Since 1991, Public Citizen's Health Research Group has tracked the Department of Health and Human Services' (HHS) record in enforcing the federal "patient dumping" law. In a report released in December 1997, we named 256 hospitals reported to HHS between April 1, 1995 and September 30, 1996 for violating the law (and later confirmed by HHS as having done so), and 26 hospitals and eight physicians who paid fines in 1995 and 1996 to settle alleged patient dumping violations. The report updates four earlier reports on this topic published in 1991, 1993, 1994, and 1996. The addition of these hospitals brings the total number that have violated the patient dumping law during its first ten years (Sept. 86 to Sept. 96) to almost 700 hospitals, or more than one in ten acute-care hospitals in the United States. The actual number of violations is much higher, since many cases are not reported to the government.
In addition to naming 256 hospitals found to have violated the law, the report includes for the first time patient-specific clinical information from the reports of government inspectors who investigated dumping complaints. Examples of violations from 31 of these government inspection reports include:
A 2-year-old child with a fever and history of vomiting and diarrhea earlier that day was brought to the hospital's emergency room by her mother, but instead of being medically screened, was referred to a physician's private practice. Seven hours later, the child was taken to the emergency department by ambulance, but was unresponsive, and died that evening.
A 16-year-old patient with history of fetal alcohol syndrome and suicide attempts, was brought to the emergency room by his father who stated that the patient had threatened to kill him. The patient was allowed to be transferred by car with his father to a facility with an adolescent psychiatric unit despite the risk of the patient becoming violent and harming others.
A 28-year-old woman went to the emergency department with severe abdominal pain. Although the medical screening exam included a positive pregnancy test, she was discharged without her severe abdominal pain being adequately investigated. Three days later, she was admitted to the hospital in shock with a ruptured ectopic pregnancy.
In 1986, Congress passed the Emergency Medical Treatment and Labor Act, which forbids the practice known as patient dumping--denial of treatment to emergency patients or women in labor, or transferring them to another hospital in an unstable condition. Patients are usually "dumped" because they are poor or uninsured, but in recent years, there have been reports of patients with health insurance through health maintenance organizations (HMOs), or other forms of managed care, finding themselves the victims of patient dumping as well.
Patients in managed care may find themselves having their treatment delayed while the hospital seeks authorization for payment, having treatment denied if the authorization is refused, or being shuffled from one hospital to another in a dangerously unstable condition because their HMO has a contract with the second hospital.
Public Citizen | Publications - Hospital Emergency Rooms and Patient Dumping
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