State regulators issued an immediate jeopardy warning to Providence Sacred Heart Medical Center in Spokane, Wash., in late April, after determining the facility failed to properly screen and supervise patients with suicidal ideation, according to records obtained by InvestigateWest.
On April 13, a 12-year-old girl who had been a patient at the hospital since February died by suicide. The girl had a history of self-harm and had been assigned a sitter for around-the-clock monitoring, according to Washington Department of Health records cited in the report. In early April, the sitter was removed with “no documentation explaining why.” A camera that had been installed for remote monitoring to the patient’s room had also been removed without a documented provider assessment or recommendation.
On April 13, the girl managed to leave her room on the pediatrics floor and later died by suicide. Investigators found delayed notification between when staff noticed she was missing and when security issued a missing child alert.
They determined the girl was one of four patients with suicidal ideation at the hospital this year who did not receive twice-daily assessments as required under the hospital’s own policy.
“Failure to implement policies and procedures, monitor patients with suicidal ideation, and activate emergency responses without delays puts patients at risk for physical and psychological harm, potential adverse outcomes or death,” state regulators said in an immediate jeopardy notice issued April 30.
The immediate jeopardy was lifted one day later, after Sacred Heart submitted a corrective action plan that involved retraining staff on existing policies and ensuring compliance. The Department of Health said an investigation is ongoing.
“Following a tragic incident, Providence launched an internal investigation and self-reported to health authorities, prompting an external investigation,” a spokesperson for the Renton, Wash.-based system said in a statement to Becker’s May 22. “Providence implemented improved protocols and trainings, which included screening all patients for potential suicide risk and responding to situations when patients go missing while hospitalized. At this time, we cannot share specifics due to patient privacy laws other than to say we are working in close partnership with all relevant health authorities to address the situation. Providence remains committed to working in close partnership with health authorities on this issue.”
