The Harris County (TX) Hospital District has begun turning away uninsured patients from other counties who show up in its facilities and do not need urgent care, unless they pay cash up front. The policy is one of several strategies the district is pursuing to prevent "cataclysmic" effects on patients as the state considers cuts that could take nearly 10% of the district's budget, president and CEO David Lopez said. If a patient enters a hospital or clinic with a medical emergency, federal law mandates treatment. Many people, however, visit emergency rooms with routine illnesses, said Shkelzen Hoxhaj, MD, chief of emergency medicine at Ben Taub General Hospital, the district's flagship facility. It cost the hospital district about $3.9 million to treat uninsured, out-of-county, non-emergency patients during the fiscal year that ended Feb. 28, said district CFO Mike Norby. About $200,000 of that will be collected, he said.