‘Patient Dumping,’ Medical Care Denials Persist Despite Legislation

By @FrederickReese |
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    In this July 12, 2012 photo, two women wait in an exam room at Nuestra Clinica Del Valle, in San Juan, Texas. About 85 percent of those served at the clinic are uninsured. Texas already has one of the nation’s most restrictive Medicaid programs, offering coverage only to the disabled, children and parents who earn less than $2,256 a year for a family of three. Without a Medicaid expansion, the state’s working poor will continue relying on emergency rooms _ the most costly treatment option _ instead of primary care doctors. The Texas Hospital Association estimates that care for uninsured patients cost hospitals in the state $4.5 billion in 2010. (AP Photo/Eric Gay)

    In this July 12, 2012 photo, two women wait in an exam room at Nuestra Clinica Del Valle, in San Juan, Texas. About 85 percent of those served at the clinic are uninsured. Texas already has one of the nation’s most restrictive Medicaid programs, offering coverage only to the disabled, children and parents who earn less than $2,256 a year for a family of three. Without a Medicaid expansion, the state’s working poor will continue relying on emergency rooms _ the most costly treatment option _ instead of primary care doctors. The Texas Hospital Association estimates that care for uninsured patients cost hospitals in the state $4.5 billion in 2010. (AP Photo/Eric Gay)


    (Mint Press) – Throughout the United States, many hospitals, doctors and health care providers are declining to treat people who can’t pay or have inadequate insurance. For example, at the Mayo Clinic in Rochester, Minn., new Medicaid patients from Nebraska or Montana will not be admitted at its Minnesota facility and Medicaid will not be accepted for payment at all at its Glendale, Ariz. facility.

    In response to the Mayo Clinic opting out of Medicaid in Arizona, the hospital wrote in a blog, “Mayo Clinic in Arizona loses a substantial amount of money every year due to the reimbursement schedule under Medicare, a loss we cannot continue to sustain … Providers who do fewer unnecessary tests and services are paid the least, and they are the doctors and hospitals which will go out of business first if we don’t change the payment system. For example, here at Mayo Clinic, the cost of providing services to Medicare patients exceeded the total amount paid on behalf of Medicare patients by $840 million in 2008.”

    The Mayo Clinic is far from being alone. According to Reuters, Vicky Hilborn was diagnosed with a rare cancer that manifested throughout her entire body — including her brain. Instead of accepting this death sentence, her husband, Keith, sought a second opinion with an “oncology information specialist” at the Cancer Treatment Centers of America (CTCA). The privately-held for-profit hospital boasted higher-than-national-average rates for survival rates for cancer treatments.

    The oncologist that examined Hilborn at CTCA attested to treating other case of histiocytic sarcoma, the immune system cancer she had. “He said, ‘We’ll have you back on your feet in no time,’” her husband recalled.

    Hilborn’s treatment was delayed due to an infection and other complications that kept her in the hospital for three weeks. After this, CTCA did not schedule another appointment, despite Hilborn growing sicker with each and every day. The “oncology information specialist” told Hilborn’s husband “don’t bring her here.”

    “I said you don’t understand; we’re going to lose her if you don’t treat her,” Keith recalled. “She told me I’d just have to accept that.” Vicky Hilburn never received another appointment with CTCA and died on September 2009.

     

    The realities of financing health care

    By law, a hospital — either public or private — may not deny a patient care in an emergency situation. The Emergency Medical Treatment and Active Labor Act (EMTALA) of 1986 explicitly forbids the denial of care to indigent or uninsured patients based on an inability to pay. It also prohibits the forced transfer of patients to other facilities while care is being administered and the cessation of care once started due to financial considerations.

    The EMTALA does, however, allow the care provider to ask the patient about his or her ability to pay, although care cannot be delayed while the ability to pay is being ascertained. Private hospitals, however, are free to deny care for non-emergencies or routine visits. Fines can be in excess of $50,000 per offense to hospitals that deny emergency care.

    For example, an uninsured pregnant woman goes into labor and goes to her local hospital — which happens to be privately-run and for-profit. According to the EMTALA, the hospital must admit the woman and proceed to deliver the baby as if she was a fully-paid patient. Only after the child is born and all complications have been cleared can the hospital ask her about payment. After the child is born, the hospital is under no further obligation of care and can turn out the new mother in as little as 24 hours.

    If the mother went to a public hospital instead, the hospital would be obligated to offer post-natal care, as well.

    EMTALA, however, only applies to Medicare “participating” hospitals — which, in the United States, include most non-military and non-specialty hospitals.

     

    “Patient dumping”

    This does not stop hospitals from illegally denying care to patients without insurance, or “patient dumping.” As reported by the Markkula Center for Applied Ethics at Santa Clara University, a private hospital in Alameda County (Calif.) turned away a woman in labor because the hospital’s computer showed that she didn’t have insurance. Her baby was born dead in a county hospital later that day.

    In another example, a hospital surgeon in San Bernardino (Calif.) sent a patient that was stabbed in the heart to a county medical center after declaring the patient’s condition stable. The patient arrived at the county medical center, had a heart attack and died.

    While paying for uninsured patients’ care places a heavy and unyielding burden on the shoulders of the nation’s hospital, it is neither legally or ethically correct to turn them away at a time of emergency.

    As argued by the Markula Center, the problem lies in for-profit hospitals’ profit motives. “Studies show that the growth of for-profits decreases the availability of health care for ‘unprofitable’ patients. Traditionally, nonprofits have financed care for the poor by overcharging paying patients to subsidize services for the poor. For-profits, by refusing to serve nonpaying patients while at the same time taking a great share of paying patients, leave nonprofits with more of the poor to serve but with fewer paying patients to subsidize their care.”

    “Furthermore, by serving only profitable patients and offering only profitable services, for profits are able to generate high revenues, which enables them to charge lower prices for their services and to invest in attractive facilities located in areas convenient to paying patients, both of which create substantial competition for nonprofits,” the center continued. “As a result, it has become increasingly difficult for nonprofits to continue to serve those who can’t pay.”

    In the case of CTCA, the rates that the hospital system boasts does not include the patients it turns away. According to Reuters, CTCA has relatively few elderly patients and no uninsured or Medicaid-covered patients. Carolyn Holmes, a former CTCA “oncology information specialist” said she and others routinely tried to turn away people who “were the wrong demographic.” Holmes stated that she would try to “let those people down easy.”

    In addition, CTCA rates do not reflect cases that referred to them as a final remedy. CTCA rates reflect only patients that receive care from CTCA for the life of the disease. Previously, the company was cited by the FTC for false advertising and for making unproven claims.


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