Patient dumping is when a hospital releases a patient to the streets rather than keeping them or connecting them with needed social services.
The University of Maryland Medical Center Midtown in Baltimore is the latest hospital across the country accused of patient dumping after discharging a woman one cold night this week dressed in only a hospital gown and socks.
Video shot by a concerned passerby depicted the disoriented woman left at a bus stop outside the hospital as four security guards walk away with a wheelchair. The video went viral thrusting the hospital into the national spotlight.
The practice of patient dumping is a national problem that’s hardly new.
When the term was first coined in the late 1800s, it involved private hospitals sending poor patients to public hospitals, but it’s come to mean any hospital that releases someone, usually a homeless and/or mentally ill person, to the streets rather than sending them to a shelter or appropriate services.
The New York Times first began writing about patient dumping in the 1870s when private hospitals were sending patients who couldn’t afford their services to Bellevue Hospital, the city’s public hospital, according to a 2011 report in the American Journal of Public Health.
Traditionally, poor patients in the United States were largely treated by public or charitable hospitals. Private hospitals were under no obligation to admit patients and could refuse service to anyone.
That changed in 1986 when Congress passed the Emergency Medical Treatment & Labor Act, which was signed by President Ronald Reagan. The law prohibited emergency rooms from denying hospital services to anyone even if they can’t pay and also from transferring or discharging patients without first stabilizing them.
The Joint Commission, which accredits hospitals, also requires that hospitals have a discharge plan. But discharge policies can differ widely by hospital.
The issue drew widespread national attention about a decade ago when the city of Los Angeles began a crackdown on patient dumping after several incidents there, particularly along Skid Row, where many of the city’s homeless people live. The city has imposed millions of dollars in fines on hospitals for the practice.
In one particularly egregious incident, a paraplegic man was found crawling around Skid Row in 2007. Hollywood Presbyterian Medical Center, which was accused of taking him there without a wheelchair, paid $1 million to settle that case.
Good Samaritan Hospital in Los Angeles had to pay $450,000 to settle allegations that it dumped a homeless patient on the street in 2014 after he was treated for a foot injury.
The Rawson-Neal Psychiatric Hospital in Las Vegas has been accused of shipping hundreds of patients out of Nevada, many of them to California, by bus, according to a 2014 report by the U.S. Commission on Civil Rights on patient dumping. Multiple lawsuits alleged the hospital dropped patients off at the bus station with a prepaid ticket and a few days food and medicine.
In May 2017, two Howard University police officers and their supervisor were fired after being recorded dumping a patient from a wheelchair outside the university’s hospital in Washington, according to reports in The Washington Post. A video of the incident showed a male officer pushing the barefoot woman to a bus stop. Two other officers watched as she fell onto the sidewalk.
The Commission on Civil Rights’ report found insufficient regulatory oversight as well as a lack of funding to adequately treat the population contributed to patient dumping.
The commission called for reforms to the Emergency Medical Treatment & Labor Act, increased oversight and training, better linking community mental health services to hospitals, and consistent discharge planning.