Adverse Events Facilities and Date of Event Report 2006-2019 Facility Credential CBC.FS.00000015 Facility County Date Confirmed 9/14/2017 Lakeside Birth Center number of events: Facility Name Lakeside Birth Center Facility Type: Psychiatric Hospital HPSY.FS.00000004 HPSY.FS.00000004 HPSY.FS.00000004 HPSY.FS.00000004 HPSY.FS.60429197 HPSY.FS.60429197 HPSY.FS.60429197 HPSY.FS.60429197 HPSY.FS.60429197 HPSY.FS.60429197 HPSY.FS.60429197 HPSY.FS.60429197 HPSY.FS.60429197 HPSY.FS.60429197 HPSY.FS.60429197 HPSY.FS.60429197 HPSY.FS.60429197 HPSY.FS.60429197 HPSY.FS.60429197 HPSY.FS.60429197 BHC Fairfax Hospital BHC Fairfax Hospital BHC Fairfax Hospital BHC Fairfax Hospital Cascade Behavioral Cascade Behavioral Cascade Behavioral Cascade Behavioral Cascade Behavioral Cascade Behavioral Cascade Behavioral Cascade Behavioral Cascade Behavioral Cascade Behavioral Cascade Behavioral Cascade Behavioral Cascade Behavioral Cascade Behavioral Cascade Behavioral Cascade Behavioral HPSY.FS.00000019 Navos Navos Navos Navos Navos Navos Navos HPSY.FS.60877559 Rainier Springs HPSY.FS.00000019 HPSY.FS.00000019 HPSY.FS.00000019 HPSY.FS.00000019 HPSY.FS.00000019 HPSY.FS.00000019 HPSY.FS.60739147 HPSY.FS.60739147 HPSY.FS.60739147 Smokey Point Behavioral Hospital Smokey Point Behavioral Hospital Smokey Point Behavioral Hospital SI.FS.00003484 2 King Hospital Hospital Hospital Hospital Hospital Hospital Hospital Hospital Hospital Hospital Hospital Hospital Hospital Hospital Hospital Hospital Facility Type: Department of Corrections Medical Facility SI.FS.00003484 6/22/2009 7/30/2014 4/25/2017 11/8/2018 BHC Fairfax Hospital number of events: King 5/26/2015 5/27/2015 6/15/2015 3/16/2017 4/7/2017 4/20/2017 6/3/2017 7/26/2017 11/16/2017 1/25/2018 2/8/2018 3/22/2018 5/13/2018 1/26/2019 4/20/2019 5/26/2019 Cascade Behavioral Hospital number of events Event Type **4D - Death or serious injury of neonate 10/12/2009 12/21/2013 7/30/2016 3/2/2017 7/12/2017 4/22/2019 6/17/2019 Navos number of events: Clark 10/15/2018 Rainier Springs number of events: Snohomish 6/18/2018 8/14/2018 6/23/2019 Smokey Point Behavioral Hospital number of events: 7C - Sexual abuse/assault 7C - Sexual abuse/assault 3B - Patient elopement (disappearance) 4A - Medication error 4 7C - Sexual abuse/assault 4E - Patient death or serious injury associated with a fall 4E - Patient death or serious injury associated with a fall 7C - Sexual abuse/assault 4E - Patient death or serious injury associated with a fall 3C - Patient suicide, attempted suicide, or self-harm 4E - Patient death or serious injury associated with a fall 4E - Patient death or serious injury associated with a fall 4E - Patient death or serious injury associated with a fall 4E - Patient death or serious injury associated with a fall 4E - Patient death or serious injury associated with a fall 4E - Patient death or serious injury associated with a fall 4E - Patient death or serious injury associated with a fall 7C - Sexual abuse/assault 7C - Sexual abuse/assault 7C - Sexual abuse/assault 16 King Spokane Airway Heights Corrections Center Airway Heights Corrections Center 3C - Patient suicide, attempted suicide, or self-harm 7D - Physical assault 3B - Patient elopement (disappearance) 7D - Physical assault 4E - Patient death or serious injury associated with a fall 7C - Sexual abuse/assault 4E - Patient death or serious injury associated with a fall 7 4E - Patient death or serious injury associated with a fall 1 4E - Patient death or serious injury associated with a fall 7D - Physical assault 4E - Patient death or serious injury associated with a fall 3 11/1/2017 11/13/2018 5D - Restraints 4A - Medication error Airway Heights Corrections Center number of events: Franklin 7/21/2017 8/15/2018 9/7/2018 3/9/2019 6/6/2019 2 Coyote Ridge Corrections Center number of events: Snohomish 7/16/2018 9/12/2018 6/29/2019 5 SI.FS.00008877 Airway Heights Corrections Center number of events: Grays Harbor 2/23/2012 2/5/2016 2/6/2016 3/26/2018 3 Stafford Creek Corrections Center Stafford Creek Corrections Center Stafford Creek Corrections Center Stafford Creek Corrections Center Washington State Penitentiary Stafford Creek Corrections Center number of events: Walla Walla 6/25/2011 4 SI.FS.00000204 Washington State Penitentiary number of events: 1 SI.FS.00004412 SI.FS.00004412 SI.FS.00004412 SI.FS.00004412 SI.FS.00004412 SI.FS.00000205 SI.FS.00000205 SI.FS.00000205 SI.FS.00008877 SI.FS.00008877 SI.FS.00008877 Coyote Ridge Corrections Center Coyote Ridge Corrections Center Coyote Ridge Corrections Center Coyote Ridge Corrections Center Coyote Ridge Corrections Center Monroe Correctional Complex Monroe Correctional Complex Monroe Correctional Complex Facility Type: Ambulatory Surgical Facility ASF.FS.60100112 ASF.FS.60101035 King 10/30/2015 ASC/Endoscopy Center number of events: Bellevue Surgery Center King 4/8/2019 Bellevue Surgery Center number of events: Bellingham Ambulatory Surgery Center Whatcom 8/11/2014 Bellingham Ambulatory Surgery Center 8/11/2014 Bellingham Ambulatory Surgery Center 1/12/2016 Bellingham Ambulatory Surgery Center 6/27/2018 Bellingham Ambulatory Surgery Center number of events: Bellingham Surgery Center Whatcom 12/29/2010 Bellingham Surgery Center 1/21/2014 Bellingham Surgery Center number of events: King Kaiser Permanente Capitol Hill Procedure Center 6/29/2017 Capital Hill Procedure Center number of events: Cascade Ear Nose and Throat Surgery Center Skagit 5/17/2018 Cascade Ear Nose and Throat Surgery Center number of events: King Cascade Surgery Center 2/15/2011 Cascade Surgery Center number of events: Snohomish 1/24/2015 Cascade Valley Arlington Surgery Center Cascade Valley Arlington Surgery Center number of events: Pierce Cedar Laser and Surgery Center 6/14/2012 Cedar Laser and Surgery Center 1/29/2015 Cedar Laser and Surgery Center number of events: Eastside Surgery Center King 11/18/2015 Eastside Surgery Center 5/12/2016 Eastside Surgery Center number of events: Snohomish 9/19/2013 Edmonds Center for Outpatient Surgery ASF.FS.60101038 Everett Bone and Joint Surgery Center ASF.FS.60287715 ASF.FS.60102997 ASF.FS.60102997 ASF.FS.60102997 ASF.FS.60102997 ASF.FS.60099795 ASF.FS.60099795 ASF.FS.60627140 ASF.FS.60442571 ASF.FS.60099142 ASF.FS.60101763 ASF.FS.60252056 ASF.FS.60252056 ASF.FS.60477711 ASF.FS.60477711 ASC/Endoscopy Center ASF.FS.60298280 Eye Associates Surgery Center ASF.FS.60641959 First Hill Surgery Center ASF.FS.60100914 Gateway Surgery Center Gateway Surgery Center ASF.FS.60100914 ASF.FS.60100954 DOH 689-013 September 2014 Office of Community Health Systems 4E - Patient death or serious injury associated with a fall 4E - Patient death or serious injury associated with a fall 3C - Patient suicide, attempted suicide, or self-harm 3C - Patient suicide, attempted suicide, or self-harm 4E - Patient death or serious injury associated with a fall 4B - Wrong blood product 3C - Patient suicide, attempted suicide, or self-harm **4I - Failure to follow up with test results **4E - Patient death or serious injury associated with a fall 4E - Patient death or serious injury associated with a fall 4E - Patient death or serious injury associated with a fall 4E - Patient death or serious injury associated with a fall 4E - Patient death or serious injury associated with a fall 1 1 4 2 1 1 1 1D - Unintended retention of foreign object 1A - Wrong surgery/invasive procedure site 1A - Wrong surgery/invasive procedure site 1D - Unintended retention of foreign object 1A - Wrong surgery/invasive procedure site 7C - Sexual abuse/assault 1 2 2 **1A - Wrong surgery/invasive procedure site 7D - Physical assault **1C - Wrong surgical/invasive procedure **2A - Contaminated drugs, devices, biologics 1D - Unintended retention of foreign object 1 Everett Bone and Joint Surgery Center number of events: Skagit 7/13/2018 1 Eye Associated Surgery Center number of events: King 5/14/2018 1 First Hill Surgery Center number of events: Kitsap 7/30/2014 1 Page 53 of 55 1B - Wrong surgery/invasive procedure patient 1A - Wrong surgery/invasive procedure site 1C - Wrong surgical/invasive procedure 1A - Wrong surgery/invasive procedure site 1A - Wrong surgery/invasive procedure site Edmonds Center for Outpatient Surgery number of events: King 11/3/2016 11/4/2016 Gateway Surgery Center number of events: King Kaiser Permanente Bellevue Ambulatory Surgery Center^* 4/17/2017 Kaiser Permanente Bellevue Ambulatory Surgery Center number of events: 1A - Wrong surgery/invasive procedure site 1A - Wrong surgery/invasive procedure site 1C - Wrong surgical/invasive procedure **1D - Unintended retention of foreign object **1A - Wrong surgery/invasive procedure site 1D - Unintended retention of foreign object 2 1D - Unintended retention of foreign object 1 Adverse Events Quarterly Report Facility by Date and Event - Q2 2019