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'Patient-dumping' costs hospital $20,000

July 14, 1998|By MARLO BARNHART

Washington County Hospital has paid a $20,000 fine for running afoul of a federal "patient-dumping" statute.

The hospital was one of 17 hospitals nationwide found by the U.S. Department of Health and Human Services to have engaged in patient-dumping, a refusal to treat people who can't pay for services.

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"We admit no guilt. This was obviously a clash of regulations between Maryland and the federal government," said hospital spokesman John Costopoulos. "We obeyed the state and that was counter to the feds."

In Washington County Hospital's case, six patients were screened by a hospital nurse in 1995 rather than by a doctor before being referred to a private-care physician for care, said Ray Grahe, vice president of finance.

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Grahe said the hospital was in compliance with a Maryland mandate that allowed nurses, rather than doctors, to screen patients in an attempt to cut back on unnecessary emergency room visits.

Federal health officials say only doctors can do the screenings before patients are referred to their family doctors.

"Of the 17 hospitals cited in the U.S., seven of them were in Maryland," Grahe said, pointing to that as proof that the problem was with conflicting regulations, not with patient care.

The federal finding resulted in a $20,000 judgment against the Hagerstown hospital. That sum has been paid and will not affect patient rates, Costopoulos said.

The deficiencies cited by the U.S. Department of Health and Human Services have been corrected and the hospital's ability to serve Medicare and Medicaid patients wasn't affected, Costopoulos said.

"Had we not complied, that could have been a possibility," Costopoulos said.

Rick Ware, of the U.S. Department of Health and Human Services, confirmed that the Washington County Hospital case was settled March 31.

He refused to comment on whether the violation was technical as asserted by hospital officials and said any further information could be obtained only by filing a Freedom of Information Act request with his department.

The state-mandated program in question, Maryland Access to Care, or MAC, was initiated in 1994.

Through the program, patients could be seen by a triage nurse and if an injury or illness was found to be minor, a patient would be referred to a primary care physician instead of being seen in the emergency room, Grahe said.

"Turns out it was that program that put us in conflict with the federal patient-dumping statute," Grahe said.

Federal regulations state that a doctor, not a nurse, must screen a patient before the patient can be referred to a family doctor, Grahe said.

Six 1995 cases were cited in the report by the U.S. Department of Human and Health Services and all six patients went to their own doctors, and no care issues arose, Grahe said.

The MAC program in Maryland was replaced in 1996 by Health Choice, which dictates that every Medicare patient who goes to the hospital must be placed in a managed care organization.

Grahe said the hospital also initiated Nurse First in 1997, in which patients are first seen by nurse and then by a doctor.

The programs were designed with the goal of streamlining the emergency room, officials said. The hospital's status as a Region II trauma center draws a high number of patients to the emergency room, about 50,000 visits a year, Costopoulos said.

Maryland hospitals paid $177,500 in fines in 1998, more than any other state, according to a story in this week's Baltimore Business Journal. The maximum penalty for patient dumping is $50,000 per violation.

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