Moving to clarify the federal "patient dumping" law, the U.S. Supreme Court will determine when hospitals must pay monetary damages to patients who claim they were denied emergency care.
It's the first time the nation's highest court has addressed the burden of proof required for patients to collect damages under the law. A lower court ruled that plaintiffs must show the hospital acted with improper economic motives.
The high court agreed last week to hear the case of Wanda Johnson, a Kentucky woman with no health insurance who charges she was transferred to a nursing home in unstable condition because she likely could not pay her ballooning hospital bills.
The law at issue is the Emergency Medical Treatment and Active Labor Act (See chart). Since the law went into effect in 1986, more than 70 hospitals have paid civil penalties to resolve charges that they didn't properly treat patients for economic reasons.
In May 1992, Johnson was taken to Humana Hospital-University of Louisville after sustaining massive injuries when she was hit by a truck. At the time, the hospital was owned by the publicly funded university but managed under contract by then for-profit hospital chain Humana, which received subsidies to care for the poor.
About two months later, a surgical resident treating Johnson requested a hospital social worker to find a long-term-care facility in which to place the patient. Johnson was transferred to Crestview Health Care Facility in Indianapolis in July 1992 after two other nursing homes refused to take her.
The day after she arrived at Crestview, Johnson's condition deteriorated. She was rushed to Midwest Medical Center, also in Indiana, where she rang up nearly $390,000 in medical bills over six months of treatment. Johnson was denied Medicaid coverage in Indiana because she was not a resident.
Johnson's aunt, Jane Roberts, sued the Humana hospital in 1993 to recover damages under the patient-dumping law, charging that Johnson was treated inappropriately because she was uninsured.
In April 1997 the U.S. Court of Appeals for the 6th Circuit in Cincinnati affirmed a lower-court ruling that found Roberts had not proved the hospital discharged her niece with "improper motives."
In an 11-page opinion following a 2-1 vote, the three-judge appeals court said that without proving the hospital was motivated by economic interests, Roberts' claims constituted a malpractice case, not a patient-dumping case.
Appellate Judge David Nelson dissented, arguing that Johnson was not necessarily in stable condition when she was transferred.
The Supreme Court will hear arguments during its 1998-1999 term, which begins this October, and issue a ruling by July 1999.