Pikeville Medical Center

“COMPLIANCE WITH 489.24 CFR(s): 489.20(l) [The provider agrees,] in the case of a hospital as defined in §489.24(b), to comply with §489.24. This Standard is not met as evidenced by: 47852 Based on interviews, medical record review, review of video footage, Emergency Medical Services (EMS) Run Sheet review, and policy review, it was determined the facility failed to provide an appropriate Medical Screening Examination (MSE) within the capability of the hospital’s emergency department (ED) including ancillary services routinely available to the emergency department to determine whether an emergency medical condition existed for one (1) of 20 sampled patients (p), P5. P5 presented to the hospital’s ED via EMS on 06/08/2026 with complaints of chest pain. However, the facility refused to provide an appropriate MSE. Cross Refer to Findings in Tag A 2406.”

“EMERGENCY ROOM LOG CFR(s): 489.20(r)(3) [The provider agrees,] in the case of a hospital as defined in §489.24(b) (including both the transferring and receiving hospitals), to maintain a central log on each individual who comes to the emergency department, as defined in §489.24(b), seeking assistance and whether he or she refused treatment, was refused treatment, or whether he or she was transferred, admitted and treated, stabilized and transferred, or discharged. §489.24 The provisions of this regulation apply to all hospitals that participate in Medicare and provide emergency services. This Standard is not met as evidenced by: 47852 Based on interviews, medical record review, review of video footage, Emergency Medical Services (EMS) Run Sheet review, and policy review, it was determined the facility failed to maintain a central log on each individual who came to the Emergency Department (ED) seeking assistance and whether he or she refused treatment, was refused treatment, or whether he or she was transferred, admitted and treated, stabilized and transferred, or discharged for one (1) of 20 sampled patients (P), P5. P5 presented to the ED via EMS on 06/08/2026 with complaints of chest pain. However, the facility failed to document P5 on the ED central log. The findings include: The facility’s Policy “Title: 8410-0005 EMTALA -Central Log” (Undated) was reviewed. The policy revealed the facility maintained a central log with information on individuals presenting to the ED of the facility requesting treatment. Further review revealed the logs contained the names of the individual seeking assistance, means of arrival, the person transporting each patient, the time of arrival, and the disposition of patients. Review of the facility’s 06/08/2026 ED Logs revealed the facility had not listed P5 as presenting to the ED on 06/08/2026. Review of P5’s Facility (FAC) 1 medical records revealed P5 had been an in-patient at FAC1 from 06/04/2026 to 06/08/2026 with diagnoses which included shortness of breath, none-ST elevated myocardial infarction (NSTEMI) (a heart attack), multifocal pneumonia, sepsis, congestive heart failure (CHF), and nonischemic cardiomyopathy. Review of the EMS run sheet, dated 06/08/2026, revealed EMS presented P5 inside FAC1’s ED where P5 was told he “Needed to go home.” Additionally, EMS departed FAC1 at 8:20 PM and transported P5 to FAC 2 (the closest hospital). Review of facility video surveillance recording, on 06/18/2026 at 1:10 PM, revealed EMS arrived to the facility’s ED department on 06/08/2026 at 8:07 PM. Further review revealed EMS transported P5 via stretcher into the ED at 8:08 PM and parked the stretcher against the wall across from the charge nurse’s desk. Continued review revealed the EMS crew talking to someone off camera, then, at 8:11 PM, the EMS crew rolled the stretcher directly in front of the desk and there appeared to be more conversation. At 8:15 PM, the EMS crew left the ED and loaded P5 back into the ambulance, then left the facility. During a telephone interview with the ED Director, on 6/17/26 at 6:02 PM, she stated the nurse should always register the patient. During an interview, on 06/18/2026 at 3:01 PM, RN1 stated she was the nurse at the charge nurse desk on 06/08/2026 when EMS brought P5 into the ED. She further stated P5 expressed concerns regarding “going home to die”. She continued to state she talked with P5 “across the desk” and he had no physical complaints at that time, and she believed he was just anxious about just being discharged from the facility a few minutes prior. Additionally, she stated if she was aware P5 was complaining of chest pain she would have registered him. The facility failed to ensure that their policy and procedure was followed as evidenced by failing to maintain a central log on Patient #5 on 6/8/2026, when he presented to the facility’s ED via ambulance requesting treatment for complaint of chest pains.”

“MEDICAL SCREENING EXAM CFR(s): 489.24(a) & 489.24(c) (a) Applicability of provisions of this section. (1) In the case of a hospital that has an emergency department, if an individual (whether or not eligible for Medicare benefits and regardless of ability to pay) “comes to the emergency department”, as defined in paragraph (b) of this section, the hospital must- (i) Provide an appropriate medical screening examination within the capability of the hospital’s emergency department, including ancillary services routinely available to the emergency department, to determine whether or not an emergency medical condition exists. The examination must be conducted by an individual(s) who is determined qualified by hospital bylaws or rules and regulations and who meets the requirements of §482.55 of this chapter concerning emergency services personnel and direction; and (ii) If an emergency medical condition is determined to exist, provide any necessary stabilizing treatment, as defined in paragraph (d) of this section, or an appropriate transfer as defined in paragraph (e) of this section. If the hospital admits the individual as an inpatient for further treatment, the hospital’s obligation under this section ends, as specified in paragraph (d)(2) of this section. (2)(i) When a waiver has been issued in accordance with section 1135 of the Act that includes a waiver under section 1135(b)(3) of the Act, sanctions under this section for an inappropriate transfer or for the direction or relocation of an individual to receive medical screening at an alternate location do not apply to a hospital with a dedicated emergency department if the following conditions are met: (A) The transfer is necessitated by the circumstances of the declared emergency in the emergency area during the emergency period. (B) The direction or relocation of an individual to receive medical screening at an alternate location is pursuant to an appropriate State emergency preparedness plan or, in the case of a public health emergency that involves a pandemic infectious disease, pursuant to a State pandemic preparedness plan. (C) The hospital does not discriminate on the basis of an individual’s source of payment or ability to pay. (D) The hospital is located in an emergency area during an emergency period, as those terms are defined in section 1135(g)(1) of the Act. (E) There has been a determination that a waiver of sanctions is necessary. (ii) A waiver of these sanctions is limited to a 72-hour period beginning upon the implementation of a hospital disaster protocol, except that, if a public health emergency involves a pandemic infectious disease (such as pandemic influenza), the waiver will continue in effect until the termination of the applicable declaration of a public health emergency, as provided under section 1135(e)(1)(B) of the Act. (c) Use of dedicated emergency department for nonemergency services. If an individual comes to a hospital’s dedicated emergency department and a request is made on his or her behalf for examination or treatment for a medical condition, but the nature of the request makes it clear that the medical condition is not of an emergency nature, the hospital is required only to perform such screening as would be appropriate for any individual presenting in that manner, to determine that the individual does not have an emergency medical condition. This Standard is not met as evidenced by: 47852 Based on interviews, medical record review, review of video footage, Emergency Medical Services (EMS) Run Sheet review, and policy review, it was determined the facility failed to provide an appropriate Medical Screening Examination (MSE) within the capability of the hospital’s emergency department (ED) including ancillary services routinely available to the emergency department to determine whether an emergency medical condition existed for one (1) of 20 sampled patients (p), P5. P5 presented to the hospital’s ED via EMS on 06/08/2026 with complaints of chest pain. However, the facility refused to provide an appropriate MSE. The findings include: Review of the facility policy, “Title: 8410.0001 Medical Screening,” (undated) , revealed that any patient who came to the hospital requesting emergency services was entitled to and received a Medical Screening Exam (MSE) performed by individuals qualified to perform such examination to determine whether an emergency medical condition existed. Further review revealed the facility defined a MSE as the process required to reach within reasonable clinical confidence the point at which it could be determined whether an emergency medical condition existed. Continued review revealed such screenings must be done within the facility’s capabilities and available personnel. Additionally, an MSE extended beyond triage and included both a generalized assessment and a focused assessment based on the patient’s chief complaint with the intent to determine the presence or absence of an emergency medical condition. An MSE must be performed by physicians or other qualified medical personnel as specified in medical staff bylaws and departmental policy. Review of the facility policy, “ Title: C6230.0057 Duties and Responsibilities of Triage,” (undated), revealed the triage RN or Paramedic would evaluate objective and subjective data collection and document, measure all vital signs, and perform an Emergency Severity Index (ESI- a tool used in emergency departments to prioritize care based on the severity of an individual’s condition) Triage Assessment on all patients and assign the level of acuity to each patient. Review of the facility policy, “Title: C6230.0054 Indication for Electrocardiogram (ECG),” (undated), revealed an ECG was indicated for patients with complaints of chest pain, chest pressure, or patients with a known cardiac history that complained of symptoms related to acute coronary syndrome (ACS). Review of the facility policy, “Title: C6230.0002 Chest Pain Procedure,” (undated), revealed the facility was certified as a Level V (5) Center and the ED followed the following steps to meet the standards set by the American College of Cardiology (ACC) Accreditation Services, when the patient arrives by EMS with complaints of chest pain, the nurse would: 1. Assign the patient an exam room after receiving report 2. Obtain a copy of the report sheet with copy of any electrocardiogram (ECG) done prior to arrival 3. Relay to the Licensed Practitioner of a high-risk acute coronary syndrome (ACS) patient Further review revealed the triage, or primary nurse would initiate the nursing Chest Pain guidelines (see Chest Pain Protocol) and initiate the Chest Pain flow sheet. Review of P5’s Facility (FAC) 1 medical records revealed P5 had been an in-patient at FAC1 from 06/04/2026 to 06/08/2026 with diagnoses which included shortness of breath, none-ST elevated myocardial infarction (NSTEMI) (a heart attack), multifocal pneumonia (Lung inflammation that affects more than one part of the lobes of the lungs), sepsis (life -threatening, medical emergency that happens when your body has an extreme response to an infection) ,congestive heart failure (CHF- chronic medical condition where the heart muscle cannot pump blood efficiently) , and nonischemic cardiomyopathy (group of heart muscles diseases where the heart’s pumping efficiency is impaired). Review of facility video surveillance recording for 06/08/2026 at 1:10 PM revealed EMS loaded P5 into an ambulance on the second level of the parking structure and left the parking area at 8:05 PM and drove immediately to the facility’s Emergency Department at 8:07 PM. Further review revealed EMS transported P5 via stretcher into the ED at 8:08 PM and parked the stretcher against the wall across from the charge nurse’s desk. Continued review revealed the EMS crew talking to someone off camera, then, at 8:11 PM, the EMS crew rolled the stretcher directly in front of the desk and there appeared to be more conversation. At 8:15 PM, the EMS crew left the ED and loaded P5 back into the ambulance, then left the facility. At no time did a facility staff member perform any hands-on assessment of P5. Review of the EMS run sheet, dated 06/08/2026, revealed EMS arrived at Facility (FAC) 1 at 7:00 PM to transport P5 home after being discharged from FAC1. Further review revealed EMS assisted P5 into the ambulance at which time P5 complained of chest pain and tingling in his legs and feet. Continued review revealed EMS returned P5 inside FAC1’s ED where P5 was told he would not be readmitted and he “needed to go home.” Additionally, EMS departed FAC1 at 8:20 PM and transported P5 to FAC 2 (the closest hospital). EMS arrived at FAC2 at 9:00 PM. Review revealed the mileage was 31 miles between FAC1 and FAC2 and was 40 minutes between the facilities. Review of P5’s FAC2 medical record revealed P5 arrived to FAC2’s ED on 06/08/2026 at 8:57 PM. Further review revealed FAC2 assessed P5 with angina, cardiomyopathy, and heart failure. FAC2 discharged P5 home on 06/09/2026 at 12:02 PM. During an interview, on 06/17/2026 at 10:19 AM, EMT 1 stated she was assigned to transport P5 home after being discharged from this facility. She further stated, once inside the ambulance, P5 complained of chest pain and vomited in the ambulance. She continued to state she explained to the ED staff (RN1) that P5 had additional complaints. Additionally, EMT1 stated RN1 informed her the facility would not readmit P5. EMT1 stated she notified dispatch and was instructed to transport P5 to the closest hospital to the patient’s home if symptoms continued and EMT1 transported P5 to Facility 2. During an interview, on 06/18/2026 at 3:01 PM, RN1 stated she was the nurse at the charge nurse desk on 06/08/2026 when EMS brought P5 into the ED. RN1 stated P5 expressed concerns regarding “going home to die”, and P5 had no physical complaints at that time of arrival at the facility. RN1 stated if P5 was complaining of chest pain, she would have registered him and performed an ECG. She stated anxiety could increase a patient’s vital signs, but she did not check vital signs or complete any assessment on P5 in the ED on 06/08/2026. The facility failed to triage, conduct a triage assessment, and did not obtain vital signs for P5 when he presented to the hospital’s ED as stated in the hospital’s policy. During an interview, on 06/18/2026 at 11:50 AM, RN2 stated a patient presenting to the ED with chest pain would be taken straight to a room and an ECG performed within 10 minutes. He further stated the goal was for a doctor to see the patient within 10-15 minutes and the ECG results were taken directly to the doctor once completed. During an interview, 06/18/2026 at 12:20 PM, RN3 stated any patient presenting to the ED with chest pain should have an ECG within 10 minutes and the ECG reading would be taken to the doctor as soon as completed. The facility failed to follow their Chest pain procedure and failed obtain an EKG on P5 when he presented to the hospital’s ED with complaints of chest pain. The facility failed to follow their policy and procedure as evidenced by failing to ensure that an appropriate medical screening examination was provided within the capability of the hospital’s ED including ancillary services routinely available to the ED to determine whether or not an emergency medical condition existed for P5 when he presented to the hospital’s ED via ambulance complaining of chest pain.”