For the months of May, June and July, 14 hospitals and one physician paid a total of $341,000 to settle allegations levelled by the HHS' inspector general's office that they dumped patients.
HHS monitors healthcare providers' compliance with the 1986 Emergency Medical Treatment and Active Labor Act, which requires hospitals with emergency rooms to appropriately screen, treat and transfer patients seeking emergency treatment and prohibits patient dumping.
In all, from Oct. 1, 1999, to Aug. 31, the latest date for which figures are available, HHS negotiated 46 EMTALA settlements and one judgment for a total of $1.27 million. In fiscal 1999, which ended Sept. 30, 1999, HHS settled 61 EMTALA cases for $1.7 million.
One of the hospitals to settle in July was Kaiser Foundation East Bay Medical Center in Richmond.
MODERN HEALTHCARE has learned that the 50-bed facility paid $25,000 to resolve three allegations that it violated EMTALA in 1996 and 1997.
The hospital, then known as Richmond Medical Center, was accused of violating EMTALA a total of six times in 1996 and 1997; the three cases in which Richmond was cleared of EMTALA violations involved three patients who came to Richmond's standby ER but died while waiting to be transferred to a full-service ER. A standby emergency room cannot handle the more serious cases.
Those deaths received a great deal of publicity and caused the hospital public embarrassment. A subsequent HCFA-ordered survey conducted by the California Department of Health Services found Richmond and its sister hospital, Kaiser Oakland Medical Center, gave inadequate care, endangered patient lives and did not meet minimum Medicare participation standards. After the report's release and a bitter nurses' strike, Kaiser closed down Richmond as an inpatient hospital and operated it as an outpatient clinic.
After the HCFA survey, the California Medical Review, the state's peer-review organization, evaluated Richmond's action in the three patient deaths and found the hospital acted correctly in transferring the patients.
After a public outcry and successful community lobbying effort, the facility reopened as East Bay Medical Center in February 1999 as a full-service hospital with an upgraded emergency room.
Sandra Sands, senior counsel to HHS' inspector general, said her agency cleared Richmond of EMTALA violations in the case of the three deaths after the PRO report.
"The settlement would have been much higher if these people were found to have been inappropriately transferred," she said. But the PRO concluded that the medical benefits of transferring the patients outweighed the risks.
"Transferring was in the best interest of the patients, even though the outcome was bad," Sands said. "Ultimately the PRO decided that what happened was tragic, but not a violation of the (EMTALA) statute."
Sands said the $25,000 HHS fine that the hospital paid resolved EMTALA allegations involving separate cases in which two pregnant women and an asthmatic baby arrived at the ER by private car. At the time ambulances did not serve Richmond's standby emergency room.
Kaiser spokeswoman Cynthia Gregory said HCFA and the inspector general felt the hospital should have provided the baby and the two pregnant women transportation from Richmond to the nearest full-service ER.
"We've paid our fines and made the necessary improvements and moved beyond this," Gregory said. She added the hospital upgraded its ER in August.
Thirteen other hospitals and one physician also resolved allegations of patient dumping with the HHS inspector general for the period of May, June and July.
According to settlements MODERN HEALTHCARE obtained through the Freedom of Information Act, the hospitals and physician paid a total of $341,000.
Another Kaiser California facility, 221-bed South Sacramento Medical Center, paid $61,000 to settle patient dumping charges.
The sole physician settling, Uzi Bodman, M.D., of Fort Lauderdale, Fla., paid $15,000 and was excluded from Medicare and Medicaid for one year.
Neither Bodman nor the hospitals admitting legal wrongdoing.