Civil Penalties for Patient Dumping

Section 1867 of the Social Security Act states that when someone goes to the emergency room for examination or treatment, a hospital which has a Medicare provider agreement is required to conduct an appropriate medical screening examination to determine whether the individual has an emergency medical condition. If the individual does, the hospital must provide, within the capabilities of the staff and facilities available, treatment to stabilize the condition.

The only exceptions are:
1) when a physician certifies that the individual should be transferred because the benefits of medical treatment elsewhere outweigh the risks associated with transfer;
2) if the patient requests to be transferred after being advised of the inherent risks. If a transfer is ordered, the transferring hospital must arrange for it to be safe--which includes providing stabilizing equipment to minimize the risks of transfer, making sure the receiving hospital has agreed to accept the transfer, and effecting the transfer through qualified personnel and transportation equipment.

A hospital is prohibited from delaying provision of examination or treatment for an emergency medical condition to inquire about an individual's method of payment or insurance status. Further, a participating hospital with specialized capabilities or facilities may not refuse to accept an appropriate transfer if the hospital has the capacity to treat that patient.

Small hospitals (those with fewer than 100 beds) can be fined up to $25,000 in civil monetary penalties and large hospitals up to $50,000 for each instance of patient dumping. Responsible physicians, including on-call physicians, can be fined up to $50,000 for each negligent violation.

Examples of Patient Dumping

A hospital paid $40,000 to settle an allegation that it refused to accept the appropriate transfer of a patient who had been critically injured in a car accident and required emergency vascular surgery. The transferring hospital did not have the specialized capabilities or facilities needed to treat the life-threatening injury to the patient's abdominal aorta. After numerous calls to other emergency rooms and physicians, the patient was eventually transferred to a hospital where surgery was performed in an unsuccessful attempt to save his life.

 A physician agreed to pay $20,000 for an allegation that he failed to stabilize an individual who had an unstable emergency medical condition. Hours after being discharged from the emergency room, the patient presented to another hospital where he was admitted and treated for ten days.

A hospital paid $30,000 to settle an allegation that it inappropriately transferred a patient to a psychiatric hospital without completing an appropriate medical screening of his physical complaints or providing stabilizing treatment.