Tristar Skyline Medical Center Agreed to Pay $725,000 for Allegedly Violating Patient Dumping Statute by Failing to Provide Available Stabilizing Treatment

On December 29, 2021, Tristar Skyline Medical Center (Tristar Skyline), Nashville, Tennessee, entered into a $725,000 settlement agreement with OIG. The settlement agreement resolves allegations that, based on OIG’s investigation Tristar Skyline violated the Emergency Medical Treatment and Labor Act (EMTALA), when it failed to provide, with the staff and facilities available, further medical examination and treatment required to stabilize 25 patients’ emergency medical conditions. In each of these incidents, a patient presented to Tristar Skyline with an unstable psychiatric emergency medical condition. Rather than admitting the patient to Tristar Skyline’s inpatient psychiatric unit that had the capability and capacity to treat the patient, Tristar Skyline held the patient inappropriately in its Emergency Department (ED) for over 24 hours before transferring the patient to a state psychiatric hospital. The decision to transfer the patient, and where to transfer the patient, was made by Tristar Skyline and the Tristar Behavioral Health Transfer Center and was based, in part, on the patient’s insurance status. Tristar Skyline asserts that its decision to transfer the patients was based on a recommendation from a mobile crisis team. The patients had varied medical histories and presented with individualized complaints to the ED. While each individual was determined to have an unstable emergency medical condition, Tristar Skyline failed to provide needed and available stabilizing treatment to each of these individuals.

The following are examples of such incidents.

Patient B.J. a 28-year-old male, presented to Tristar Skyline’s ED on October 21, 2017, at 7:31 A.M. with complaints of aggressive behavior, schizophrenia, and hallucinations. B.J. had out-of-state Medicaid insurance. B.J. presented to the ED after his family brought him to Tristar Skyline’s Madison Campus for psychiatric care, but the family was instructed to bring B.J. to Tristar Skyline’s ED for medical clearance. At 7:58 A.M., a physician’s assistant initiated an examination of B.J., and an ED physician completed a Certificate of Need for Emergency Involuntary Admission. B.J. remained in the ED for 57 hours and 19 minutes, without receiving available stabilizing treatment before being transferred to a state psychiatric hospital with an unstable emergency psychiatric condition.

Patient W.I., a 30-year-old male, was brought by ambulance to Tristar Skyline’s ED on September 16, 2017, at 9:22 P.M. with complaints of depression, suicidal ideations, and plans to harm himself. W.I. had out-of-state Medicaid insurance. At 9:48 P.M., an ED physician initiated an examination of W.I., and a Certificate of Need for Emergency Involuntary Admission was completed. W.I. was transferred to a state psychiatric hospital after being held in the ED for 81 hours and 38 minutes, during which time he did not receive available stabilizing treatment

Patient J.P., a 26-year-old female, presented to Tristar Skyline’s ED on June 14, 2017, at 4:08 P.M. with complaints of a psychotic break, suicidal ideations and plans to shoot herself. J.P. was uninsured. At 4:37 P.M., an ED physician initiated an examination, and a Certificate of Need for Emergency Involuntary Admission was completed by the ED physician. S.B. remained in the ED for 76 hours and 35 minutes, without receiving stabilizing treatment, before being transferred to a state psychiatric hospital with an unstable emergency psychiatric condition.

Patient C.G., a 46-year-old female, presented to Tristar Skyline’s ED on July 16, 2017, at 5:25 A.M. with complaints of suicidal ideations. C.G. was uninsured. At 5:41 P.M., an ED physician initiated an examination. C.G. had major depressive disorder and had plans to shoot herself. C.G. had presented to the Madison Campus for psychiatric care but was sent to the ED for medical clearance and placement. On July 19, 2017, C.G. was transferred to a state psychiatric hospital after being held in the ED for 59 hours and 21 minutes, during which time she did not receive available stabilizing treatment for her emergency medical condition.

Similar incidents occurred for the following 21 individuals presenting to the ED: B.K. (2/17/2017); T.B. (2/20/2017); D.C. (7/17/2017); D.N. (9/28/2017); J.P. (10/13/2017); J.Y. (1/22/2016); M.E. (7/8/2017); B.H. (1/14/2017); B.A. (5/3/2017); A.B. (5/11/2017); T.T. (5/10/2017); J.P. (2/17/2017); J.N. (6/14/2017); T.T. (7/12/2017); W.F. (7/12/2017); J.J.M. (5/31/2017); J.B. (8/26/2017); L.D. (10/19/2017); S.A. (7/27/2017); J.H. (1/12/2017); and I.H. (6/3/2017).

In each of these cases, TriStar Skyline determined the individual had an unstable emergency medical condition and failed to provide needed and available treatment to stabilize that emergency medical condition. Senior Counsel Sandra Sands and Associate Counsel Tessa Deveraux represented OIG.

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