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Some patients who arrive for treatment in the emergency room at the University of South Alabama Medical Center may be admitted at the hospital's cross-town sibling, USA Knollwood Hospital, under a new plan.

USA wants to steer more patients to Knollwood in an attempt make more money, helping the frequently half-empty, smaller hospital cover more of its overhead. The plan also lines up with other efforts to make Knollwood the center of USA's medical system for adult patients.

"We are trying to build up Knollwood, yes, so it's working more at its capability," said Stan Hammac, chief of USA's three-hospital system.

Hammac said that at times, USA Medical Center hits its overall capacity or its intensive-care-unit capacity. During those times, the hospital system wants emergency room doctors at the north Mobile hospital to send their patients by ambulance to Knollwood in southwest Mobile.

That way, hopefully, USA will keep more patients under its auspices and won't lose them to other hospitals.

Both USA Medical Center and Knollwood are chronic money-losers.

Hammac said unaudited figures show the medical center lost about $16 million in the 2003-04 budget year, while Knollwood lost between $3 million and $4 million. Hammac said that USA Medical Center and Knollwood lose money for different reasons. At the medical center, most losses come from treating uninsured patients. Knollwood, though, is losing money because it's inefficient to run a hospital with so few patients.

"Knollwood needs to have a little bit more patient activity to cover its costs," Hammac said.

A busier hospital would also have a greater capacity to care for patients who might be admitted from USA's Cancer Research Institute. USA plans to begin building the center in April.

"We need to be sure that Knollwood, as a hospital, is up to a speed that it can handle the referral business generated by the Cancer Research Institute," Hammac said.

USA Children's and Women's Hospital made about $12 million in profits last year, because delivering babies pays well under Medicaid and because the hospital is fully utilized.

Under federal law, a hospital that accepts Medicaid or Medicare must examine anyone who arrives in its emergency room and stabilize anyone with an urgent health condition. A patient can't be transferred until a doctor has determined that being moved wouldn't likely cause any harm, and the destination must be willing to take the patient, have the space for the patient and have the ability to provide the right kind of care.

"If it's still an emergency, a physician has to certify that the benefits of going to another hospital outweigh the risk (of the transfer)," said Colleen Sandmann, an official with the federal Centers for Medicare and Medicaid Services.

Hammac said USA doesn't believe the plan will violate the Emergency Medical Treatment and Active Labor Act, the federal law meant to prevent refusal of services or improper transfers, practices commonly known as patient dumping.

"As long as you have a physician on the other end, it's not an EMTALA problem," Hammac said.

USA Medical Center usually has about 105 patients, Hammac said, but its patient load can swing from the mid-90s to the mid-120s. Though the hospital is licensed for 346 beds by the state, it only is staffed to care for about 130 patients. The medical center has 30 beds in its intensive-care unit, including beds set aside just for burn patients.

Knollwood is licensed for 100 beds. Right now, the hospital is staffed to care for about 40 patients, including 11 intensive care beds.

Hammac, though, said USA could increase staffing to cover 100 beds if demand developed. Under the plan, Hammac said that before admitting someone, emergency room physicians at USA Medical Center and Knollwood would check in with a doctor at each hospital assigned to help manage capacity.

If the medical center were nearing capacity or if the intensive-care unit were doing that, the capacity manager might tell the physician to put the patient in an ambulance and send them to Knollwood. Insurance would pay for the ambulance, Hammac said.

There would be some limitations on the plan. For example, Knollwood can't handle heart surgery, severe burns or trauma cases. Also, Hammac said, USA would try to honor the wishes of patients who specifically asked to stay at the medical center. Finally, he said, the procedure would apply only to USA physicians and not private physicians who admit patients

University officials portray the plan as another step toward improving Knollwood. Under a plan announced in 2003, USA moved most of its physicians who see adult patients to Knollwood, in part to fight criticism that doctors were spending too much time shuttling between main campus offices and various hospitals.

This article reproduced with special permission from the Mobile Register.