After weeks in the hospital for spiking blood sugar levels and an infected bed sore on his back, the 83-year-old patient was stable enough to leave MedStar Good Samaritan Hospital in Baltimore in early April. Staff lined up two nursing homes willing to take him, but he refused to go.

Unable to get buy-in from the patient or locate a family decision-maker over the next month, the hospital sued the man for trespassing.

It’s an extraordinary, and perhaps unseemly, step to legally oust an elderly patient with serious health conditions. But to advocates, the hospital and observers, the case also illustrates how Maryland’s overcrowded health care system can end up ill-serving patients — both those in hospitals and those who need to be. The state’s emergency room wait times are now the nation’s longest.

“Both history and science consistently demonstrate that patients are best served by being discharged from an acute care setting such as the hospital when they are medically ready for discharge,” said the lawsuit, filed May 8 in Baltimore City Circuit Court.

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Further, the suit said, Good Samaritan “has been at or near crisis capacity, i.e., there were no available beds for patients who actually are in need of acute medical care, approximately 99% of the time. This presents a dangerous situation for the community.”

MedStar and the Maryland Hospital Association declined to comment on pending litigation.

Joseph DeMattos, president and CEO of the Health Facilities Association of Maryland, said hospitals and nursing homes in the state are legally required to ensure discharges to appropriate destinations. When there are options, patients are allowed to choose the location.

But he said that accommodating patients’ wants and needs can be a challenge because of low availability and affordability. The bill for most nursing home stays is footed by taxpayers through Medicaid.

“There can be tension between the urgency of hospital discharge, patient preferences and the availability of nursing home facilities to meet specific clinical needs,” DeMattos said.

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The bottom line is that there’s not always a choice, or even one option agreeable to all. That is most often the case for patients with behavioral health conditions, traumatic brain injuries, chronic illnesses and high drug costs that are covered only in hospitals, he said.

It’s not clear why the Good Samaritan patient refuses to go. The patient has no attorney listed in court records. His listed address is the same as the hospital’s. The Banner’s attempts to reach his family were unsuccessful.

The patient came from an unnamed nursing home, and it’s not clear if it’s one of the two where the hospital proposes sending him. Both of the proposed facilities are part of the same large for-profit chain, and have low ratings on the federal ranking system.

Further, advocates recently charged in a separate lawsuit that the state’s lack of inspections of nursing homes has generally led to severe neglect of people with disabilities.

Still, the patient did have somewhere to go, while many others can’t find anywhere willing and able to care for them. They sometimes end up boarding at hospitals.

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The hospitals don’t always know what to do with them. In one instance in 2018 found to violate federal law, workers at another Baltimore hospital were caught on video leaving a dazed woman in a hospital gown at a bus stop.

Other states such as California have sued patients for trespassing. Maryland, the lawsuit says, has had three similar cases since 2020, including another at Good Samaritan, one at Johns Hopkins Hospital and one at the Hopkins-operated Suburban Hospital in the Washington, D.C., suburbs.

In the Hopkins case, the lawsuit said, a judge authorized the hospital to use “reasonable and necessary physical force to remove” the patient from the hospital.

In a statement, Hopkins acknowledged experiencing “challenges concerning long term boarding for patients, which ultimately impacts all patients,” and pointed to insufficient primary care and space in behavioral health and skilled nursing facilities outside the hospitals.

“The issues are ones that hospitals across the country are facing and is impacting the health care industry at large,” the statement said.

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Anna Palmisano, director of Marylanders for Patient Rights, successfully lobbied for a state Patients’ Bill of Rights in 2019, but it doesn’t necessarily give patients say on their discharges. She said hospitals should have a professional patient advocate working with vulnerable or fearful patients, and before a lawsuit is launched, “every avenue should be explored to help the patient.”

Palmisano also said some backlogs could be solved by adding hospital beds. A 2022 analysis by KFF, formerly the Kaiser Family Foundation, found that Maryland ranked fifth from the bottom for bed availability, with 1.81 beds per 1,000 residents. The national average was 2.35.

She blamed a state regulatory system that prioritizes controlling hospital costs.

“Blaming the patient is not going to fix the bed availability problem,” she said. “Ensuring that quality of care takes precedence, not just cost reduction, is vitally important.”

The Maryland General Assembly passed legislation this year requiring hospitals to evaluate the whole health care system as a means of reducing emergency room delays. A March report by hospitals already identified issues including staff shortages and payment-related factors, as well as slow bed turnover.

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The Maryland Hospital Association “concluded that a lack of opportunities for patients to be swiftly discharged to more appropriate care settings negatively affected patients and caused delays for all patients.”

The Health Services Cost Review Commission, the state regulatory agency overseeing the efforts to reduce emergency wait times, said a new state panel dedicated to the effort was, among other things, looking for ways to add “resources” for patients who are ready to leave hospitals.

The panel will work to address the bottlenecks over the next three years.