Hospital after hospital refused to treat a patient with an open leg fracture, in need of an orthopedist, after suffering an injury in a moped accident.
The orthopedist at Palms West said the wound was open for too long. The specialist at Wellington Regional Medical Center passed the case off to another hospital and the specialist at JFK Medical Center simply said “no.”
The three hospitals above were among five hospitals in Palm Beach County that received citations last year for violating a federal law to prevent patient dumping. The hospitals denied treatment of about 30 patients emergency specialty care that they could have provided.
Compared to a total of 450,000 emergency room visits during 2007, the number of patients is rather small. However, the violations offer a different view of how emergency patients are getting passed off among hospitals and it highlights a larger crisis in emergency specialty care.
The lack of specialists or their reluctance to treat emergencies is affecting much of the state and several parts of the nation. Florida has the most complaints of patient dumping and accounts for about a third of the nearly 750 total cases nationwide, according to the Centers for Medicare and Medicaid Services.
Doctors argue several points – the high cost of malpractice insurance, fear of being sued and low reimbursement for care or no pay at all from the uninsured. The handling of emergency calls is significantly different today than it was years ago, meaning, patients might wait longer amounts of time before a specialist can be found.
Good Samaritan Medical Center, in West Palm Beach, is a prime example. Last year the facility was citied after its gastroenterologists refused to care for a jaundiced patient. Hospitals that provide elective specialty care are bound by law to offer it in emergency situations.
Federal reports show – two specialists were out of town and unreachable. Three others refused to treat the patient and the sixth specialist called was in the emergency department at the time, but when asked for a consult, replied, “Never.”
Nine hours later – after calls to seven hospitals – the patient was transported to another hospital.
According to federal records 26 complaints were filed last year. Of the other hospitals cited, Wellington Regional, St. Mary’s Medical Center and JFK each had two citations. Palms West had the most, with three violations.
The hospitals did not receive fines nor did they lose their Medicare licenses, both potential consequences of the violations.
Many hospitals are trying to remedy their staffing shortage by paying specialists to treat emergency patients.
A few years back, a group of hospital CEOs and surgeons created a regional call plan to help combat the confusion. Patients would be sent directly to the hospital known to have a specialist readily available.
Local efforts received encouragement recently when the federal government announced proposed changes to the anti-patient dumping law, so hospitals could organize regional call schedules. While it would be a step in the right direction if the law was amended, that is only half the battle; hospitals still must sign on to the idea and make it work. #