The General Accounting Office is studying patient transfers between Washington hospitals to see if patients are being dumped on D.C. General, the city's public hospital.
The study, sought by House District Committee Chairman Rep. Ronald Dellums (D-Calif.), is to be finished next September, according to committee staff member Ron Willis.
"We want to see what is the appropriate rate of transfer," said Willis. "We need to know what's happening in local hospitals."
Figures compiled by D.C. General show that patient transfers to the public hospital have risen 374 percent in recent years as private hospitals in Washington increasingly refuse to admit poor people.
In 1984, for example, 904 patients were transferred to D.C. General from other hospitals for financial reasons. In 1981, there were 169 such transfers.
A lawsuit also was filed last year by the mother of a knifing victim who went to Providence Hospital twice during a three-day period before dying in emergency surgery after a transfer to Washington Hospital Center. Providence Hospital has denied that the man's lack of health insurance was a factor in not admitting him.
Because fewer paying patients are being hospitalized and their stays are shorter -- partly because of restrictions by government medical programs -- most Washington private hospitals say they can no longer subsidize unlimited charity care and no longer accept all patients who enter their doors. Only D.C. General, which is financed by tax dollars, is obligated to accept all patients.
But because of past problems with D.C. General having "the dead and dying dropped on our doorstep," according to hospital spokeswoman Penelope Anderson, the hospital established policies last fall to improve patient transfers. The director of its emergency room has to approve all transfers and medical records must accompany the patients. Patients must be stable and need emergency care; they cannot already be patients of another hospital, she said.
"There have been very minimal violations of the policy, less than 4 to 5 percent of the cases," said hospital administrator Robert B. Johnson.
Johnson said the GAO study will cover the reasons for transfers, if some are inappropriate and if there are unofficial transfers that don't get recorded. Studies by public health officials in other cities have found some poor patients have died during hospital transfers. Patients transferred to D.C. General are sent by ambulance.
The D.C. Hospital Association, an organization of the city's 17 hospitals, is cooperating with the study, according to spokeswoman Joan Lewis, and is compiling its own report on how to arrange medical care for the poor. That report is due next month, Lewis said.
Association members have suggested solutions ranging from a pooled fund, based on hospital revenues, to finance care for the poor, to regulations that require all hospitals to share the charity burden equally. Currently, hospitals closest to poor neighborhoods, such as D.C. General, Greater Southeast Community Hospital and Washington Hospital Center, receive the greatest number of poor patients.
"We all know there is a problem with the number of District residents without insurance," Johnson said.
"We hope that the city's Medicaid budget might be expanded to include some people not currently eligible. We're also looking for the city to set up some low-cost health insurance that small-businessmen can offer to their employes, so many of whom aren't covered."