The devil or the sea? Transfer regs create a dilemma

With the advent of strict federal regulations, physicians considering whether to transfer patients seeking emergency treatment can find themselves between the devil and the deep blue sea. Do they spar with the diabolical guidelines and follow their best medical instincts and training? Or, do they abandon their instincts and training and depend on a regulatory life preserver to keep their heads above water? Victoria obstetrician/gynecologist Michael L. Burditt, MD, embodies this unenviable dilemma. After he ordered the transfer of an indigent pregnant patient from Victoria to Galveston, the federal government accused him of knowingly making an inappropriate decision to transfer. Dr Burditt appealed the government's ruling, and the confrontation eventually led him to the courtroom in the nation's first test of the 1986 law that prohibits patient "dumping." Dr Burditt came close to settling the case, but, with assistance from the Texas Medical Association, the Victoria-Goliad-Jackson County Medical Society, and the American Medical Association, he's still in the fight. At the heart of the case is the issue of guaranteeing physicians due process in the review system for transfers. (Due process, the physician's right to be heard before fines or sanctions are imposed, is guaranteed in Medicare's quality review procedures, but not in transfer reviews). The case is in the hands of an administrative law judge, who is expected to hand down a decision in June. This article examines Dr Burditt's case in light of developments that brought hospital transfers under federal scrutiny.