In 2005 and 2006, patient dumping in Los Angeles' Skid Row captured national attention after a string of horrific cases came to light. Over and over, hospitals were dumping homeless and mentally ill patients in fragile condition onto street corners, leaving them to wander, disoriented and sick.
At the time, the city forced several large hospitals and chains, including Kaiser Permanente, to pay huge civil fines, agree to new regulations and in some cases, accept supervision by an independent monitor. Apparently, however, that wasn't enough to keep the problem from cropping up again.
Recently, Pacifica Hospital of the Valley reached a settlement with the city under which it would pay $500,000 in fines, and agreed to rules requiring it to personally deliver homeless patients to a home or facility along with an appropriate aftercare plan, with someone present to accept the patient. The fines spring from an incident in which Pacifica allegedly discharged a man with a serious mental disability and dropped him off on Skid Row.
So how have hospitals in the region responded to this crisis? Evasively, I'd argue. A trade group for 170 Southern California hospitals has agreed to consider new rules to stop homeless patient dumping on Skid Row. But note that they're "considering" and haven't promised anything.
The reality is that patient dumping is a national problem, with hospitals going to great lengths to rid themselves of homeless and disenfranchised people. Consider the case of James Brown, a psychotic patient who was kicked out of Rawson-Neal Psychiatric Hospital in Las Vegas in 2013. After three days in the hospital, the staff sent him to California, handing him a one-way ticket and three days worth of medication though his group home was in Vegas. He was told to call 911 when he arrived.
And his situation is far from unique; according to a Sacramento Bee story, Nevada providers have purchased nearly 1,500 bus tickets since 2008, sending patients by bus to every state in the continental United States.
Unfortunately, hospitals have a strong incentive to turn away or discharge patients to the street, as they can't provide a home for homeless patients and can't afford to keep them indefinitely. That being said, it's unconscionable to handle the problem by sending patients out the door with no real destination and in some cases, far away from home, as if the problem no longer exists if they don't have to look at it.
Considering the frequency at which forms of patient dumping occur, and hospitals' seeming unwillingness to take the bit in their teeth and establish clear regulations that would prevent dumping from happening, I'd argue that it's time for CMS and the legislature to step in.
If existing financial penalties aren't enough to dissuade hospitals from dumping patients, it's time to up the ante. One option is to double or triple the statutory penalties hospitals face when they engage in this behavior; If a $500,000 fine isn't enough to scare hospitals straight, maybe $1 million fines (or higher) will be required to get the C-suite's attention.
If you really want to get tough, perhaps patient dumping should endanger a hospital's certification to treat patients under Medicare and Medicaid. For most hospitals, being legally blocked from accepting payments under these programs would be a terrible body blow if not a death sentence. If CMS rules don't allow for this kind of censure under these circumstances, they should.
The truth is, the behavior some hospitals engage in is just a symptom of the larger problems of homelessness and mental illness in our society. And hospitals can't single-handedly solve these problems. But they're going to have to come up with a better solution than "out of sight, out of mind."