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Patient safety at its core involves commitment from healthcare providers, entities etc., to practice safely and do no harm. A report released in 2016 by CRICO strategies states communication failures were a factor in 30 percent of malpractice cases. The report cites several examples of hierarchical workplace culture, cumbersome electronic health record, constant interruption as some of the challenges faced by healthcare professionals trying to render care. Hierarchical workplace culture affecting patient safety is something that is not talked about much.  The US government and states across the US have put many regulations to promote a safe environment for patients to get treated. However, some of these regulations tend to hinder patient safety. How you ask? In a recent lawsuit filed by a former employee against his employer, in the District Court of Maryland, the employee has alleged that his employer favored and prioritized out-of-state patients over Maryland residents to boost revenue. According to the lawsuit filed in the U.S. District Court in Maryland, against the healthcare system, the employee has alleged the healthcare entity gave priority to treat out of state patients without considering the extent of sickness of these patients over patients in Maryland.

According to the lawsuit, the employee states, starting in 2015, his department was directed to implement policies that “resulted in out-of-state patients being provided preferential treatment without regard to clinical necessity.”  


In Maryland, they use an all-payer rate setting payment plan that limits how much money a hospital can get from patients.

Maryland law requires hospitals to be in an agreement with the federal government that requires them to operate under a budget that has been assigned to the hospital limiting how much revenue they can make in a single year. These budgets are in place to help cut soaring healthcare costs while improving the hospital’s care. However, these set budgets only apply to patients that reside in Maryland, allowing the defendant hospital to gain additional revenue for seeing out-of-state patients. WIth healthcare costs on the rise, hospitals such as the one named in the lawsuit have to turn to out of state patients to generate substantial revenue to offset the costs of caring for instate patients.


Maryland budget agreements also include a clause in which hospitals cannot deny services to patients for inappropriate financial reasons and should also provide care that focuses on the community. The lawsuit states that the hospital is violating this clause and also lacks providing care that is community-focused since they are pursuing out-of-state patients. Furthermore according to the lawsuit, the health system failed to inform the Health Service Cost Review Commission and Centers for Medicaid and Medicare of their act. Both of these agencies play a role in processing global budgets and public health program payments.

Unfortunately, it seems to get worse as the lawsuit claims that aggressive tactics were made to accommodate out-of-state patients. According to the lawsuit, the healthcare system assigned a concierge team to attract patients and accommodate their travel needs. Additionally, the hospital created a policy that required non-Maryland patients to be offered an appointment within the first month of contact and lacked an in-state contact policy. Based on the allegations in this lawsuit, the law that was put in place to cut healthcare costs had unintended consequence for Maryland residents.  


Mitra Rangarajan is an expert in the healthcare field and strives to empower patients to take charge of their health and safety. Read more on her patient safety research here!


All PDFs can be found on Mitra Rangarajan’s Behance Profile

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