The first of four Oklahoma City hospitals implicated in the death of an emergency patient has settled charges that it refused to accept the patient's transfer in violation of the federal patient dumping law.
The other three hospitals involved in the alleged dumping case are either in settlement negotiations with HHS' inspector general's office or are fighting the allegations administratively.
The matter is the first known example of federal health officials going after multiple hospitals accused of dumping the same patient.
The patient in the case, Robert Meier, died on April 11, 1995, three days after a car accident. Meier's family filed a civil lawsuit against several of the hospitals; that suit has been settled out of court for an undisclosed amount of money.
Stephen Frew, a Rockford, Ill., health attorney and expert on the patient dumping law, said the Oklahoma City case is significant. "It's putting teeth behind the requirement in the law that larger, more capable hospitals (should) accept patients from smaller, less capable facilities in emergencies," he said.
"That remains a major problem in some parts of the country. While HCFA is citing almost 300 hospitals per year for violating the law, many have been looking to see if the OIG will stand behind that. The answer is a profound yes."
The hospitals targeted in the probe are: 506-bed Integris Baptist Medical Center; 304-bed Mercy Health Center; 408-bed St. Anthony Hospital; and 614-bed University Hospital. The physician who eventually treated the patient blew the whistle on the facilities that refused treatment.
In June, Mercy settled the dumping allegations against its facility for $18,250 without admitting any wrongdoing. The settlement also requires the hospital to inform its emergency-room and specialist physicians of their legal and treatment obligations under the dumping law.
The 1986 Emergency Medical Treatment and Active Labor Act bars hospitals from refusing or delaying treatment to emergency patients for economic or other reasons. It also requires hospitals to treat women in active labor. Violating the civil statute could result in exclusion or suspension from Medicare and Medicaid and fines of up to $50,000 per incident, depending on hospital size. For hospitals with fewer than 100 beds, the maximum fine is $25,000 per incident.
MODERN HEALTHCARE obtained a copy of the Mercy settlement last week under the federal Freedom of Information Act.
Settlement talks between the inspector general and Integris Baptist are in preliminary stages, while negotiations with University Health Partners, parent of University Hospital, are pending.
Also in June, St. Anthony lost a ruling with a three-judge departmental appeals panel, which upheld an earlier ruling by an administrative judge who said the hospital violated the dumping law. Usually hospitals charged with patient dumping settle with the inspector general. St. Anthony, however, contested the allegations. On the recommendation of the inspector general, which did not think the penalty was high enough, the appellate panel judges also took the unusual step of increasing the hospital's fine to $35,000 from the $25,000 assessed by the administrative law judge.
HHS alleges that all four hospitals refused to treat Meier, a former deputy sheriff who was fully insured. One hospital said its emergency room was full and too busy to accept Meier; investigating agencies later allegedly found otherwise. According to the settlement, another hospital said Meier was University Hospital's problem and wasn't obligated to take him. A vascular surgeon on call at several of the hospitals said he "wasn't interested" in the case and was saving himself for several planned elective surgeries early the next morning, the settlement shows. He allegedly refused to accept Meier at any of the hospitals where he worked.
Meier's case attracted national media attention, spurred a governor's task force and investigation, and created a new trauma network law in Oklahoma.
The Oklahoma City hospitals in discussions with the inspector general denied the government's allegations.
C.L. Archiniaco, spokeswoman for St. Anthony's parent company, SSM Health Care of Oklahoma, said the hospital will appeal the administrative panel's decision to the 10th U.S. Circuit Court of Appeals in Denver. "We're innocent," she said.
Gay Conner, a spokeswoman for University Health Partners, said University Hospital had a full emergency room and was diverting its ambulances when it received the request to accept Meier. Though Conner confirmed the discussions with the inspector general, she refused to elaborate.
Damon Gardenhire, a spokesman for Integris Health, the Oklahoma City-based parent company of Integris Baptist Medical Center, also would not comment on the investigation but said the hospital is cooperating.
Mercy spokeswoman Judy Akins declined to discuss the settlement.
Carl Spengler, M.D., tried to save Meier when he was brought by ambulance to the emergency room of 126-bed Shawnee (Okla.) Regional Hospital around 5 p.m. April 8, 1995, after a single-car accident. Recognizing that Meier suffered a life-threatening aortic injury and broken ribs, Spengler said he recommended immediate vascular surgery and contacted multiple area hospitals, including the four named above, fruitlessly seeking hospitals that offered the procedure. Finally, just before 10 p.m., Meier was accepted at Presbyterian Hospital in Oklahoma City, where he died of an aortic blockage three days later.