Public Health Law Map - Beta 5 - Medical and Public Health Law Site

to refer a patient to such an institution must make sure that the patient is eligible for
care and that the institution is willing to accept him or her. The best way to do this
is to call someone in charge of admissions at the institution and follow up the
conversation with a letter. If the patient is not eligible for that institution, care can
be sought elsewhere quickly and without the inconvenience of being turned away.
Eligibility may be based on the patient’s financial status or residence. Public charity
hospitals normally serve residents of a specific area who have incomes below a
certain level. These hospitals do not provide free care to everyone. A patient who
has no medical insurance may be considered indigent by a private hospital but not
be eligible for free services at the county hospital. Before referring a patient to a
charity hospital, the physician should check to make sure that the patient will be
accepted, as he or she would with any other institutional referral. The referring
physician also must be aware of federal antidumping regulations that carry a fine of
up to $50,000 against the physician personally for improper transfers to charity
hospitals. The fine is beyond any malpractice claim that might be paid by insurance.
d) The Duty To Find Care
The regionalization of care poses problems for even the best-insured patients. A
regional facility, with its complement of subspecialist practitioners, has a
substantial stake in keeping specialty beds full. This situation can lead to
overinclusive policies on the necessity for specialty care. Neonatologists in some
centers, for example, establish standards of care that require pediatricians to refer
as many infants as possible to the neonatologists for care. A failure to make these
referrals could be malpractice by a pediatrician. The pediatrician, however, does
not have the power to force acceptance of a particular patient. If the regional care
system is full, the problem of finding a place for a severely premature infant falls to
the pediatrician because there is no duty for the neonatologists to transfer less-ill
infants to make room for more- ill patients.
A physician with a patient who needs special care must pursue all options until a
place is found for that patient. In some celebrated cases involving indigent,
premature infants, this has required searching in several states and calling on the
military for emergency transport. The physician’s best allies in such situations are a
newspaper reporter and a public interest attorney. The threat of adverse publicity
and litigation can work wonders in finding care for an individual patient.
If rejections happen too frequently, community physicians should work with the
regional centers to correct the problem. Specific guidelines should be established
that specify which patients have priority for the space available and which patients
will be moved or discharged first when a higher- priority patient comes in. It is hard
to defend keeping a terminal cancer patient in the only intensive care bed available
if it means that a patient with a heart attack may die for lack of care. Physicians
who practice in communities that do not provide adequate indigent or specialty
medical care services must warn their patients that they may be denied necessary
care. Physicians in these areas also should assist patients in using the federal and
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