Texas outlaws `dumping' poor patients; Congress may do same

Private hospitals across the country that routinely send indigent emergency patients to public hospitals could soon face stiff penalties if Congress follows Texas in outlawing such transfers. Congress is considering legislation making it a civil offense to transfer to another hospital any patient whose medical condition has not been stabilized. Under the proposed law, hospitals violating the regulation could be denied medicare funding, and physicians approving the transfers could face up to $25,000 in civil penalties.

Last year Texas became the first state to approve regulations prohibiting the transfer of patients for economic reasons. The Texas rules, stronger than those now being considered by Congress, go beyond emergency cases to include all patients, and allow transfers only for medical reasons, and only if the receiving hospital has agreed to accept the patient. In December, the state Board of Health approved the regulations as part of an indigent health-care package.

``Dumping,'' the practice of sending patients who are poor financial risks to public hospitals, has received growing attention as beleagured public hospitals have publicized glaring examples of abuse. The problem is centered primarily in urban areas, where large public institutions, and many of the poor, are concentrated.

A force behind the proposed federal regulations is Rep. Fortney H. Stark (D) of California, whose San Francisco-area east bay district was the site of a Harvard University study of dumping. An aide to Representative Stark said the rules would allow patients, as well as hospitals, to sue in federal court the hospitals and physicians accused of dumping. Stark is chairman of the House Ways and Means Committee's subcommittee on health.

The Texas rules were originally proposed by state Board of Health Chairman Ron Anderson, who is also the chief executive officer of Parkland Memorial Hospital, a large county-operated hospital in Dallas where dumping had become a regular occurrence.

According to Parkland spokesman Gregory Graze, the problem is exacerbated in Texas because of the state's low medicaid funding. Texas has very stringent rules for determining who is eligible for medicaid and thus covers only the poorest of the poor. (Texas ranks 48th among the 50 states in the level of payments under the federally mandated program.)

The Legislature last year approved $70 million to help counties pay for care for the poor but turned down a proposal for broader indigent health-care coverage.

Emergency physicians are unhappy with the federal proposal because they feel it ``singles them out,'' according to Virginia Pitcher, director of the American College of Emergency Physicians' Washington, D.C., office.

She continues, ``The real problem that has yet to be addressed is indigent health care. . . .The reason the dumping is going on is that these patients have no source of funding.''

Mr. Graze agrees but says that because there is no national indigent health care plan on the horizon, all hospitals should share the financial burden of providing care to the poor.

Dennis Andrulis, director of research for the National Association of Public Hospitals, says the proposed federal law would put those hospitals that routinely dump patients on notice that they will be subject to penalties.

He says, ``It's important we make this clear now, because as the screws continue to tighten on the financial spigot, the temptation for other facilities to divest themselves of individuals who are financial liabilities will increase.''