PATIENT DUMPING:
A LONG-STANDING AMERICAN PRACTICE Emily K. Abel
Viewers of “The Pitt” may have been surprised to learn that, even in Trump’s America, there is one place where everyone can get health care--the ER. To be sure, the fictitious-urban-emergency room in the show has many problems. Largely as a result of the corporatization of health care, a trend the Trump administration encourages, the ER is so underfunded that the doctors and nurses are on the verge of burnout, the waiting room is often standing-room only, there are too few rooms for trauma patients, the halls are chaotic, and patients often become ‘boarders,” lying on stretchers while waiting for a hospital bed to open up; meanwhile, a hospital administrator continually pressures the staff to work faster. The ER also has to contend with many issues the regime has aggravated—homelessness, the lack of insurance, vaccine skepticism, and the mental health crisis. Despite these myriad difficulties, however, no one is turned away.
A major reason is that the 1986 Emergency Medical Treatment and Active Labor Act (EMTALA) requires all hospitals receiving Medicare (virtually all facilities) to screen and stabilize all patients who arrive with emergency conditions, regardless of their ability to pay. The Act represented a response to terrifying stories about patient dumping that had begun to circulate a few years earlier. One of the first was published in 1981. A Chicago Tribune reporter had found “seriously ill patients lying on the floor” in Cook County Hospital’s emergency room. Although the hospital usually had between 90 and 125 patients who had been transferred from private hospitals each month, the facility had 365 in July and 560 in August. A very high proportion were members of racially marginalized groups. One woman had been sent from a private hospitals to receive a CAT-scan, although the transferring hospital knew that Cook County lacked the necessary equipment. “Officials at County don’t call this transferring,” the article noted. “They call it ‘dumping,’ a deliberate attempt to get rid of Medicaid patients.” Soon reports began to provide examples of the practice throughout the country.
Although patient dumping first began to receive widespread attention in the 1980s, it was not a new phenomenon. A century earlier, The New York Times began to report that private hospitals were sending patients who arrived by ambulance to Bellevue, the city’s public hospital. For example, when eight-year-old Julia Bictor was run over by a coal cart one December morning, an ambulance delivered her to Chambers Street Hospital. But at midnight, “the little sufferer was place in an ambulance and driven over three miles to Bellevue Hospital [New York’s public facility]. Five minutes after reaching the hospital on Twenty-Sixth Street the child expired.” The Bellevue night captain stated that although he had “seen many hard cases, this one was enough to touch the heart of a stone. The poor little thing had no covering but a bandage around its arm and waist, and sending a patient out in the night air in that condition certainly did not prove of benefit to it.”
Dumping did not end when patients reached public facilities. One historian notes that after receiving chronically ill patients from private facilities, public hospitals “shipped them as quickly as possible to isolated hospitals that cities had established for long-term care in out-of-the-way places—on nearby islands, as in Boston and New York, or in the far suburbs, as in Philadelphia, Chicago, and Washington.”
Trips to those island facilities were often harrowing ordeals. Homer Folks, the NYC Commissioner of Charities, later recalled that “the ‘stretcher cases”’ were placed in the long-open passageways” and “exposed to the wind and cold, and protected only by a blanket” during the half-hour trip across the river. Although Bellevue Hospital attendants transported patients to the dock, workhouse residents were responsible for helping them on and off the boat. By the time Folks wrote, reforms instituted in the late 1890s and early 1900s had greatly improved transportation to Blackwell’s Island. Nurses were now responsible for patients throughout the boat trip, and those on stretchers traveled in a special heated room. Nevertheless, the hospitals on Blackwell’s Island continued to direct the same criticism toward Bellevue that it had leveled against private hospitals—too many seriously ill dying patients were transferred, and the rigors of travel often accelerated the end.
New York was not unique. In 1903, the visiting medical staff of Long Island Hospital, Boston’s chronic disease facility, complained that the method used to transport patients from the city inflicted “discomforts and hardship, if not actual suffering” on patients who were “in the last stages of disease.” Delays in reaching the island were not only “inevitable” but also very dangerous for the very sick. Such “inadequate provision for their comfort would not be tolerated in hospitals wards” and “should not be during the trip.”
Care in these island facilities was often abysmal. A 1903 investigation of Long Island Hospital found extreme overcrowding as well as numerous examples of neglect and abuse. In May of that year, a nurse administered poison to four patients, two of whom died. In 1911 the New York City Charity Organization Society, the city’s major philanthropic organization, castigated the city for the “disgraceful” overcrowding in a Blackwell’s Island hospital. Beds “regularly lined” the halls, and many patients were forced to sleep on the floor.
Although the EMTALA has succeeded in reducing the long-standing practice of patient dumping, the Act contributed to the abysmal emergency-room conditions depicted in The Pitt; numerous ER doctors and nurses applauded the show for its realistic portrayal of the environment in which they work. The Act also did little to address the overall problem of access. Hospitals now are required to screen and stabilize everyone who arrives with an emergency condition, but the United States remains virtually the only high income country without a statutory right to ongoing care. Despite his lack of a medical degree, Noah Wyle’s role as the star of The Pitt has encouraged him to opine about the US health care system. He has condemned its “profit-driven” character and called for “universal coverage.”
Sources:
Beatrix Hoffman, “Emergency Rooms: The Reluctant Safety Net,” in History and Health Policy in the United States, ed. Rosemary A. Stevens, Charles E. Rosenberg, and Lawton R. Burns (Rutgers University Press, 2006), 150-272.
Emily K. Abel, The Inevitable Hour: A History of Caring for Dying Patients in America (Johns Hopkins University Press, 2013).
Ankita Shaw, “The Pitt’s Noah Wyle Blasts ‘Profit-Driven’ US Healthcare System,” Yahoo, March 25, 2026.