Subscribe for 17¢ / day

Hundreds of hospitals around the United States have violated the 15-year-old federal law that requires them to provide emergency care to anyone, regardless of ability to pay, according to a federal survey of emergency room workers and a consumer group’s report released Thursday.

Government investigative files reviewed by the consumer group, Public Citizen showed that more than 500 hospitals were cited by the federal government from 1997 to 1999. That amounts to about 10 percent of the nation’s hospitals.

Turning away such vulnerable patients is “a national disgrace,” said Dr. Sidney Wolfe, medical director of Public Citizen, which was founded 30 years ago by consumer activist Ralph Nader.

He called for an increase in seldom-imposed fines, which now top out at $50,000 — a sum so low, he said, that “it’s almost an open invitation to American hospitals to violate the patient dumping law.”

Alicia Mitchell, spokeswoman for the American Hospital Association, countered that the report “highlights the exception, not the rule.” She said American hospitals provided $20 billion in uncompensated care in 1999, the last year for which there is data.

Federal law requires hospitals to screen without delay all emergency room patients by giving them examinations and tests to make diagnoses. Hospitals must also try to stabilize the patients by using doctors who are on hand or on call.

If patients cannot be stabilized, hospitals generally are free to transfer them to more sophisticated medical centers, which are required to accept them.

The law means hospitals and on-call physicians must provide services first and worry about payment later. They are not allowed, for example, to postpone a screening until they have determined how a patient will pay his or her bill.

(Begin optional trim)

But that did not stop the Kaiser Foundation Hospital in Bellflower, Calif., from refusing to care for a man brought by ambulance after a motor vehicle accident in 1999, according to federal documents cited by Public Citizen. He was told he would have to pay $75 before a nurse or doctor looked at him, since he was not a Kaiser member.

Similarly, at Coastal Communities Hospital in Santa Ana, Calif., in 1997, a man who was having a heart attack came to the emergency room but was told to go elsewhere because the hospital did not have a contract with his HMO, documents show.

And New York’s St. Luke’s-Roosevelt Hospital in 1999 told uninsured patients they would have to pay a fee of at least $400, the consumer agency’s report said. According to government documents, patients would simply leave.

Spokesmen for all three hospitals said the incidents were isolated and have been corrected. Almost all of the hospitals cited since the law was passed have filed plans of correction as they were required to do to maintain eligibility to receive Medicare reimbursements. Only six hospitals lost Medicare eligibility when they did not fix cited problems.

(End optional trim)

It is difficult to say precisely how widespread patient dumping is. There are, however, some indicators.

More than one in five of the nation’s roughly 5,000 hospitals have been cited for violations since the anti-dumping law passed in 1986. More than 100 have been cited more than once.

Wolfe said he believes this is the tip of the iceberg, since most victims of violations do not complain.

A spokeswoman for the federal agency that issues the citations noted that the number of citations peaked in 1994 at 465. That year the federal Centers for Medicare and Medicaid Services, adopted regulations that clarified the law. Since then, citations have hovered between 180 and 210 per year.

A federal hospital survey published this year suggests that many screen patients for their insurers’ ability to pay — a practice that is not illegal unless it results in delays.

According to the survey of 100 hospitals by the U.S. Department of Health and Human Services, one of every three hospitals reported that they routinely contact health plans to authorize screening examinations. And one in four said they routinely ask health plans to authorize stabilizing treatment.

Of the hospitals that seek authorizations, 10 percent to 15 percent do not screen or treat patients if health plans deny the authorizations, staff members reported. This would be unlawful.

Hospitals that do not have the medical resources to help emergency patients may transfer them to hospitals that do. And the hospitals with resources are compelled to accept them.

Hospitals with emergency departments are required by law to have specialists on call who must respond to emergency requests to stabilize a patient.

But many specialists are reluctant to be on call because there is a good chance they won’t be paid, according to a Health and Human Services report this year citing research by the California Medical Association and other groups. This is especially true in areas with high uninsured populations and high rates of participation in HMOS.

Sometimes, even physicians who have agreed to be on call panel refuse to show up, either because they will not be paid or for other reasons.

Copyright © 2001 Los Angeles Times. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.