The “Permanent” Patient Problem

Roberts S. , Nowhere to Go, Patients Linger in Hospitals, at a High Cost, New York Times, January 3, 2012, at A18.

Vickery K. D. Sauser K. , and Davis M. M. , Policy Responses to Demand for Health Care Access: From the Individual to the Population, JAMA 309, no. 7 (2013): 665–666. See also Kocher R. Emanuel E. Z. , and DeParle N. A. , The Affordable Care Act and the Future of Clinical Medicine: The Opportunities and Challenges, Annals of Internal Medicine 153, no. 8 (2010): 536–539. Over half the states are not moving forward with Medicaid expansion at this time. Kaiser Family Foundation, Status of State Action on the Medicaid Expansion Decision, as of September 30, 2013, available at <http://kff.org/health-reform/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act> (last visited February 11, 2014).

Some have argued that medical repatriation may be acceptable ethically as well as legally, but only if the patient gives full and informed consent. Kuczewski M. G. , Who Is My Neighbor? A Communitarian Analysis of Access to Health Care for Immigrants, Theoretical Medicine and Bioethics 32, no. 4 (2011): 327–36. See also Parsi K. Hossa N. , Complex Discharges and Undocumented Patients: Growing Ethical Concerns, Journal of Clinical Ethics 23, no. 4 (2012): 299–330; Agraharkar V. , Deporting The Sick: Regulating International Patient Dumping by U.S. Hospitals, Columbia Human Rights Law Review 41 (2010): 569–600.

Snow K. Klein J. , and Stephens D. , Health Care Laws Leave Hospitals Overwhelmed by ‘Permanent Patients, Rock Center, April 24, 2012, available at <http://rockcenter.nbcnews.com/_news/2012/04/24/11371569-health-care-laws-leave-hospitals-overwhelmed-by-permanent-patients?lite> (last visited February 11, 2014).

Condition of Participation: Discharge Planning, in Hospital Conditions of Participation: Quality Assessment & Performance Improvement Final Rule (68 F.R. 3435); published January 24, 2003, effective March 25, 2004, as amended at 69 F.R. 49268, August 11, 2004; 42 C.F.R. §482.43 (2011); Centers for Medicare and Medicaid Services, Revisions to State Operations Manual (SOM), Hospital Appendix A –Interpretive Guidelines for 42 C.F.R. 482.43, Discharge Planning, available at <http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-13-32.pdf> (last visited February 11, 2014). See also Agraharkar V. , Deporting The Sick: Regulating International Patient Dumping by U.S. Hospitals, Columbia Human Rights Law Review 41 (2010): 569–600; Sangerman J. J. Levy J. T. , The Attorneys Role in the Hospital Discharge Planning Process for the Elderly, New York State Bar Association Journal 65, no. 22 (1993); Montejo v. Martin Memorial Medical Center, 874 So.2d 654,657 (Fla. Dist. Ct. App. 2004); Winton R. DiMassa C. M. ,L.A. Files Patient ‘Dumping Charges, Los Angeles Times, November 16, 2006, available at <http://articles.latimes.com/2006/nov/16/local/me-dumping16> (last visited February 11, 2014); Chipli A. J. , Breathing Life into Discharge Planning, Elder Law Journal 13, no. 1 (2005): 1–37; Cotera-Perez-Perez O. , Discharge Planning in Acute Care and Long-term Facilities, Journal of Legal Medicine 26, no. 1 (2005): 85–95.

Wycoff Heights Medical Center v. Louis Rodriguez, 741 N.Y.S.2d 400 (N.Y. Sup. Ct. 2002).

National Priorities Partnership, Input to the Secretary of Health and Human Services on priorities for the National Quality Strategy, September 1, 2011, available at <http://www.qualityforum.org/Setting_Priorities/NPP/Input_into_the_National_Quality_Strategy.aspx> (last visited February 11, 2014).

Swidler R. N. Seastrum T. , and Shelton W. , Difficult Hospital Inpatient Discharge Decisions: Ethical, Legal, and Clinical Practice Issues, American Journal of Bioethics 7, no. 3 (2007): 23–28.

See supra note 8. See also Agraharkar , supra note 3.

American Hospital Association (AHA), AHA Policies and Guidelines on Billing, Collections, Tax-Exempt Status, and Community Health, April 29, 2006, available at <http://www.aha.org/content/00-10/07nov-billingpolicyguidelines.pdf> (last visited February 11, 2014).

See, e.g., Swidler ., supra note 8; see also Snow , supra note 4.

See, e.g., Parsi Hossa supra note 3; see also Snow , supra note 4.

See, e.g., Cotera-Perez-Perez , supra note 5; see also Chipli , supra note 5.

ABIM Foundation, Medical Professionalism in the New Millennium: A Physician Charter, February 5, 2002, available at <http://www.abimfoundation.org/Resource-Center/Bibliography/∼/media/Files/Physician20Charter.ashx> (last visited February 14, 2014); see also American Medical Association Council on Ethical and Judicial Affairs (CEJA), Physician Stewardship of Health Care Resources, 2012, available at <https://www.ama-assn.org/resources/doc/ethics/ceja-1a12.pdf> (last visited February 11, 2014).

Fasser C. McGuire A. Erdman K. Nadaldo D. Scott S. , and Waters V. , The Ethics Workup: A Case-Based Approach to Ethical Decision-Making Instruction, Journal of Physician Assistant Education 18, no. 1 (2007): 34–41; see also Center for Medical Ethics and Health Policy, Ethics Work-Up, September 1, 2011, available at <http://www.bcm.edu/ethics/?pmid=21192> (last visited February 11, 2014).

See Swidler ., supra note 8; Parsi Hossa , supra note 3. See also Pope T. M. Arnold R. M. , and Barnato A. E. , Caring for the Seriously Ill: Cost and Public Policy, Journal of Law, Medicine & Ethics 39, no. 2 (2011): 111–113.

See, e.g., Parsi Hossa supra note 3; see, e.g., Snow , supra note 4; see also Winton DiMassa , supra note 5.

See, e.g., Schmidt H. , Just Health Responsibility, Journal of Medical Ethics 35, no. 1 (2009): 21–26; see also Good Stewardship Working Group, The ‘Top 5 Lists in Primary Care: Meeting the Responsibility of Professionalism, Archives of Internal Medicine 171, no. 15 (2011): 1385–1390.

Id. (Good Stewardship Working Group).

See, e.g., Cotera-Perez-Perez , supra note 5; see, e.g., Chipli , supra note 5; see also Fasser , supra note 15.

See Good Stewardship Working Group, supra note 18; see also Schmidt, supra note 18.

Id.

American Medical Association, Code of Medical Ethics. Opinion 10.02 (5), Patient Responsibilities, June 1, 2001, available at <https://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion1002.page?> (last visited February 11, 2014); see Hamowy R. , Medical Responsibility, Journal of Law, Medicine & Ethics 40, no. 3 (2012): 532–545; Kontos N. Querques J. Freudenreich O. , Fighting the Good Fight: Responsibility and Rationale in the Confrontation of Patients, Mayo Clinic Proceedings 87, no. 1 (2012): 63–66. See also Schmidt, supra note 18.

See supra note 23.

See supra note 18.

See Good Stewardship Working Group, supra note 18.

Id.

See, e.g., Cotera-Perez-Perez , supra note 5; see, e.g., Chipli , supra note 5. See also Fasser , supra note 15 and supra note 18.

Proposed Rule, 77 Fed. Reg. 38148 (to be codified at 26 C.F.R. §1.501(r)), June 22, 2012, available at <http://www.gpo.gov/fdsys/pkg/FR-2012-08-10/pdf/FR-2012-08-10.pdf> (last visited February 11, 2014).