Regulatory agencies have started investigations into a claim by a former Centra Health employee that the healthcare provider violated a federal emergency medical treatment law by wrongfully refusing to admit certain juvenile psychiatric patients.

Some investigating personnel were on the Virginia Baptist Hospital campus this week, according to a spokesperson with the state agency.

Kimberly Hartman was the manager of Centra’s Child & Adolescent Psychiatric Unit within Virginia Baptist Hospital from 2014 until she was terminated June 6, according to an email she sent to regulatory officials. Children are referred to the unit by emergency room personnel, a mental health care provider or a community services board like Horizon Behavioral Health to receive treatment for emergency emotional or behavioral issues.

In a statement emailed June 29 to the Virginia Board of Medicine, the Virginia Department of Behavioral Health and Developmental Services, the Centers for Medicare & Medicaid Services and the Virginia Office of the Attorney General, Hartman said she was fired after she raised concerns to other Centra employees about denying admission of patients to the unit.  

She claimed some denials of patient admission to her unit violated the federal Emergency Medical Treatment & Labor Act (EMTALA), which ensures access to emergency services regardless of someone’s ability to pay.

Centra spokesperson Diane Ludwig said Hartman hadn’t brought forward any concerns while she was employed prior to the events at the beginning of June. She said Centra is investigating her claims and intends to work with other investigating agencies.

“We have thoroughly investigated the EMTALA concerns and have confirmed there was no violation of law,” she stated in an email, referring to the concerns Hartman raised prior to her dismissal.

She confirmed Hartman was terminated on June 6, “although Centra does not typically comment on personnel matters.”

The Virginia Department of Behavioral Health and Developmental Services (DBHDS) confirmed receiving Hartman’s email concerns and “we are taking it very seriously,” according to spokesperson Maria Reppas. The department is conducting its own investigation into parts of her complaint outside of the EMTALA violations, since those claims fall under the purview of other agencies, Reppas said.

Reppas said DBHDS licensing staff visited Virginia Baptist three times last week and were on campus again on Tuesday.

Hartman said she was going over a patient denial report on June 2 because the unit, which has 20 beds for kids ages 5 to 18, had only nine children in it. In her statement, she said she saw two children were denied admittance to the unit because they were “autistic and out of the area” and notified other Centra workers a denial for that reason was a violation of EMTALA.

Other Centra workers told her they’d been instructed not to accept children from out of the area with autism diagnoses because it was “‘too hard to find after care appointments,’” she wrote in the statement.

Centra’s primary service area is the city of Lynchburg and the counties of Amherst, Appomattox, Bedford, Campbell and Prince Edward, and it provides medical services to more than 500,000 people across a more than 9,000-square-mile service area.

Hartman said she arranged for one of the children — who was in the Novant Health UVA Prince William Medical Center’s emergency department for 36 hours and had been restrained — to be admitted to her unit. She also said in the statement she set up a meeting with leading Centra staff on June 5 to address the issue.

The Centers for Medicare & Medicaid Services (CMS) handle complaints for Medicare and Medicaid-certified facilities, including EMTALA violation complaints. According to a letter from a program analyst with CMS’s Certification and Enforcement Branch that Hartman forwarded to The News & Advance, CMS has authorized the Virginia Department of Health’s Office of Licensure & Certification to look into Hartman’s concerns.

The Joint Commission, which provides accreditation to healthcare providers including Centra, confirmed to The News & Advance last week that its Office of Quality and Patient Safety is aware of Hartman’s report and is reviewing it.

While reviewing denial reports from 2018 and early 2019 before the meeting she proposed with staff, Hartman said she found “numerous” EMTALA violations for improper denial criteria. One of the reasons for denial was listed as “homeless,” she wrote in her June 29 email.

At the meeting, Hartman said she presented the denial reports and other paperwork to the three lead staff members there, including “the email I had sent out about the EMTALA violations, and my demand to stop these illegal actions.”

A second meeting, held immediately after the first meeting, ended with a staffer demanding she leave the unit, she wrote in her June 29 email. The next day, she received an email from Centra HR staff stating she was terminated, but thanking her for raising her EMTALA violation concerns.

Hartmann secured an attorney after her dismissal. Her attorney, Paul Valois, last week, said what happened to her constitutes wrongful termination and “we’ll be filing an action very soon.” Valois has a hand in several other open civil cases against Centra.

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