How can an injured homeless person expect to be treated at a hospital?

February 1, 2009 8:13 AM

How can a homeless person who has been injured (stabbed, for instance) expect to be treated at a U.S. city hospital with no money or health insurance? Surely they wouldn't let him bleed to death? And if they do turn him away, what are his options?
posted by Sully to health & fitness (21 comments total)

Emergency Medical Treatment and Active Labor Act
posted by JonB at 8:18 AM on February 1

I'm not sure how billing would work, but in terms of treatment, U.S. E.R.'s are required to treat anyone who comes in the door, regardless of ability to pay.

I'm sure JonB's link has more info on that, but I know that it's true that they can't refuse someone at the door for being homeless. This is actually a big problem in cities where because of this policy, a lot of people living in poverty tend to use the E.R. as a doctor's office/clinic because they can't afford regular follow-up care.
posted by grapefruitmoon at 8:46 AM on February 1

Answers.Yahoo is not exactly brimming with MetaFilter quality, but you might want to have a look at this thread.
posted by crapmatic at 8:50 AM on February 1

If he is picked by an ambulance, he would be taken to the nearest hospital for emergency treatment, and then, depending upon his condition, would be either sent to the nearest public hospital or released. If he were to get himself to an emergency room, he would most likely be taken in immediately if he was seriously hurt (the hitch being that one's own idea of seriously hurt and the hospital's idea of the same are often different).
posted by The Light Fantastic at 9:06 AM on February 1

I volunteered at the Peoria Public Library for awhile in high school[*]. There was one homeless guy who every week would walk up to the circulation desk and ask them to call 911. A couple minutes latter an ambulance would arrive and take him to the hospital.

I asked the staff what was going on, and they said he just got lonely and wanted the attention. So even though everyone knew the drill, they'd still come and take a look at him.

[*] not a saint; they made us volunteer a 100 hours before we could graduate.
posted by sbutler at 9:18 AM on February 1

As already said, public hospitals must treat anyone that comes in the door regardless of their ability to pay. I work for one and there are signs posted all over stating such. I believe the government provides some reimbursement for this but I'm not sure.
posted by absquatulate at 9:22 AM on February 1

See also this recent question, especially this comment:

"What a lot of people don't understand is that it IS a horror show to be uninsured in America if you have a little money, or a bit more than a little, but that if you're impoverished you get as good as the next guy and often free and at least next to free, as others have mentioned, $25 bucks a month until the end of time..."

The Asker wasn't homeless, but sounds like there are options for those that can't pay.
posted by ArgentCorvid at 9:25 AM on February 1

he just got lonely and wanted the attention

Munchausen Syndrome?

I had a roommate in college who I was absolutely certain suffered from this. I could never figure out how she managed to pay for all her medical care, but eventually she let slip that she was on public aid. great.

I can't remember the percentage off the top of my head, but i think a pretty good chunk of hospital bills never get paid. because the uninsured (homeless, illegal aliens, whatnot) go to the ED. where else can they go? and those who have money but just happened to be uninsured for whatever reason get slammed with huge bills that they just can't pay at all.

medicine is expensive for those who can pay, and this is part of why. it sucks.
posted by lblair at 9:56 AM on February 1

Most US emergency rooms are required to treat--to the point of stabalization--any emergency.

If you have no insurance, it is highly unlikely that a hospital (other than a charity hospital) will agree to treat you after your initial complaint has been stabalized.

You can be eligible for many different assistance programs such as veteran's benefits, Medicaid, etc. regardless of where your permanent residence is (i.e., your house or a cardboard box on the corner). These benefits are based on service in the military or income level.

So, the homeless person in the OP's original situation would be stabalized and then most likely discharged after stabalization, unless the hospital could either establish the homeless person for benefits under a public assistance/VA plan or transfer to a charity hospital.
posted by FergieBelle at 10:23 AM on February 1

Every US hospital will treat an injured person, regardless of any other criteria than that they need immediate medical help.

Once stable, hospitals may decide to transfer patients to publicly funded hospitals.

Most all states have medical funding for people with chronic conditions that cannot afford to pay. Here in California, it's known as Medi-Cal.
posted by Argyle at 10:46 AM on February 1

I know snowboarder who works on the mountains in Tahoe that was stabbed in the gut during a bar fight. He wasn't homeless, just one of the millions of American working poor. He spent a few days in the hospital then applied for and was retroactively accepted into Medi-Cal, California's indigent medical insurance program. He didn't pay a dime.

There are millions of Americans working full time that can't afford health insurance.
posted by spork at 11:28 AM on February 1

Bum friend couldn't get finger infection treated, chopped his finger off with tree clippers to get to emergency room. Go ahead, kid yourself.
posted by zengargoyle at 11:38 AM on February 1

As others have pointed out, she would be taken to the nearest ER by an ambulance/etc., good samaritan, or, if located near a homeless mission, a worker there. After they're in the hospital, the approach differs depending on the specific hospital. Some non-profit hospitals are mandated to treat a certain segment of the population in an area gratis to maintain their non-profit status (and to receive all of those grants), other hospitals attempt to qualify the individuals for some sort of benefit after the fact (despite the appallingly low compensation) to meet cost, and still others, such as the VA, have a single-payer.

To clarify on FergieBelle's point: if after being stabilized, the pt is still presenting with symptoms that require hospitalization, certain classes of hospitals such as NP and county will maintain them as inpatients, and other hospitals may discriminate a bit more about the necessity of further treatment in the hospital vs. sending them to a community outpatient setting.
posted by palionex at 12:07 PM on February 1

Munchausen Syndrome?

Don't know. Since I worked at the reference desk I never had direct contact with the guy. From what I could see, however, he looked fine. Would just sit on a bench by the door and quietly wait for the ambulance.

My point was that the EMTs had seen enough of this guy and I doubt they got a cent from him. Yet they still came every time and took him to the hospital. So some anecdotal evidence that 10 years ago in Peoria they didn't turn homeless people away from the emergency room. For what it's worth...
posted by sbutler at 12:17 PM on February 1

A lot of hospitals will help indigent patients apply for Medicaid, and will treat them as Medicaid-pending (usually if the social worker or billing person thinks they will probably qualify), including in non-emergency situations.
posted by fructose at 12:36 PM on February 1

Check out the various message boards online frequented by ER personnel, and you'll find that it's business as usual for homeless folks to claim some unidentified (but desperately painful) stomach ailment in order to get an ambulance ride to the ER, and then a warm bed while various tests are run to find the cause of the distress. If a patient is there long enough, they also get a meal. (Vague abdominal pain takes longer to diagnose and requires more tests than, say, a complaint of chest pain.)

But in answer to the OP's question, the indigent are never turned away from emergency rooms, which is why insurance costs are so high - someone has to pay for their care. (Please don't start a socialized medicine debate; for every "that's why it's better in Canada" argument, I'll raise you a "that's why 60% of the patients at Henry Ford Hospital are Canadian.")
posted by Oriole Adams at 12:49 PM on February 1 [1 favorite has favorites]

^ Canadian health insurance extends to the US. Just sayin'.
posted by troy at 1:19 PM on February 1

If you have no insurance, it is highly unlikely that a hospital (other than a charity hospital) will agree to treat you after your initial complaint has been stabalized.

Actually, most public hospitals in the US (58%, with some regions such as the Northeast nearing 90%) are non-profits, and as such are required to offer a public benefit to maintain that status. The problem becomes when they cannot afford charity care beyond a certain point. Congressional Budget Office study on "Nonprofit Hospitals and the Provision of Community Benefits". This includes subsidized care as well as "free" care, e.g. where the patient pays only a portion of the costs based on a sliding income scale.

For my own uninsured state, I have hospital bills that I just can't pay and will probably have to declare bankruptcy to get out of. If I could pay, though, the hospital would work with me on a payment plan, and in rare cases they will forgo interest.

I think "highly unlikely" is actually incorrect. This is actually how a vast swath of care is provided. It is probably accurate, however, to say that urban public hospitals are the most likely to refuse care.

Another aspect to consider is whether the hospital is a Level I, II, III or IV trauma facility. This applies, probably, to the Yahoo! Answers question.
posted by dhartung at 2:14 PM on February 1

DH would often take call at the El Paso county hospital, and it was incredibly common for an injured Mexican citizen to have his buddy drop him off at the border. Our border patrol agents would call for an ambulance to take said person to the county hospital. What percentage of the ER patients were actually Mexican citizens is impossible to say since it's illegal to ask. Nonetheless, I often wondered why everybody near the border (even if they could pay in Mexico) wouldn't just do the same thing? Surely our county hospital is nicer that their hospitals...and would they have any incentive to pay? Does the hospital bill somehow transfer to their record in Mexico?
posted by texas_blissful at 3:20 PM on February 1

I think in life-threatening situations, any ER is obligated to treat you regardless of whether you can pay or not. For other situations (say, a broken leg or pneumonia)...if you're in Birmingham AL and you don't have insurance, you go to Cooper Green Mercy hospital and sign up for a "HealthFirst" card. Basically you have to show proof of residence in Jefferson county (utility bill works), and proof of income if you have it. This process takes between 3-4 hours, depending on how many people are in front of you in line. Then, if you have received your HealthFirst card in time, you wait to be seen by a doctor (most likely, resident from the teaching hospital supervised by an attending). If you got to the clinic late and did not plan ahead for the time it would take to get the card, you make an appointment to come back later on in the week. If you have no way to pay your balance, the hospital will sue you.

You can also try to be seen at one of the free/true sliding scale clinics in town (usually staffed by UAB med students & attendings). I'm not sure of the exact process there, but I do know they usually don't take walk-ins and, given the state of Birmingham mass transit, they can be difficult to get to if you are truly injured.
posted by wearyaswater at 9:13 PM on February 1

A friend recently had to have his gallbladder removed in an emergency situation (adhesions and infection meant he couldn't just go home and wait for outpatient surgery in a few weeks). He is a full time student with no steady income and no insurance. Emergency surgery plus 4 days of hospital care ended up costing him nothing because the wealthy, private hospital bills uninsured patients on a sliding scale.
posted by hydropsyche at 7:43 AM on February 5