Friday, October 2, 2015

Dumping: Why Hospitals Continue to Abandon their Homeless Patients

by Nomad

The problem of hospital's dumping homeless patients back on the street is a shame for the nation.

The practice of homeless dumping has been for some time now a shame of the national healthcare system. Nobody is very much surprised that it happens. In a system where money outranks almost other considerations, priorities can pretty regularly become warped by the profit margin. The penniless and homeless simply aren't worth the expense of adequate healthcare when the chief aim is to make a return on investment. 

That's the harsh reality of privatized healthcare. 

In numerous incidents, hospital employees and/or emergency services  have been caught releasing back to the streets otherwise homeless patients who may be in need of expensive medical care. These patients should have been placed in shelters or in some kind of adequate facility. The street is the last place for them, for their sake's and for the sake of general public health.

The Law and the Reality
It's not as though the problem was totally ignored.
Anti-dumping laws have been on the books since the 1980s but these laws have never been successful at totally eliminating the practice.
The Emergency Medical Treatment and Active Labor Act (EMTALA) was enacted by Congress in 1986 and further amendments were added in piecemeal fashion since that time.
EMTALA was enacted in response to studies that found that indigent emergency patients had been turned away from hospitals for necessary services or transferred (i.e., “dumped”) to public and charity hospitals in an unstabilized condition.
This law applied to all patients regardless of financial or insurance status. Forty-three of the 50 states have adopted statutes similar to the federal requirements. The penalties for violations  can be up to $50,000 against hospitals and physicians ($25,000 for hospitals with less than 100 beds). Additionally, hospital or physician found guilty of “gross and flagrant or repeated” dumping" may be excluded from Medicare and Medicaid programs

You might think that should have been enough. However, the problem comes in implementation of the provisions, the enforcement and uniform punishments for violations. 
EMTALA's inability to curb denial of treatment has been attributed to the ambiguity of the statutory provisions, poor enforcement mechanisms, and divergent judicial interpretations of the statutory provisions. A 2001 Office of the Inspector General (OIG) study revealed that emergency-care personnel and hospital staff are often unaware of EMTALA provisions and policy changes, and, even when they are aware, there is uncertainty about the proper interpretation and application of the provisions. Furthermore, most emergency personnel do not receive EMTALA guidelines.
AMA Journal of Ethics points out that, besides dumping patients, some hospitals turn homeless patients away.
From 1996 to 2000, the watchdog organization Public Citizen confirmed violations from 527 hospitals in 46 states, as well as the District of Columbia and Puerto Rico  Of the 527 hospitals, 117 had violated the act more than once, and for-profit hospitals were significantly more likely to do so.
So, despite these laws, patient dumping continues. One would like to think that in fifteen years, things might have improved but that seems to be wishful thinking.
According to one source, dumping is still a problem.
Various reports from the past decade allege similar cases: a hospital van in 2007 dropping off a paraplegic man on Skid Row, leaving him crawling in the street wrapped in a soiled gown and a broken colostomy bag; and another female patient in 2006 transported by taxi cab to the area wearing only a hospital gown and slippers.
It may be easy to sensationalize these events or exaggerate how often they occur. 
Do they happen all the time? Or rarely? 
For obvious reasons, nobody knows how common this practice actually is, since many of the victims are unable or unwilling to report the problem to the police. It's hard enough just to get an accurate number of people on the street.

Of all members of our society, homeless patients, which often includes sub-groups, like the elderly, children or the mentally impaired, are the least capable of protecting themselves, financially or legally.
So, if hospitals turn their backs on such patients, who is there to give a damn? 

Skid Row
A CBS report sheds a little light on the problem in one urban area, the Skid Row district of Los Angeles.

A 50 square-block area, Los Angeles' Skid Row district is home to the highest concentration of homeless in the country. It has been called "the homeless capital of the United States."  
This is the place where the fallacy of trickle-down economics is not much more than a cruel joke. Even when the economy picks up, nothing changes here. 
"It’s the most people, the most tents, the most obstructive sidewalks. It’s the worst I’ve ever seen.”
Just last week, Los Angeles officials were forced to declare a “state of emergency” over the rising problem of homelessness and poverty. Since  2013. the city's homeless population has risen 12 percent. 

Skid Row residents number anywhere from between 3,000 and 6,000. For the most part, live and sleep on public sidewalks, in unsanitary camps under tarps. Under those circumstances, attempting to police hospitals that dump homeless patients is next to impossible.

The Los Angeles City Attorney Rocky Delgadillo has been investigating more than 50 cases of alleged homeless dumping on LA's Skid Row. He said:
"These may be the perfect victims. Because a homeless individual dumped on Skid Row disappears into the chaos of Skid Row within minutes. It's hard for us to find them and then get the evidence that we need."
One  advocate for the Skid Row homeless said that the area has become home to more than just the homeless, but also to mentally ill, to drug addicts, and their dealers, to defenseless children. 
And all of them, she pointed out, are being exposed to diseases, like hepatitis, typhus, tuberculosis, lice and scabies. She calls the area “the perfect storm for the spread of disease." 
Dumping patients with compromised immune systems or who may have serious and/or contagious illnesses back into this environment is inexcusable. It is a case of medical malpractice.

Moreover, by increasing the chances of the spread of disease among a vulnerable population, it is also a threat to public health.
Proof, (if any more is necessary) that we all live in the same world and that we ignore these people at our own risk. 

Keep in mind, that's just Los Angeles. Many cities around the nation have similar problems. Failing to treat this segment of the population and dumping them is not acceptable, whatever the reason.

To Be Humane and Decent
There's also the problem of dumping patients with conditions cannot be stabilized without long term illness management. Putting those patients back on the street is as good as writing them off. They are simply left to survive on their own as best as they can.

Take this example. Susan Abram, of Los Angeles Daily News reported earlier this year on an incident involving a 38-year-old woman.
The person suffered from schizophrenia, asthma, diabetes and other illnesses. After a stay in the hospital, the individual was dumped on Skid Row where she was later found three days later by her sister sitting behind a dumpster. She was found to be "disoriented and sitting in her own waste, with ants and other insects climbing on her."

Los Angeles City Attorney and member of the California State Assembly from the 42nd district, Mike Feuer filed a lawsuit against the hospital in question. It wouldn't be the first time.
According to the article
Feuer said he is seeking an injunction against Gardens Regional to prohibit the hospital from discharging a patient without a proper discharge and aftercare plan. The hospital could also face additional civil penalties of up to $2,500 for each violation.
Even if this case were a one-off, it would be shameful enough. In fact, in the last two years, his office has filed anti-dumping lawsuits against several other hospitals. The Los Angeles Times reports on one suit:
In the most significant case, Adventist Health, which runs 19 hospitals and clinic centers in four states, including Glendale Adventist Medical Center, paid $700,000 last year to settle dumping allegations without admitting wrongdoing.
"It is possible" Feure told reporters, "for a healthcare facility to adopt humane and decent treatment." He added:
We’re continuing to do everything we can to stop it. Every patient, regardless of housing status, deserves to be treated with dignity and respect when he or she is discharged.
Of course how can we talk about dignity and respect when some states criminalize being homeless? How can we talk of being humane and decent when some lawmakers and city councils have tried to outlaw the feeding of the homeless hungry? 

Thankfully, this administration is using its funding authority through The Department of Housing and Urban Development (HUD) to counter this trend of outlawing the people who most need our help.  
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In contrast to the problem of patient dumping, here's a rather odd story out of Turkey. While the story is interesting, annoyingly the reporter seems to have left a lot of questions unanswered.

LOCAL - Turkish man dies after staying in Bursa hospital for 47 years