Kings County Hospital Center said it received word from HCFA last week that it is no longer in danger of losing its Medicare certification. The government said it's satisfied that the facility had fixed the problems that triggered HCFA to threaten Medicare termination late last year.
In a letter dated Nov. 17, HCFA told the 744-bed hospital, the largest in Brooklyn, N.Y., that unless it addressed "patient dumping" charges in its emergency room operations, it would be cut off from Medicare payments Dec. 8. A HCFA-ordered survey had turned up those violations in late October. The agency generally surveys hospitals that are accredited by the Joint Commission on Accreditation of Healthcare Organizations only if serious problems are alleged.
Patient dumping-the refusal to treat patients for economic reasons or the transfer of medically unstable patients based on economic factors-is prohibited by the federal Emergency Medical Treatment and Active Labor Act.
On Nov. 25, Kings County Hospital submitted a plan of correction, which was quickly reviewed and accepted by HCFA.
On Jan. 4, 5 and 21, the hospital was subject to follow-up surveys by the state health department. HCFA mandates such complete surveys after violations have been uncovered, even if the hospital says it has fixed the problems.
Surveyors reviewed not only the changes in the emergency department but the operation of the entire facility.
In last year's statement of deficiencies, HCFA said the hospital had delayed treatment of patients while it asked about payment status. Such delays are illegal under EMTALA.
The surveyors also found that the hospital did not appropriately screen and transfer patients, two conditions of Medicare participation.
Local 420 of the Municipal Hospital Workers Union reacted to the HCFA report by demonstrating at the headquarters of Kings County Hospital's parent company, New York City Health and Hospitals Corp. Local 420 President James Butler said he deplored "the continued understaffing of all the public hospitals. Kings County is in such bad shape they are turning away poor patients."
Kings County Hospital maintains that it sees patients regardless of their insurance status.
"The letter does not indicate we were dumping patients and does not indicate we withheld treatment," said hospital Chief Executive Officer Jean Leon.
Like many public hospitals, Kings County Hospital sees a large proportion of poor patients. About half the 100,000 patients seen annually in its emergency room are uninsured, a hospital spokeswoman said.
But according to HCFA's statement of deficiencies, a sign had been posted in the emergency room telling patients covered by Medicaid that they would be treated only if they had preauthorization. The report noted that hospital staffers removed the sign when state surveyors called it to their attention.
Many of the deficiencies found by surveyors stemmed from an emergency room triage system whereby less-seriously ill patients were sent unescorted to a separate facility.
Under that system, which the hospital says it corrected Nov. 9, those patients were given "tickets" to take to an urgent-care center a block away. Under anti-dumping regulations, medical personnel must accompany patients during any kind of transfer.
According to the initial survey, some seriously ill patients were referred to the urgent-care center inappropriately, and their treatment was delayed by several hours. The survey also found that some patients who were referred to the care center never arrived there.
Leon said the care center has been relocated to a room adjacent to the emergency room. In addition, all patients are logged into a central system, minimizing the chance that a patient might fall through the cracks.