The Fifth Amendment and the "Right" to Medical Care

'Homeless dumping' charges for hospital

The case against it stems from a March surveillance video showing a 63-year-old patient from Kaiser Permanente's Bellflower hospital wandering Skid Row in a hospital gown and slippers. Prosecutors describe what happened to Carol Ann Reyes in a 20-page document supporting the false imprisonment and dependent-care abuse charges.



"We seek to end the inhumane and illegal practice," City Attorney Rocky Delgadillo said in Thursday's Los Angeles Times.



Delgadillo's office is also suing Kaiser under a state law on unfair business practices. The lawsuit asks a judge to forbid all Kaiser hospitals from dumping homeless patients on Skid Row and to impose financial sanctions if the order is violated.

You know, I want to see folks get good medical care. But there's this little niggling issue:



The Fifth Amendment of the US Constitution:

No person shall be held to answer for a capital, or otherwise infamous crime, unless on a presentment or indictment of a Grand Jury, except in cases arising in the land or naval forces, or in the Militia, when in actual service in time of War or public danger; nor shall any person be subject for the same offence to be twice put in jeopardy of life or limb; nor shall be compelled in any criminal case to be a witness against himself, nor be deprived of life, liberty, or property, without due process of law; nor shall private property be taken for public use, without just compensation.

Emphasis mine, to show the important part.



Basically, Kaiser Hospital, among many others, is being forced to treat these people, despite no reasonable expectation of payment. Even when they do get paid, it is far below cost, and months to years after the fact. Kaiser would not have a hospital in the area did they not have a need to serve their members. When the county of Los Angeles or state of California or even the United States Government is paying, they are paying far below market rates, and months to years after the fact. This is not a case of the hospital making a decision to accept (for example) Medicare, where they agree ahead of time that they want the business more than they don't want the short payments and waiting times. They have no legal option but to treat these people. So not only are the members who pay Kaiser's insurance fees subjected to a tax, but unavoidably, in many cases they are going to wait longer, suffering additional pain and possibly additional damage while people who do not pay those fees are treated ahead of them. In some instances, there may be enough overflow to cause Kaiser to direct patients elsewhere. This tax on Kaiser insurees is no less a taking than the condemnation of their residence.



Now Kaiser could stop the majority of these charges easily enough, by limiting its emergency services to areas with few homeless or uninsured. Of course, this would make it more difficult and costly for lower income people to obtain coverage through Kaiser, which is one of the better and more affordable health plans out there. It might even mean that more people go uninsured, go untreated even if they are insured due to the difficulty of reaching services, etcetera.



If the government is going to mandate that these people be treated, particularly with the same legal and medical responsibilities as any other patient, then the government needs to reimburse Kaiser in full and in a timely manner for the treatment of those patients. Kaiser would be very glad to treat the patients on that basis. But it is not happening, or Kaiser wouldn't be trying to get rid of the patients. Yes, it disturbs me. No, I don't want them discharged. But forcing Kaiser, or any other health provider, to spend the money it pays for housekeeping and drugs and doctors and nurses and everything else from the chief surgeon down to the newest laundry employee, without just compensation is a violation of the fifth amendment. If the Bill of Rights is important to you, you need to support this no less than the right to avoid self-incrimination, which is a part of this same amendment, or double jeopardy, or due process of law itself, which, by the way, are also part of the Fifth Amendment. But if we're not going to pay the bill (and the County of Los Angeles hasn't paid these medical bills in a timely fashion for decades), then we cannot mandate treatment. Just because someone receives a medical license does not exempt them from coverage under the Fifth Amendment.