Hey Mutt, here's your amazing US healthcare system at work!
 

L.A. poised to go after Las Vegas hospital in patient-dumping cases

Years before a Las Vegas psychiatric hospital bused a homeless, schizophrenic man to Sacramento without arranging contacts or a plan for care, a different hospital ditched Gabino Olvera on Skid Row in Los Angeles.
Olvera, homeless and paraplegic, still dressed in his hospital gown and connected to a catheter bag, was found dragging himself along a gutter in 2007.

The case and others like it motivated the city of Los Angeles to adopt one of the toughest "patient-dumping" laws in the nation.

"It's just an abhorrent practice," said Gil Cedillo, a candidate for Los Angeles City Council and former state senator who played a role in shaping his city's law. "You can't just take someone from a facility and dump them downtown."

Multiple agencies, including the Los Angeles city attorney's office, are investigating whether Rawson-Neal Psychiatric Hospital in Las Vegas, Nevada's primary public mental health facility, has been systematically dumping patients across state lines for years.

A Bee investigation found that the hospital had bused roughly 1,500 psychiatric patients to cities across the nation over the past five years, a third of them to California. By policy, those patients were put on buses alone, with one-way tickets out of town, a small supply of medication and several bottles of Ensure nutritional supplement for the journey.

Nevada health officials maintain that the bulk of those patients were shipped to communities where they had family, friends or treatment waiting. Late last month, following The Bee's report, the hospital revised its policy to require psychiatric patients bused out of state to be accompanied by a chaperone.

But questions linger about the safety of the busing practice ? both for patients and the public ? and whether Rawson-Neal was routinely sending patients out of town without arrangements for their care and treatment. That was the case with James Flavy Coy Brown, the 48-year-old homeless man who was bused to Sacramento though he knew no one in the city and had never visited.

In response to The Bee's findings, the city attorneys in Los Angeles and San Francisco have launched probes into Rawson-Neal's busing practices. The U.S. Centers for Medicare and Medicaid Services, following its own investigation, cited the hospital for "systemic" problems that compromise patient safety and has put the facility on notice that it risks losing critical federal funding if the issues are not addressed.

The Joint Commission, an independent agency that certifies hospitals nationwide, is considering whether to pull Rawson-Neal's accreditation.

All of those investigations could result in steep financial penalties for Rawson-Neal and its umbrella agency, Southern Nevada Adult Mental Health Services.

But Los Angeles is the only agency that has announced a criminal investigation.

Los Angeles is able to take a hard line because it has an ordinance that defines patient-dumping explicitly and lays out criminal penalties for violations. Other agencies are making use of state and federal laws that apply more broadly to hospital discharge practices ? often targeting emergency rooms ? or that don't list specific penalties.

"Doesn't this represent to you a crime?" asked Los Angeles City Attorney Carmen Trutanich, soon after the investigation was launched.

Rawson-Neal bused about 150 patients to the Greyhound bus station near Los Angeles' Skid Row in the past five years, far more than were sent to any other city.

To build their case, Trutanich's investigators are searching for former Rawson-Neal patients to learn if the circumstances of their discharges violated the city's ordinance against patient-dumping. That ordinance says patients cannot be transported from hospitals to anywhere but their homes, or the location they give as their home, without written consent.

Investigators have contacted area homeless agencies and will interview Greyhound, the company that transported the patients.

They've also put up fliers across parts of the city asking anyone who has been discharged from Rawson-Neal to call investigators.

If the investigation ends like several others, the hospital could settle with the city, be forced to adopt stringent discharge protocols and pay a fine.

Alternatively, the case could go to court, potentially leading to a misdemeanor criminal conviction for the hospital or some of its employees, Trutanich said.

"This is 150 people allegedly on the streets of L.A.," Trutanich said. "We're already stretched as it is."

L.A. noticed in '07

The issue of patient-dumping caught fire around 2007 as Los Angeles homeless shelters noticed hospitals increasingly leaving patients on Skid Row.
Most of the hospitals accused of dumping patients were traditional medical facilities, not mental hospitals. Advocates for the homeless contended that the patients often still needed medical care ? or something better to sleep on than a cold bench on Skid Row ? when they were dumped.

After Hollywood Presbyterian Hospital, through a contractor, drove Olvera to Skid Row, the city attorney at the time, Rocky Delgadillo, launched a civil investigation that resulted in a $1 million settlement. Over the years, his office also reached large settlements with Kaiser hospitals and Methodist Hospital in nearby Arcadia.

The city worked with Cedillo to draft a bill introduced in the California Senate that sought to criminalize patient-dumping and impose large fines on hospitals that repeatedly engaged in the practice.

The bill was opposed by many hospitals, which argued that the penalties were onerous. The bill passed the Legislature but was vetoed by then-Gov. Arnold Schwarzenegger, who said existing law was strong enough to curb the practice.

Another bill by then-Assemblyman Dave Jones, D-Sacramento, did become law. It requires California hospitals to develop a plan in consultation with homeless services providers for discharging patients between counties.

It banned the transport of homeless patients who require services from one county to another county without written authorization from the agency that would be providing those services. But it did not set explicit penalties for violating the law.

"The purpose was to try to get hospitals to put in place policies for busing homeless people," Jones, now the state's insurance commissioner, said last week, adding that he believes patient-dumping has decreased since the bill passed.

Los Angeles wanted more. So it used Cedillo's bill as a template for a local ordinance.

"We realized there wasn't really a good statewide law that just dealt with the practice as it was being done," said Deputy City Attorney Michael Dundas.

The city law sets a penalty of up to $1,000 for violations. Los Angeles also began stipulating in settlements with hospitals that they adopt strict policies regulating patient discharges.

Other cities' strategies

Other agencies will take a different path toward investigating and possibly prosecuting Rawson-Neal.
San Francisco will pursue financial damages from Rawson-Neal if it confirms that public services were provided to patients improperly discharged to the city, said Matt Dorsey, a spokesman for the city attorney.

San Francisco is pressing, along with the city attorneys in Los Angeles and Sacramento, and county counsels in Alameda and Santa Clara counties, for a meeting with the Nevada Attorney General's Office to review discharge practices at Rawson-Neal.

Dorsey said San Francisco's civil investigation could make use of a federal law called the Emergency Medical Treatment and Active Labor Act, which requires hospitals to evaluate and stabilize patients before transferring them.

The federal Centers for Medicare and Medicaid Services are also investigating possible violations of that act.

Melissa Brown, supervising attorney in the Elder Law and Health Clinic at the University of the Pacific's McGeorge School of Law, said the federal law usually applies only to traditional emergency rooms, which could make building a case difficult.

But Rawson-Neal's practice of treating patients in an observation unit for up to 72 hours before admitting or discharging them could leave it open to prosecution, she added. Such a prosecution would hinge on whether patients left Rawson-Neal too soon.

Patients "have to be properly screened and stabilized," she said.

Nevada State Health Officer Tracey Green said last month that an internal review at Rawson-Neal showed that staff members consistently made informed decisions about when to bus patients.

"The clients are stable. They are ready for discharge," she said. "We see a coordinated discharge plan."

L.A.'s Trutanich said he hopes his investigators find nothing wrong with the hospital's discharges but that he is skeptical given the large numbers of patients sent to his city.

"To me," he said, "this is very base conduct."

http://www.sacbee.com/2013/05/20/543...las-vegas.html

I like living in Vegas in general but the hospitals here are awful. I'd go down to Phoenix for anything important healthcare-wise.

Found at: http://www.reddit.com/r/politics/com...ed_of_dumping/

From the top comment:

I just wanna bring up the subject of my medical bills. I'm easily in 20k plus debt for the E.R, while I was waiting to be transported. They charge like $600 for one ambulance ride that took ten minutes. This is astronomical and this is what is wrong with our healthcare system and our country. /rant

Curious how much an ambulance costs here (which used to be totally free).... $45.

http://www.health.gov.on.ca/en/publi.../ohip/amb.aspx

If the doctor deems you took an ambulance for a non-emergency, it's $240.

We'll even cover the whole cost if it is a medical emergency and you're being transferred to another hospital in Canada.. Or even another country.. Wow.

hopefully after los angeles pushes the adult industry or LA the tax revenue will go up so LA can pay for all this stuff :thumbsup

These are hopeless psychiatric cases, absolutely hopeless, every city has them, go to downtown Vancouver and Toronto, you'll find homeless men, most of them mentally ill, many schizophrenic.

Show me them dumping cancer patients and I'll be interested. Of course in Canada it takes up to 6 months to begin cancer treatments after diagnosis.

it doesnt always take up to 6 months.. i know many people who have gotten their treatments right away after diagnosis

Well, if it was the schizophrenic patients doing it themselves I would understand... But it's people with real jobs with no mental illness who are making these decisions. I don't think it should matter what type of patient it is...

You're right about it taking too long to start treatment, according to this article:

http://www.mississauga.com/news/arti...to-start-chemo

"While the Cancer System Quality Index report released yesterday lauds the system for its improvements in wait times, the numbers show not a single hospital met the provincial target of 85 per cent of patients beginning chemotherapy treatment within 28 days of receiving a consultation."

The source:

http://www.csqi.on.ca/

Also:

http://www.csqi.on.ca/by_patient_jou.../#.UZrlmbU-Zc4

Eighty-two percent (82%) of Stage I/II/III breast cancer patients and 86% of Stage III colon cancer patients started adjuvant chemotherapy within the American Society of Clinical Oncology (ASCO) and the National Comprehensive Cancer Network’s (NCCN) benchmark of 120 days following diagnosis 1 . Only 50% of lung cancer patients (Stage II) started adjuvant chemotherapy within 120 days of diagnosis, with longer wait times from diagnosis to surgery.

Lucky, it's $300 here, but if you're paying $70/mth for bluecross, then it's free...

Trust me.. Las Vegas learned it from Calf..

LOL at FREE

Do you honestly believe there is a healthcare fairy who brings free healthcare to Canadians?

Here's where your 'free' comes from - top marginal income tax rate of 50%, 15% harmonized goods and services tax on practically everything you buy and a hundred and one other taxes - that's where FREE comes from.

The US system is a racket, the insurance companies, hospitals, drug companies and everybody down the line are greedy profiteers.

I believe that the one industry that needs to be heavily regulated is healthcare, there should be wage and price controls - those companies who don't like it can move on to other fields of endeavor. There's nothing wrong with making a profit - how much is the question.

HST is 13%.

50% is wrong top tax bracket is about 40%. We have a tiered system so everyone pays 5% from $0-39k, then if you make over that you pay 9% on the money over $39k, etc etc. You guys surely have something similar. This ensures you can't "lose money by making more money" because you moved into a bigger bracket.

Federal

15% on the first $43,561 of taxable income, +
22% on the next $43,562 of taxable income (on the portion of taxable income over $43,561 up to $87,123), +
26% on the next $47,931 of taxable income (on the portion of taxable income over $87,123 up to $135,054), +
29% of taxable income over $135,054.

Ontario

5.05% on the first $39,723 of taxable income, +
9.15% on the next $39,725, +
11.16% on the next $429,552, +
13.16 % on the amount over $509,000 **** New in 2012, see http://www.fin.gov.on.ca/en/media/2012/tax-bk.html

Also note everyone gets their first $9,500 in income tax free, and if you claim a spouse or dependent that can almost double.

The average person in Canada is not paying a ton of income tax. Most people get large returns every year.

I've read that this is true. One of the main reasons I have reservations about moving there.

So if you make $40k a year which is a reasonably decent salary, more than a lot of people make, you're getting taxed at 20%, and getting 5% back on the first-$10k tax free. And for that you get free healthcare.. Is that such a terrible system?

It's more the general attitude of nurses and doctors. I really got the impression they were severely understaffed and overworked across the board.

Weirdly enough though, every time I've gone to an emergency room here for myself or someone else the wait time was surprisingly low. They get the work done but you're pretty much one of many on the assembly line.

I already stated in the other thread that Canada is a better place to be if you are poor OR lower middle class and 40-50K a year is lower middle class.

Americans who make 40K or less I believe pay NO income tax.

And you're wrong about the top marginal income tax rate in Canada - it is 50%. You must be mixing up average tax rate and marginal tax rate.

Financially the US is better place to be IF you are moderately successful - and IF you are moderately successful that means you can afford decent medical insurance and you will get better/faster treatment in the US.

The differences in the two countries is closing - the US is becoming Canada 2. Healthcare reform will inevitably end up with a single payer system like Canada's, eventually there will be a national sales tax like the GST and VAT taxes in Europe.

So you agree we're ahead of you, and you're playing ketchup? :winkwink: just fuckin with ya.

The marginal rate as I understand it is basically "how much you'd pay in taxes on an extra dollar earned" (over what you made), so that's not really an effective way to look at things in a tiered tax system, as you're discounting all the benefits of a tiered system.

For example in Ontario that means income in excess of $509,000/year (not including capital gains). To be part of the 1% in Canada you need to make over $201,000 a year. So we're looking at a tiny sliver of the most well paid people who would ever pay this, and even then they're only paying this on the money they make above and beyond $509,000...

People who make $40k in the US pay NO income tax?! That's nuts!!! No wonder the rich are so mad lol. :P

"The favourable treatment of tax-preferred investment income plays a significant role in lowering a taxpayer’s average tax rate. The average tax rate for the 19,073,000 taxpayers who filed a return in 2009 and who reported less than $50,000 of income was 6.66%. For the fortunate 183,000 who reported income of $250,000 or more, the average rate jumps to 24.82%, which is still a far cry from the top marginal tax rate of 50% often associated with high-income earners."

Here's a good comparison: (edit: maybe not so good, since it says the US data is Federal only, while the Canadian data is Federal+Provincial)

Canada:

This progressivity can help us understand why the top 1% of income earners paid a staggering 21.2% of the total federal and provincial taxes in 2010. The top 10% paid 54.8% of all taxes while the bottom 50% of Canadian income earners contributed 4% towards the collective personal tax bill.

USA:

This maxim indeed appears to hold true, according to IRS data released earlier this month. To join the top 1% club in the U.S., your 2010 income would have to have exceeded US$369,691 – nearly 85% higher than Canada’s 1% elite income threshold. This group paid 37.4% of total 2010 U.S. personal federal income taxes.

U.S. tax filers with income above US$116,623 represented the top 10% of taxpayers and paid 70.6% of total 2010 taxes. By contrast, the bottom 50% of income earners paid only 2.4% of the total federal income taxes collected in the U.S.

we have americans that come to our 3rd world shit hole to get everything done from complicated tooth work to various surgeries and treatments...its much cheaper down here and they actually get better service (not because our 3rd world shit hole service is any good, but because the one in the USA sucks so much)...

but most americans are overly patriotic and do not mind the ass fucking from their own country too much...

Just a couple of things.

The US Census Bureau says that the average household in America is comprised of 2 adults and 2 kids and they have an average income of $51K per year. This means that $50K is not the lower end of the middle class, it is the heart of the middle class. This is part of the reason the middle class is going bankrupt. The US Census Bureau also says $20,600 to $102,000 is considered the range for middle class.

As for those making $40K paying no taxes. That all depends. A person with two kids and a house that they can write off will likely only pay the 7% social security tax and not much else. A single guy who rents an apartment and has no write offs will end up paying somewhere between 10-12% to federal (this includes social security tax) and then more for state tax unless they live in a state that has no income tax.

So they don't pay a ton, but between federal and state you could easily end up paying 14-18% of your income in taxes if you make $40K.

That sounds an awful lot like... Canada... :P