Patient Dumping

Nature and Extent

No one really knows the magnitude of patient dumping in the nation. Every so often, a headline-making incident occurs. In 2006, for example, a Los Angeles hospital was criminally charged with discharging a medically unstable homeless woman from her hospital bed-and still in her gown and slippers-to a skid-row neighborhood. But quantitative analyses do not exist, in part because there is no good way to know how many people may be turned away from hospitals with no service at all. Thus, reliable statistics are lacking regarding the number of persons who may be turned away without treatment or who may be prematurely discharged from hospitals in an unstable condition for reasons unrelated to medical need. Relatively precise standards outline the duties of hospitals where emergency care is concerned, and to estimate the dumping problem accurately, incidents would need to be aligned with an array of terms and standards that, in certain aspects, also turn on medical judgment, an added confounder. The federal government does not publicly report on the number of emergency department examinations that fail to result in a finding of an emergency

medical condition, nor are there reports on the number of persons with emergency conditions who are discharged or transferred in an unstable state. That patient dumping is a real problem is not a matter of serious debate; indeed, the legal framework for patient antidumping standards evolved from the reports of a series of spectacular incidents. Antidumping laws are controversial, in part because of the high level of stress faced by hospital emergency departments. Between 1991 and 2003, hospital emergency department visits in the nation increased by 26%, reaching a 2003 level of about 114 million visits. Of the total number of emergency department visits, about one-third were considered to be nonurgent, meaning that about 38 million visits annually are for conditions that, on examination, may be considered nonemergent. Since antidumping duties commence with the obligation to examine, the fact that many exams reveal nonemergent conditions is actually somewhat tangential. Furthermore, emergency department statistics are predicated on individuals who become registered emergency department patients. How many individuals are actually dumped-that is, turned away without any exam or diverted away from a hospital while in an ambulance-must be factored into the equation when thinking about the true reach of antidumping laws.

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