe. This is "barely a drop in the bucket" in the budgets of most hospitals, which can have annual budgets of up to $200 million, he said.

The hospital industry objected to the findings in the report. "This report highlights the exception, not the rule," Alicia Mitchell, spokeswoman for the American Hospital Association, tells WebMD.

Most hospitals do not violate EMTALA, she says, noting that U.S. hospitals see 100 million emergency visits a year, which results in $20 billion in uncompensated care.

Mitchell concedes that some instances of patient dumping do occur. But she insists that these are the result of "poor judgement" or a failure to document care that was actually delivered.

The AHA works with hospitals to make sure they understand their responsibilities by providing educational programs and issuing advisories whenever there is a change that affects EMTALA regulations, Mitchell says.

Public Citizen believes that one solution to the problem may be federal legislation that creates liability for insurers that require prior authorization or that refuse to reimburse for emergency treatment.

Senators Bob Graham (D-Fla.) and Lincoln Chafee (R-R.I.) have introduced the Access to Emergency Medical Services Act, which would require insurance companies to pay for emergency treatment without the need for prior authorization, Wolfe tells WebMD. He notes that Public Citizen is sending the report to members of Congress and president Bush.

Another way to increase hospital compliance with EMTALA may be to increase the maximum allowable fine to hundreds of thousands of dollars, Wolfe said.

In the meantime, Wolfe has the following recommendations to consumers to avoid being dumped:

Patients should, if possible, have a friend or family member attend the ER with them. If a patient suspects he or she is being dumped, he or she should immediately complain to the hospital administrator and inform them that they plan to report the incident to the Centers for Medicare and Medicaid Services, or CMS.

The CMS and the Office of Inspector General, the two governmental agencies directly responsible for enforcing EMTALA, declined to comment about this story to WebMD.