According to documents at the center of a court hearing late last month, Mobile Infirmary Medical Center was within weeks of being terminated from participation in the federal Medicare program in 2013, after a state investigation found “an immediate and serious threat to the health and safety of any individual who comes to the emergency department and requests examination or treatment for an emergency medical condition.”

The investigation, launched after a complaint involving the lack of treatment given to Lejuan Johnson — an indigent AIDS patient who died on a street next to Mobile Infirmary after being forcibly removed and abandoned there by security personnel — was detailed in a letter written by the Center for Medicare and Medicaid Services (CMS) to Infirmary Administrator Joe Stough on Nov. 1, 2013.

CMS determined the Infirmary’s failure to evaluate or admit Johnson constituted a violation of the Emergency Medical Treatment and Active Labor Act (EMTALA).

“Consequently, we plan to terminate Mobile Hospital [sic] participation in the Medicare program,” according to the letter.

Attorneys for Mobile Infirmary and Johnson’s estate were in court April 22 arguing separate motions to strike the letter, the investigation and a related affidavit from an ongoing wrongful death case resulting from Johnson’s death. That case is scheduled for trial in October.

Working on behalf of the plaintiff, attorneys Vince Kilborn and David McDonald said the CMS letter and investigation were uncovered last year as the result of a Freedom of Information Act (FOIA) request they initiated. The discovery phase of the case has lasted nearly three years.

Kilborn told Circuit Court Judge Michael Youngpeter the documents “go to the heart of how deliberate, malicious and intentional” Johnson’s death was.

The investigation, performed by the Alabama Department of Public Health in June 2013, detailed two incidents in which people who sought treatment at Mobile Infirmary died as the result of nontreatment.

Johnson, identified as PI#2 (Patient Indentifier 2) in the investigation, arrived March 5, 2013, displaying “inappropriate behavior,” but was neither examined nor stabilized. Instead, “according to a security videotape, a security officer picked up the patient and put [Johnson] in a wheelchair. The security officer transported [Johnson] off of hospital property and dumped [him] out of the wheelchair. Hours later, the patient was picked up via Emergency Medical Services, transported to another acute-care hospital and was admitted to the intensive care unit. [Johnson] died on March 18, 2013.”

Another patient, allegedly driven to the hospital by someone else, was having seizures upon arrival but ordered to leave the premises by a security officer. The driver complied and went to another hospital, but the patient had no pulse and was not breathing when they arrived.

“It’s pretty remarkable,” McDonald explained. “Medicare sent Mobile Infirmary a letter saying ‘listen, y’all are doing such a terrible job we think y’all are dangerous to patients.’”

In tax forms submitted to the IRS in 2014, Mobile Infirmary reported $107.6 million in total revenue from the Medicare program, or roughly 26 percent of its total revenue.

Under a section describing the Infirmary’s program service accomplishments, it was noted Medicare and Medicaid patients accounted for 46.80 percent of total inpatient visits and 28.91 percent of outpatient gross revenue in the fiscal year ending March 31, 2014. The statement specified, “while the organization is reimbursed to some extent for treating Medicare and Medicaid patients, the total received was approximately $330 million less than what would have been received had these programs paid full charges.”

As a result of this story, the Infirmary issued a statement advising specifics of the case cannot be discussed due to active litigation, but said the CMS complaint was resolved before its participation in Medicare could be terminated.

“CMS investigates any and all potential violations of [EMTALA],” the statement read. “It is standard procedure for CMS to send a letter to hospitals identifying any possible deficiencies and indicating that one possible outcome for failure to resolve such deficiencies is exclusion from participation in the Medicare program. Mobile Infirmary Medical Center has always complied, in full, with all CMS investigations and requests for information and has never been excluded from participation in the Medicare program. All actions that have been put into place by Mobile Infirmary resulting from prior EMTALA investigations have been universally accepted as satisfactory by CMS.”

The Monday after the court hearing, Youngpeter agreed to admit the documents conditionally while also allowing the deposition of a disputed witness.

Defendants in the case include Mobile Infirmary and two security guards involved in the incident, Shawn Poff and Jerry Ripple.

McDonald said the videotape, testimony and physical evidence is damning, but emphasized it’s not a case of malpractice. Johnson ultimately died of organ failure as the result of exposure to the elements while he was outside the Infirmary.

“It’s a wrongful death suit,” he said. “We could have sued [the Infirmary] for malpractice, because [they] failed to treat this guy. But we’re not. We’re saying, ‘you didn’t even have to treat him, all you had to do was not drag him across the street and leave him in the dark to die in the cold.’ If they would have just sent him back home he would have still been alive today. ”

Motion to strike, with CMS investigation and letter attached