As HHS' inspector general's office awaits Senate confirmation of General Services Administration Inspector General Daniel Levinson as its new chief (July 19, p. 8), the agency continues to approve patient-dumping settlements with hospitals and the occasional physician.
Four hospitals and healthcare systems and a doctor recently settled civil allegations with HHS' inspector general, paying $115,000 to resolve violations of the 1986 Emergency Medical Treatment and Active Labor Act, Modern Healthcare has learned. The inspector general reported 29 EMTALA settlements in fiscal 2003 and recovered $730,000. In fiscal 2004, ending Sept. 30, the agency so far has logged 18 settlements for $467,000, down from a high in 1999 of 61 settlements for $1.72 million, inspector general figures showed.
Susan Lapenta, an EMTALA expert and a lawyer with the firm Horty, Springer & Mattern, said that although many doctors and physicians still don't fully understand the antidumping statute's requirements, she believes the decreasing numbers of EMTALA settlements are not attributable to fewer violations in ERs. Instead, she ascribed the continuing decline to a new enforcement approach by the inspector general.
"In the past the inspector general seemed to take the position upfront that it would find a violation," Lapenta said. "Now they are less likely to find violations. I think they are not being as vigorous or as punitive as in the past."
Earlier this month, 54-bed Kentucky River Medical Center, a rural Jackson, Ky., hospital owned by Community Health Systems, paid $12,500 to settle allegations that it turned away a nursing home resident suffering from acute pneumonia. The inspector general said the settlement amount was low because the hospital was small and it had implemented a corrective action plan. Miami Beach, Fla.-based South Shore Hospital and Medical Center, a 155-bed hospital, also paid $12,500 to resolve an alleged EMTALA violation that it failed to provide a medical screening for a 19-year-old with a severed fingertip whom the hospital sent to another facility.
Last month, 653-bed Christus Schumpert Medical Center, in Shreveport, La., paid $50,000 to settle two violations, both involving pregnant women. Also last month, 16-bed Regions Hospital in St. Paul, Minn., paid $30,000 to resolve an EMTALA violation relating to an alleged refusal of services to a sick baby's mother.
In addition, a physician at 59-bed Oakdale (La.) Community Hospital, owned by HCA, agreed to pay $10,000 to settle an allegation of patient-dumping in 2001. The inspector general found that the doctor did not stabilize the patient, who left and died the next day from complications of a tubal ligation pregnancy.
HCA spokesman Jeffrey Prescott said Oakdale is engaged in settlement negotiations and expects to resolve its portion of the issue soon.
Regions spokeswoman Jennifer Kovacich said the facility takes its EMTALA obligations very seriously and takes corrective action when necessary. A Community Health spokeswoman declined to comment and South Shore officials didn't return calls seeking comment.