Transfer of Unstable Patients: Dumping or Duty?

Olga Jonasson, MD; John A. Barrett, MD
JAMA. 1987;257(11):1519. doi:10.1001/jama.1987.03390110095036.
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The public tax-supported hospitals of this country were established primarily to ensure access to a decent minimum of health care for the poor. Unless and until a system is substituted whereby medical care to the poor in private hospitals is compensated by tax dollars, it is inevitable that indigent patients will be transferred from private to public institutions for financial reasons. The increasingly competitive financial climate of private health care and the inability of private hospitals any longer to shift the costs of uncompensated care to paying patients have resulted in dramatic increases in the numbers of patients transferred to public hospitals in recent years. To make the best of this situation, transfer policies designed to safeguard the patient's welfare have been implemented1; compliance is variable but, in general, most parties involved follow the rules.

But should this practice be permitted when the patient is in an unstable condition and


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