Title: Refusal of Emergency Care and Patient Dumping | Journal of Ethics | American Medical Association
Headings: Refusal of Emergency Care and Patient Dumping
Refusal of Emergency Care and Patient Dumping
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Content: Recent cases in Los Angeles demonstrate that the threat of large fines might deter the practice of patient dumping under state law. The Los Angeles City attorney secured a settlement with Methodist Hospital amid allegations of patient dumping that required the hospital to implement detailed protocols for the discharge of homeless patients. The hospital will also contribute $215,000 to fund recuperative care beds for homeless individuals at the Salvation Army's Bell Shelter and pay $5,000 in civil penalties and $20,000 in investigative costs [19]. Kaiser Hospital reached a similar agreement in May 2007, resulting in court-ordered protocols for the proper discharge of homeless patients, as well as $500,000 in donations to a charitable foundation that offers services to the homeless and $5,000 in civil penalties [19]. In response to recent incidents in California, Los Angeles passed a city ordinance that prohibits transporting or arranging for the transport of patients to somewhere other than their home without their written consent [20]. A violation of the ordinance warrants a $25,000 penalty for the misdemeanor and the suspension of the hospital's Medicare finding for at least 5 years [20]. The underfunded health care system in the United States drives the practices of patient dumping and refusal of care. Caring for patients who do not have insurance is costly, and much of the treatment often goes without reimbursement. From 1994 to 2005, the number of emergency department visits increased 18 percent from 93.4 million to 110.2 million annually, a rate that coincided with the rising costs of care and lower reimbursement by managed-care organizations and other payers, including Medicare and Medicaid [21]. The trend disproportionately affects low-income patients, who generally do not have access to health care and often seek it in emergency rooms.