“Patient dumping”, when hospital patients are improperly discharged, sometimes to dangerous areas, or even out of state, and sometimes without proper instructions for care, is a serious risk to patient safety and health and can result in serious costs for the hospitals and people involved. In a recent case, a California hospital made a settlement for $250,000 in civil penalties and legal fees for leaving a patient at skid row without making any arrangements for her.
This case – and others like it – lead to obvious concerns for the health and safety of these patients. That’s led city attorneys and homeless advocates to crack down. Operators of homeless shelters and rescue missions in the area have installed “dump cams”, which allow them to identify cases where patients are being “dumped”. In Los Angeles, the police department has stated they will arrest anyone who leaves patients outside a shelter. And Mike Feuer, a city attorney, says, “Patient dumping is intolerable to me. I do have it in my mind to send a message to other hospitals that this won’t be tolerated.”
Although patient dumping appears to have lessened in recent years, it’s still a real problem. In other newsworthy cases, another Los Angeles hospital settled a group of charges in 2011 when it discharged a disoriented patient – still in her hospital gown – by taxi and she was left in the street. Yet another area hospital was sued for negligence in 2012 when it left a patient being treated for schizophrenia outside a rehabilitation center without notifying the patient’s family. In 2013, the city of San Francisco filed suit against the state of Nevada, saying that a psychiatric hospital had issued bus tickets to California cities for mentally ill patients without making arrangements for them.
Even though the risks to patients are apparent (and financial costs to hospitals are possible), these problems continue to occur. In cases where organizations don’t seem successful at ensuring the safety of its patients (or employees), the government will step in. In this case, Los Angeles in particular has implemented a “patient safety zone” which encompasses most of the city’s downtown, where it is illegal to leave patients unless they are in the care of a family member. Additionally, hospitals must obtain written consent from patients to take them to a place other than their home.
This of course can be tricky when dealing with homeless, mentally ill, or patients without relatives living nearby. Although patient resources when dealing with these cases are limited – making proper discharge difficult in some cases – leaving a patient alone in an unfamiliar, dangerous area is never the right answer.
The impacted goals resulting from patient dumping, some potential causes, and the solutions that have been implemented by the city of Los Angeles are shown in a Cause Map, or visual root cause analysis. To view the Outline and Cause Map, please click “Download PDF” above. Or click here to read more.