COMPLAINT INTAKE SUMMARY WORKSHEET RESPONDENT INFORMATION Name & Address PROVIDENCE HOSPICE OF SEATTLE 425 PONTIUS AVE N STE 300 SEATTLE, WA 98109-5450 Case # Allegation 2014-4871 (FS)IHS Failure to Provide Medically Reasonable and/or Necessary Items or Services Substandard or Inadequate Care License # IHS.FS.00000336 Issued Phone # Legal Action Yes No Compliance Yes No Expires 9/30/15 Status Active Cases Open: 0 Closed: 0 COMPLAINANT INFORMATION Name & Address COMPLAINANT WANTS TO REMAIN ANONYMOUS. 1 - Name - Whistleblower Regarding Health Care Provider o... Phone # E-Mail SUMMARY OF COMPLAINT COMPLAINANT WANTS TO REMAIN ANONYMOUS. Respondent facility is alleged to have failed in properly assisting a patient seeking information regarding the Death With Dignity Law. The patient made requests to his physician and numerous hospice clinicians who didn't provide him with the information. The patient was under the facility service with brain cancer and wanted to end his life as he didn't want his disease to advance. The patient shot himself in the bathtub which could have been prevented peacefully if the information had been available to the patient. The complainant is concerned that other patient's are not given these options and they are not documented in the patient's record. The respondent facility has told employees that if they discuss these matters with patients, they could be fired. Companion cases: Unknown Medical Unknown Nurse Y:\Confidential\HSQA\CSO\ComplaintIntake\Facilities -\Case Summarys\2014\6 - June\Providence Hospice of Seattle\20144871(FS)IHS.doc PROVIDENCE HOSPICE OF SEATTLE 2014-4871FS PAGE 1 1 - Name - Whistleblower Regarding Health Care Provider or Health Care Facilit... 1 - Name - Whistleblower Regarding Health Care Provider or H... PROVIDENCE HOSPICE OF SEATTLE 2014-4871FS PAGE 2 1 - Name - Whis... 1 - ... 1 - Name - Whistle... 1 - Name - Whistleblower Regarding Health Ca... 1 - Name - W... 1 - Nam... 1 - Name - Whistleblower ... 1 - Name - Whi... 1 - Name - Whistleblower Regarding Health Care Provide... PROVIDENCE HOSPICE OF SEATTLE 2014-4871FS PAGE 3 gather all pertinent subjective and objective information. I strongly believe that omitting such a request falls under this category. Recently, as a result of this incident, the organizaiton changed their policy to allow health care providers to discuss death with dignity with patients. That being said, Providence Hospice should be held responsible for the tragic, violent death of their patient which, had he been given more resources. would have been more peaceful. I strongly believe this constitutes patient abandonment. 11. Please summarize your primary concerns: Hospital policy preventing discussion of the full range of patient choices, effectively neglecting this patients need and request for accurate information from health care providers. When the patient complained about not having and of life options, he was not provided any information or referrals to an organization that could meet his needs, including transfer to another hospice organization. 12. Have you filed a complaint with anyone at the facility? If so, with whom, when and have you received a response? I have not filed a complaint with the facilitysome point in the future apply for employment with Providence, arr] afraid of retribution. 13. Have you reported this to, or filed a complaint or action with, any other agency or organization? Such as law enforcement. Adult Protective Services, professional licensing boards? If so, which agencies, when and what were the actions or findings? No You may submit this form by mail, email or fax. Mail: Health Systems Quality Assurance Complaint Intake Unit PO Box 47857 Olympia. WA 98504-7857 Mark clearly on the envelope ?Confidential? Email: Fax: 360236-2626 DOH 655-055 October 2013 Page 2 of 2 PROVIDENCE HOSPICE OF SEATTLE 2014-4871FS PAGE 4 2014-4871FS_pdf-r.pdf redacted on: 1/12/2017 10:08 Redaction Summary ( 12 redactions ) 1 Privilege / Exemption reason used: 1 -- "Name - Whistleblower Regarding Health Care Provider or Health Care Facility - RCW 43.70.075(1), RCW 42.56.070(1)" ( 12 instances ) Redacted pages: Page 1, Name - Whistleblower Regarding Health Care Provider or Health Care Facility - RCW 43.70.075(1), RCW 42.56.070(1), 1 instance Page 2, Name - Whistleblower Regarding Health Care Provider or Health Care Facility - RCW 43.70.075(1), RCW 42.56.070(1), 2 instances Page 3, Name - Whistleblower Regarding Health Care Provider or Health Care Facility - RCW 43.70.075(1), RCW 42.56.070(1), 9 instances Page 1