Claiming increasing financial pressure in their emergency room operations, U.S. hospitals continue to deny care to emergency patients who don't have insurance.

According to a new report by the consumer group Public Citizen, more than 500 hospitals have violated federal law between 1986 and 1995 by transferring emergency patients and women in labor for financial reasons before they've been treated.But fewer than one out of 10 of those hospitals cited has sustained any penalty since the law took effect 10 years ago.

The Department of Health and Human Services has fined only 32 of the hospitals, and nine have been cut off from participation in the Medicare program for the violations, the group said.

"As long as hospitals find it cheaper to refuse service to an uninsured patient with a potentially expensive illness than to pay a fine for violating the law, patient dumping will continue to be a problem in our hospitals," said Lauren Dame, an attorney with Public Citizen who wrote the report along with Dr. Sidney Wolfe, director of the group's health research arm.

Among other things, the law requires that all patients be screened to determine their medical condition, promptly treated without regard to insurance status and transferred only when attending physicians feel that another hospital has expertise that justifies the move.

The report identifies 162 dumping violations at 153 different hospitals in 31 states confirmed by HHS officials between April 1, 1994, and March 31, 1995.

It also notes 10 hospitals that were fined in 1994 in amounts ranging from $2,500 to $40,000 for violations that took place between 1990 and 1992.

Texas had the most violations, 31, followed by Florida with 22 and California with 14.

HHS officials defended their record, however.

"We take these violations very seriously, and when one is confirmed we immediately send a letter advising them that we are initiating a fast-track process to terminate them from the Medicare program in 23 days," said Jean-Marie Moore, a health insurance specialist with the Health Care Financing Administration.

The hospitals either must prove no violation occurred or present a plan to ensure compliance with the law before they're cut off from Medicare.

"We don't want to further reduce access to health care by closing these hospitals down. We want them to come back into compliance with the law," Moore added.

About 40 million Americans have no health insurance, and many turn to hospital emergency rooms when they become ill or injured.

Typically, only about half the patients seen in emergency rooms wind up paying for their care themselves or through insurance. Hospitals have made up for these losses by charging more to patients who are covered by insurance, but this is becoming increasingly difficult in a more competitive, price-conscious market.

For-profit hospitals are most likely to engage in patient dumping, accounting for 27 percent of those listed, although such hospitals made up only about 18 percent of all non-federal hospitals. There are about 10,000 hospitals in the U.S.

Dame noted that under regulations imposed last fall, HHS requires receiving hospitals to report all cases in which illegal transfer of a patient is suspected, "which should help improve reporting of this discrimination, although we don't know how aggressively these rules will be enforced, either."

Rachael Weinstein, another insurance specialist with HHS, said more dumping incidents between hospitals are being reported under the new rules, "but we don't know whether there will be an increase in confirmed violations."

In the past, about a quarter of all allegations have resulted in citations against hospitals.