For the second time in six months, HHS' inspector general's office has shown mercy to a small rural hospital accused of "patient dumping."
But the hospital's chief executive officer attributed the outcome to his being a good negotiator and the fact that no patients were harmed by the alleged incidents.
The agency fined 41-bed York (Neb.) General Hospital just $8,000 in civil monetary penalties for seven alleged cases of patient dumping in a July settlement that absolved the hospital of any wrongdoing.
Under the 1986 Emergency Medical Treatment and Active Labor Act, or EMTALA, York could have faced fines of as much as $175,000, or $25,000 per violation, the maximum penalty for hospitals with fewer than 100 beds.
The law requires all hospitals to provide basic medical screenings for all emergency patients, and it bars facilities from transferring emergency patients to other hospitals for economic reasons.
The inspector general's office alleged that York's emergency room failed to screen seven patients who came to the hospital in 1997.
In fining York a minimal amount, the agency showed its wide latitude in enforcing the law and its sensitivity to the fragile finances of many small or rural hospitals.
In March, the agency settled dumping charges against 45-bed Elmore Community Hospital in Wetumpka, Ala., without assessing any fines. That was the first time a hospital resolved dumping allegations without paying a civil monetary penalty (June 21, p. 62).
But York CEO Charles Schulz said the fine was nominal because most of the violations were minor and administrative.
"There were no bad patient outcomes or fatalities," said Schulz, who pointed out that HCFA had originally charged the hospital with 22 violations. The inspector general referred the violations to the state's Medicare peer-review organization, which, after reviewing the complaints with York, recommended dismissing 15.
"We worked with our legal counsel, looked at previous settlements with similar violations and made an offer," Schulz said. "We felt what we offered was fair."
York was one of four hospitals across the country to settle patient-dumping charges in July (See chart).
The inspector general settled 61 EMTALA cases for $1.7 million for fiscal 1999 ended Sept. 30.