An ongoing government study of hospitals' awareness of the federal law prohibiting "patient dumping" has caused some hospitals to wonder whether the survey is a benign policy study or a tip sheet for law enforcers.
The HHS inspector general's Office of Evaluation and Inspection launched the voluntary study in January, but it's unclear how many of the 157 hospitals approached by the agency have agreed to participate.
HHS' inspector general's office, which enforces the patient-dumping law, won't release that information.
Spokeswoman Alwyn Cassil said the agency does not comment on the content of ongoing studies. She said survey results would be tallied later this year and published in 2000, and the results won't be used against participating hospitals.
"Throughout this process we are committed to preserving the anonymity of hospitals and participants," Cassil said. "Through the study we're hoping to get a good snapshot of the level of awareness about EMTALA."
The Emergency Medical Treatment and Active Labor Act, or EMTALA, is a 1986 law that requires hospitals to provide basic medical screenings to all emergency patients and bars facilities from transferring those patients for purely economic reasons.
Hospitals and other providers are subject to a $50,000 civil monetary penalty per violation. HHS' inspector general's office has said hospitals have been concerned about heightened EMTALA enforcement, which has resulted in more EMTALA settlements.
Patient-dumping settlements with hospitals and other providers jumped to 53 last year from just 13 in 1997, according to the agency. Through June 30 of this year, 49 settlements have been logged.
With those numbers in mind, numerous hospitals are somewhat concerned about a different branch of the same agency asking them what they know about the patient-dumping law.
Healthcare lawyer Lowell Brown with the Los Angeles office of Foley & Lardner said, "Any time a law enforcement agency is asking questions internally at a hospital about the hospital's compliance with the law, you have to raise your eyebrows a little bit. The survey information and letters were sent not to hospital administrators, but to ER managers. It makes it look like they were going behind the administration's back. I wouldn't blame any administrator for being a little paranoid."
Brown said he is advising his clients to be careful if they participate.
"We're telling clients to be aware of this study and ask their emergency departments to forward any correspondence from the inspector general to someone in administration and to contact legal counsel to review the request and prepare a thoughtful response," Brown said.
In fact, Brown said, "I'd feel most comfortable if clients didn't cooperate. There are some questions in the questionnaire that (the inspector general) has no business asking unless they are conducting an investigation."
In January, the Office of Evaluation and Inspection sent letters to emergency department directors of 157 hospitals in three size categories.
The survey, which is being conducted in phases, includes focus groups, mail-in questionnaires and phone surveys with ER directors, doctors, nurses, on-call physicians and registration staff.
"This is totally divorced from our enforcement responsibilities," Cassil said. "We understand that there is a concern there might be some enforcement action related to this study and that it could be a disincentive to participation. But that is not the purpose of this study."
Although American Hospital Association executives don't seem as concerned about the study as Brown, the association has remained neutral about whether its members should participate.
Ultimately, hospitals "have to make their own decisions," said Maureen Mudron, AHA Washington counsel.
Mudron said HHS' inspector general's office consulted the AHA in the planning stages of the study.
"We understood they were trying to learn more about how EMTALA is working in the current environment," Mudron said. "We've told our members that this is a policy study."