Baltimore Incident Is Simply The Latest In Patient Dumping: Hospitals And Jails Find Creative Ways To Rid Themselves Of Patients

(1-15-17) The viral video footage of a woman, clad only in a hospital gown, being literally dumped on a Baltimore street by University of Maryland Medical Center (UMMC) employees last week in freezing temperatures outraged viewers.

In a mea culpa press conference, the hospital’s top official, Dr. Mohan Suntha, declared: “We take full responsibility for this failure,” and left the impression that patient dumping is rare and a freak occurrence.

Sadly, that’s just not true. It has been going on for decades and now hospitals are not the only ones finding creative ways to rid themselves of poor patients with serious mental illnesses rather than treating them.

First, let’s talk about Maryland.

The Treatment Advocacy Center was quick to report last week that in Maryland alone, 750 individuals with schizophrenia or bipolar disorder were discharged from hospital emergency departments ‘against medical advice’ in 2014.

At least, those folks got through the emergency department door.

A 2011 report by G. Douglas Bevelacqua, then-Inspector General for Behavioral Health and Developmental Services in Virginia, found that 200 persons in the midst of a mental health crisis were refused admittance to hospitals in the Hampton Roads area from April 1, 2010, through March 31, 2011.

A follow-up report noted that between July 15 through Oct. 13, a total of 72 people, who were in need of a “temporary detention order” to allow for a comprehensive evaluation to determine the proper level of care due to clinical risks, were ignored.

Turning away patients was so common in Hampton Roads that hospital officials had a slang term for it: “streeting.”

The Virginia legislature decided to end the practice after state Sen. Creigh Deeds’ son, Gus, attacked him and took his own life in 2013. Father and son had been turned away from a local mental health center after being mistakenly told no hospital beds were available. Legislators passed a “bed of last resort” law that said state run mental hospitals were required to accept patients if no hospital psychiatric bed could be found in their communities.

Problem solved, right?

Not according to an advocate who spoke recently at a convening of mental health officials brought together to make recommendations to newly sworn-in Virginia Gov. Ralph Northam. She reported that Virginia hospitals were now “dumping ” patients by sending them to state hospitals for problems as minor as urinary tract infections because the state couldn’t refuse them and the local hospital didn’t want to foot the bill of treating them. 

Virginia hospitals are not the only public facilities finding ways to dump the seriously mentally ill. During a visit to a local Virginia jail, I was told that seriously mentally ill arrestees were being immediately released on personal recognizance bonds because the sheriff couldn’t afford to pay for their medications. (If admitted into jail, an arrestee loses federal health care coverage.)

Even more blatant, it’s been alleged that a Reston hospital has been known to call the police when   someone,who has a mental illness but no insurance, arrives seeking help.

After the latest Baltimore incident, Baltimore Sun newspaper reporter Andrea K. McDaniels  reminded readers that patient dumping is nothing new.  She wrote:

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.

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.

The trans-institutionalization (transferring of seriously mentally ill patients from state hospitals to jails and prisons) is another form of dumping. Again, the Treatment Advocacy Center, which has done a superb job focusing on the criminalization of persons with mental illnesses, reports that 90,000 inmates with serious mental illnesses are waiting for a psychiatric hospital bed.

I wonder how healthcare workers whose calling is to help the sick can be so heartless. I also wonder what those dumping numbers would total if you added patients who get admitted to emergency rooms but receive little more than a shot of Haldol before being shoved out the door within 48 hours?

If you have a personal story about being dumped, please share it on my Facebook page so I can forward it to members of Congress and share it with my fellow members on the federal ISMICC committee.

About the author:

Pete Earley is the bestselling author of such books as The Hot House and Crazy. When he is not spending time with his family, he tours the globe advocating for mental health reform.

Learn more about Pete.