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Appendix 1
APPENDIX A SUMMARY OF FACILITIES REPORTING EVENTS FOR 2009
Hospital (42 ) Reported Events
Inpatient Discharges*
Outpatient Visits*
Procedures*
Clarian [Methodist, I.U., Riley](Indianapolis) 18** 56,022 168,689 65,738 Deaconess (Evansville) 4 22,572 97,576 39,357 Methodist (Gary) 4 19,331 53,548 15,042 St. Vincent (Indianapolis) 4** 35,619 129,490 58,650 St. Vincent Heart (Indianapolis) 4 5,775 4,538 6,422 Clark (Jeffersonville) 3 12,095 47,033 19,558 Floyd (New Albany) 3 14,037 53,474 18,252 Memorial (South Bend) 3 20,127 72,841 29,541 St. Mary’s (Evansville) 3 17,522 76,952 35,471 St. Vincent Seton Specialty (Indianapolis) 3 No Report No Report No Report Clarian Arnett (Lafayettel) 2 7,102 36,969 15,433 Community North (Indianapolis) 2 15,242 78,067 41,542 Goshen (Goshen) 2 6,511 35,517 10,940 Kindred (Indianapolis) 2 433 0 174 Lutheran (Fort Wayne) 2 23,548 82,339 45,104 Reid (Richmond) 2 10,863 72,399 20,922 St. Elizabeth Med Ctr (Lafayette) 2 4,349 38,883 7,421 St. Joseph (South Bend) 2 16,065 42,928 17,615 Bloomington (Bloomington) 1 14,429 73,711 18,604 Clarian North (Carmel) 1** 10,593 22,129 15,767 Clarian West (Avon) 1 7,447 40,522 10,245 Columbus (Columbus) 1 10,089 46,344 15,075 Community South (Indianapolis) 1 7,557 46,772 20,604 Dearborn (Lawrenceburg) 1 4,987 25,207 9,385 Elkhart (Elkhart) 1 14,283 60,825 16,408 Heart at Deaconess Gateway (Newburgh) 1 1,363 3,973 2,261 Henry (New Castle) 1 3,821 33,478 9,077 Home (Lafayette) 1 9,026 34,284 11,293 Indiana Orthopaedic (Indianapolis) 1 2,500 7,569 10,060 Johnson (Franklin) 1 3,389 28,643 6,152 Marion (Marion) 1 5,837 36,962 5,291 Monroe (Monroe) 1 No Report No Report No Report Parkview Lagrange (Lagrange) 1 1,445 10,538 2,477 Riverview (Noblesville) 1 6,153 35,616 12,020 St. Catherine (Charlestown) 1 1,982 7,046 1,782 Schneck (Seymour) 1 4,113 32,041 9,609 St. Anthony (Crown Point) 1 12,630 42,267 13,522 St. Clare (Crawfordsville) 1 2,477 25,644 6,236 St. Francis (Beech Grove) 1 10,161 53,301 11,789 St. Joseph (Kokomo) 1 5,750 30,174 10,839 Wishard (Indianapolis) 1 19,542 122,129 13,798 Witham (Lebanon) 1 2,621 20,186 6,180 Total Reported Events in Hospitals 89 * Explanation of these terms is found on page Appendix 3. ** At least one event occurred in 2008, but was reported after the 2008 Report was issued.
Appendix 2
Ambulatory Surgery Centers (5) Reported Events Procedures Elkhart Clinic Endoscopy (Elkhart) 1 6,725 Indiana Orthopaedic Surgery Center (Indianapolis) 1 No Report Indiana Surgery Center East (Indianapolis) 1 8,505 Indiana Surgery Center North (Indianapolis) 1 17,453 Surgery One (Fort Wayne) 1 11,389 Total Reported Events in Ambulatory Surgery Centers 5 Total Reported Events (All Entities) 94
Appendix 3
Appendix B
The data tables for individual hospitals found in Appendix B provide the number of inpatient discharges, the number of outpatient visits, and the number of procedures performed by each hospital. This data is provided for the purpose of comparison of how many individuals seek medical services and how many surgical procedures are performed by each hospital in relation to the number of reported events. This data is required to be reported to the Indiana State Department of Health by hospitals no later than 120 days after the end of each calendar quarter. The Indiana Hospital Association is the contractor that collects the data from each hospital. They perform quality checks and report the data to the Indiana State Department of Health in a standardized format. Appendix B reflects the number of inpatient discharges, the number of outpatient visits, and the number of procedures performed by each hospital reported for the calendar year 2009 by hospitals as of July 14, 2010. In order to eliminate mistakes in the report and give facilities the opportunity to review their data for accuracy, the ISDH sent to each facility their final report for 2009. The report was sent in June 2010. Facilities were instructed to review their data for correctness and completeness. Facilities then returned a verification of data to the ISDH. In July 2010, the ISDH contacted all facilities that had not returned their verification form to request that the form be returned. The report for each facility reflects whether the data was verified by the facility.
HOSPITAL DATA Data Category Definition Total Number Reported
Inpatient Discharges
Inpatient Discharge means the discharge of an individual who had been admitted to the hospital as an inpatient. It does not include hospice, skilled nursing facility and observation patients.
809,600
Outpatient Visit Outpatient Visit refers to a visit to a facility for the purpose of emergency services, outpatient surgery, occupation and physical therapy/rehabilitation, cardiac diagnostic and treatment procedures, or psychiatric and social services. These classifications are based on selected billing or diagnosis codes.
3,878,619
Procedures Procedure includes any surgical procedure coded “00.30” to “86.99” inclusive in the principal procedure field as reported by the hospital for both inpatient discharges and outpatient visits.
1,277,994
Appendix 4
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Adams Memorial Hospital Adams County 1100 Mercer Avenue 2009 Inpatient Discharges: 2,215 Decatur, IN 46733 2009 Outpatient Visits: 15,041 2009 Procedures: 3,593
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 5
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Dupont Hospital Allen County 2520 East Dupont Road 2009 Inpatient Discharges: 7,754 Fort Wayne, IN 46825 2009 Outpatient Visits: 29,749 2009 Procedures: 16,884
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 6
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Lutheran Hospital of Indiana Allen County 7950 West Jefferson Blvd 2009 Inpatient Discharges: 23,548 Fort Wayne, IN 46804 2009 Outpatient Visits: 82,339 2009 Procedures: 45,104
Reportable Event Number Reported Totals
SURGICAL 1 1. Surgery performed on the wrong body part 1 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 1 12. Death or serious disability associated with medication error 1 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 2
Appendix 7
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Orthopaedic Hospital of Lutheran Health Allen County 7952 West Jefferson Blvd 2009 Inpatient Discharges: No Report Fort Wayne, IN 46804 2009 Outpatient Visits: No Report 2009 Procedures: No Report
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 8
APPENDIX B
HOSPITAL REPORTABLE EVENTS FOR 2009 Orthopaedic Hospital at Parkview North Allen County 1119 Parkview Plaza Drive 2009 Inpatient Discharges: 1,664 Fort Wayne, IN 46845 2009 Outpatient Visits: 1,840 2009 Procedures: 3,490
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 9
APPENDIX B
HOSPITAL REPORTABLE EVENTS FOR 2009 Parkview Hospital Allen County 2200 Randallia Drive 2009 Inpatient Discharges: 26,353 Fort Wayne, IN 46805 2009 Outpatient Visits: 104,371 2009 Procedures: 36,772
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 10
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Progressive Hospital Allen County 2626 Fairfield Avenue 2009 Inpatient Discharges: No Report Fort Wayne, IN 46807 2009 Outpatient Visits: No Report 2009 Procedures: No Report
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 11
APPENDIX B
HOSPITAL REPORTABLE EVENTS FOR 2009 Rehabilitation Hospital of Fort Wayne Allen County 7970 West Jefferson Blvd 2009 Inpatient Discharges: 529 Fort Wayne, IN 46804 2009 Outpatient Visits: 0 2009 Procedures: 1
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 12
APPENDIX B
HOSPITAL REPORTABLE EVENTS FOR 2009 Select Specialty Hospital - Fort Wayne Allen County 700 Broadway 2009 Inpatient Discharges: No Report Fort Wayne, IN 46802 2009 Outpatient Visits: No Report 2009 Procedures: No Report
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 13
APPENDIX B
HOSPITAL REPORTABLE EVENTS FOR 2009 St. Joseph Hospital Allen County 700 Broadway 2009 Inpatient Discharges: 5,843 Fort Wayne, IN 46802 2009 Outpatient Visits: 25,305 2009 Procedures: 6,861
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 14
APPENDIX B
HOSPITAL REPORTABLE EVENTS FOR 2009 Columbus Regional Hospital Bartholomew County 2400 East 17th Street 2009 Inpatient Discharges: 10,089 Columbus, IN 47201 2009 Outpatient Visits: 46,344 2009 Procedures: 15,075
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 1 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 1 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 1
Appendix 15
APPENDIX B
HOSPITAL REPORTABLE EVENTS FOR 2009 Blackford Community Hospital Blackford County 410 Pilgrim Blvd 2009 Inpatient Discharges: 556 Hartford City, IN 47348 2009 Outpatient Visits: 10,527 2009 Procedures: 1,149
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 16
APPENDIX B
HOSPITAL REPORTABLE EVENTS FOR 2009 Witham Hospital Boone County 2605 North Lebanon Street 2009 Inpatient Discharges: 2,621 Lebanon, IN 46052 2009 Outpatient Visits: 20,186 2009 Procedures: 6,180
Reportable Event Number Reported Totals
SURGICAL 1 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 1 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 1
Appendix 17
APPENDIX B
HOSPITAL REPORTABLE EVENTS FOR 2009 Memorial Hospital Cass County 1101 Michigan Avenue 2009 Inpatient Discharges: 2,429 Logansport, IN 46947 2009 Outpatient Visits: 21,718 2009 Procedures: 5,062
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 18
APPENDIX B
HOSPITAL REPORTABLE EVENTS FOR 2009 Clark Memorial Hospital Clark County 1220 Missouri Avenue 2009 Inpatient Discharges: 12,095 Jeffersonville, IN 47130 2009 Outpatient Visits: 47,033 2009 Procedures: 19,558
Reportable Event Number Reported Totals
SURGICAL 2 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 1 5. Intra-operative or post-operative death in a normal, healthy patient 1
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 1 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 1
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 3
Appendix 19
APPENDIX B
HOSPITAL REPORTABLE EVENTS FOR 2009 Kentuckiana Medical Center Clark County 4601 Medical Plaza Way 2009 Inpatient Discharges: No Report Clarksville, IN 47129 2009 Outpatient Visits: No Report 2009 Procedures: No Report
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - NOT VERIFIED BY FACILITY 0
Appendix 20
APPENDIX B
HOSPITAL REPORTABLE EVENTS FOR 2009 St. Catherine Regional Hospital Clark County 2200 Market Street 2009 Inpatient Discharges: 1,982 Charlestown, IN 47111 2009 Outpatient Visits: 7,046 2009 Procedures: 1,782
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 1 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 1 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 1
Appendix 21
APPENDIX B
HOSPITAL REPORTABLE EVENTS FOR 2009 St. Vincent Clay Hospital Clay County 1206 East National Avenue 2009 Inpatient Discharges: 685 Brazil, IN 47834 2009 Outpatient Visits: 17,536 2009 Procedures: 2,321
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 22
APPENDIX B
HOSPITAL REPORTABLE EVENTS FOR 2009 St. Vincent Frankfort Hospital Clinton County 1300 South Jackson Street 2009 Inpatient Discharges: 1,099 Frankfort, IN 46041 2009 Outpatient Visits: 13,168 2009 Procedures: 2,179
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 23
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Daviess Community Hospital Daviess County 1314 East Walnut Street 2009 Inpatient Discharges: 3,172 Washington, IN 47501 2009 Outpatient Visits: 20,634 2009 Procedures: 5,341
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 24
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Dearborn County Hospital Dearborn County 600 Wilson Creek Road 2009 Inpatient Discharges: 4,987 Lawrenceburg, IN 47025 2009 Outpatient Visits: 25,207 2009 Procedures: 9,385
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 25
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Decatur County Memorial Hospital Decatur County 720 North Lincoln Street 2009 Inpatient Discharges: 1,491 Greensburg, IN 47240 2009 Outpatient Visits: 16,349 2009 Procedures: 3,079
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 26
APPENDIX B
HOSPITAL REPORTABLE EVENTS FOR 2009 Dekalb Memorial Hospital Dekalb County 1316 East Seventh Street 2009 Inpatient Discharges: 2,389 Auburn, IN 46706 2009 Outpatient Visits: 17,032 2009 Procedures: 4,830
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 27
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Ball Memorial Hospital Delaware County 2401 University Avenue 2009 Inpatient Discharges: 16,040 Muncie, IN 47303 2009 Outpatient Visits: 65,234 2009 Procedures: 24,748
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 28
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Renaissance Specialty Hospital of Central Indiana Delaware County 3400 West Community Drive 2009 Inpatient Discharges: No Report Muncie, IN 47304 2009 Outpatient Visits: No Report 2009 Procedures: No Report
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 29
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Memorial Hospital & Health Care Center Dubois County 800 West 9th Street 2009 Inpatient Discharges: 8,334 Jasper, IN 47546 2009 Outpatient Visits: 38,803 2009 Procedures: 15,310
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 30
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Elkhart General Hospital Elkhart County 600 East Blvd 2009 Inpatient Discharges: 14,283 Elkhart, IN 46514 2009 Outpatient Visits: 60,825 2009 Procedures: 16,408
Reportable Event Number Reported Totals
SURGICAL 1 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 1 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 1
Appendix 31
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Goshen General Hospital Elkhart County 200 High Park Avenue 2009 Inpatient Discharges: 6,511 Goshen, IN 46526 2009 Outpatient Visits: 35,517 2009 Procedures: 10,940
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 2 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 2 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 2
Appendix 32
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Fayette Memorial Hospital Fayette County 1941 Virginia Avenue 2009 Inpatient Discharges: 2,628 Connersville, IN 47331 2009 Outpatient Visits: 15,759 2009 Procedures: 2,737
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 33
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Floyd Memorial Hospital & Health Services Floyd County 1850 State Street 2009 Inpatient Discharges: 14,037 New Albany, IN 47150 2009 Outpatient Visits: 53,474 2009 Procedures: 18,252
Reportable Event Number Reported Totals
SURGICAL 2 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 2 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 1 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 1 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 3
Appendix 34
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Physicians’ Medical Center Floyd County 4023 Reas Lane 2009 Inpatient Discharges: No Report New Albany, IN 47150 2009 Outpatient Visits: No Report 2009 Procedures: No Report
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 35
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Southern Indiana Rehabilitation Hospital Floyd County 3104 Blackiston Blvd 2009 Inpatient Discharges: No Report New Albany, IN 47150 2009 Outpatient Visits: No Report 2009 Procedures: No Report
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 36
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Woodlawn Hospital Fulton County 1400 East 9th Street 2009 Inpatient Discharges: 1,330 Rochester, IN 46975 2009 Outpatient Visits: 11,564 2009 Procedures: 2,967
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 37
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Gibson General Hospital Gibson County 1808 Sherman Drive 2009 Inpatient Discharges: 772 Princeton, IN 47670 2009 Outpatient Visits: 15,283 2009 Procedures: 2,587
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 38
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Marion General Hospital Grant County 441 North Wabash Avenue 2009 Inpatient Discharges: 5,837 Marion, IN 46952 2009 Outpatient Visits: 36,962 2009 Procedures: 5,291
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 1 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 1 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 1
Appendix 39
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Greene County General Hospital Greene County Lone Tree Rd. 2009 Inpatient Discharges: 1,127 R.R. 1, Box 1000 2009 Outpatient Visits: 8,354 Linton, IN 47441 2009 Procedures: 1,555
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 40
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Clarian North Medical Center Hamilton County 11700 North Meridian Street 2009 Inpatient Discharges: 10,593 Carmel, IN 46032 2009 Outpatient Visits: 22,129 2009 Procedures: 15,767
Reportable Event Number Reported Totals
SURGICAL 1 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 1** 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 1
** At least one event occurred in 2008, but was reported after the 2008 Report was issued.
Appendix 41
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Riverview Hospital Hamilton County 395 Westfield Drive 2009 Inpatient Discharges: 6,153 Noblesville, IN 46060 2009 Outpatient Visits: 35,616 2009 Procedures: 12,020
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 1 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 1 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 1
Appendix 42
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
St. Vincent Carmel Hospital Hamilton County 13500 North Meridian Street 2009 Inpatient Discharges: 6,675 Carmel, IN 46032 2009 Outpatient Visits: 30,807 2009 Procedures: 21,071
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 43
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
St. Vincent Heart Center of Indiana Hamilton County 10580 North Meridian Street 2009 Inpatient Discharges: 5,775 Indianapolis, IN 46290 2009 Outpatient Visits: 4,538 2009 Procedures: 6,422
Reportable Event Number Reported Totals
SURGICAL 1 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 1 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 3 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 3 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 4
Appendix 44
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Hancock Regional Hospital Hancock County 801 North State Street 2009 Inpatient Discharges: 3,898 Greenfield, IN 46140 2009 Outpatient Visits: 29,424 2009 Procedures: 8,385
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 45
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Harrison County Hospital Harrison County 1141 Hospital Drive NW 2009 Inpatient Discharges: 1,600 Corydon, IN 47112 2009 Outpatient Visits: 16,667 2009 Procedures: 3,073
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 46
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Clarian West Medical Center Hendricks County 111 North Ronald Reagan Parkway 2009 Inpatient Discharges: 7,447 Avon, IN 46123 2009 Outpatient Visits: 40,522 2009 Procedures: 10,245
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 1 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 1 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 1
Appendix 47
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Hendricks Regional Health Hendricks County 1000 East Main Street 2009 Inpatient Discharges: 6,269 Danville, IN 46122 2009 Outpatient Visits: 40,698 2009 Procedures: 15,051
Reportable Event Number
Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 48
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Henry County Memorial Hospital Henry County 1000 North 16th Street 2009 Inpatient Discharges: 3,821 New Castle, IN 47362 2009 Outpatient Visits: 33,478 2009 Procedures: 9,077
Reportable Event Number Reported Totals
SURGICAL 1 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 1 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 1
Appendix 49
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Howard Regional Health System Howard County 3500 South Lafountain Street 2009 Inpatient Discharges: 5,332 Kokomo, IN 46904 2009 Outpatient Visits: 31,240 2009 Procedures: 6,683
Reportable Event Number
Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 50
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Howard Regional Health System – West Campus Howard County 829 North Dixon Road 2009 Inpatient Discharges: 529 Kokomo, IN 46901 2009 Outpatient Visits: 480
2009 Procedures: 0
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 51
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
St. Joseph Hospital & Health Center Howard County 1907 West Sycamore Street 2009 Inpatient Discharges: 5,750 Kokomo, IN 46901 2009 Outpatient Visits: 30,174 2009 Procedures: 10,839
Reportable Event Number Reported Totals
SURGICAL 1 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 1 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 1
Appendix 52
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Parkview Huntington Hospital Huntington County 2001 Stults Road 2009 Inpatient Discharges: 2,095 Huntington, IN 46750 2009 Outpatient Visits: 19,329 2009 Procedures: 4,024
Reportable Event Number
Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg.
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 53
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Schneck Medical Center Jackson County 411 West Tipton Street 2009 Inpatient Discharges: 4,113 Seymour, IN 47274 2009 Outpatient Visits: 32,041 2009 Procedures: 9,609
Reportable Event Number
Reported Totals
SURGICAL 1 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 1 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 1
Appendix 54
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Jasper County Hospital Jasper County 1104 East Grace Street 2009 Inpatient Discharges: 1,347 Rensselaer, IN 47978 2009 Outpatient Visits: 2,507 2009 Procedures: 2,880
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 55
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Jay County Hospital Jay County 500 West Votaw Street 2009 Inpatient Discharges: 1,296 Portland, IN 47371 2009 Outpatient Visits: 11,839 2009 Procedures: 1,887
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 56
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
King’s Daughters Hospital and Health Center Jefferson County One King’s Daughters Drive 2009 Inpatient Discharges: 4,421` Madison, IN 47250 2009 Outpatient Visits: 24,067 2009 Procedures: 7,995
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 57
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
St. Vincent Jennings Hospital Jennings County 301 Henry Street 2009 Inpatient Discharges: 454 North Vernon, IN 47265 2009 Outpatient Visits: 11,344 2009 Procedures: 510
Reportable Event Number
Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 58
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Johnson Memorial Hospital Johnson County 1125 West Jefferson Street 2009 Inpatient Discharges: 3,389 Franklin, IN 46131 2009 Outpatient Visits: 28,643 2009 Procedures: 6,152
Reportable Event Number Reported Totals
SURGICAL 1 1. Surgery performed on the wrong body part 1 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 1
Appendix 59
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Kindred Hospital – South Johnson County 898 East Main Street 2009 Inpatient Discharges: 573 Greenwood, IN 46143 2009 Outpatient Visits: 0 2009 Procedures: 219
Reportable Event Number
Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 60
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Select Specialty Hospital – Indianapolis Johnson County 898 East Main Street 2009 Inpatient Discharges: No Report Greenwood, IN 46143 2009 Outpatient Visits: No Report 2009 Procedures: No Report
Closed March 18, 2009
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg.
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - NOT VERIFIED BY FACILITY 0
Appendix 61
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Good Samaritan Hospital Knox County 520 South 7th Street 2009 Inpatient Discharges: 8,028 Vincennes, IN 47591 2009 Outpatient Visits: 41,395 2009 Procedures: 11,254
Reportable Event Number
Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 62
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Kosciusko Community Hospital Kosciusko County 2101 East Dubois Avenue 2009 Inpatient Discharges: 5,332 Warsaw, IN 46580 2009 Outpatient Visits: 29,329 2009 Procedures: 7,963
Reportable Event Number
Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 63
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Parkview Lagrange Hospital Lagrange County 207 North Townline Road 2009 Inpatient Discharges: 1,445 Lagrange, IN 46761 2009 Outpatient Visits: 10,538 2009 Procedures: 2,477
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 1 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 1 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 1
Appendix 64
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Community Hospital Lake County 901 MacArthur Blvd. 2009 Inpatient Discharges: 21,905 Munster, IN 46321 2009 Outpatient Visits: 76,769 2009 Procedures: 33,447
Reportable Event Number
Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 65
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Franciscan Physicians Hospital Lake County 701 Superior Avenue 2009 Inpatient Discharges: 734 Munster, IN 46321 2009 Outpatient Visits: 3,389 2009 Procedures: 2,821
Reportable Event Number
Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 66
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Hind General Hospital Lake County 101 West 61st Avenue 2009 Inpatient Discharges: No Report Hobart, IN 46342 2009 Outpatient Visits: No Report 2009 Procedures: No Report
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 67
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Methodist Hospital Lake County 600 Grant Street 2009 Inpatient Discharges: 19,331 Gary, IN 46402 2009 Outpatient Visits: 53,548 2009 Procedures: 15,042
Reportable Event Number
Reported Totals
SURGICAL 3 1. Surgery performed on the wrong body part 1 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 1 4. Retention of a foreign object in a patient after surgery 1 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 1 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 1 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 4
Appendix 68
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Pinnacle Hospital Lake County 9301 Connecticut 2009 Inpatient Discharges: No Report Crown Point, IN 46307 2009 Outpatient Visits: No Report 2009 Procedures: No Report
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 69
APPENDIX B
HOSPITAL REPORTABLE EVENTS FOR 2009 Progressive Hospital of Merrillville Lake County 9509 Georgia Street 2009 Inpatient Discharges: No Report Crown Point, IN 2009 Outpatient Visits: No Report 2009 Procedures: No Report
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 70
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Regency Hospital of Northwest Indiana Lake County 4321 Fir Street, 4th Floor 2009 Inpatient Discharges: No Report East Chicago, IN 46312 2009 Outpatient Visits: No Report 2009 Procedures: No Report
Reportable Event Number
Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 71
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Select Specialty Hospital – Northwest Indiana Lake County 5454 Hohman Avenue 2009 Inpatient Discharges: No Report Hammond, IN 46325 2009 Outpatient Visits: No Report 2009 Procedures: No Report
Reportable Event Number
Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 72
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
St. Anthony Medical Center Lake County 1201 South Main Street 2009 Inpatient Discharges: 12,630 Crown Point, IN 46307 2009 Outpatient Visits: 42,267 2009 Procedures: 13,522
Reportable Event Number Reported Totals
SURGICAL 1 1. Surgery performed on the wrong body part 1 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 1
Appendix 73
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
St. Catherine Hospital Lake County 4321 Fir Street 2009 Inpatient Discharges: 9,103 East Chicago, IN 46312 2009 Outpatient Visits: 34,508 2009 Procedures: 7,567
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 74
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
St. Margaret Mercy Healthcare Centers Lake County 24 Joliet Street 2009 Inpatient Discharges: 8,314 Dyer, IN 46311 2009 Outpatient Visits: 28,546 2009 Procedures: 8,414
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 75
APPENDIX B
HOSPITAL REPORTABLE EVENTS FOR 2009 St. Margaret Mercy Healthcare Centers Lake County 5454 Hohman Avenue 2009 Inpatient Discharges: 11,429 Hammond, IN 46320 2009 Outpatient Visits: 41,234 2009 Procedures: 10,794
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 76
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
St. Mary’s Medical Center Lake County 1500 South Lake Park Avenue 2009 Inpatient Discharges: 11,106 Hobart, IN 46342 2009 Outpatient Visits: 39,906 2009 Procedures: 11,832
Reportable Event Number
Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 77
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Surgical Hospital of Munster Lake County 7847 Calumet Avenue 2009 Inpatient Discharges: 121 Munster, IN 2009 Outpatient Visits: 3,187 2009 Procedures: 3,261
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 78
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Laporte Hospital & Health Services Laporte County 1007 Lincolnway 2009 Inpatient Discharges: 5,798 Laporte, IN 46350 2009 Outpatient Visits: 24,537 2009 Procedures: 9,218
Reportable Event Number
Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 79
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
St. Anthony Memorial Health Centers Laporte County 301 West Homer Street 2009 Inpatient Discharges: 7,666 Michigan City, IN 46360 2009 Outpatient Visits: 46,263 2009 Procedures: 16,686
Reportable Event Number
Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 80
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Bedford Regional Medical Center Lawrence County 2900 West 16th Street 2009 Inpatient Discharges: 1,456 Bedford, IN 47421 2009 Outpatient Visits: 17,269 2009 Procedures: 3,606
Reportable Event Number
Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 81
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Dunn Memorial Hospital Lawrence County 1600 23rd Street 2009 Inpatient Discharges: 1,957 Bedford, IN 47421 2009 Outpatient Visits: 14,702 2009 Procedures: 3,196
Reportable Event Number
Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 82
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Community Hosp. of Anderson & Madison Co Madison County 1515 North Madison Avenue 2009 Inpatient Discharges: 7,567 Anderson, IN 46011 2009 Outpatient Visits: 38,576 2009 Procedures: 12,416
Reportable Event Number
Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 83
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
St. John’s Health System Madison County 2015 Jackson Street 2009 Inpatient Discharges: 8,042 Anderson, IN 46016 2009 Outpatient Visits: 55,720 2009 Procedures: 17,628
Reportable Event Number
Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 84
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
St. Vincent Mercy Hospital Madison County 1331 South A Street 2009 Inpatient Discharges: 838 Elwood, IN 46036 2009 Outpatient Visits: 14,919 2009 Procedures: 1,950
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 85
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Clarian Health Partners Marion County (Methodist, I.U., Riley Hospitals) 2009 Inpatient Discharges: 56,022 1701 North Senate Blvd. 2009 Outpatient Visits: 168,689 Indianapolis, IN 46206 2009 Procedures: 65,738
Reportable Event Number
Reported Totals
SURGICAL 7 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 7** 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 2 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 2
PATIENT PROTECTION 1 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 1
CARE MANAGEMENT 8 12. Death or serious disability associated with medication error 1 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 1 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 6 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 18**
** At least one event occurred in 2008, but was reported after the 2008 Report was issued.
Appendix 86
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Community Hospitals of Indiana East Marion County 1500 North Ritter Avenue 2009 Inpatient Discharges: 14,606 Indianapolis, IN 46219 2009 Outpatient Visits: 79,390 2009 Procedures: 30,256
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 87
APPENDIX B
HOSPITAL REPORTABLE EVENTS FOR 2009 Community Hospital North Marion County 7150 Clearvista Drive 2009 Inpatient Discharges: 15,242 Indianapolis, IN 46256 2009 Outpatient Visits: 78,067 2009 Procedures: 41,542
Reportable Event Number
Reported Totals
SURGICAL 1 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 1 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 1 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 1 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 2
Appendix 88
APPENDIX B
HOSPITAL REPORTABLE EVENTS FOR 2009 Community Hospital South Marion County 1402 East County Line Road South 2009 Inpatient Discharges: 7,557 Indianapolis, IN 46227 2009 Outpatient Visits: 46,772 2009 Procedures: 20,604
Reportable Event Number
Reported Totals
SURGICAL 1 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 1 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 1
Appendix 89
APPENDIX B
HOSPITAL REPORTABLE EVENTS FOR 2009 Indiana Heart Hospital Marion County 8075 North Shadeland Avenue 2009 Inpatient Discharges: 3,737 Indianapolis, IN 46250 2009 Outpatient Visits: 19,557 2009 Procedures: 4,591
Reportable Event Number
Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 90
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Indiana Orthopaedic Hospital Marion County 8400 Northwest Blvd 2009 Inpatient Discharges: 2,500 Indianapolis, IN 46278 2009 Outpatient Visits: 7,569 2009 Procedures: 10,060
Reportable Event Number Reported Totals
SURGICAL 1 1. Surgery performed on the wrong body part 1 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 1
Appendix 91
APPENDIX B
HOSPITAL REPORTABLE EVENTS FOR 2009 Kindred Hospital - Indianapolis Marion County 1700 West 10th Street 2009 Inpatient Discharges: 433 Indianapolis, IN 46222 2009 Outpatient Visits: 0 2009 Procedures: 174
Reportable Event Number
Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 2 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 2 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 2
Appendix 92
APPENDIX B
HOSPITAL REPORTABLE EVENTS FOR 2009 Rehabilitation Hospital of Indiana Marion County 4141 Shore Drive 2009 Inpatient Discharges: 1,502 Indianapolis, IN 46254 2009 Outpatient Visits: 0 2009 Procedures: 14
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - NOT VERIFIED BY FACILITY 0
Appendix 93
APPENDIX B
HOSPITAL REPORTABLE EVENTS FOR 2009 Select Specialty Hospital - Beech Grove Marion County 1600 Albany Street, Suite 200 2009 Inpatient Discharges: No Report Beech Grove, IN 46107 2009 Outpatient Visits: No Report 2009 Procedures: No Report
Reportable Event Number
Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - NOT VERIFIED BY FACILITY 0
Appendix 94
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
St. Vincent Seton Specialty Hospital Marion County 8050 Township Line Road 2009 Inpatient Discharges: No Report Indianapolis, IN 46260 2009 Outpatient Visits: No Report
2009 Procedures: No Report
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 3 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 3 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 3
Appendix 95
APPENDIX B
HOSPITAL REPORTABLE EVENTS FOR 2009 St. Francis Hospital & Health Centers Marion County 1600 Albany Street 2009 Inpatient Discharges: 10,161 Beech Grove, IN 46107 2009 Outpatient Visits: 53,301 2009 Procedures: 11,789
Reportable Event Number Reported Totals
SURGICAL 1 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 1 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 1
Appendix 96
APPENDIX B
HOSPITAL REPORTABLE EVENTS FOR 2009 St. Francis Hospital & Health Centers Marion County 8111 South Emerson Avenue 2009 Inpatient Discharges: 13,336 Indianapolis, IN 46237 2009 Outpatient Visits: 94,220 2009 Procedures: 29,787
Reportable Event Number
Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 97
APPENDIX B
HOSPITAL REPORTABLE EVENTS FOR 2009 St. Vincent Hospital & Health Services Marion County 2001 West 86th Street 2009 Inpatient Discharges: 35,619 Indianapolis, IN 46260 2009 Outpatient Visits: 134,028 2009 Procedures: 58,650
Reportable Event Number
Reported Totals
SURGICAL 3 1. Surgery performed on the wrong body part 1** 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 2** 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 1 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 1 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 4
** At least one event occurred in 2008, but was reported after the 2008 Report was issued.
Appendix 98
APPENDIX B
HOSPITAL REPORTABLE EVENTS FOR 2009 Westview Hospital Marion County 3630 Guion Road 2009 Inpatient Discharges: 2,078 Indianapolis, IN 46222 2009 Outpatient Visits: 14,642 2009 Procedures: 5,495
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 99
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
William N. Wishard Memorial Hospital Marion County 1001 West 10th Street 2009 Inpatient Discharges: 19,542 Indianapolis, IN 46202 2009 Outpatient Visits: 122,129 2009 Procedures: 13,798
Reportable Event Number Reported Totals
SURGICAL 1 1. Surgery performed on the wrong body part 1 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 1
Appendix 100
APPENDIX B
HOSPITAL REPORTABLE EVENTS FOR 2009 Community Hospital of Bremen Marshall County 1020 High Road 2009 Inpatient Discharges: 586 Bremen, IN 46506 2009 Outpatient Visits: 8,594 2009 Procedures: 1,671
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 101
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Doctors Hospital Marshall County 411 South Whitlock Street 2009 Inpatient Discharges: No Report Bremen, IN 46506 2009 Outpatient Visits: No Report 2009 Procedures: No Report
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 102
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
St. Joseph’s Regional Medical Center Marshall County 1915 Lake Avenue 2009 Inpatient Discharges: 2,831 Plymouth, IN 46563 2009 Outpatient Visits: 18,075 2009 Procedures: 5,337
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 103
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Dukes Memorial Hospital Miami County 275 West 12th Street 2009 Inpatient Discharges: 1,749 Peru, IN 46970 2009 Outpatient Visits: 13,897 2009 Procedures: 2,843
Reportable Event Number
Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 104
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Bloomington Hospital Monroe County 601 West Second Street 2009 Inpatient Discharges: 14,429 Bloomington, IN 47403 2009 Outpatient Visits: 73,711 2009 Procedures: 18,604
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 1 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 1 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 1
Appendix 105
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Monroe Hospital Monroe County 4011 S. Monroe Medical Park Blvd. 2009 Inpatient Discharges: No Report Bloomington, IN 47403 2009 Outpatient Visits: No Report 2009 Procedures: No Report
Reportable Event Number Reported Totals
SURGICAL 1 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 1
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 1
Appendix 106
APPENDIX B
HOSPITAL REPORTABLE EVENTS FOR 2009 St. Clare Medical Center Montgomery County 1710 Lafayette Road 2009 Inpatient Discharges: 2,477 Crawfordsville, IN 47933 2009 Outpatient Visits: 25,644 2009 Procedures: 6,236
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 1 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 1 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 1
Appendix 107
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Morgan Hospital & Medical Center Morgan County 2209 John R Wooden Drive 2009 Inpatient Discharges: 2,090 Martinsville, IN 46151 2009 Outpatient Visits: 20,180 2009 Procedures: 4,085
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 108
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
St. Francis Hospital & Health Centers Morgan County 1201 Hadley Road 2009 Inpatient Discharges: 3,603 Mooresville, IN 46158 2009 Outpatient Visits: 39,129 2009 Procedures: 5,985
Reportable Event Number
Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 109
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Parkview Noble Hospital Noble County 401 Sawyer Road 2009 Inpatient Discharges: 2,041 Kendallville, IN 46755 2009 Outpatient Visits: 23,807 2009 Procedures: 3,708
Reportable Event Number
Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 110
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Bloomington Hospital of Orange County Orange County 642 West Hospital Road 2009 Inpatient Discharges: 639 Paoli, IN 47454 2009 Outpatient Visits: 13,042 2009 Procedures: 1,290
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - NOT VERIFIED BY FACILITY 0
Appendix 111
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Perry County Memorial Hospital Perry County One Hospital Road 2009 Inpatient Discharges: 1,529 Tell City, IN 47586 2009 Outpatient Visits: 14,253 2009 Procedures: 2,161
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 112
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Porter Hospital Porter County 814 Laporte Avenue 2009 Inpatient Discharges: 13,872 Valparaiso, IN 46383 2009 Outpatient Visits: 67,828 2009 Procedures: 21,120
Reportable Event Number
Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 113
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Pulaski Memorial Hospital Pulaski County 616 East 13th Street 2009 Inpatient Discharges: 867 Winamac, IN 46996 2009 Outpatient Visits: 6,835 2009 Procedures: 1,642
Reportable Event Number
Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 114
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Putnam County Hospital Putnam County 1542 Bloomington Street 2009 Inpatient Discharges: 1,322 Greencastle, IN 46135 2009 Outpatient Visits: 14,236 2009 Procedures: 4,422
Reportable Event Number
Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 115
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
St. Vincent Randolph Hospital Randolph County 473 Greenville Avenue 2009 Inpatient Discharges: 1,363 Winchester, IN 47394 2009 Outpatient Visits: 15,786 2009 Procedures: 2,075
Reportable Event Number
Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 116
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Margaret Mary Community Hospital Ripley County 321 Mitchell Avenue 2009 Inpatient Discharges: 2,175 Batesville, IN 47006 2009 Outpatient Visits: 15,790 2009 Procedures: 5,174
Reportable Event Number
Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 117
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Rush Memorial Hospital Rush County 1300 North Main Street 2009 Inpatient Discharges: 529 Rushville, IN 46173 2009 Outpatient Visits: 12,279 2009 Procedures: 1,255
Reportable Event Number
Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 118
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Memorial Hospital of South Bend St. Joseph County 615 North Michigan Street 2009 Inpatient Discharges: 20,127 South Bend, IN 46601 2009 Outpatient Visits: 72,841 2009 Procedures: 29,541
Reportable Event Number
Reported Totals
SURGICAL 2 1. Surgery performed on the wrong body part 1 2. Surgery performed on the wrong patient 1 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 1 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 1 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 3
Appendix 119
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Our Lady of Peace Hospital St. Joseph County 801 East Lasalle Avenue 2009 Inpatient Discharges: 360 South Bend, IN 46617 2009 Outpatient Visits: 0 2009 Procedures: 2
Reportable Event Number
Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 120
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Rivercrest Specialty Hospital St. Joseph County 1625 East Jefferson Road 2009 Inpatient Discharges: No Report South Bend, IN 2009 Outpatient Visits: No Report 2009 Procedures: No Report
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 121
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
St. Joseph Regional Medical Center St. Joseph County 801 East Lasalle Avenue 2009 Inpatient Discharges: 16,065 South Bend, IN 46634 2009 Outpatient Visits: 42,928
2009 Procedures: 17,615
Reportable Event Number Reported Totals
SURGICAL 1 1. Surgery performed on the wrong body part 1 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 1 12. Death or serious disability associated with medication error 1 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 2
Appendix 122
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Unity Medical and Surgical Hospital St. Joseph County 4455 Edison Lakes Parkway 2009 Inpatient Discharges: No Report Mishawaka, IN 46545 2009 Outpatient Visits: No Report
2009 Procedures: No Report
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 123
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Scott County Memorial Hospital Scott County 1451 North Gardner 2009 Inpatient Discharges: 1,535 Scottsburg, IN 47170 2009 Outpatient Visits: 19,135 2009 Procedures: 2,196
Reportable Event Number
Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 124
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Major Hospital Shelby County 150 West Washington Street 2009 Inpatient Discharges: 3,015 Shelbyville, IN 46176 2009 Outpatient Visits: 28,538 2009 Procedures: 5,882
Reportable Event Number
Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 125
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Starke Memorial Hospital Starke County 102 East Culver Road 2009 Inpatient Discharges: 836 Knox, IN 46534 2009 Outpatient Visits: 8,980 2009 Procedures: 1,366
Reportable Event Number
Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 126
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Cameron Memorial Community Hospital Steuben County 416 East Maumee Street 2009 Inpatient Discharges: 1,266 Angola, IN 46703 2009 Outpatient Visits: 17,343 2009 Procedures: 4,172
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 127
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Sullivan County Community Hospital Sullivan County 2200 North Section Street 2009 Inpatient Discharges: 862 Sullivan, IN 47882 2009 Outpatient Visits: 10,238 2009 Procedures: 1,362
Reportable Event Number
Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 128
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Clarian-Arnett Health System Tippecanoe County 5165 McCarty Lane 2009 Inpatient Discharges: 7,102 Lafayette, IN 47905 2009 Outpatient Visits: 36,969 2009 Procedures: 15,433
Reportable Event Number
Reported Totals
SURGICAL 2 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 2 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 2
Appendix 129
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Home Hospital Tippecanoe County 2400 South Street 2009 Inpatient Discharges: 9,026 Lafayette, IN 47904 2009 Outpatient Visits: 34,284 2009 Procedures: 11,293
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 1 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 1
Appendix 130
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
St. Elizabeth Medical Center Tippecanoe County 1501 Hartford Street 2009 Inpatient Discharges: 4,349 Lafayette, IN 47904 2009 Outpatient Visits: 38,883 2009 Procedures: 7,421
Reportable Event Number Reported Totals
SURGICAL 1 1. Surgery performed on the wrong body part 1 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 1 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 1
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 2
Appendix 131
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
St. Vincent Seton Specialty Hospital Tippecanoe County 1501 Hartford Street 2009 Inpatient Discharges: No Report Lafayette, IN 47904 2009 Outpatient Visits: No Report 2009 Procedures: No Report
Reportable Event Number
Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 132
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Tipton County Memorial Hospital Tipton County 1000 South Main Street 2009 Inpatient Discharges: 1,339 Tipton, IN 46072 2009 Outpatient Visits: 9,294 2009 Procedures: 2,900
Reportable Event Number
Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 133
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Deaconess Hospital (incl. Cross Pointe & Gateway) Vanderburgh County 600 Mary Street 2009 Inpatient Discharges: 22,572 Evansville, IN 47747 2009 Outpatient Visits: 97,576 2009 Procedures: 39,357
Reportable Event Number Reported Totals
SURGICAL 3 1. Surgery performed on the wrong body part 1 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 1 4. Retention of a foreign object in a patient after surgery 1 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 1 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 1 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 4
Appendix 134
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Healthsouth Deaconess Rehabilitation Hospital Vanderburgh County 4100 Covert Avenue 2009 Inpatient Discharges: 1,166 Evansville, IN 47714 2009 Outpatient Visits: 0 2009 Procedures: 6
Reportable Event Number
Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 135
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Select Specialty Hospital - Evansville Vanderburgh County 400 SE 4th Street 2009 Inpatient Discharges: No Report Evansville, IN 47713 2009 Outpatient Visits: No Report 2009 Procedures: No Report
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 136
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
St. Mary’s Medical Center Vanderburgh County 3700 Washington Avenue 2009 Inpatient Discharges: 17,522 Evansville, IN 47750 2009 Outpatient Visits: 76,952 2009 Procedures: 35,471
Reportable Event Number
Reported Totals
SURGICAL 1 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 1 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 1 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 1 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 1 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 1 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 3
Appendix 137
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Union Hospital – Clinton Vermillion County 801 South Main Street 2009 Inpatient Discharges: 1,361 Clinton, IN 47842 2009 Outpatient Visits: 13,752 2009 Procedures: 1,453
Reportable Event Number
Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 138
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Terre Haute Regional Hospital Vigo County 3901 South Seventh Street 2009 Inpatient Discharges: 7,592 Terre Haute, IN 47802 2009 Outpatient Visits: 30,183 2009 Procedures: 12,406
Reportable Event Number
Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 139
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Union Hospital Vigo County 1606 North Seventh Street 2009 Inpatient Discharges: 16,040 Terre Haute, IN 47804 2009 Outpatient Visits: 70,998 2009 Procedures: 31,152
Reportable Event Number
Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 140
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Wabash County Hospital Wabash County 710 North East Street 2009 Inpatient Discharges: 658 Wabash, IN 46992 2009 Outpatient Visits: 2,419 2009 Procedures: 2,510
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 141
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
St. Vincent Williamsport Hospital Warren County 412 North Monroe Street 2009 Inpatient Discharges: 853 Williamsport, IN 47993 2009 Outpatient Visits: 15,756 2009 Procedures: 1,741
Reportable Event Number
Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 142
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Heart Hospital at Deaconess Gateway Warrick County 4007 Gateway Blvd 2009 Inpatient Discharges: 1,363 Newburgh, IN 47630 2009 Outpatient Visits: 3,973 2009 Procedures: 2,261
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 1 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 1 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 1
Appendix 143
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
St. Mary’s Warrick Hospital Warrick County 1116 Millis Avenue 2009 Inpatient Discharges: 848 Boonville, IN 47601 2009 Outpatient Visits: 9,234 2009 Procedures: 988
Reportable Event Number
Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 144
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Women’s Hospital Warrick County 4199 Gateway Blvd. 2009 Inpatient Discharges: 6,652 Newburgh, IN 47630 2009 Outpatient Visits: 1,496 2009 Procedures: 6,301
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 145
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
St. Vincent Salem Hospital Washington County 911 North Shelby Street 2009 Inpatient Discharges: 720 Salem, IN 47167 2009 Outpatient Visits: 1,957 2009 Procedures: 2,106
Reportable Event Number
Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 146
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Reid Hospital and Health Care Services Wayne County 1401 Chester Blvd 2009 Inpatient Discharges: 10,863 Richmond, IN 47374 2009 Outpatient Visits: 72,399 2009 Procedures: 20,922
Reportable Event Number
Reported Totals
SURGICAL 2 1. Surgery performed on the wrong body part 2 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 2
Appendix 147
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Bluffton Regional Medical Center Wells County 303 South Main Street 2009 Inpatient Discharges: 2,741 Bluffton, IN 46714 2009 Outpatient Visits: 10,964 2009 Procedures: 4,466
Reportable Event Number
Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 148
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
White County Memorial Hospital White County 1101 O’Connor Blvd. 2009 Inpatient Discharges: 1,505 Monticello, IN 47960 2009 Outpatient Visits: 14,727 2009 Procedures: 2,046
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 149
APPENDIX B HOSPITAL REPORTABLE EVENTS FOR 2009
Parkview Whitley Hospital Whitley County 353 North Oak Street 2009 Inpatient Discharges: 1,738 Columbia City, IN 46725 2009 Outpatient Visits: 15,010 2009 Procedures: 3,031
Reportable Event Number
Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 150
Appendix C As a way of providing some comparative figures for ambulatory surgery centers and the reported events, the reports for individual ambulatory surgery centers found in Appendix C provide the number of procedures performed by each ambulatory surgery center. This data is provided in this report for the purpose of comparison of how many patients are treated and how many procedures are performed by each ambulatory surgery center in relation to the number of events reported. This data is required to be reported to the Indiana State Department of Health. Appendix C reflects the surgical procedures performed as reported by ambulatory surgery centers for the calendar year 2009. In order to eliminate mistakes in the report and give facilities the opportunity to review their data for accuracy, the ISDH sent to each facility their final report for 2009. The report was sent in June 2010. Facilities were instructed to review their data for correctness and completeness. Facilities then returned a verification of data to the ISDH. In July 2010, the ISDH contacted all facilities that had not returned their verification form to request that the form be returned. A few facilities failed to return the verification prior to the publishing of the report. The report for each facility reflects whether the data was verified by the facility.
AMBULATORY SURGERY CENTER DATA Data Category Definition Total Number Reported
Procedures Procedure includes any procedure reported by the ambulatory surgery center on the ASC Utilization Report, State Form 49933
436,606
Appendix 151
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
CLI Surgery Center Allen County 7747 West Jefferson Blvd. 2009 Procedures: 2,887 Fort Wayne, IN 46804
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 152
APPENDIX C
AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009 Eye Surgical Center of Fort Wayne Allen County 321 East Wayne Street 2009 Procedures: 2,887 Fort Wayne, IN 46802
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 153
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
Fort Wayne Cardiology Allen County 1819 Carew Street 2009 Procedures: Fort Wayne, IN 46805
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 154
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
Fort Wayne Endoscopy Center Allen County 3415 Hobson Road 2009 Procedures: 3,721 Fort Wayne, IN 46805
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 155
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
Inverness Surgery Center Allen County 8004 Carnegie Blvd. 2009 Procedures: Fort Wayne, IN 46804
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 156
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
MGFW Surgery Center Allen County 7916 West Jefferson Blvd. 2009 Procedures: Fort Wayne, IN 46804
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 157
APPENDIX C
AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009 Northeast Indiana Endoscopy Center Allen County 7900 West Jefferson Blvd. 2009 Procedures: Fort Wayne, IN 46804
Closed December 1, 2009
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - NOT VERIFIED BY FACILITY 0
Appendix 158
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
Neurospine/Pain Surgery Center Allen County 7956 West Jefferson Blvd. 2009 Procedures: 1,630 Fort Wayne, IN 46804
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 159
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
Premier Surgery Center Allen County 11141 Parkview Plaza Dr. 2009 Procedures: Fort Wayne, IN 46845
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 160
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
Southwest Surgical Suites Allen County 7920 West Jefferson Blvd. 2009 Procedures: 2,003 Fort Wayne, IN 46804
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 161
APPENDIX C
AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009 The Surgery Center Allen County 7900 West Jefferson Blvd, Ste. 102 2009 Procedures: 6,408 Fort Wayne, IN 46804
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 162
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
Surgery Center of Ophthalmology Allen County 7232 Engle Road 2009 Procedures: 1,201 Fort Wayne, IN 46804
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 163
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
Surgery One Allen County 5052 North Clinton Street 2009 Procedures: 11,389 Fort Wayne, IN 45825
Reportable Event Number Reported Totals
SURGICAL 1 1. Surgery performed on the wrong body part 1 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 1
Appendix 164
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
Columbus Pain Institute Bartholomew County 2400 North Park, Suite 20 2009 Procedures: 1,653 Columbus, IN 47203
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 165
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
Columbus Surgery Center Bartholomew County 940 North Marr Road 2009 Procedures: 4,367 Columbus, IN 47201
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 166
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
Pankratz Eye Institute Bartholomew County 3135 Middle Road 2009 Procedures: 2,107 Columbus, IN 47203
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 167
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
Vision Surgical Center at Springhill Clark County 302 West 14th Street 2009 Procedures: 4,378 Jeffersonville, IN 47130
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 168
APPENDIX C
AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009 American Health Network Delaware County 3631 North Morrison Road, Suite 106 2009 Procedures: 845 Muncie, IN 47304
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 169
APPENDIX C
AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009 Ball Outpatient Surgery Center Delaware County 2401 W. University Avenue 2009 Procedures: 802 Muncie, IN 47303
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 170
APPENDIX C
AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009 Central Indiana Orthopedic Surgery Center Delaware County 3600 West Bethel Avenue 2009 Procedures: 3,055 Muncie, IN 47304
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 171
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
Medical Consultants Endoscopy Center Delaware County 800 South Tillotson Avenue 2009 Procedures: 5,606 Muncie, IN 47304
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 172
APPENDIX C
AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009 Mid-America Surgery Center Delaware County 6004 Kilgore Avenue 2009 Procedures: Muncie, IN 47304
Closed October 1, 2009
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - NOT VERIFIED BY FACILITY 0
Appendix 173
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
Muncie Cataract and Laser Eye Center Delaware County 3300 West Purdue Avenue 2009 Procedures: 1,225 Muncie, IN 47304
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 174
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
Muncie Eye Specialists Surgery Centers Delaware County 200 North Tillotson Avenue 2009 Procedures: 4,909 Muncie, IN 47304
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 175
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
St. Charles Surgical Pavilion Dubois County 1900 St. Charles Street 2009 Procedures: 2,461 Jasper, IN 47546
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 176
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
Elkhart Clinic Endoscopy and Surgery Center Elkhart County 2117 West Lexington Avenue 2009 Procedures: 6,725 Elkhart, IN 46514
Reportable Event Number Reported Totals
SURGICAL 1 1. Surgery performed on the wrong body part 1 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 1
Appendix 177
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
Goshen Ambulatory Care Center Elkhart County 1605 Winsted Drive 2009 Procedures: 2,451 Goshen, IN 46526
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 178
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
OSMC Outpatient Surgery Center Elkhart County 2310 California Road, Suite B 2009 Procedures: Not Reported Elkhart, IN 46514
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 179
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
Riverpointe Cardiovascular Laboratory Elkhart County 500 Arcade Avenue 2009 Procedures: 300 Elkhart, IN 46514
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 180
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
Riverpointe Surgery Center Elkhart County 500 Arcade Avenue 2009 Procedures: Elkhart, IN 46514
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 181
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
Whitewater Valley Surgery Center Fayette County 1475 State Road 44E 2009 Procedures: Connersville, IN
Closed March 31, 2009
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - NOT VERIFIED BY FACILITY 0
Appendix 182
APPENDIX C
AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009 Kleinert Kutz Surgery Center Floyd County 3605 Northgate Court 2009 Procedures: 3,019 New Albany, IN 47150
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 183
APPENDIX C
AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009 Novamed Eye Surgery Center of New Albany Floyd County 520 West First Street 2009 Procedures: 5,676 New Albany, IN 47150
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 184
APPENDIX C
AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009 Novamed Pain Management of New Albany Floyd County 520 West First Street 2009 Procedures: 2,427 New Albany, IN 47150
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 185
APPENDIX C
AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009 Southern Indiana Endoscopy Floyd County 825 University Woods Drive 2009 Procedures: 6,407 New Albany, IN 47150
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 186
APPENDIX C
AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009 Surgical Center of New Albany Floyd County 2201 Green Valley Road 2009 Procedures: 5,123 New Albany, IN 47150
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 187
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
Oakview Surgical Center Fulton County 120 East 18th Street 2009 Procedures: 98 Rochester, IN 46975
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 188
APPENDIX C
AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009 The Surgery Center Gibson County 2030 Sherman Drive 2009 Procedures: 1,940 Princeton, IN 47670
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 189
APPENDIX C
AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009 Marion Eye Specialists Surgery Center Grant County 711 Gardner Drive 2009 Procedures: 2,059 Marion, IN 46952
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 190
APPENDIX C
AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009 River View Surgery Center Grant County 330 North Wabash Avenue 2009 Procedures: 4,871 Marion, IN 46952
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 191
APPENDIX C
AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009 Aesthetic Surgery Center Hamilton County 13590 North Meridian Street 2009 Procedures: Carmel, IN 46032
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 192
APPENDIX C
AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009 Beltway Surgery Center Hamilton County 151 Pennsylvania Parkway 2009 Procedures: 19,637 Indianapolis, IN 46280
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 193
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
Beltway Surgery Center at Spring Mill Hamilton County 200 West 103rd Street 2009 Procedures: Indianapolis, IN 46290
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 194
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
Carmel Ambulatory Surgery Center Hamilton County 13421 Old Meridian Street 2009 Procedures: 16,020 Carmel, IN 46032
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 195
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
Digestive Health Center Hamilton County 1120 AAA Way, Suite A 2009 Procedures: 4,324 Carmel, IN 46032
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 196
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
Endoscopy Center Hamilton County 13421 Old Meridian Street 2009 Procedures: Carmel, IN 46032
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 197
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
Fishers Ambulatory Surgery Center Hamilton County 13914 State Road 238 East, Suite 200 2009 Procedures: Fishers, IN 46037
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 198
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
Indiana Endoscopy Centers Hamilton County 10967 Allisonville Road 2009 Procedures: Fishers, IN 46038
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 199
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
Indiana Surgery Center – Noblesville Hamilton County 9700 East 146th Street 2009 Procedures: 4,647 Noblesville, IN 46060
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 200
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
Laser and Skin Surgery Center of Indiana Hamilton County 13450 North Meridian Street 2009 Procedures: Carmel, IN 46302
Closed January 13, 2009
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - NOT VERIFIED BY FACILITY 0
Appendix 201
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
North Meridian Surgery Center Hamilton County 10601 North Meridian Street 2009 Procedures: 2,634 Indianapolis, IN 46290
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 202
APPENDIX C
AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009 The Surgery Center of Carmel Hamilton County 12188 North Meridian Street, Suite 150 2009 Procedures: Not Reported Carmel, IN 46032
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 203
APPENDIX C
AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009 Hancock Surgery Center Hancock County One Memorial Square 2009 Procedures: 4,018 Greenfield, IN
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 204
APPENDIX C
AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009 Indiana Endoscopy Centers Hendricks County 1115 North Ronald Reagan Parkway 2009 Procedures: Avon, IN 46123
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 205
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
CLI Surgery Center Howard County 1601 West Lincoln Road 2009 Procedures: 1,670 Kokomo, IN 46904
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 206
APPENDIX C
AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009 Indiana Surgery Center Howard County 3503 South Reed Road 2009 Procedures: 5,284 Kokomo, IN 46902
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 207
APPENDIX C
AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009 Ambulatory Surgery Center at Indiana Eye Clinic Johnson County 30 North Emerson Avenue 2009 Procedures: 3,335 Greenwood, IN 46143
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 208
APPENDIX C
AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009 Indiana Skin Cancer Ambulatory Surgery Center Johnson County 701 East County Line Road 2009 Procedures: 1,805 Greenwood, IN 46143
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 209
APPENDIX C
AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009 South Central Surgery Center Johnson County 5002 East State Road 44 2009 Procedures: 670 Franklin, IN 46131
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 210
APPENDIX C
AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009 Vincennes Surgery Center Knox County 300 North First Street 2009 Procedures: 4,679 Vincennes, IN 47591
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 211
APPENDIX C
AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009 Wabash Valley Eye Surgery Center Knox County 2020 Clearview Drive 2009 Procedures: 1,390 Vincennes, IN 47591
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 212
APPENDIX C
AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009 Grossnickle Eye Center Kosciusko County 2251 Dubois Drive 2009 Procedures: 180 Warsaw, IN 46580
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg.
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 213
APPENDIX C
AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009 Advanced Pain Centers Lagrange County 5355 Commerce Blvd 2009 Procedures: Crown Point, IN 46307
Closed December 31, 2009
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - NOT VERIFIED BY FACILITY 0
Appendix 214
APPENDIX C
AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009 APAC Surgical Center II Lake County 11460 South Broadway 2009 Procedures: 8,997 Crown Point, IN 46307
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 215
APPENDIX C
AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009 Broadwest Specialty Surgical Center Lake County 315 West 89th Street 2009 Procedures: 2,044 Merrillville, IN 46410
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 216
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
Calumet Surgery Center Lake County 7847 Calumet Avenue 2009 Procedures: Munster, IN 46321
Closed February 14, 2009
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - NOT VERIFIED BY FACILITY 0
Appendix 217
APPENDIX C
AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009 CBC, LLC Lake County 5355 Commerce Blvd. 2009 Procedures: 382 Crown Point, IN 46307
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 218
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
Center For Specialty Surgery Lake County 1950 45th Street 2009 Procedures: 0 Munster, IN 46321
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 219
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
Community Surgery Center Lake County 801 MacArthur Blvd. 2009 Procedures: Munster, IN 46321
Closed October 1, 2009
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 220
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
Grand Park Surgical Center Lake County 1479 East 84th Place 2009 Procedures: Merrillville, IN 46410
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 221
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
Hammond Community Ambulatory Care Center Lake County 2143 Calumet Ave. 2009 Procedures: 162 Hammond, IN 46394
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 222
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
IMA Endoscopy Surgicenter Lake County 8895 Broadway 2009 Procedures: 3,381 Merrillville, IN 46410
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 223
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
Lake Park Surgicare Lake County 7921 Grand Blvd. 2009 Procedures: 5,569 Hobart, IN 46342
Closed December 31, 2009
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - NOT VERIFIED BY FACILITY 0
Appendix 224
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
Lakeside Surgery Center Lake County 810 West Chicago Avenue 2009 Procedures: 1,880 East Chicago, IN 46312
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 225
APPENDIX C
AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009 Merrillville Plaza Surgery Center Lake County 255 East 90th Drive 2009 Procedures: 1,634 Merrillville, IN 46410
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 226
APPENDIX C
AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009 Merrillville Surgery Center Lake County 101 East 87th Avenue 2009 Procedures: Merrillville, IN 46410
Closed December 1, 2009
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - NOT VERIFIED BY FACILITY 0
Appendix 227
APPENDIX C
AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009 Munster Same Day Surgery Lake County 761 45th Street 2009 Procedures: 4,623 Munster, IN 46321
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 228
APPENDIX C
AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009 Novamed Surgery Center of Merrillville Lake County 8514 Broadway 2009 Procedures: 2,103 Merrillville, IN 46410
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 229
APPENDIX C
AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009 White Oak Surgery Center Lake County 1950 45th Street 2009 Procedures: 2,361 Munster, IN 46321
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 230
APPENDIX C
AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009 Williams Eye Surgery Center Lake County 6836 Hohman Avenue 2009 Procedures: 1,606 Hammond, IN 46324
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 231
APPENDIX C
AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009 Laporte Medical Group Surgical Center Laporte County 900 I Street 2009 Procedures: 1,977 Laporte, IN 46350
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 232
APPENDIX C
AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009 Woodland Healthcare Surgicenter Laporte County 8865 West 400 North 2009 Procedures: Michigan City, IN 46360
Closed June 1, 2009
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - NOT VERIFIED BY FACILITY 0
Appendix 233
APPENDIX C
AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009 Anderson Laser Eye Center Madison County 1931 Brown Street 2009 Procedures: Anderson, IN 46016
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 234
APPENDIX C
AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009 Community Center For Digestive Care Madison County 1601 Medical Arts Blvd, Suite 300 2009 Procedures: 2,696
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 235
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
The Care Labs Marion County 8333 Naab Road, Suite 180 2009 Procedures: 1,030 Indianapolis, IN 46260
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 236
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
Center for Special Surgery Marion County 8805 North Meridian Street 2009 Procedures: Indianapolis, IN 46260
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 237
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
Central Indiana Surgery Center Marion County 9002 North Meridian Street, Lower Level 2009 Procedures: 3,184 Indianapolis, IN 46260
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 238
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
Eagle Highlands Surgery Center Marion County 6850 Parkdale Place 2009 Procedures: 6,204 Indianapolis, IN 46254
Reportable Event Number Reported Totals
SURGICAL 1 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 1 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 1
Appendix 239
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
The Endoscopy Center at St. Francis Marion County 8051 South Emerson, Suite 150 2009 Procedures: 10,443 Indianapolis, IN 46237
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 240
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
Foot & Ankle Surgery Center Marion County 8651 Township Line Road 2009 Procedures: 1,417 Indianapolis, IN 46260
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 241
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
Franciscan Cardiovascular Laboratory Marion County 5330 East Stop 11 Road 2009 Procedures: Indianapolis, IN 46237
Closed August 3, 2009
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - NOT VERIFIED BY FACILITY 0
Appendix 242
APPENDIX C
AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009 Franciscan Surgery Center Marion County 5255 East Stop 11 Road, Suite 100 2009 Procedures: 9,362 Indianapolis, IN 46237
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 243
APPENDIX C
AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009 Indiana Orthopaedic Surgery Center Marion County 5255 East Stop 11 Road, Suite 110 2009 Procedures: 6,685 Indianapolis, IN 46237
Reportable Event Number Reported Totals
SURGICAL 1 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 1 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 1
Appendix 244
APPENDIX C
AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009 Indiana Surgery Center East Marion County 5445 East 16th Street 2009 Procedures: 8,505 Indianapolis, IN 46218
Reportable Event Number Reported Totals
SURGICAL 1 1. Surgery performed on the wrong body part 1 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 1
Appendix 245
APPENDIX C
AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009 Indiana Surgery Center – North Marion County 8040 Clearvista Parkway 2009 Procedures: 17,453 Indianapolis, IN 46256
Reportable Event Number Reported Totals
SURGICAL 1 1. Surgery performed on the wrong body part 1 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20 Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 1
Appendix 246
APPENDIX C
AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009 Indiana Surgery Center – South Marion County 1550 East County Line Road South 2009 Procedures: 10,198 Indianapolis, IN 46227
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 247
APPENDIX C
AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009 Indiana Endoscopy Centers Marion County 1801 North Senate Blvd. 2009 Procedures: 8,773 Indianapolis, IN 46202
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 248
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
Indianapolis Endoscopy Center Marion County 8315 East 56th Street 2009 Procedures: 10,272 Indianapolis, IN
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 249
APPENDIX C
AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009 Meridian Plastic Surgery Center Marion County 170 West 106th Street 2009 Procedures: 3,474 Indianapolis, IN 46290
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 250
APPENDIX C
AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009 Naab Road Surgery Center Marion County 8260 Naab Road 2009 Procedures: 8,764 Indianapolis, IN 46260
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 251
APPENDIX C
AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009 Northside Cardiac Cath Lab Marion County 8333 Naab Road, #180 2009 Procedures: 4,352 Indianapolis, IN 46260
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 252
APPENDIX C
AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009 Northside Gastroenterology Endoscopy Center Marion County 8424 Naab Road 2009 Procedures: 11,074 Indianapolis, IN 46260
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 253
APPENDIX C
AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009 Senate Street Surgery Center Marion County 1801 North Senate Boulevard 2009 Procedures: 4,148 Indianapolis, IN 46202
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 254
APPENDIX C
AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009 South Emerson Surgery Center Marion County 8141 South Emerson Avenue, Suite C 2009 Procedures: 2,894 Indianapolis, IN 46237
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 255
APPENDIX C
AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009 Surgery Center Marion County 8501 Harcourt Road 2009 Procedures: 10,721 Indianapolis, IN 46280
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 256
APPENDIX C
AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009 The Surgery Center of Indianapolis Marion County 2007 North Capitol Avenue 2009 Procedures: 2,915 Indianapolis, IN 46202
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 257
APPENDIX C
AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009 Surgery Center of Eye Specialists of Indiana Marion County 1901 North Meridian Street 2009 Procedures: 7,989 Indianapolis, IN 46202
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 258
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
Surgery Center Plus Marion County 7430 North Shadeland Avenue, Suite 100 2009 Procedures: Indianapolis, IN 46250
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 259
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
Surgical Care Center Marion County 8103 Clearvista Parkway 2009 Procedures: 4,365 Indianapolis, IN 46256
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 260
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
Sycamore Springs Surgery Center Marion County 4715 Statesmen Drive, Suite A 2009 Procedures: 4,076 Indianapolis, IN 46250
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 261
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
Women’s Physician Surgery Center Marion County 8081 Township Line Road 2009 Procedures: 1,261 Indianapolis, IN 46260
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 262
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
Bloomington Endoscopy Center Monroe County 550 Landmark Avenue 2009 Procedures: 6,275 Bloomington, IN 47402
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 263
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
Bloomington Surgery Center Monroe County 1011 West Second Street 2009 Procedures: 3,853 Bloomington, IN 47403
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 264
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
Center for Advanced Laparoscopic/Bariatric Center Monroe County 506 West Second Street 2009 Procedures: 220 Bloomington, IN 47403
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 265
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
Indiana Specialty Surgery Center Monroe County 1380 West Arch Haven Ave. 2009 Procedures: 5,924 Bloomington, IN 47403
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 266
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
Southern Indiana Surgery Center Monroe County 2800 Rex Grossman Blvd 2009 Procedures: Bloomington, IN 47403
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 267
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
Surgery Center for Pain of Southern Indiana Monroe County 2920 McIntire Drive, Suite 150 2009 Procedures: 49 Bloomington, IN 47403
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 268
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
Surgicare Monroe County 2907 McIntire Drive, Suite C 2009 Procedures: 6,602 Bloomington, IN 47403
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 269
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
Mooresville Endoscopy Morgan County 1215 Hadley Rd., Ste 101 2009 Procedures: 712 Mooresville, IN 46158
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 270
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
Endolabs Porter County 2206 North Roosvelt Road 2009 Procedures: 4,003 Valparaiso, IN 46383
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 271
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
Lakeshore Surgicare Porter County 3111 Village Pointe 2009 Procedures: 5,177 Chesterton, IN 46304
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 272
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
Allied Physicians Surgery Center St. Joseph County 53990 Carmichael Drive 2009 Procedures: 23,342 South Bend, IN 46635
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 273
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
Memorial Spine & Neuroscience Center St. Joseph County 100 Navarre Place 2009 Procedures: 1,681 South Bend, IN 46601
Reportable Event Number
Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 274
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
Michiana Endoscopy Center St. Joseph County 53830 Generations Drive 2009 Procedures: South Bend, IN 46635
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 275
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
South Bend Clinic & Surgicenter St. Joseph County 211 North Eddy Street 2009 Procedures: 8,755 South Bend, IN 46617
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 276
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
Unity Surgical Arts Surgery Center St. Joseph County 4455 Edison Lakes Parkway 2009 Procedures: Mishawaka, IN 46545
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 277
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
Sullivan Surgicenter Sullivan County 320 North Section Street 2009 Procedures: 642 Sullivan, IN 47882
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 278
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
Advanced Surgery Center Tippecanoe County 1400 Teal Road 2009 Procedures: 3,116 Lafayette, IN 47905
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 279
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
Arnett Surgery Center Tippecanoe County 1327 South 500 East 2009 Procedures: Lafayette, IN 47905
Closed November 10, 2009
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - NOT VERIFIED BY FACILITY 0
Appendix 280
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
North Central Health Services Tippecanoe County 201 Main Street, Suite 606 2009 Procedures: 337 Lafayette, IN 47904
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 281
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
Sagamore Surgical Services Tippecanoe County 2320 Concord Road, Suite B 2009 Procedures: 1,657 Lafayette, IN 47909
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 282
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
Unity Surgical Center Tippecanoe County 1411 South Creasy Lane 2009 Procedures: 13,775 Lafayette, IN
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 283
APPENDIX C
AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009 Ambulatory Surgery Center for Pain Relief Vanderburgh County 2330 Lynch Road, Suite 100B 2009 Procedures: 0 Evansville, IN 47711
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - NOT VERIFIED BY FACILITY 0
Appendix 284
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
Crescent City Surgery Center Vanderburgh County 220 East Virginia Street 2009 Procedures: 2,539 Evansville, IN 47711
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 285
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
Evansville Surgery Center –Deaconess Hospital Vanderburgh County 520 Mary Street, Suite 130 2009 Procedures: 6,914 Evansville, IN 47710
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 286
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
Eyecare Consultants Surgery Center Vanderburgh County 101 NW First Street 2009 Procedures: 2,192 Evansville, IN 47708
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 287
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
Eye Care Surgery Center of Evansville Vanderburgh County 6540 Logan Drive 2009 Procedures: Evansville, IN 47715
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 288
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
Gastrointestinal Endoscopy Center Vanderburgh County 801 St. Mary’s Drive 2009 Procedures: 9,767 Evansville, IN 47714
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 289
APPENDIX C AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009
St. Mary’s Freestanding Cath Lab Vanderburgh County 3700 Washington Avenue 2009 Procedures: Evansville, IN 47750
Closed December 1, 2009
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - NOT VERIFIED BY FACILITY 0
Appendix 290
APPENDIX C
AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009 Welborn Clinic Surgery Center Vanderburgh County 421 Chestnut Street 2009 Procedures: Evansville, IN 47713
Closed March 9, 2009
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - NOT VERIFIED BY FACILITY 0
Appendix 291
APPENDIX C
AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009 St. Vincent Surgery Center of Terre Haute Vigo County 227 East McCallister Drive 2009 Procedures: Terre Haute, IN 47802
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 292
APPENDIX C
AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009 Terre Haute Heart Center Outpatient Cath Lab Vigo County 455 East Hospital Lane 2009 Procedures: 472 Terre Haute, IN 47802
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 293
APPENDIX C
AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009 Evansville Surgery Center, Gateway Warrick County 4133 Gateway Blvd 2009 Procedures: 4,773 Newburgh, IN 47630
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 294
APPENDIX C
AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009 Reid Outpatient Surgery and Endoscopy Wayne County 1350 Chester Blvd 2009 Procedures: Richmond, IN 47374
Closed July 1, 2009
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - NOT VERIFIED BY FACILITY 0
Appendix 295
APPENDIX C
AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009 Tower Specialty Surgery Wayne County 1400 Highland Road, Suite 2 2009 Procedures: 2,109 Richmond, IN 47374
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 296
APPENDIX C
AMBULATORY SURGERY CENTER REPORTABLE EVENTS FOR 2009 Whitewater Surgery Center Wayne County 1900 Chester Blvd 2009 Procedures: 552 Richmond, IN 47374
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25 Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 297
APPENDIX D In order to eliminate mistakes in the report and give facilities the opportunity to review their data for accuracy, the ISDH sent to each facility their final report for 2009. The report was sent in June 2010. Facilities were instructed to review their data for correctness and completeness. Facilities then returned a verification of data to the ISDH. In July 2010, the ISDH contacted all facilities that had not returned their verification form to request that the form be returned. A few facilities failed to return the verification prior to the publishing of the report. The report for each facility reflects whether the data was verified by the facility.
Appendix 298
APPENDIX D ABORTION CLINICS REPORTABLE EVENTS FOR 2009
National Women’s Health Organization Allen County 2210 Inwood Drive Fort Wayne, IN 46815
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 299
APPENDIX D ABORTION CLINICS REPORTABLE EVENTS FOR 2009
Planned Parenthood of Indiana – Merrillville Clinic Lake County 8645 Connecticut Street Merrillville, IN 46410
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - NOT VERIFIED BY FACILITY 0
Appendix 300
APPENDIX D ABORTION CLINICS REPORTABLE EVENTS FOR 2009
Friendship Family Planning Clinic Lake County 3700 Broadway Gary, IN 46408
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - NOT VERIFIED BY FACILITY 0
Appendix 301
APPENDIX D ABORTION CLINICS REPORTABLE EVENTS FOR 2009
Affiliated Women’s Services Marion County 2215 Distributors Drive Indianapolis, IN 46241
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 302
APPENDIX D ABORTION CLINICS REPORTABLE EVENTS FOR 2009
Clinic For Women Marion County 3607 West 16th Street Indianapolis, IN 46222
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 303
APPENDIX D ABORTION CLINICS REPORTABLE EVENTS FOR 2009
Indianapolis Women’s Center Marion County 1201 North Arlington Avenue Indianapolis, IN 46219
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 304
APPENDIX D ABORTION CLINICS REPORTABLE EVENTS FOR 2009
Planned Parenthood of Indiana- Indianapolis, Clinic Marion County 8590 Georgetown Road Indianapolis, IN 46268
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 305
APPENDIX D ABORTION CLINICS REPORTABLE EVENTS FOR 2009
Planned Parenthood of Indiana – Bloomington Clinic Monroe County 421 South College Avenue Bloomington, IN 47403
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 306
APPENDIX D ABORTION CLINICS REPORTABLE EVENTS FOR 2009
Women’s Pavilion St. Joseph County 2010 Ironwood Circle South Bend, IN 46635
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - NOT VERIFIED BY FACILITY 0
Appendix 307
APPENDIX E
In order to eliminate mistakes in the report and give facilities the opportunity to review their data for accuracy, the ISDH sent to each facility their final report for 2009. The report was sent in June, 2010. Facilities were instructed to review their data for correctness and completeness. Facilities then returned a verification of data to the ISDH.
Appendix 308
APPENDIX E BIRTHING CENTERS REPORTABLE EVENTS FOR 2009
Expectations Women’s Health & Childbearing Center Delaware County 1506 West White River Blvd. Muncie, IN 47303
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 309
APPENDIX E BIRTHING CENTERS REPORTABLE EVENTS FOR 2009
Goshen Birth Center, Inc. Elkhart County 1155 Lighthouse Lane Goshen, IN 46526
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 310
APPENDIX E BIRTHING CENTERS REPORTABLE EVENTS FOR 2009
New Eden Care Center Lagrange County 7980 W 100 S Lagrange, IN 46571
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
Appendix 311
APPENDIX E BIRTHING CENTERS REPORTABLE EVENTS FOR 2009
Nurse – Midwives of Indianapolis Marion County 2110 West 38th Street Indianapolis, IN 46228
Reportable Event Number Reported Totals
SURGICAL 0 1. Surgery performed on the wrong body part 0 2. Surgery performed on the wrong patient 0 3. Wrong surgical procedure performed on a patient 0 4. Retention of a foreign object in a patient after surgery 0 5. Intra-operative or post-operative death in a normal, healthy patient 0
PRODUCTS OR DEVICES 0 6. Death or serious disability associated with contaminated drugs, devices, or biologics 0 7. Death or serious disability associated with misuse or malfunction of device 0 8. Death or serious disability associated with intravascular air embolism 0
PATIENT PROTECTION 0 9. Infant discharged to wrong person 0 10. Death or serious disability associated with patient elopement 0 11. Suicide or attempted suicide resulting in serious disability 0
CARE MANAGEMENT 0 12. Death or serious disability associated with medication error 0 13. Death or serious disability associated with hemolytic reaction 0 14. Maternal death or serious disability associated with low risk pregnancy labor or delivery 0 15. Death or serious disability associated with hypoglycemia 0 16. Death or serious disability (kernicterus) associated with hyperbilirubinemia in neonates 0 17. Stage 3 or 4 pressure ulcers acquired after admission 0 18. Death or serious disability due to joint movement therapy 0 19. Artificial insemination with the wrong donor sperm or wrong egg. 0
ENVIRONMENTAL 0 20. Death or serious disability associated with electric shock 0 21. Wrong gas / contamination in patient gas line 0 22. Death or serious disability associated with a burn 0 23. Death or serious disability associated with a fall 0 24. Death or serious disability associated with restraints or bedrails 0
CRIMINAL 0 25. Care ordered by someone impersonating a health care provider 0 26. Abduction of patient of any age 0 27. Sexual assault of a patient on the facility grounds 0 28. Death / injury of patient or staff from physical assault occurring on facility grounds 0
TOTAL NUMBER OF REPORTED EVENTS - VERIFIED BY FACILITY 0
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