Patient dumping is a serious problem
James Flavy Coy Brown has become the national face of a shady yet little-known practice at many hospitals in the United States. But Brown never wanted to become the symbol of a cause — he just wanted someone to help him.
The former South Carolina resident has suffered from depression, anxiety, schizophrenia and other mental disabilities since 2006 when he was badly injured in a car accident. For years, he received treatment in his home state until cuts to mental health funding prompted his doctors to suggest he look elsewhere.
Go west, they told him. That was his best prospect for getting help.
Acting on their advice, Brown chose Nevada, where he received treatment at a group home called Annie’s Place in Las Vegas. When the facility shut down, he and four other patients were sent to Rawson-Neal Psychiatric Hospital, an inpatient medical facility run by the Southern Nevada Adult Mental Health Services.
Brown says he received treatment at Rawson-Neal for three days before a doctor decided he was well enough to be discharged. The doctor asked Brown a question he wasn’t expecting: where do you want to go?
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Brown told the doctor he didn’t want to leave Nevada, but the doctor was insistent. “California sounds like a really nice state,” the doctor said, according to Brown. “I think you’ll be happy there.”
The hospital gave Brown three days worth of medication, four bottles of Ensure, a handful of crackers and a Greyhound bus ticket. Staff members instructed Brown to call 911 for help once he reached his final destination and wished him well.
Fifteen hours and 600 miles later, he and five other patients arrived in Sacramento. For Brown, Northern California was like an alien planet — he didn’t know where he was, and he had no connections in the city. Worse, he had no money and no identification — just hospital paperwork that listed his discharge address as “Greyhound Bus Station to California.” He was left to aimlessly wander the streets.
Hospitals call it “bus therapy,” but the federal government has another term for it: patient dumping, a practice where medical centers turn away or discharge patients who cannot afford services.
Patient dumping was made illegal in the late 1980s under the Emergency Medical Treatment and Active Labor Act (EMTALA), which states that any hospital that receives Medicare funding cannot turn away an individual who seeks medical care, regardless of their ability to pay. Under the act, hospitals also cannot discharge a patient without their consent, but they are allowed to transfer a patient to another facility that can better accommodate them.
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Almost all hospitals in the United States receive some form of Medicare funding, including Rawson-Neal, the hospital that discharged Brown. But for years, hospitals have routinely made “patient dumping” a part of their practice with very little consequence.
According to data reviewed by TheBlot, 12 hospitals — mostly in the south and midwest — settled with federal medical regulators last year over “patient dumping.” The settlements ranged anywhere from $20,000 to $50,000 — a drop in the bucket for an industry that charges up to $300 for four boxes of gauze (retail price: $3). As part of the settlement, none of the hospitals had to admit any kind of wrongdoing.
Those settlements involved one or two cases of patient dumping. Rawson-Neal, on the other hand, has been accused of dumping nearly 1,500 patients over the course of five years based on case reviews cited by The Sacramento Bee. In many of those cases, Rawson-Neal patients were sent via bus to metropolitan cities in California, including Los Angeles and San Francisco. Some of those patients wound up homeless; others became violent criminals.
Brown could have ended up either way. When he stepped off the Greyhound bus last February, he wandered aimlessly through the streets of Sacramento until he stumbled upon a homeless shelter called Loaves and Fishes. By then, his medication had run out and the voices in his head had returned. His depression was back, and he was having thoughts of suicide.
Loaves and Fishes took him in and, with their help, Brown eventually found his way to U.C. Davis Medical Center. He wound up in at least two boarding homes in Sacramento before his daughter — who became aware of Brown’s plight after being contacted by a Sacramento Bee reporter — brought him home to North Carolina.
After the Bee published its report on Brown, the federal government opened an investigation into Rawson-Neal. Of the cases it reviewed, the government found the hospital violated “patient dumping” laws 40 percent of the time by failing to make sufficient arrangements for discharged patients. It is unclear how many of the 1,500 cases cited by the Bee were reviewed by the government.
The review cost Rawson-Neal its accreditation
. It also prompted Brown, armed with the American Civil Liberties Union
and civil rights attorney Mark Merin
, to file a class action civil lawsuit
against the State of Nevada alleging the state-run hospital violated both Nevada law and the U.S. Constitution. A federal judge dismissed the lawsuit in February
, saying doctors didn’t force Brown onto the Greyhound bus and that Brown wasn’t harmed by the hospital’s decision to send him to Sacramento because he eventually received treatment at the U.C. Davis Medical Center.
But the U.S. Commission on Civil Rights isn’t convinced that Brown, and others like him, aren’t harmed when a hospital transports them out of state without adequate arrangement. Last Friday, the federal oversight board held a hearing to determine if patient dumping had become a systemic problem.
“In three decades since EMTALA’s passage, the healthcare delivery system has changed dramatically,” medical expert Katherine van Tassel testified at the hearing. “But EMTALA has been left far behind.”
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There was little argument from advocates of the healthcare industry. They acknowledged patient dumping is a serious and pervasive problem, but said there wasn’t much they could do about it. The recession had caused the government to slash funding for public and mental health, and that leaves hospitals with little options when it comes to treating the needy.
“We have a great law called EMTALA that requires us to transfer patients,” said health attorney Gina Greenwood. “But where the heck are we going to transfer them? If you can address that problem, you won’t be bussing James to California anymore.”
The solution to that problem: more money.
“Federal funding is not available to the most vulnerable population that is out there,” Mike Wildon, the director of the Nevada Department of Health and Human Services, told the Las Vegas Sun. “If you don’t have federal participation, in the majority of the cases, hospitals won’t build the beds.”
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Healthcare officials say unless the federal government pumps more money into the Medicare system, hospitals like Rawson-Neal (which is still operating despite losing its accreditation) will have no choice but to continue sending the impoverished out of state — something Brown doesn’t wish on anyone.
“We were dumped off like unwanted people,” Brown said at a recent press conference. “We’re not supposed to be treated that way. We’re human beings.”