In just one three-month period, 17 hospitals in 11 states settled "patient dumping" charges, paying a total of more than $530,000.
The settlements, which were entered from February to April of this year, ranged from as little as $5,000 to as much as $150,000.
Federal law prohibits patient dumping, the practice of denying basic medical screening to patients because they lack the ability to pay. The 1986 law, known as Emergency Medical Treatment and Active Labor Act, also prohibits the transfer of medically unstable patients based on economic reasons. The maximum civil monetary penalty for patient dumping is $50,000 per violation.
None of the 17 hospitals admitted to any wrongdoing or liability.
The unusually high number of settlements is a sign that HHS is getting more aggressive in its enforcement efforts involving dumping.
In this year's first quarter, 23 hospitals inked patient-dumping settlements with HHS. Six hospitals in four states settled dumping charges with HHS in January alone, paying a total of $129,000 (April 6, p. 48).
The number of settlements reached this year has already exceeded the total number signed in 1996. That year, HHS settled with at least 15 hospitals accused of patient dumping.
MODERN HEALTHCARE obtained copies of the settlements through the federal Freedom of Information Act.
The 17 hospitals represent urban and rural hospitals and all kinds of ownership. Three are church-owned, five are for-profit, and eight are private, not-for-profits. One, 1,376-bed Public Health Trust-Jackson Memorial Hospital in Miami, is a public hospital.
Fallston (Md.) General Hospital, a 115-bed not-for-profit, paid $150,000 to settle allegations that it failed to give appropriate medical screenings to 10 patients between October 1994 and January 1995.
The hospital chose to settle to avoid the cost and uncertainly of a lawsuit, the settlement said.
Debbie Egerland, a hospital spokeswoman, said the alleged violations were primarily related to documentation issues and did not result in any adverse patient outcomes.
Alexian Brothers Hospital in San Jose, Calif., paid $37,500 to resolve allegations that on two occasions in 1996 it failed to provide appropriate medical examinations to a patient.
One of those alleged incidents involved a child who was brought to the Alexian Brothers emergency room after being bitten by a dog. The child's insurer requested that the child be transferred to another hospital that was included in the insurer's system, said Ross Landess, M.D., the hospital's chief medical officer.
"We would not have (transferred the patient) if this was a life-threatening situation," Landess said.
The other alleged incident was a complex and sensitive psychiatric case, Landess said.
"We feel very strongly about our commitment to provide care to our community," Landess said. "There are facilities that are unwilling to provide care to patients because of their lack of coverage, but we are not one of those. We provide $3 million a year in charity care, and that's a lot for a hospital of our size.
"The EMTALA law is very important and should be rigorously enforced. We are sorry this occurred, and our record speaks strongly for itself," Landess said.
Alexian Brothers, a Roman Catholic facility, is part of the three-hospital Alexian Brothers Health System based in Elk Grove Village, Ill.
Issues surrounding patient dumping were pushed into the limelight this month when the U.S. Supreme Court agreed for the first time to hear a case involving a Kentucky woman who sued to collect damages under EMTALA (June 15, p. 17).
The 5-year-old lawsuit contends that Wanda Johnson was transferred to a nursing home from Humana Hospital-University of Louisville (Ky.) in unstable condition because she was uninsured. Johnson's aunt and guardian, Jane Roberts, claimed Johnson rang up nearly $390,000 in medical bills because her condition deteriorated after the transfer.
A lower-court ruling saying Roberts had failed to prove the hospital acted with "improper economic motives" was upheld by the 6th Circuit of the U.S. Court of Appeals in Cincinnati.
The high court will determine when hospitals must pay monetary damages to patients who claim they were denied emergency care or transferred based on their ability to pay.
Oral arguments in the case are set for this fall, and a decision is expected by July 1999.