Nearly 700 American hospitals have illegally "dumped" untreated patients from their emergency rooms in the past 10 years, but just a handful of the hospitals have been punished, a consumer group said Monday.
In a report, Public Citizen blamed hospitals for breaking the law and the Department of Health and Human Services for failing to enforce it."The hospitals are paying Russian roulette that they may not get caught," said Dr. Sidney Wolfe, director of Public Citizen's Health Research Group. "They're really gambling with people's lives."
In most cases, dumped patients do not have insurance, Wolfe said, but an increasing number are not treated because their managed-care plans refuse to pay. The insurance companies are wrong, the report said, but hospitals are still required to treat the patient.
Since 1986, when the patient dumping law took effect, the government has confirmed violations at 692 hospitals, the report said. But only 67 hospitals have been fined or dropped from the Medicare program - the ultimate punishment.
A spokesman for the American Hospital Association said hospitals are doing their best to care for the uninsured, writing off $17.5 billion in 1996 for people who cannot pay their bills.
"Our members are struggling with the uninsured problem," said the spokesman, Rick Wade.
Monday's report is Public Citizen's fifth since the law took effect. The group noted an increasing number of violations are confirmed each year, partly due to new reporting requirements on hospitals.
Between April 1995 and September 1996, the report said, 264 patients were dumped from 256 hospitals. Just 26 hospitals and eight doctors were fined.
Among many examples, the report cited the case of a 2-year-old Massachusetts girl brought to an emergency room with fever after experiencing vomiting and diarrhea earlier in the day.
She was not medically screened, but referred to a doctor's private practice. Seven hours later, the girl was taken to the emergency room by ambulance and died that evening. The hospital has not been fined.
Under the 1986 law, hospitals that treat Medicare patients - nearly every hospital - are required to screen each emergency room patient, including women in labor, and give whatever aid is needed to stabilize the medical condition.
Unstable patients may not be transferred unless a doctor certifies in writing that the benefits of the transfer - such as more specialized facilities - outweigh the risks. They are not allowed to delay treatment to check on health insurance coverage.