7 min reading time

University of Maryland Medical Center security guards forcibly removed a mentally-ill patient.

https://medgroup.biz/dumping

She was dressed only in a thin hospital gown. It was 30 degrees. And it was night.

And I thought, this is indefensible. What possibly justifies discharging a barely-dressed patient into a wintry Baltimore night? They couldn’t even dress her first?

Then I did some homework.

While this incident was captured and went viral, “patient dumping” is nothing new. In the 1870’s, New York private hospitals sent poor patients to the city’s public hospital. Today it includes releasing someone, usually homeless or mentally ill, to the streets rather than a shelter or related service.

Then I found a doctor share his “hypothesis,” in quotes because he and admits having spoken to “the front lines.” His story – and plea – gave me valuable perspective I lacked.

https://medgroup.biz/Baltimore
Watch both videos. Then come back and share what we can do to prevent future cases like this one.

To my outside-the-US friends, does patient dumping happen where you live?

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Joe Hage
🔥 Find me at MedicalDevicesGroup.net 🔥
I hear you, Cormac. Will you agree the physician’s gave some perspective the first video lacked? He proffered, what if:
• This was an inner-city hospital in an incredibly impoverished area of Baltimore with high crime, drug, homeless, and mental-illness rates.
• ER departments recognize frequent patients constantly in and out for reasons other than a physical medical emergency.
• The patient has a history of belligerence and violence towards health care staff and non-adherence to admission or discharge plans.
• The patient refused transport to a cold shelter or other follow-up.
• The patient did not meet criteria to an inpatient.
• The patient’s family did not want her, she was unable to follow commands.

He still felt the outcome was wrong but placed the blame on society and government versus scapegoating this particular ER team.

Jessica Ching
Chief Marketing Officer, Disruptive Health Innovator & Speaker
Very interesting solution that is effective: 91% reduction in chronic homelessness (the most costly and difficult type). The common thread between the guy who frame the problem so accurately seems to be compassion for humanity…
https://www.ted.com/talks/lloyd_pendleton_the_housing_first_approach_to_homelessness

Erik Vollebregt
Partner at Axon Lawyers
Patient dumping does not happen in the Netherlands because it’s quite illegal and hospitals do not have a commercial interest to do so. There is a special government budget that pays for treatment of persons that manage not to be insured regardless of the obligation to be insured and the basic insurance covering all necessary hospital treatment.

Jessica Ching
Chief Marketing Officer, Disruptive Health Innovator & Speaker
Hey Joe, I didn’t want to get into politics but was up last night thinking about this. I wonder how many Trump voters/supporters are still outraged after watching video #2? Although 21 minutes of attention and using your brain to get beyond tabloid information is a lot to ask of some people. Enough bashing and venting. I’m going to the Women’s March this weekend. Have a great rest of week! 🙂 🙂

Jessica Ching
Chief Marketing Officer, Disruptive Health Innovator & Speaker
oh another comment after thinking about this all night. What is the root cause of homelessness? Lack of homes or homelessness itself? NO! I suspect it’s the cumulative and crushing effect of INEQUITY. It starts with impeded/reduced/nonexistent access to “childhood luxuries:” a stable family that comes from mom and/or dad having a stable job, which means the child has a palace (any stable place) to live; gets to eat lavish meals (any meal, especially with fresh food); receives a priority for their prep school education (any education, in any decent school); has role model adults and other kids who also have these extravagant living conditions! How’s that for satire? And those who manage to get some education get a job, or even get a job without education, do they have the same opportunities for advancement? Because advancement, especially as you move up, depends on your ability to gain trust & network with people at a personal level. Video #2 guy is right: WE are the problem.

Amichay H. Gross
Founder, CEO and Board Member
This will never happen in Israel.
I don’t know if it’s illegal, or not, but no Israeli physician would allow that to happen. They treat wounded people from other countries, so kicking our someone is an impossibility here.

Robert Christensen
Medical Consultant
I’m afraid so much of the homelessness that we see or hear about is caused likely first by our broken marriages followed by our broken families.
There is a dissolution of each part of the family, thus causing the homelessness we are experiencing today. We need God’s love.

Jessica Ching
Chief Marketing Officer, Disruptive Health Innovator & Speaker
To respond, I think this is an issue of HOMELESSNESS and its effects (which include the downstream activity at the hospital/ER). The overflowing Emergency Room is a symptom of the ROOT CAUSE issue of homelessness. Fixing the ER/symptom is unrealistic given our broken healthcare system as well as the fact that a hospital isn’t the best place to handle homelessness. If we kept all the homeless+mentally unstable people there, it would be, by far, the most expensive housing we could provide. That does not make sense. What they guy in video #2 is saying is that we need compassionate solutions for the root cause. I agree, which is what brought the Utah TED talk to mind.

Kurt Jeffry Wilson
Global Regulatory, Quality, and Clinical Executive
From UMMC Website: “Our Vision: UMMC will be known for providing high value and compassionate care, improving health in Maryland and beyond, educating future health care leaders and discovering innovative ways to advance medicine worldwide.”

Seems they’ve confused being hypocrites with the Hippocratic Oath.

There is no way that turning someone out into the cold night in just a hospital gown is “compassionate care”. I’d like to hear one executive/administrator/doctor at UMMC state on the record that such an action contributes to “improving health”.

Duty of care cannot be relieved just because a patient is discharged; the physicians (and by extension all those working with/for them, such as security personnel) have an obligation, legally enforceable through most medical boards, to not put patients at more risk.

Neelima Firth
Biotech Executive ǀ VP ǀ Director ǀ Commercialization ǀ Reimbursement
This is a complicated US based problem. I volunteer with a local homeless charity in Los Angeles. Many of the homeless have mental illness and lack access to treatment. The increase in homelessness can be linked to decisions made in the 80s to stop funding of federal community mental health centers which has resulted in more mentally ill people being in the community rather than being institutionalized. Ultimately, we know our system is working badly when we get this outcome even if each player in the system has seemingly good intentions.

Dan Dorulla
Henkel’s & McCoy, Inc. We build, engineer, and connect the world’s strongest utility infrastructure networks.
Sad.

Cormac O’Prey
Principal and Director in the Kestrel Consultancy Group
I can’t believe this question is even being asked.
“What if, what if, what if…?” The bottom line is that someone who is clearly unfit to be discharged has been, supposedly to fend for themselves and may well pose a risk to the public. The medical care team who were looking after her basically wiped their hands of her and turned their back on her. I don’t know what their understanding “care” is but I suspect they may need to check the definition in a dictionary. Patients with mental illnesses – temporary or inherited – could display all of the “what if” behaviours described. Yes they’re difficult to treat – that’s why professionals are highly trained, rigorously selected and dedicated. The mentally ill are NOT abandoned in any civilised society. Even the Victorian asylums – barbaric by today’s standards – understood the need for mentally ill people to be taken care of. What on Earth is the thinking behind this decision?

Abdelkader Abdallah El Hirtsi
Diplôme d’ingénieur d’état chez Ecole Nationale Polytechnique (ENP) – Algeria
In Algeria it doesn’t happen and it’s not legal because government supports uninsured patients.Everyone does the best he can.
In many countries of the world it’s going like this, unfortunately.
Lack of care, drugs and doctors to alleviate the suffering of others precipitate many patients to death .

Ying C.
Adjunct Professor － Stanford University
Though I can’t say this won’t happen in Taiwan, but it’s much less likely — because everyone – yes, EVERYONE- rich and poor- homeless and sick all included – has the same universal governmental medical coverage. US healthcare system is simply dysfunctional, and as a result, you see the ugly side of human nature. As a “partial” outsider, it’s really difficult to understand why half of Americans resist universal medical insurance plan. Well, this is what you got- inhuman treatment .

Doug Pergamella
Sales Manager/Business Adviser to California Manufacturing Packaging, Robotic Automation, Aerospace
Hi Jessica, mental illness effects both Trump supporters and non supporters. You can’t politicize a broken system where both parties have had an opportunity to build up care for the homeless or the mentally ill. My heart breaks for both, and I know first hand how the system can work and not work. Behavioral health system is so frustrating and needs national attention.

Gary Chuven
Director of Regulatory Affairs at Cosmedent, Inc.
All Israelis have Kupat Cholim (hope I spelled it properly). Four HMOs. Getting to see a specialist or scheduling needed surgery can be daunting. I know; I have children who are Olim Chadashim.

James Williamson
Optical Engineer at Technical Optics
I hope the lady sues them and gets a huge payout.

Patrick Logan
Health Care/ C-Level Executive/ Consulting/Product & Service Line Development/Licensed & Certified Prosthetist/Orthotist
The solution to this problem is compassion towards our fellow humans. Unfortunately it seems self-interest has become the driving force in society these days. Unless we learn to see beyond our own needs and desires I have little hope problems like this will be solved.