Piedmont 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: 53615 Based on facility policy review, medical record reviews, and interview, it was determined the hospital failed to 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 an emergency medical psychiatric condition existed for 1 (#21) of 27 patients. Pt. #21 presented to the hospital’s ED with complaints of Suicidal Ideations (thoughts of preoccupation with ending one’s life) and suspected sexual abuse at home. The findings included: Cross Refer to A-2406 related to the failure to provide Patient (Pt) #21 an appropriate MSE.”

“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: 53615 Based on facility policy review, medical record reviews, and interview, it was determined the hospital failed to 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 an emergency medical psychiatric condition existed for 1 (#21) of 27 patients. Pt. #21 presented to the hospital’s ED with complaints of Suicidal Ideations (thoughts of preoccupation with ending one’s life) and suspected sexual abuse at home. Findings included: A facility policy titled, “Emergency Medical Treatment and Labor Act of 1986 (EMTALA),” revised 08/2025, revealed the purpose of the policy was “To ensure individuals presenting to [Facility Name] emergency departments receive an appropriate Medical Screening Examination (MSE) and stabilizing treatment or appropriate transfer in accordance with Emergency Medical Treatment and Labor Act of 1986 (EMTALA) and that incoming transfer requests are accepted or declined in accordance with EMTALA.” The policy revealed, “Procedure A. Guidelines 1. [Facility Name] will provide an appropriate MSE within the capability of [Facility Name] to any individual coming to the Dedicated Emergency Department, including ancillary services routinely available, to determine whether or not an Emergency Medical Condition exists.” The policy also revealed “D. 2. The MSE will be performed by a physician or other Qualified Medical Personnel. The examination should be specific to the patient’s complaint and presenting symptoms.” A facility policy titled, “Emergency Department Standards of Practice of Care,” revised 07/2025, revealed, “Standard III 2. A. The patient will receive age-appropriate care by competent providers, consistent with diagnostic condition, assessment and treatment goals.” Patient #21’s “ED note,” dated 03/27/2025 at 5:42 PM, revealed the patient a 12-year-old was seen at 2:05 PM, with a chief complaint of wanting to hurt himself/herself, “wanted to throw [his/her] head against the wall.” Patient #21’s history of present illness indicated the patient presented to the ED for suicidal ideation and suspected sexual abuse at home. Per the ED note, Patient #21 had written an assignment that he/she wanted to hurt himself/herself. Patient #21’s “Orders,” included an order for a medical service consult for “ Psychiatry, Psychiatric Evaluation dated 03/27/2025 at 2:05 PM., ordered by the ED physician. Further review of “Orders” dated 3/27/25 at 2:06 PM, revealed in part, Order: Nursing Communication (Determine level of risk utilizing psych (Psychiatric) screening too and follow algorithm and precautions listed) ...”Order Details: Stat (Immediately or without delay) ...Continuous, Determine level of risk utilizing psych (Psychiatric) screening tool and follow algorithm and predations listed in psych packet.” The medical record contained no documented evidence that Patient #21 received a psychiatric evaluation prior to being transferred to another facility on 03/27/2025 at 8:25 PM. Patient #21 was in the ED for 6.5 hours without receiving a psychiatric evaluation by the psychiatric evaluation nurse who was available at the time of patient #21’s ER visit. An “Assessment - Behavioral Health,” for Patient #21 was completed on 03/27/2025 at 2:44 PM, revealed in part, “CSSRS (Columbia-Suicide Severity Rating scale [also called the Columbia protocol] It is the screening tool used by healthcare providers to quickly assess a patient’s risk of suicide, identify their severity of their thoughts and determine the level of immediate care they need). CSSRS Youth Wish to be dead: Lifetime,- yes. CSSRS Past Mo (month) Suicide Thought- yes. CSSRS Youth Past Mo Suicide Method- yes. CSSRS Youth Past Mo Suicide with Plan- No. CSSRS Youth Lifetime Suicide Behavior- yes. Self-Harm interventions, Youth (See below) Patient is 6 years of Age or older: Yes. Suicide Prsnt (Present) Sign Sympt (symptoms( BH (Behavioral Health)- yes. Patient #21 had suicidal thoughts, Per the Assessment - Behavioral Health, “Suicide precautions were initiated, Environmental checklist initiated.” Patient #21’s “Nursing Note,” dated 03/27/2025 at 3:39 PM, the nurse consulted with their director and a psychiatric intake RN (registered nurse) regarding the patient. Per the Nursing Note, Patient #21 being a pediatric case, needed transported to Facility #3. Per the Nursing Note, the psychiatric intake RN was consulted again and indicated the facility would do nothing further with Patient #21. During an interview on 02/06/2026 at 11:35 AM, the ED Manager (EDM #1) for Facility #1 stated that the facility did not have a pediatric unit/floor but expected patients to receive an MSE. The facility failed to provide an appropriate MSE due to the absence of Patient #21 on 3/27/2025 receiving a psychiatric evaluation that was ordered by the ED physician to determine whether the patient had an emergency psychiatric condition existed. The psychiatric evaluation was needed to determine whether Patient #21’s Suicidal ideation posed a threat to harm to herself.”