The New York Times - December 14, 1985
Wayne King

The regulations are intended to stop the shipping of patients without insurance - including women in labor and people in the midst of emergency treatment - to public hospitals.

The problem is nationwide and has attracted the attention of Congress, where legislation is now pending in the House. No other state is known to have adopted regulations like those of Texas.

House budget legislation for 1986 calls for civil penalties for doctors and hospitals that transfer patients without adequate medical evaluation.

The House provision would require that patients be evaluated and given "necessary stabilizing treatment" before they could be transferred for economic reasons.

The rules adopted today by the Texas health authorities are far more stringent, and prohibit the transfer of patients for economic reasons altogether.

Possible AIDS Quarantine

In other action, the board voted tentatively to allow physicians to impose some form of quarantine on victims of AIDS, or acquired immune deficiency syndrome, who may pose a threat to the health of others. Details of how such a quarantine would work were not spelled out, but officials said it was not their intention to isolate all AIDS victims.

The Texas rules on transferring patients were approved largely at the instigation of Dr. Ron Anderson, chairman of the State Board of Health. Dr. Anderson is also the chief executive officer of Parkland Memorial Hospital in Dallas, a county-operated facility that has been a prime recipient of patients "dumped" by private hospitals for economic reasons.

In one instance earlier this year, a middle-aged man, suffering from third-degree burns from a grease fire, stumbled into the hospital trailing a catheter and an intravenous tube.

"The guy staggers in with all these lines hanging out of him, and a nurse asked if she could help him," recalled Gregory Graze, a hospital spokesman. "He managed to say, 'I sure hope so, this is the fourth hospital I've been to.' "

According to Mr. Graze, the man had been burned in a neighboring county and had driven himself to three private hospitals after being turned away with an emergency patch-up.

'Getting Outrageous Cases'

Mr. Graze told of other cases: A woman in the midst of labor was sent over from another private hospital after it found that her husband had lost his medical insurance. A stabbing victim arrived in a private car, also with an intravenous line in place.

"We were getting outrageous cases, a heart patient in critical condition, all kinds of things," Mr. Graze said. "It's a continuing thing."

The problem has received particular attention in Texas because of what Mr. Graze said was the relatively high concentration of private hospitals, about one-third of the total, and because of the economic downturn here that has resulted in the loss of thousands of jobs in the last few years, with the attendant loss of medical insurance.

The state is also very conservative with Medicaid, the health care program for the poor, ranking 48th among the states in the level of payments under the system.

The rules adopted today specify that patients can be transferred only for medical reasons, and they also set standards for transfers in general.

Requirement for Emergency Care

The rules establish that emergency care must be provided to all patients regardless of ability to pay, that all medically necessary transfers be done expeditiously, that the receiving hospital approve the transfer and that transportation be safe and appropriate.

The rules also prohibit discrimination against patients based on race, religion, national origin, age, sex, physical condition or economic status, and require that all pertinent medical information be transferred with the patient, and that patients be fully informed about free or reduced-cost care at both the transferring and receiving hospitals.

The provision insuring the transfer of medical information was necessary because some hospitals would simply send a patient to another hospital emergency room with no explanation of what the medical problem was, health officials said.

Rules Set Penalties

Full disclosure of free or reduced care provisions was necessary, according to health officials, because in an effort by hospitals to persuade some patients to agree to transfers, the patients were told falsely that another hospital would give them free care.

The new standards provide for administrative and judicial penalties, including revocation of a hospital's license.

The rules adopted today were mandated by a sweeping indigent health care package passed by the Legislature last May.

Although the new rules were endorsed by the Texas Medical Association, their adoption was delayed until today because of resistance from hospital administrators who said they feared earlier versions of the rules might increase the number of malpractice suits.

The board's preliminary action on AIDS victims resulted from concern over a recent case in Houston where health officials were unable to restrain a male prostitute known to have AIDS from continuing in his trade.

The board provided no details on how such a quarantine would be imposed, but Dr. Robert Bernstein, the health commissioner for Texas, said it should not be confused with a conventional health quarantine in which public notices warn of the presence of a virulent disease.

The board's tentative action would add AIDS to the list of virulently communicable diseases that might, in the assessment of medical authorities, justify some form of quarantine.

851214
NYT851223