Title: Patient dumping a symptom of health system woes | Healthcare Dive
Headings: Patient dumping a symptom of health system woes
Patient dumping a symptom of health system woes
A brief history of patient dumping
The Emergency Medical Treatment and Labor Act
Mental health cuts
Laws and ethics
Ideas for change

Content: The majority of emergency departments — 83%, according to NAMI — don’t have a psychiatrist on call, and 29% of doctors said patients have waited more than two days in their emergency department for an inpatient psychiatric bed. Snook blamed what he calls a “discriminatory and outdated” federal rule called the The Medicaid Institutions for Mental Diseases Exclusion, which prohibits use of federal Medicaid funds for care at an inpatient psychiatric facility. In other words, states are responsible for the brunt of the cost for anyone who goes into a psychiatric bed — which means those are often the first beds to be eliminated. “They just cost more money,” Snook said. “ You have this really small number of beds that gum up the entire system because the most severely ill folks can’t get into the treatment beds they need, so they end up in the less-intensive beds.” That means patients experiencing a mental health episode who end up in ERs are often discharged before they’ve been properly stabilized. Laws and ethics
Rules for hospital discharges differ from those for nursing homes, noted Samuel Brooks, a staff attorney with Community Legal Services in Philadelphia. “While the regulations for hospitals clearly require discharge planning, they don’t explicitly state that a person can’t be dumped or discharged to the street,” he told Healthcare Dive. Federal nursing home regulations are more clear, delineating the only reasons a patient may be transferred and grounds for why a patient should be discharged. EMTALA mandates that if a hospital takes a patient in and a patient-physician relationship is established, physicians need to provide “appropriate care” until the relationship is terminated.