Public Health Crunch

SiCKO Primer #3: ” Patient Dumping “

Only since 1986 was Emergency room physicians mandated to provide care to all patients – regardless of their medical condition, age, or ability to pay. Before 1986, some hospitals participated in a practice called “patient dumping” as a solution to address emergency department overcrowding. Patient dumping is the denial of care by hospital emergency departments despite being capable of providing the needed medical care. Patient dumping is defined as the transfer of patients from one hospital to another based on the patient’s inability to pay for care. Schiff (1986) reported that 250,000 inappropriate transfers of medically unstable patients occurred, resulting in increased patient morbidity and mortality. The reason this is import behavior to critique, is that it was the founding action of a federal law that eventually became a contributor to the emergency department overcrowding situation.

Congress created and passed the Emergency Medical Treatment and Active Labor Act (“EMTALA”) as a response to “patient dumping”, EMTALA was written so that federally funded hospitals were required to give emergency aid in order to “stabilize” a patient suffering from an “emergency medical condition” or “active labor” before discharging or transferring that patient to another facility (Fosmire, 2003). An “emergency medical condition” is defined by Section (e)(1) of EMTALA as a condition with “acute symptoms” of a “sufficient severity” such that the absence of “immediate medical attention” could reasonably be expected to result in serious health risks and/or disability. The courts have interpreted the phrase “emergency medical condition” to mean a condition which puts the patient in imminent danger of death or serious disability. Unfortunally hospitals still do practice patient dumping.

In order to combat “patient dumping” hospital must fulfill six duties. They include providing a medical screening examination to all patients that present themselves ED premises regardless of ability to pay; providing stabilizing care; not transferring patients who are potentially unstable if the hospital has the capabilities to treat the patient (Patients may only be transferred under EMTALA for medical necessity such as burn patients who need a Burn Unit); providing medically appropriate transfers where the patient is transferred for medically necessity; maintaining an on-call system for physicians to provide coverage to be available to assist stabilizing patients; and accepting requests for in-coming transfer if the hospital has the specialized capabilities needed by the patient, and the transferring hospital is relatively less able to care for the patient (Fosmire, 2003).

Federal government penalties under EMTALA may be against hospitals and or individual physicians if they negligently dump a patient. They may face civil penalties up to $50,000/violation and or exclusion from participation in the Medicare and Medicaid reimbursement programs. In addition, EMTALA allows for civil actions for individual who experience personal harm. Interestingly, enforcement of EMTALA remains a patient complaint-driven process. In other words, the investigation of a hospital’s practices, are initiated only by a patient or public complaint. Thus, there is no federal “EMTALA Police” performing undercover hospital inspections. However, as patients become more consumer-oriented and informed about their patient rights, it is probable that dissenting hospitals and physicians will be identified and curtailed.