Dumping the Poor

The dumping of uninsured patients into county hospitals by private and community hospitals continues at a rate that justifies tighter controls. Two bills that offer needed help--AB 3403, sponsored by Assemblyman Burt Margolin (D-Los Angeles), and S 1607, sponsored by Sen. Ken Maddy (R-Fresno)--are moving through committees in Sacramento and should be approved.

Two elements are important. One is to put teeth into existing regulations against dumping by implementing penalties for hospitals and doctors violating the rules. The other is to define clearly when a patient’s condition has been stabilized so that transfer to another facility can safely be made.

The California Medical Assn. opposes Margolin’s bill, even though it meets all important criteria, on the ground that it makes no explicit call on counties to compensate private providers of care to uninsured patients. The association argues that this will encourage four Bay Area counties that have no no such provision to continue to deny help to non-county facilities taking care, for example, of medically indigent patients in emergency facilities. That issue, it seems to us, cannot be resolved under the current budget constraints. The CMA prefers Maddy’s bill, which makes no specific provision for penalties for doctors guilty of illegal transfers of patients--a fatal flaw. The California Hospital Assn., on the other hand, supports the sanctions of the Margolin legislation.

Clearly there is agreement on the critical elements of useful legislation. This opportunity should not be lost. There is no persuasive reason why the California Legislature cannot iron out the remaining disagreements. New anti-dumping legislation would not resolve the enormous injustices that exist in the state’s health-financing system. But it would reduce the abuses of agreed federal and state rules--abuses that have proved life-threatening in numerous cases.