Patient dumping represents one of the darker sides of the medical profession. Physicians take the Hippocratic Oath promising they “will apply, for the benefit of the sick, all measures [that] are required.” Unfortunately, hospital administrators don’t take the same oath. These days many seem to care more about the hospital’s financial health rather than the health of their patients. Nowhere is this more evident than with patients who lack insurance.
When a hospital refuses to treat an uninsured person or sends them to another city, the practice is called “patient dumping.”
Reports of patient dumping became a problem in the 1980’s as hospitals saw a rapid rise of uninsured, poor patients. Few states had any laws that prevented a hospital from denying service. Congress responded with the Emergency Medical Treatment & Labor Act – EMTALA for short. That law says that any hospital that accepts Medicare has a duty to provide medical screening and stabilizing treatment to any patient, regardless of ability to pay, who seeks care in a hospital emergency room.
For a patient to be protected by EMTALA, the injury or illness must be serious or the patient must be in labor. And the services must be sought at an emergency room. Urgent cares don’t count.
In simple terms, if you show up at an ER with a stroke, fractured skull, heart attack or you are in labor, the facility must admit you. They may not be required to keep you but they at least must stabilize you. That means providing emergency cardiac car or delivering your baby.
According to the regulations, a hospital can’t refuse discharge or transfer a critical care patient until any conditions that are immediately life-threatening, limb-threatening, or organ-threatening have been treated to the best of the hospital’s ability to ensure the patient does not need further inpatient care.
Since its passage in 1986, many hospitals have attempted to circumvent the law resulting in a pandemic of EMTALA claims.
Why do hospitals continue to illegally dump patients? Money.
Hospitals consider charity care an unfunded mandate. They think taxpayers should fit the bill. Nationally uncompensated care represents 6% of hospital healthcare costs.
How do these cases get discovered? Sometimes its patients that complain. Other times it is local public hospitals that see a sudden influx of patients with no insurance.
California believes that some hospitals in Nevada are deliberately sending critically ill patients to big cities like San Francisco and Los Angeles. (Hospitals aren’t the only ones playing this game. Some police departments have been accused of engaging in “Greyhound justice.” That usually means putting homeless or petty criminals on buses or trains bound to other cities so that these folks become someone else’s responsibility.)
EMTALA: Whistleblower Rewards and Patient Lawsuits
Despite being on the books many years, EMTALA cases are not seen often in the courts. Medicare and the Justice Department resolve them without trial and patients don’t know they have rights. (Because many turned away are undocumented residents, they are also afraid of the courts.)
EMTALA Patient Lawsuits
If a patient is wrongly denied service, he or she can sue for damages. The law establishes a private cause of action for violations. Any person who suffers harm as a direct result of a participating hospital’s violation of EMTALA may file a lawsuit.
How much can a patient expect if successful? EMTALA looks to the damages available for personal injury victims under the laws of the state in which the hospital is located.
What does all this mean? Let’s look at a real example. In a recent Louisiana case, a young teenage girl, “J.S.”, was seen in the emergency room of the Northern Louisiana Medical Center. She was first seen in the early morning hours. Later a physician would examine her. At 9:07 am he ordered an MRI.
The MRI was not performed until after 3:00 pm. By the time the MRI was performed and physicians realized she had a spinal girl injury, the girl was permanently paralyzed.
The parents sued the hospital under EMTALA claiming that the lengthy delay was the same as refusing her treatment. The doctor testified that the delay was the result of a hospital policy “that requires that emergency room requests for MRIs be summarily denied and delayed until reimbursement from the insurance company has been certified.”
The girls’ parents believe that if she received timely treatment, their daughter’s injury could have been treated early enough to avoid being paralyzed. If they win, the damages could be in the millions.
Even though the law was passed in 1986, early cases often resulted in patients losing. Access to the courts by the poor and undocumented is already difficult. The courts didn’t help.
Many courts said that proof of intent or improper motive was a prerequisite to a successful EMTALA claim. In other words, it wasn’t enough for a patient to prove he or she were improperly turned away. The patients also had to prove the hospital intended to violate EMTALA. For all practical purposes, EMTALA lawsuits became unwinnable. There was no way for a patient to prove what the hospital was thinking when he or she was turned away.
The good news came in 1999 when the U.S Supreme Court tossed out the improper intent or motive requirements. Proving patient dumping complaints became much easier.
Of the cases we see, most patient dumping cases with for profit hospitals. We also see these cases in areas along the Mexican border and areas with high populations of undocumented residents or areas with high rates of poverty.
If you were illegally denied emergency treatment and believe you have an EMTALA claim, please give us a call. Contact us online, by email or by phone at 414-704-6731 (direct).
Huge Whistleblower Rewards Possible for Inside Info about Patient Dumping Violations
We don’t think EMTALA violations occur randomly. It is almost never the doctor who suddenly decides not to treat a person who is poor and uninsured. Usually those decisions are made by senior hospital management. That means if it happens once in a hospital, it probably happens many times.
In a 2013 case, an acute care administrator at Southwest Regional Medical Center, a for profit hospital in Waynesburg, Pennsylvania, claimed she was fired after seeking to report EMTALA patient dumping claims to the state health department.
The administrator claims a pregnant woman was refused treatment and referred to another hospital. When she sought to report the violation, she says that the hospital’s CEO told her no. Knowing the hospital’s behavior was wrong, she insisted that the incident should be reported. At that point, the CEO allegedly replied that if she reported the violation, the Department of Health “would be on us like flies on shit.”
We know that reporting these violations is challenging. Many hospital workers and physicians fear for their jobs. Luckily, whistleblowers are protected to state and federal whistleblower anti-retaliation laws.
We also know that patients turned away in violation of the law are by definition in extreme pain and most in need of help.
When this blog was first written in 2013, we said that EMTALA patient dumping cases could be the basis for a federal false claims whistleblower action. That law allows healthcare workers and others with inside information about federally funded healthcare fraud to collect an award for reporting wrongdoing. Million dollar awards are common.
By their very nature, patients suffering from an EMTALA violation by definition don’t receive proper care. They usually received no care.
So how can there be a Medicare or Medicaid fraud? The government isn’t losing any money.
Medicare law says any hospital that accepts Medicare insurance must comply with all Medicare requirements. One of those requirements is EMTALA. We believe that hospitals can’t pick and choose which laws they will obey. If they want Medicare money, they have to comply with EMTALA and promptly treat women in labor and the very sick and injured.
As noted above, this post was first written in 2013. We were pretty certain back then that whistleblower awards were available for EMTALA violations.
Five years later we are happy to report that we are not alone in our thinking!
Dr. Blake Vanderlan worked at Central Mississippi Medical Center, also known as Merit Health Center-Jackson. He believed that the hospital wrongfully transferred African-American trauma patients without insurance to the University of Mississippi hospital.
According to his complaint, Dr. Vanderlan “became aware of multiple instances of patients presenting to the [Jackson HMA] emergency department and being denied the care required by a Level III trauma center and/or being transferred/dumped to a Level I facility in violation of EMTALA,”
The hospital denies the claims.
In a ruling last week, the court indicated it was open to considering that EMTALA violations, if proven, can give rise to a whistleblower reward. The case is still ongoing.
Each time a hospital bills the Medicare program, the hospital certifies that it is complying with a number of healthcare laws including EMTALA. That means hospitals that certify thousands of bills and collect millions from Medicare may be liable for big penalties under the false claims act. Congress doesn’t want hospitals to collect from Medicare while turning away poor and indigent patients.
We are seeking both patients and healthcare workers with inside information about illegal patient dumping schemes. We are especially interested in speaking to current or former employees of HCA, Tenet Healthcare and other “for profit” hospitals as well as schemes that involve undocumented residents.
Whistleblowers under the false claims act are entitled to receive up to 30% of whatever the government collects from healthcare providers under this program.
Have Information about Patient Dumping – Denial of Service [EMTALA]?
Whether you are a patient wrongfully denied care or a healthcare professional who witnesses such illegal discrimination, you may be entitled to compensation.
Updated November 22, 2018. The court refused a request by the hospital to stay the case. Instead, the court ordered that the case be stayed while the hospital and government explore possible settlement. The doctor also sought relief, he worries that such a settlement might deprive him of a reward. Under the False Claims Act, however, a whistleblower may still be entitled to a reward if the government utilizes the whistleblower’s information but settles the case under some other law.