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Mod3EMTALAarticlesandresources6_3_21.docxEMTALA Articles and resources 6/3/21
L.A. nursing home ‘dumped’ residents to bring in lucrative COVID patients, authorities say
Los Angeles City Atty. Mike Feuer said the Lakeview Terrace skilled nursing home had agreed to settle a lawsuit alleging that it discharged patients to make room for others suffering from COVID-19, who are generally more lucrative to treat.
(Francine Orr / Los Angeles Times)
By JAMES RAINEY STAFF WRITER
MARCH 1, 2021 4:13 PM PT
A nursing home accused of illegally “dumping” patients onto city streets and into ill-equipped homes in order to take in more lucrative COVID-19 patients will nearly double its nursing staff, allow increased oversight and pay $275,000 in penalties and costs to settle a lawsuit brought by the Los Angeles city attorney’s office.
City Atty. Mike Feuer on Monday announced the legal agreement with the Lakeview Terrace skilled nursing facility, which he had accused of “sustained” and “intentional” misconduct in failing to adequately tend to some patients, while pushing others out of the 99-bed home.
The city alleged in its lawsuit that the facility west of downtown had an incentive to discharge long-term residents in order to make room for COVID-19 patients, who brought Lakeview Terrace much higher reimbursement payments from Medicare.
“This victory for these patients is all the more important given COVID-19’s devastating impact on nursing home residents in L.A. and across the nation,” Feuer said in announcing the settlement. He predicted that the agreement would result in “dramatic improvements in patient care, new COVID-related protections [and] improved oversight when patients are discharged.”
The city attorney’s lawsuit said Lakeview Terrace had failed to give prescribed medication to chronically ill patients and falsely reported that the medicine had been given.
Tracking the coronavirus in California
Dec. 19, 2020
The July action, filed in Superior Court, also charged that family members were not consulted when patients were “dumped” at other facilities or onto the street.
In one instance, the lawsuit said, an 88-year-old man with dementia was transferred from the nursing home in the Westlake neighborhood to a boarding house in Van Nuys, only to be found a day later wandering the streets, profoundly confused.
Another Lakeview Terrace patient who is positive for HIV was released and ended up cowering in a friend’s backyard, hoping he would be safe there from the coronavirus, the suit contended.
“Although Lakeview disputes the underlying allegations, the costs associated with litigating against the City are most appropriately put towards resident care,” the facility’s administrator, DJ Weaver, said via email.
Feuer acknowledged that the facility had cooperated with the city attorney’s office throughout the investigation. Weaver’s statement concluded: “Put simply, all Lakeview residents can expect the utmost in care and treatment. Residents have been, and will continue to be, Lakeview’s highest priority.”
Healthcare experts have warned that the money skilled nursing facilities are paid under a plan by the federal government to care for people stricken by the coronavirus would lead to patient-dumping by unscrupulous operators. The reimbursement plan pays more than four times more for COVID-19 patients than homes can charge for long-term residents with relatively mild conditions.
The lawsuit is similar to another filed in 2019 by the city attorney’s office against Lakeview Terrace. That action also accused the home of patient-dumping, inadequate care and failure to maintain adequate patient records.
The new settlement brings back an outside monitor first imposed on Lakeview Terrace following the 2019 lawsuit. This time, the monitor will have broader powers to protect residents, with 24-hour access to patient records and the ability to make unannounced inspections. The outside overseer will remain in place for up to 18 months, at the discretion of Feuer’s office.
According to county health officials tracking care facilities, Lakeview Terrace has reported that 38 staff members and 48 patients have contracted the coronavirus since the start of the pandemic. The facility has recorded three COVID-19 deaths.
Other resources to view:
Physician review sheet: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/som107_exhibit_138.pdf
Washington State Hospital Associate EMTALA Fact Sheet: http://www.wsha.org/wp-content/uploads/emergencies_EMTALA-fact-sheet.pdf
EMTALA Quick Sheet¨ https://assets.hcca-info.org/Portals/0/PDFs/Resources/Conference_Handouts/Compliance_Institute/2019/410_Handout.3.pdf
Patient Dumping Still a Problem Despite Law 4/1/19: https://www.usnews.com/news/health-news/articles/2019-04-01/patient-dumping-still-a-problem-despite-federal-law
'Patient Dumping’ Still a Problem Despite Law
Financial motivations play a strong role in hospitals providing appropriate care, new research suggests.
By Gaby Galvin
|
April 1, 2019, at 11:00 a.m.
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Study: ‘Patient Dumping’ Still a Problem
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New study findings indicate that lower-income patients still face unequal treatment in emergency care settings. (GETTY IMAGES/BLEND IMAGES)
A sweeping new analysis indicates a federal law designed to prevent hospital "patient dumping" and ensure equal access to emergency medical care is falling short.
Researchers from Yale University and elsewhere analyzed 215,028 emergency department visits to 160 hospitals for pneumonia, asthma and chronic obstructive pulmonary disease in 2015.
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After being stabilized, patients who were uninsured or covered by Medicaid were more likely to be transferred to another hospita l than privately insured patients. Uninsured patients also were "markedly" more likely to be discharged from the emergency department, according to the study, published Monday in JAMA Internal Medicine.
The results "confirm the belief that financial incentives, or a patient's ability to pay, may be associated with hospitalization decisions," researchers wrote. They adjusted for factors such as patient age, sex, income and health conditions in an effort to eliminate bias in the results.
The findings indicate that more than three decades after the Emergency Medical Treatment and Active Labor Act took effect, lower-income patients still face unequal treatment in emergency care settings. The law requires hospitals to screen anyone who comes into their emergency department and stabilize anyone with an emergency medical condition, regardless of citizenship status, insurance status or ability to pay.
The law was enacted in 1986 amid concern that hospitals were "patient dumping," or discharging people before they'd been stabilized and denying care to poor patients with medical emergencies. Its requirements have fed into the debate over whether government-provided universal health coverage is necessary, since everyone has access to care in a true medical emergency.
But the new research indicates the decision to transfer lower-income patients to other facilities – reducing the chance a hospital will not be paid for providing care – means hospitals can technically meet the law's requirements without meaningfully helping patients who need inpatient hospital care. Notably, patients severely ill from pneumonia, COPD or asthma "can generally be cared for in hospitals with standard intensive care capabilities," researchers say, so transfers to other facilities may not meet the law's threshold for "appropriate" transfers.
"By restricting this analysis to hospitals capable of providing critical care for patients with pulmonary conditions, we were less prone to incorrectly identifying medically necessary transfers as financially motivated," the study says.
A secondary analysis conducted by researchers showed how the decision to transfer patients to other hospitals from the emergency department unfolds by hospital ownership status. Using a smaller sample of hospitals and patients, researchers found that compared with privately insured patients, uninsured patients were more likely to be transferred from for-profit hospitals and less likely to be transferred from nonprofit hospitals, though researchers said further study is needed to confirm those conclusions.
"Policymakers should broaden the scope of hospital quality, payment, and certification initiatives to reduce these disparities and improve access to hospital-based care," study authors wrote.
Addressing the gap in insurance coverage and ensuring access to non-emergency care would be the surest way to improve the U.S. health care system, Dr. Mitchell Katz, president and CEO of NYC Health + Hospitals, and Dr. Eric Wei, the health system's vice president and chief quality officer, wrote in a commentary accompanying the research.
There is no equivalent mandate in the U.S. to provide medically necessary non-emergency care, they note, which may force patients with chronic conditions like diabetes or hypertension to wait until their conditions become an emergency to seek care and contribute to worse health outcomes.
"Providing universal health insurance would improve the health of uninsured persons, reduce unnecessary emergency care, and strengthen the health care system in the United States," Katz and Wei wrote.
