This month has brought more news showing that too many hospitals in this country have lost their moral compass.
First though, we have to back up a couple of years to when some California hospitals were getting nabbed for dumping indigent patients near homeless shelters. The now iconic video of a woman being transported in a taxi from a Kaiser Foundation hospital touched off a wave of indignation and legal actions.
Then, earlier this month, authorities discovered a reverse-dumping scheme in which two for-profit Los Angeles hospitals and a third in nearby Tustin, Calif., allegedly conspired for at least three years to fill empty beds with homeless people on the basis of fabricated diagnoses (Aug. 11, p. 6). The hospitals billed Medicare and Medi-Cal, the states Medicaid program, according to federal officials. A co-owner and chief executive officer of City of Angels Medical Center was arrested as was another person said to run a sham assessment center and own shell companies to convey kickbacks.
Southern California residents could open their morning paper to see photographs of FBI agents raiding the accused hospitals and bringing in boxes to haul off documents.
Meanwhile, Los Angeles City Attorney Rocky Delgadillo, who has been probing the dumping of indigent patients, filed a civil lawsuit against City of Angels, the other hospitals and several executives in connection with the bilking scheme.
On another front, an entirely different form of what critics call patient dumping was examined in a chilling Page 1 New York Times article on Aug. 3. The story said that some hospitals are engaged in a little-known but widespread practice of repatriating seriously ill or injured illegal immigrants because they cannot find nursing homes willing to accept them without insurance. Often, these patients are taken to countries with substandard healthcare systems.
Moreover, American immigration authorities play no role in the transfers, which are carried out by ambulance, air ambulance and commercial aircraft. The newspaper said the repatriations occur with varying degrees of patient consent. In one case that the story focuses on, Martin Memorial in Stuart, Fla., obtained a state court order to return a man to Guatemala. An appeals court later overturned the order, saying deportation is the province of the federal government. Unfortunately, the man had already been returned.
You do have to sympathize in some ways with these hospitals. They are faced with huge bills the government wont pay.
On the other hand, as the article notes, the hospital involved in the Guatemalan case was a not-for-profit that reported a total margin of 3.6% last year and 6% in 2006. Its senior executives earned more than $4 million in salary and benefits, the story said.
The story paints a picture of hospitals staging the healthcare equivalent of extraordinary renditions. Whats the next step down this roada Guantanamo for indigent aliens?
The root cause of all these problemsthe in-country dumping, the international transfers and the homeless billing schemeswas identified by Delgadillo, the Los Angeles city attorney. Our healthcare system in America is brokenits never been more clear to me that is the case, he said, adding: Are there great doctors and great hospitals doing the right thing? Absolutely there are. But theres so much pressure at every corner, and the pressure is to make profits.
Hospitals need moral authority to argue for increased funding for the indigent, whether citizens or illegal immigrants. Stories like the recent ones, which demonstrate an obsession with the bottom line, wont help.