patient dumping

Los Angeles issues new rule limiting discharges

Anne Zieger — Mon, 04 Aug 2008 09:36:11 -0400

After a long battle over the alleged dumping of homeless patients in the street, the city of Los Angeles has enacted a new ordinance making it a misdemeanor for hospitals to transport a patient to a place other than their residence without written consent. Over the last year or so, several city hospitals have been accused of dumping homeless patients in the street in hospital gowns, including patients who were disoriented or mentally ill. In fact, city attorney Rockard Delgadillo is investigating 50 suspected cases from before June 30, when the new city rule took effect. Now the ordinance, believed to be the first of its kind in the U.S., would allow city officials to take direct action rather than suing the hospitals and working things out via court system.

Hospital administrators in the city, for their part, say they're afraid a conviction under the new law could trigger an automatic exclusion by CMS. They're also worried about the cost of keeping patients beyond when they're healthy enough to be discharged. Meanwhile, the Hospital Association of Southern California is investigating whether the measure violates state law, and has also asked CMS what it would do if a hospital was convinced of violating the ordinance.

In the mean time, county agencies and private hospitals have launched a pilot project providing "recuperative beds"--transitional housing for discharged patients who need more care--adding 30 more beds to system. Hospitals are also rethinking their discharge planning process and are providing specialized training to their staffs.

To learn more about the ordinance:
- read this Wall Street Journal piece (sub. req.)

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South FL emergency depts cited for denying care

Anne Zieger — Tue, 01 Jul 2008 01:46:24 -0400

Five hospitals based in South Florida's Palm Beach County were recently cited for denying treatment to 30 patients entering their emergency departments last year. While these incidents reflect a relatively small percentage of the 450,000 emergency department visits that took place in the county in 2007, the incidents add up to a large number, part of trends which have made Florida the state with the largest number of patients dumping complaints to CMS.

The cases are also a good example of the stresses EDs are facing nationwide in finding specialists to treat some incoming patients. Incidents identified by CMS include a 24-year-old who waited 12 hours with an open leg fracture and bounced from hospital to hospital as none were able to find an orthopedist to treat the patient. A West Palm Beach hospital was cited after six gastroenterologists refused care to a jaundiced patient with a distended stomach and shortness of breath.

All of the hospitals involved in these incidents have attempted to remedy specialist shortages by paying specialists to go on call. Hospitals in the area have also attempted to work together to establish a regional call plan to route patients to locations where specialists are available, but the going has been slow given hospitals' and doctors' sensitivities over fairness.

To learn more about the problem:
- read this South Florida Sun-Sentinel article

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Patient dumping issues need systematic look

Fri, 16 May 2008 06:59:59 -0400

At this point, you've heard frequently about the problem Los Angeles faces with "patient dumping," which takes place when hospitals discharge indigent patients and more or less kick them to the curb.

Allegedly, several LA hospitals with otherwise decent reputations have engaged in this practice. Some have been caught leaving mentally-handicapped or severely ill patients to wander around the city's infamous Skid Row in the hopes somebody else--probably, the homeless mission there--would deal with the patient's problems from that point on.

Now, I've taken a potshot or two at LA's hospitals, but in reality, I'm betting they don't dump patients any more often than hospitals in any other big cities. Sadly, I've little doubt that homeless patients get discharged and kicked out of vans and taxis onto rough streets in New York, Dallas and Miami, too.

The thing is, just how widespread is this practice? I wish I could tell you. While I wanted to share statistics that would give us a better overview of the problem, I didn't find any. The best I could come up with in my web research was a report released by Public Citizen in 2001. Public Citizen's data, which consisted only of EMTALA violations taking place between 1997 and 1999, noted that violations had been confirmed for 527 hospitals in 46 states during that period.

However, if that many EMTALA violations are being confirmed, one can only imagine that the kind of patient dumping we've described is even more common. After all, to commit an EMTALA violation, it has to happen in your emergency department, and it probably was documented in some form. Dumping a poor, homeless, mentally-ill patient and sticking a homeless shelter with their care may barely show up.

All told, it seems to me that this class of patient dumping needs far more study, and once the subject is better understood, the industry needs to take aggressive steps to address the problem before it happens. While I commend the LA city attorney's office for attempting to solve the problem by censuring offenders, it's our job as industry participants to see if we can fix what's broke. Readers, do you have any thoughts on this (or relevant research to share)? I'd love to hear from you. - Anne

Los Angeles investigates another patient dumping case

Wed, 07 May 2008 06:59:58 -0400

Los Angeles city prosecutors have begun investigating another alleged patient dumping incident, this time a Costa Mesa hospital, which allegedly took a mentally ill man 42 miles to the city's Skid Row. City prosecutors say College Hospital dropped the man outside of Skid Row's Union Rescue Mission. If the hospital did do what it's accused of doing, it may have violated a state law that makes it a misdemeanor to dump patients in another county.

This follows a string of actions by city officials against providers they contend have engaged in patient dumping. Los Angeles prosecutors have investigated more than 50 cases of alleged dumping since 2005. It has filed charges against a handful of providers, including Kaiser Permanente, which eventually agreed to establish new discharge rules, train employees more and allow monitoring by a former U.S. attorney to settle the matter.

To learn more about these cases:
- read this Los Angeles Times article

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Kaiser settles patient-dumping charges

Tue, 15 May 2007 20:01:37 -0400

Kaiser Permanente has agreed to settle a group of civil and criminal patient-dumping charges filed by the Los Angeles city attorney's office. Under the terms of the agreement, Kaiser will establish new discharge rules, improve employee training and submit to ongoing monitoring. It will also pay $5,000 in civil penalties, $50,000 in investigative costs to the city attorney's office and $500,000 to a charitable foundation. Officials had charged that Kaiser's Bellflower hospital had packed a disoriented 63-year-old patient into a taxi and dumped her in the street in her hospital gown and slippers. The settlement came as the city attorneys issued subpoenas to obtain Kaiser's records on discharge of homeless patients, as well as taxi and transportation companies' records. The Kaiser suits and charges are just one of more than 50 cases the city attorney's office has filed alleging patient dumping by the city's hospitals.

To get more background on the settlement:
- read this Los Angeles Times piece

Related Articles:
Calif. law would ban patient dumping. Report
Hospitals accused of dumping homeless. Report
Kaiser faces patient dumping charges. Report
LA hospital investigated for patient dumping. Report