While many in the healthcare industry decry the government's aggressive prosecutorial tactics, a small county hospital in Alabama has become the first hospital in the country to settle patient-dumping charges without paying a fine.
"In light of respondent's documented financial condition, the parties agree that respondent shall pay no amounts to resolve this matter," according to the agreement.
Under the settlement with HHS' inspector general's office, 50-bed Elmore Community Hospital in Wetumpka, Ala., admitted to no violations of the 1986 federal anti-patient-dumping law.
The law, the Emergency Medical Transfer and Active Labor Act, bars hospitals from refusing to treat emergency patients or transferring them for economic reasons. It also requires them to provide a basic medical screening to all emergency patients.
Hospitals that violate the law face civil monetary penalties of up to $50,000 per dumping incident.
HHS accused Elmore of violating the law in March 1998, when it allegedly failed to treat an emergency patient. The hospital allegedly sought payment before it would screen the patient for an emergency condition.
"We view this as an egregious violation. But it's fairly unusual for us not to impose a monetary penalty in an anti-dumping case," said HHS spokeswoman Alwyn Cassil. "But this is a good example of our philosophy: It's not about extracting money from hospitals, it's about getting hospitals to meet their obligations under the law."
Cassil said the point is to end the behavior that caused the problems.
"If hospitals are suffering financial hardships we are certainly willing to look at that," she said. "Our office of audit services will review their finances and determine whether they are having financial difficulties."
Elmore is a freestanding, county-owned hospital that eked out a $29,862 profit on total patient revenues of $12.8 million in 1997, according to the latest financial data from HCIA, a Baltimore-based healthcare information company.
Elmore's administrator, Marshall Nero, declined to comment on the dumping allegation, the settlement agreement or the hospital's financial condition.
The hospital and the government signed the settlement in March. MODERN HEALTHCARE recently obtained a copy under the federal Freedom of Information Act. It was one of nine hospital dumping settlements signed in March (See chart).
Although it didn't have to pay a fine, Elmore, like hospitals in all other dumping settlements, must run a series of advertisements in its local newspaper telling readers that its emergency room is open to all patients regardless of their ability to pay, and that it accepts all Medicare and Medicaid patients.