In the U.S., “patient dumping”, i.e. turning away or transferring uninsured patients with emergency medical conditions, has been legally prohibited for the last 25 years. However, a study published in the August edition of Health Affairs reveals that uninsured Americans are still at risk.

The study, which was conducted by a national team of researchers, indicates that hospitals are violating the law by continuing to practice “patient dumping.” The team investigated and presented case studies of 5 patients who were either denied care or who were transferred in an unstable condition to Denver Health hospital. The team conclude that it is not only a fact that “patient dumping” still occurs under the current interpretation and enforcement of the law, they also state that Denver Health is not the only hospital where this happens.

Lead investigator Sara Rosenbaum, the Harold and Jane Hirsh Professor of Health Law and Policy at George Washington University School of Public Health and Health Services in Washington, D.C, says:

“Federal and state investigators must do a better job of identifying violators of the law and enforcing the ban on patient dumping. If we do not start aggressively enforcing the law, millions of uninsured Americans will continue to get no care at all or incomplete care.”

The cost of treating millions of uninsured Americans has been rising in Denver and also in communities around the nation. This comprehensive study of the law and individual case studies indicates that both profit- and non-profit hospitals participate in this practice. The burden ultimately lies on the hospitals of the last resort, which are often public hospitals that already have a high percentage of non-insured patients or those without means to pay for their care.

The team examined the legal interpretation and enforcement of the 1986 Emergency Medical Treatment and Labor Act (EMTALA), which requires hospitals to provide appropriate medical screening and stabilizing care to uninsured patients with emergency conditions. They also investigated real case studies of events that occurred at Denver Health, highlighting the type of violations that occur frequently.

Rosenbaum and her team investigated existing lawsuits and a 2003 rule issued under the George W. Bush administration to clarify the law’s implementation, concluding that court rulings, regulations and other factors have allowed hospitals to bypass the law’s intent. For instance, according to the 2003 regulations, patients have to arrive at a “dedicated emergency department” and that EMALTA is not applicable for critically ill patients who seek medical help in another department.

The team also highlights the fact that even outright violators of the law are rarely identified or penalized with the result that public hospitals like Denver Health often receive uninsured patients who are diverted or transferred in a medical emergency. They refer to 5 real-life examples of these potential violations. One such violation involved a 64-year old who was transferred 350 miles to Denver Health despite the fact that local hospitals had the capacity to treat the woman’s life-threatening condition.

The researchers call for the federal government to develop a more effective system for reporting non-compliances with the law in order to stop this practice, arguing that federal and state regulators must establish clearer standards to simplify matters for hospitals to avoid violations. They add that an easier reporting system, such as a system whereby responsibilities are shifted from patients and hospitals to enforcement agencies, would make a huge difference in helping to enforce the law with regard to “patient dumping.”

Written by Petra Rattue