At least four California health systems declined or delayed the receipt of transferred COVID-19 patients due in part to their health insurance or lack thereof, according to a Wall Street Journal report based on internal emails from California's Emergency Medical Services Authority.
The WSJ obtained the documents and emails through a public-records request. The communications between local and state government, hospital and emergency-response officials identify four hospital systems as refusing or delaying receiving transfer patients in May, but the WSJ notes that "denying hospitals weren't named or quantified, so the total could be higher." The four systems that were identified are: Cedars-Sinai in Los Angeles; Sharp HealthCare in San Diego; Prime Healthcare in Ontario, Calif.; and Loma Linda (Calif.) University Health.
The May 26 transfers in question came from two hospitals in Imperial County that were crowded overrun with COVID-19 patients. Although the WSJ reports that emails show state officials called and emailed hospitals telling them that the state would cover treatment costs of uninsured patients, hospitals either refused or held up transfers based on patients being uninsured, on Medicaid or for other reasons related to reimbursement.
In one case, Loma Linda University Health sought assurance from transfer coordinators that it would be paid rates at 130 percent of Medicare prices for two uninsured patients, according to the WSJ's obtained emails. The system said in a statement that it followed standard industry practice and stopped demanding the payments after it learned how overrun the hospitals in Imperial County were.
In another case, a 56-year-old patient who tested positive for COVID-19 needed to be transferred from El Centro (Calif.) Regional Medical Center for supplemental oxygen due to the hospital's patient volumes. Emails show Huntington Beach Hospital refused to accept the patient until her insurer preapproved payments, the WSJ reports. The patient was instead taken to a temporary alternative-care site at a local community college.
Prime Healthcare, which owns Huntington Beach Hospital, told WSJ the patients for which El Centro sought transfers had been stabilized at El Centro and therefore no longer fell under the federal Emergency Medical Treatment and Labor Act.
The WSJ reports that El Centro physicians and administrators said interactions like this left patients waiting up to four days for transfers and forced some to fly hundreds of miles for a hospital bed, leaving some patients with lung damage and health complications as a result.
Each system identified in the report as delaying or refusing COVID-19 patients from Imperial County shared statements with the WSJ in response to its reporting on the internal emails. They are listed below, in addition to Loma Linda and Prime's responses, which were previously mentioned in this brief:
- A spokesperson for Cedars-Sinai said the system complied with the law and standard practices when it declined transfers, noting that patients in need of transfer on May 26 didn't require specialized care available at its hospital and the system sought to reserve beds for an anticipated local surge.
- A spokesperson for Sharp said the system does not limit transfers based on insurance, and did not do so on May 26, noting a transfer request that day from El Centro was later canceled and the patient was transferred elsewhere.