Several large hospital systems in Southern California appear to have been dodging their duties to uninsured COVID patients, delaying or refusing to accept transfers of these sick members of local communities for financial reasons.
In some cases the actions were clearly unethical and may have been illegal as well. Either way, the decisions have shown a number of hospital leaders to be lacking in judgment on the patient-centered care front.
The troubling news and analysis comes from The Wall Street Journal, whose investigative reporters uncovered the misconduct by combing through emails and other documents to which they were granted access upon filing a public-records request with the California Emergency Medical Services Authority.
“The emails identified four major hospital systems as refusing or delaying receiving transfer patients, but in some instances, denying hospitals weren’t named or quantified, so the total could be higher,” write Melanie Evans and co-reporters. “In some cases, it couldn’t be determined whether more than one hospital in the system refused or delayed accepting patients.”
One case involved Loma Linda University Health in San Bernardino County, which asked transfer coordinators to make sure the academic institution would be reimbursed at 130% of Medicare rates for uninsured patients coming from two smaller hospitals.
“In a statement, Loma Linda said it followed standard industry practice and stopped demanding the payments after it was told how overrun the hospitals were,” Evans and colleagues report.
The team notes that California is one of a few states that have been hit hard by COVID and have no binding state mandate to make capable hospitals accept emergency transfers from strained or underequipped hospitals.
The reporters further point out that the federal Emergency Medical Treatment and Labor Act says well-resourced hospitals must accept transfers of emergency patients from hospitals lacking sufficient human or equipment resources.
But there are loopholes in the federal statute.
For this reason and others, it probably should shock no one that the emails reviewed by the WSJ reporters “provide an unusually frank look into the often-hidden way that hospitals sometimes deny or delay critical care due to financial reasons,” as Evans and co-authors write. “The practice isn’t unique to California or to the coronavirus pandemic, and the disclosure highlights gaps in federal law, health experts said. Some emergency-health officials call the common process a ‘wallet biopsy.’”
Among the outside observers the reporters quote is Marc Rosenthal, chair of the American College of Emergency Physicians’ disaster preparedness and response group.
“We have an ethical duty to treat people and treat people humanely,” Rosenthal says in the (paywall protected) article.
Dave P. has worked in journalism, marketing and public relations for more than 30 years, frequently concentrating on hospitals, healthcare technology and Catholic communications. He has also specialized in fundraising communications, ghostwriting for CEOs of local, national and global charities, nonprofits and foundations.