Agency Says UCI Broke Patient-Dumping Law

Federal regulators notified UCI Medical Center on Tuesday that it violated a patient-dumping law when it failed to obtain proper physician authorization for transferring a psychiatric patient from its emergency room to another hospital last year.

The U.S. Health Care Financing Administration has given UCI 90 days to prepare a plan of correction in response to the finding, which came during an inspection of more than 20 patient charts last March, said Kenneth W. Simpson, a federal surveyor in San Francisco.

If the plan does not meet the requirements--an extremely rare occurrence--UCI would face loss of federal funding for Medicare and Medi-Cal, he said.

“What we’re looking for is that the corrective plan will keep this from happening again,” Simpson said.

UCI Medical Center Executive Director Mark Laret said the violation was “a paperwork issue” that had nothing to do with patient care. Laret said the threat of a federal funding cutoff is standard for this type of violation--but he vowed “it’s not going to happen” because UCI already has taken corrective action.

UCI officials said the case was among 26 emergency room charts reviewed by state inspectors on behalf of federal regulators March 25 and 26.

It involved a 38-year-old Medi-Cal patient on a health maintenance organization plan who, inspection of records show, was suffering from hallucinations and paranoia. The patient was voluntarily transferred to another hospital, with approval from the HMO, and was properly screened and deemed stable by a UCI physician, university officials said. However, a summary transfer sheet, indicating a doctor had cleared the move and the patient had consented, was missing, records show.

“There are many provisions of the dumping law and this is a technical violation of one of the . . . subparagraphs of that, but this is not, by any stretch of the imagination, what people refer to as a patient dump,” Laret said.

A former UCI contractor raised concerns internally about the transfer of patients last year. Connie Potter said that she and a colleague were worried about whether patients were being properly stabilized and treated before transfer, and sought legal advice on the subject. But Potter said she was placed on leave last July, and her contract was not renewed in October--in part, she believes, because she voiced these concerns.

Under federal laws only recently given regulatory teeth, hospitals that receive federal dollars must provide appropriate medical screening to patients seeking care in the emergency room. If a patient is to be transferred, a physician must sign a certification indicating that the benefits of the transfer outweigh the risks. The laws are designed, in part, to keep hospitals from transferring poor patients for financial reasons.

Laret said it was “tremendously ironic” that UCI should be accused of dumping patients when the hospital, over the years, “has been the primary recipient of dumps.”

Simpson said inspectors looked for, but did not find, a pattern of patient dumping violations at UCI. But, under the strict anti-dumping law, “one case is good enough” to warrant threat of termination of federal funding, he said.

In the past year, the agency has given 40 to 50 violations of this kind in a region including more than 1,000 hospitals, Simpson said. In the last six years, no hospital in the region has been cut off from federal funding.

Though Simpson declined to discuss the specifics of the patient transfer, he said he does not believe that it was “a money issue per se.”

The inspection came as a result of a complaint from an unidentified source, who was aided by the office of U.S. Rep. Christopher Cox, a Cox spokesman said Tuesday.

The March audit found two other minor violations for insufficient documentation of training for triage nurses and improper storage of oxygen.