Department of Health & Human Services

Centers for Medicare & Medicaid Services
Form Approved

OMB No. 0938-0391
Statement of Deficiencies (X1) Provider/Supplier/CLIA Identification Number 010001 (X3) Date Survey Completed 08/24/2017
Name of Provider or Supplier Southeast Health Medical Center Street Address, City, State 1108 Ross Clark Circle, Dothan, AL
For information on the provider's plan to correct this deficiency, please contact the provider or the state survey agency.
(X4) ID Prefix Tag Summary Statement of Deficiencies

(Each deficiency should be preceded by full regulatory or LSC identifying information)
A0000 An abbreviated survey was conducted on 8/24/17 to investigate complaint number AL00035294. Patient Identifier (PI) # 1 presented to the Emergency Department (ED) on 5/14/17 at 3:21 AM with complaints of "... can't remember anything... back hurts so bad and I don't know if it is my body or just life in general..." The patient was subsequently admitted to the Behavioral Medicine Unit (BMU) with Auditory Hallucinations, Psychosis and Suicidal Ideations. On 5/30/17, PI # 1 was found hanging from the door to the patient bathroom door, cardiopulmonary resuscitation was initiated and the patient was pronounced dead. The hospital performed a Root Cause Analysis of the sentinel event, which indicated staff were not performing Q15 (Every 15) minute safety checks as ordered by the physician. Two Mental Health Technicians were fired and measures were put in place to protect other patients in the unit from immediate harm. There was no immediate threat to patient safety identified during the survey. The complaint was substantiated with conditions cited out of compliance at: 482.12, Governing Body; 482.13, Patient Rights; 482.21, Quality Assurance Performance Improvement and 482.23, Nursing Services. The state agency recommends the conditions at 482.13 (Patient Rights) and 482.23 (Nursing Services) be placed out of compliance.