Patient dumping in New York City, 1877-1917.

Although the term "patient dumping" was rarely used before the 1960s, the practice started much earlier. In the late 1870s, the New York Times began to report that private hospitals were using ambulances to shift poor, moribund patients to Bellevue, the city's preeminent public facility. Many trips had serious medical consequences. Private hospitals also instructed ambulances to take critically ill patients directly to Bellevue regardless of the distance. Efforts to combat such practices took various forms. When transfers resulted in death, Manhattan coroners held inquests. In 1902, the Commissioner of Charities issued an order requiring that he be sent a full report from the superintendent of any hospital in which a patient transferred from another facility died within three days after admission. Four years later, the city passed an ordinance imposing a severe penalty on any hospital official who transferred an ill patient. Those reforms were only partially effective at deterring such transfers.