ustxtxb_obs_1987_04_03_50_00010-00000_000.pdf

McAllen Medical Center Pho to by Marco Garc ia ‘ X latt lagOkkg* ttitriPZ -AU:* JAMMV.AP: There is a law in Texas which prohibits “wallet biopsies,” or discrimination against poor people requiring emergency medical services. The law, enacted in 1983, states, in part: “No officer or employee or member of a general hospital medical staff . . . shall deny emergency services . . . to a person diagnosed by a licensed physician as requiring emergency services because the person is unable to establish his ability to pay for the services. . . ” The statute carries criminal penalties and could also lead to suspension and /or revocation of a hospital’s license, according to Texas Department of Health attorney Susan Steeg. Maurice Shaw, head of TDH’s hospital licensing and certification division, told the Observer that “in my opinion, McAllen Medical Center violated the law. If they ask about insurance and turn him down, that means they’re refusing him because of his inability to pay.” McAllen Medical Center administrator John Mims said the decision not to admit Carlos Garcia was not related to his ability to pay but rather was due to a lack of space in the intensive care unit. Shaw said the U.S. Health Care Financing Administration, which oversees Medicare contracts with hospitals, has also indicated to him that McAllen Medical Center “was not in compliance” with Medicare regulations. A spokesman for’ the federal agency declined to comment on the case. Additional questions have also been raised about whether the hospital violated the federal Hill-Burton program, which provides that a hospital must offer free or low-cost care to poor persons if it received federal funds for construction. THE GARCIA FAMILY moved to Zapata, a town of 3,500 people about 50 miles south of Laredo, from Ciudad Guerrero when Carlos was 13. Carlos’s parents and five brothers and sisters live in a small, tidy house on a corner lot a block off the main highway running through town. Martin Garcia, the father, works as a day laborer when work is to be found; Maria, the mother, is a janitor at the Zapata Health Clinic. Family photos adorn the walls; a framed picture of Carlos wearing dark sunglasses and a broad smile and his two-year-old nephew sits atop the television set in the living room. i Carlos’s ambitions were modest, his parents said. He wanted to earn enough money to buy himself a car. He liked watching football on television, tinkering with cars, and dancing. It was for a dance Carlos was readying himself on this afternoon, Friday, December 19. There was, after all, reason to celebrate: school had just recessed for the Christmas holidays. Carlos had hurried to his cousin’s house after school, where he customarily waited for his mother to pick him up after she got off work. This day Carlos asked his mother to stop off on the way home at the dry cleaner’s, where he had left a borrowed tuxedo for pressing. On Saturday, he planned to wear it to a friend’s quinceanera But tonight, he and his cousin, also named Carlos, and another friend, were going to a dance hall in Guerrero. They planned to spend the night there at Carlos’s grandmother’s house. His friends picked up Carlos about 6 on Friday evening, just as Martin Garcia returned home from work. After a couple hours of dancing and drinking, the boys decided to “cruise” downtown Guerrero for awhile. Around midnight, they dropped in for a bite to eat at the house in which Carlos was raised, and which the family still maintains. There Carlos found the pistol, which he and his friends began playing with. A short while later, they left, Carlos still carrying the gun. They arrived at Carlos’s grandmother’s house around 2, exhausted but in good spirits after a night on the town. The two others went immediately to bed; Carlos, not yet tired enough to sleep, and perhaps enjoying the intoxicating feel of the drink and the gun, again pulled out the weapon. At 3 a.m. his friends were awakened by a single shot. ON DECEMBER 19, less than 24 hours before Carlos’s mishap, McAllen Medical Center had stopped accepting Medicaid and uninsured transfer patients. John Mims, the hospital’s administrator, told the McAllen Monitor the state and federal governments’ “stream-lined” methods of reimbursement for indigent care were to blame for the policy, specifically the revamping in 1983 of Medicare payments coupled with similar, more recent changes in the state-administered Medicaid program. In the past, hospitals were reimbursed by Medicare and Medicaid for each day a patient stayed. The incentive was to keep the patient longer the longer the stay the more money for the hospital. Now the opposite is true. Under the Social Security Amendments of 1983, Medicare pays a fixed amount for each patient, based on diagnosis. There are hundreds of categories of illness, known as DiagnosisRelated Groups, or DRGs. Each DRG has an assigned dollar value like a menu and each patient is tagged at the hospital door. \(In Texas, the Department of Human Services in September instituted a similar Medicaid system, There is no adjustment for severity of illness; pneumonia has a set price, whether the patient stays two days or two weeks. If a hospital can treat the patient for less than the set price, it keeps the extra money. But if the hospital spends too much on treatment, it eats the difference. By the time Carlos Garcia came knocking with a bullet in his brain, McAllen’s Mims had decided he could swallow no more. “Medicaid really messed us up,” Mims said. “We take a tremendous loss on transfers and simply cannot take these multi-million dollar hits any more.” Mims said the hospital lost $1,087,000 last year on 397 Medicaid and uninsured transfer pa 10 APRIL 3, 1987