HealthLawProf Blog

Editor: Katharine Van Tassel
Concordia University School of Law

Friday, November 17, 2006

Patient Dumping on Skidrow

The Los Angeles Times reports on hospital dumping in that city.  It is really shocking - this isn't just tranferring a severaly ill patient to another hospital but dumping them literally on the street in dangerous sections of LA.  The Times reports,

After a year of investigation, the Los Angeles city attorney's office has identified 10 hospitals it suspects of dumping discharged patients on skid row and is now preparing to take legal action to stop the practice, according to two sources familiar with the planned litigation.

The action comes after talks between the city attorney and a hospital trade group broke down in April. City Atty. Rocky Delgadillo said he had hoped to negotiate a legally binding agreement with hospitals that would have established practices for discharging the homeless. But the hospitals balked at what they considered too-stringent regulations and the city attorney's intransigence. They also objected to a proposal that the American Civil Liberties Union be involved in monitoring the agreement.

Now sources familiar with the investigation say the city attorney, the ACLU and the pro bono law office Public Counsel are preparing civil litigation targeting several hospitals for unfair business practices. The city attorney has not ruled out filing criminal charges as well, the sources said. . . .

Officials have spent months examining more than 40 allegations that hospitals dropped patients on skid row after discharge, often against the wishes of the patient. The investigation yielded 15 potential cases, top city attorney officials said.  The latest incident of alleged patient dumping occurred last week when a man with a foot wound was dropped off by taxi after being discharged from a Covina area hospital. Prosecutors said the man went to skid row's Union Rescue Mission, where he was in so much pain that he had to be rehospitalized immediately.

Delgadillo said hospitals have resisted changing their practices — in some cases "threatening to close doors on emergency rooms" if there were more costly regulations.

Jim Lott, executive director of the Hospital Assn. of Southern California, which represents most of Los Angeles County's hospitals, blamed the talks' failure on a heavy-handed, "take-it-or-else" approach by the city attorney. But city attorneys said the inability of the hospital association to be able to "legally bind" its members led to the end of the talks.

Officials have not revealed the names of all the hospitals they are investigating. But the Los Angeles Police Department has publicly identified several that it suspects of dumping, including Kaiser Permanente's Bellflower Medical Center, Martin Luther King Jr./Drew Medical Center and Los Angeles Metropolitan Medical Center. Those facilities have denied any wrongdoing. . . .

Jeff Isaacs, chief of the city attorney's Criminal and Special Litigation Branch, said his office's investigation suggested that some medical centers in the suburbs dumped patients on skid row instead of in their areas because "it was one way to guarantee they would not come back again." Several hospitals have strongly denied such motivation.

The state Legislature recently passed a law aimed at curtailing dumping across city boundaries, but it won't take effect until January.

The city attorney's office acknowledged that legal proceedings could be difficult given both the transient nature of many victims and the lack of a specific state statute prohibiting the discharge of patients onto skid row. Officials said, however, that potential criminal charges might include false imprisonment and "dependent adult" abuse. "These are the most challenging cases because the victims are the perfect victims. We have a challenge just finding them," Deputy City Atty. Carolyn Phillips said.

The city attorney is also looking at whether hospitals that engage in dumping could be penalized for violating the federal Emergency Medical Treatment and Active Labor Act, which requires medical facilities to screen and stabilize all patients and penalizes them for releasing those who are medically unstable.

Isaacs said the city attorney's office is also considering suing offending hospitals for violating a state law that deals with unfair business practices. The law allows a corporation to be sued for unscrupulous behavior and has been used in the past to successfully sue slumlords.

In the meantime, Lott said, his organization is pursuing its own policy changes. The association, which represents more than 170 hospitals in Southern California, has recommended that all hospitals get signed waivers from patients before they are released on skid row. The hospitals also are working on a plan to have Volunteers of America, a skid row charity, provide van service from hospitals to homeless service providers. The association also would seek to reserve 45 beds for homeless people at hospitals across the county for longer term recoveries.

Prosecutors and others, however, accuse the hospitals of dragging their feet. Mark Rosenbaum, legal director of the ACLU of Southern California, said that although he still hopes for a resolution, the hospitals so far have shown "they don't really want to solve the problem."  Dan Grunfeld, president and chief executive of Public Counsel, said the continuing dumping shows that a "systemic approach" is needed to change the way hospitals discharge the homeless.  "Dumping someone in skid row can be tantamount to killing them," he said.

Today's NPR Morning Edition has some more details as well as a video of a female patient woman being dropped off on skidrow.

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