A recent California patient-dumping settlement may be the first in which a hospital allegedly admitted a patient with an emergency condition in order to circumvent the 1986 Emergency Medical Treatment and Active Labor Act.
Mercy San Juan Medical Center, Carmichael, Calif., a not-for-profit hospital owned by Catholic Healthcare West, paid $25,000 to resolve allegations that 31/2 years ago it admitted a woman as an inpatient and then transferred her to another hospital without screening or stabilizing her as required under EMTALA. Healthcare lawyers say the October settlement might have been the catalyst for a new standard incorporated into federal EMTALA regulations that went into effect on Nov. 10.
That standard states the patient antidumping law does not apply once a patient is hospitalized, provided the admission is performed in good faith and not to skirt the law.
In the Mercy San Juan case, HHS' inspector general alleged that after the patient was admitted, hospital staff checked her insurance information and phoned her doctor, transferring her with his permission to Sutter Roseville (Calif.) Medical Center, 10 miles away. There she was diagnosed with several conditions that required immediate attention and was given a transfusion. She was admitted to Sutter Roseville for further treatment. A subsequent report by a peer-review group, a private organization charged with investigating EMTALA violations and Medicare complaints, concluded that the woman had an emergency condition. In its response the hospital said EMTALA did not apply to direct admissions, and that since the hospital had not detected the emergency condition, it had no obligation to provide screening or stabilization.
The inspector general disagreed. "The facts of this case clearly indicate that (the patient) was not provided with a medical screening examination and that she was transferred solely for insurance reasons," the inspector general concluded in a report.
Bryan Gardner, spokesman for Mercy San Juan, said the hospital has denied wrongdoing and is committed to complying with EMTALA regulations. "Mercy San Juan vigorously disputed the allegations of this case being an EMTALA violation and settled the case because the cost of litigation would have greatly exceeded the settlement," Gardner said.
Chip Kahn, president of the Federation of American Hospitals, said he had heard about the possibility of hospitals admitting patients to skirt EMTALA. "But I always thought that was only a hypothetical," Kahn said. "And I think that for 9.99 out of 10 hospitals, it remains a hypothetical. It would be wrong to abuse an admission that way."
Los Angeles healthcare lawyer Lowell Brown of the firm Foley & Lardner said until the new regulations went into effect it was not technically illegal to admit a patient to circumvent EMTALA. "It was a gray area. The question before was whether the patient was stable enough to be transferred," Brown said. "This kind of alleged activity will be harder to pull off under the new regulations."
A CMS spokeswoman said the final regulations were intended to settle the question of EMTALA's obligations regarding patient admissions. "What we said in the final rule was that EMTALA obligations end with admission, unless that admission is a subterfuge to avoid the law," the spokeswoman said. "Prior to that there had been questions in court about whether it applied."
Louise Joy, an Austin, Texas, healthcare lawyer who specializes in EMTALA law, said she's never encountered an allegation of admitting to circumvent EMTALA. "I saw this as a concern, that CMS thought this was going to be an issue," Joy said.
She suggested that if this were something other than a mistake, the government might have more settlements. "We haven't seen any cases like this," she said.