Adverse Events Facilities and Date of Event Report 2006-2020 · 2020-06-02 · Facilities and Date...

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Adverse Events Facilities and Date of Event Report 2006-2020 DOH 689-013 September 2014 Office of Community Health Systems Page 1 of 62 Adverse Events Quarterly Report Facility by Date and Event - Q2 2020 Facility Credential Facility Name Facility County Date Confirmed Event Type Facility Type: Hospital Acute Care HAC.FS.60790591 Astria Regional Medical Center Yakima 1/2/2018 1D - Unintended retention of foreign object HAC.FS.60790591 Astria Regional Medical Center 12/4/2018 4F - Pressure ulcer 2 HAC.FS.00000183 Auburn Regional Medical Center King 4/16/2007 1D - Unintended retention of foreign object HAC.FS.00000183 Auburn Regional Medical Center 4/16/2008 1C - Wrong surgical/invasive procedure HAC.FS.00000183 Auburn Regional Medical Center 4/29/2008 4E - Patient death or serious injury associated with a fall HAC.FS.00000183 Auburn Regional Medical Center 4/29/2008 4E - Patient death or serious injury associated with a fall HAC.FS.00000183 Auburn Regional Medical Center 6/17/2008 3C - Patient suicide, attempted suicide, or self-harm HAC.FS.00000183 Auburn Regional Medical Center 6/23/2009 4E - Patient death or serious injury associated with a fall HAC.FS.00000183 Auburn Regional Medical Center 7/2/2009 4E - Patient death or serious injury associated with a fall HAC.FS.00000183 Auburn Regional Medical Center 4/20/2010 4E - Patient death or serious injury associated with a fall HAC.FS.00000183 Auburn Regional Medical Center 4/26/2010 4E - Patient death or serious injury associated with a fall HAC.FS.00000183 Auburn Regional Medical Center 5/2/2010 4E - Patient death or serious injury associated with a fall HAC.FS.00000183 Auburn Regional Medical Center 5/14/2010 4E - Patient death or serious injury associated with a fall HAC.FS.00000183 Auburn Regional Medical Center 7/23/2010 4E - Patient death or serious injury associated with a fall HAC.FS.00000183 Auburn Regional Medical Center 8/10/2010 1D - Unintended retention of foreign object HAC.FS.00000183 Auburn Regional Medical Center 10/14/2010 4E - Patient death or serious injury associated with a fall HAC.FS.00000183 Auburn Regional Medical Center 1/4/2011 4E - Patient death or serious injury associated with a fall HAC.FS.00000183 Auburn Regional Medical Center 1/21/2011 4E - Patient death or serious injury associated with a fall HAC.FS.00000183 Auburn Regional Medical Center 4/5/2011 4B - Wrong blood product HAC.FS.00000183 Auburn Regional Medical Center 9/26/2011 4E - Patient death or serious injury associated with a fall HAC.FS.00000183 Auburn Regional Medical Center 12/19/2011 4E - Patient death or serious injury associated with a fall HAC.FS.00000183 Auburn Regional Medical Center 1/21/2012 4E - Patient death or serious injury associated with a fall HAC.FS.00000183 Auburn Regional Medical Center 3/28/2012 4E - Patient death or serious injury associated with a fall 21 HAC.FS.00000197 Capital Medical Center Thurston 9/8/2010 4E - Patient death or serious injury associated with a fall HAC.FS.00000197 Capital Medical Center 1/6/2011 1D - Unintended retention of foreign object HAC.FS.00000197 Capital Medical Center 1/25/2011 4E - Patient death or serious injury associated with a fall HAC.FS.00000197 Capital Medical Center 1/17/2012 4F - Pressure ulcer HAC.FS.00000197 Capital Medical Center 7/9/2012 1D - Unintended retention of foreign object HAC.FS.00000197 Capital Medical Center 11/7/2012 4E - Patient death or serious injury associated with a fall HAC.FS.00000197 Capital Medical Center 5/22/2014 1A - Wrong surgery/invasive procedure site HAC.FS.00000197 Capital Medical Center 7/2/2014 1A - Wrong surgery/invasive procedure site HAC.FS.00000197 Capital Medical Center 7/31/2014 1A - Wrong surgery/invasive procedure site HAC.FS.00000197 Capital Medical Center 8/4/2015 3C - Patient suicide, attempted suicide, or self-harm HAC.FS.00000197 Capital Medical Center 11/12/2015 1A - Wrong surgery/invasive procedure site HAC.FS.00000197 Capital Medical Center 3/14/2016 4D - Death or serious injury of neonate HAC.FS.00000197 Capital Medical Center 9/3/2016 4E - Patient death or serious injury associated with a fall HAC.FS.00000197 Capital Medical Center 10/8/2016 4D - Death or serious injury of neonate HAC.FS.00000197 Capital Medical Center 12/19/2016 4E - Patient death or serious injury associated with a fall HAC.FS.00000197 Capital Medical Center 11/9/2017 1D - Unintended retention of foreign object HAC.FS.00000197 Capital Medical Center 7/5/2018 4E - Patient death or serious injury associated with a fall HAC.FS.00000197 Capital Medical Center 11/2/2018 5C - Burn HAC.FS.00000197 Capital Medical Center 4/25/2019 5C - Burn 19 HAC.FS.60986502 Capital Medical Center Thurston 11/4/2019 4F - Pressure ulcer HAC.FS.60986502 Capital Medical Center 11/13/2019 4F - Pressure ulcer HAC.FS.60986502 Capital Medical Center 11/15/2019 4F - Pressure ulcer HAC.FS.60986502 Capital Medical Center 11/19/2019 4F - Pressure ulcer HAC.FS.60986502 Capital Medical Center 11/22/2019 4F - Pressure ulcer HAC.FS.60986502 Capital Medical Center 12/1/2019 4F - Pressure ulcer HAC.FS.60986502 Capital Medical Center 12/6/2019 4F - Pressure ulcer HAC.FS.60986502 Capital Medical Center 12/12/2019 4F - Pressure ulcer HAC.FS.60986502 Capital Medical Center 12/20/2019 4F - Pressure ulcer HAC.FS.60986502 Capital Medical Center 2/10/2020 4F - Pressure ulcer HAC.FS.60986502 Capital Medical Center 2/14/2020 4F - Pressure ulcer HAC.FS.60986502 Capital Medical Center 2/19/2020 4F - Pressure ulcer HAC.FS.60986502 Capital Medical Center 3/25/2020 4F - Pressure ulcer HAC.FS.60986502 Capital Medical Center 4/23/2020 4F - Pressure ulcer HAC.FS.60986502 Capital Medical Center 5/27/2020 4F - Pressure ulcer 15 HAC.FS.00000158 Cascade Medical Center Chelan 4/15/2016 1E- Post-operative death HAC.FS.00000158 Cascade Medical Center 4/29/2016 7C - Sexual abuse/assault HAC.FS.00000158 Cascade Medical Center 12/1/2016 4F - Pressure ulcer HAC.FS.00000158 Cascade Medical Center 8/22/2018 7D - Physical assault 4 HAC.FS.00000106 Cascade Valley Hospital Snohomish 11/25/2009 4A - Medication error HAC.FS.00000106 Cascade Valley Hospital 7/2/2012 4F - Pressure ulcer HAC.FS.00000106 Cascade Valley Hospital 7/11/2012 4F - Pressure ulcer HAC.FS.00000106 Cascade Valley Hospital 4/29/2015 1D - Unintended retention of foreign object HAC.FS.00000106 Cascade Valley Hospital 4/29/2015 7C - Sexual abuse/assault HAC.FS.00000106 Cascade Valley Hospital 2/1/2016 4E - Patient death or serious injury associated with a fall 6 HAC.FS.60655126 Cascade Valley Hospital Snohomish 6/21/2018 **1D - Unintended retention of foreign object HAC.FS.60655126 Cascade Valley Hospital 10/12/2018 **4F - Pressure ulcer HAC.FS.60655126 Cascade Valley Hospital 10/16/2018 **4E - Patient death or serious injury associated with a fall HAC.FS.60655126 Cascade Valley Hospital 3/25/2019 4F - Pressure ulcer HAC.FS.60655126 Cascade Valley Hospital 5/20/2020 **7D - Physical assault 5 HAC.FS.00000168 Central Washington Hospital Chelan 7/13/2007 1D - Unintended retention of foreign object HAC.FS.00000168 Central Washington Hospital 8/23/2007 1D - Unintended retention of foreign object HAC.FS.00000168 Central Washington Hospital 8/25/2007 1D - Unintended retention of foreign object HAC.FS.00000168 Central Washington Hospital 9/26/2007 4F - Pressure ulcer HAC.FS.00000168 Central Washington Hospital 7/13/2008 1A - Wrong surgery/invasive procedure site HAC.FS.00000168 Central Washington Hospital 7/23/2008 1D - Unintended retention of foreign object HAC.FS.00000168 Central Washington Hospital 10/30/2009 4E - Patient death or serious injury associated with a fall HAC.FS.00000168 Central Washington Hospital 12/2/2009 4E - Patient death or serious injury associated with a fall HAC.FS.00000168 Central Washington Hospital 1/29/2010 4E - Patient death or serious injury associated with a fall HAC.FS.00000168 Central Washington Hospital 3/31/2010 4F - Pressure ulcer HAC.FS.00000168 Central Washington Hospital 2/4/2011 4F - Pressure ulcer HAC.FS.00000168 Central Washington Hospital 6/30/2011 5C - Burn HAC.FS.00000168 Central Washington Hospital 12/23/2011 4F - Pressure ulcer HAC.FS.00000168 Central Washington Hospital 2/6/2012 5C - Burn HAC.FS.00000168 Central Washington Hospital 5/24/2012 1D - Unintended retention of foreign object HAC.FS.00000168 Central Washington Hospital 7/27/2012 1C - Wrong surgical/invasive procedure HAC.FS.00000168 Central Washington Hospital 11/7/2012 4F - Pressure ulcer HAC.FS.00000168 Central Washington Hospital 12/10/2012 4F - Pressure ulcer HAC.FS.00000168 Central Washington Hospital 12/12/2012 1D - Unintended retention of foreign object HAC.FS.00000168 Central Washington Hospital 1/3/2013 4E - Patient death or serious injury associated with a fall Astria Regional Medical Center number of events: Auburn Regional Medical Center number of events: Capital Medical Center number of events: Cascade Medical Center number of events: Cascade Valley Hospital number of events: Cascade Valley Hospital number of events: Capital Medical Center number of events:

Transcript of Adverse Events Facilities and Date of Event Report 2006-2020 · 2020-06-02 · Facilities and Date...

Page 1: Adverse Events Facilities and Date of Event Report 2006-2020 · 2020-06-02 · Facilities and Date of Event Report 2006-2020 DOH 689-013 September 2014 Office of Community Health

Adverse EventsFacilities and Date of Event Report 2006-2020

DOH 689-013 September 2014Office of Community Health Systems Page 1 of 62

Adverse Events Quarterly ReportFacility by Date and Event - Q2 2020

Facility Credential Facility Name Facility County Date Confirmed Event TypeFacility Type: Hospital Acute CareHAC.FS.60790591 Astria Regional Medical Center Yakima 1/2/2018 1D - Unintended retention of foreign objectHAC.FS.60790591 Astria Regional Medical Center 12/4/2018 4F - Pressure ulcer

2HAC.FS.00000183 Auburn Regional Medical Center King 4/16/2007 1D - Unintended retention of foreign objectHAC.FS.00000183 Auburn Regional Medical Center 4/16/2008 1C - Wrong surgical/invasive procedureHAC.FS.00000183 Auburn Regional Medical Center 4/29/2008 4E - Patient death or serious injury associated with a fallHAC.FS.00000183 Auburn Regional Medical Center 4/29/2008 4E - Patient death or serious injury associated with a fallHAC.FS.00000183 Auburn Regional Medical Center 6/17/2008 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.00000183 Auburn Regional Medical Center 6/23/2009 4E - Patient death or serious injury associated with a fallHAC.FS.00000183 Auburn Regional Medical Center 7/2/2009 4E - Patient death or serious injury associated with a fallHAC.FS.00000183 Auburn Regional Medical Center 4/20/2010 4E - Patient death or serious injury associated with a fallHAC.FS.00000183 Auburn Regional Medical Center 4/26/2010 4E - Patient death or serious injury associated with a fallHAC.FS.00000183 Auburn Regional Medical Center 5/2/2010 4E - Patient death or serious injury associated with a fallHAC.FS.00000183 Auburn Regional Medical Center 5/14/2010 4E - Patient death or serious injury associated with a fallHAC.FS.00000183 Auburn Regional Medical Center 7/23/2010 4E - Patient death or serious injury associated with a fallHAC.FS.00000183 Auburn Regional Medical Center 8/10/2010 1D - Unintended retention of foreign objectHAC.FS.00000183 Auburn Regional Medical Center 10/14/2010 4E - Patient death or serious injury associated with a fallHAC.FS.00000183 Auburn Regional Medical Center 1/4/2011 4E - Patient death or serious injury associated with a fallHAC.FS.00000183 Auburn Regional Medical Center 1/21/2011 4E - Patient death or serious injury associated with a fallHAC.FS.00000183 Auburn Regional Medical Center 4/5/2011 4B - Wrong blood productHAC.FS.00000183 Auburn Regional Medical Center 9/26/2011 4E - Patient death or serious injury associated with a fallHAC.FS.00000183 Auburn Regional Medical Center 12/19/2011 4E - Patient death or serious injury associated with a fallHAC.FS.00000183 Auburn Regional Medical Center 1/21/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000183 Auburn Regional Medical Center 3/28/2012 4E - Patient death or serious injury associated with a fall

21HAC.FS.00000197 Capital Medical Center Thurston 9/8/2010 4E - Patient death or serious injury associated with a fallHAC.FS.00000197 Capital Medical Center 1/6/2011 1D - Unintended retention of foreign objectHAC.FS.00000197 Capital Medical Center 1/25/2011 4E - Patient death or serious injury associated with a fallHAC.FS.00000197 Capital Medical Center 1/17/2012 4F - Pressure ulcerHAC.FS.00000197 Capital Medical Center 7/9/2012 1D - Unintended retention of foreign objectHAC.FS.00000197 Capital Medical Center 11/7/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000197 Capital Medical Center 5/22/2014 1A - Wrong surgery/invasive procedure siteHAC.FS.00000197 Capital Medical Center 7/2/2014 1A - Wrong surgery/invasive procedure siteHAC.FS.00000197 Capital Medical Center 7/31/2014 1A - Wrong surgery/invasive procedure siteHAC.FS.00000197 Capital Medical Center 8/4/2015 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.00000197 Capital Medical Center 11/12/2015 1A - Wrong surgery/invasive procedure siteHAC.FS.00000197 Capital Medical Center 3/14/2016 4D - Death or serious injury of neonateHAC.FS.00000197 Capital Medical Center 9/3/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000197 Capital Medical Center 10/8/2016 4D - Death or serious injury of neonateHAC.FS.00000197 Capital Medical Center 12/19/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000197 Capital Medical Center 11/9/2017 1D - Unintended retention of foreign objectHAC.FS.00000197 Capital Medical Center 7/5/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000197 Capital Medical Center 11/2/2018 5C - BurnHAC.FS.00000197 Capital Medical Center 4/25/2019 5C - Burn

19HAC.FS.60986502 Capital Medical Center Thurston 11/4/2019 4F - Pressure ulcerHAC.FS.60986502 Capital Medical Center 11/13/2019 4F - Pressure ulcerHAC.FS.60986502 Capital Medical Center 11/15/2019 4F - Pressure ulcerHAC.FS.60986502 Capital Medical Center 11/19/2019 4F - Pressure ulcerHAC.FS.60986502 Capital Medical Center 11/22/2019 4F - Pressure ulcerHAC.FS.60986502 Capital Medical Center 12/1/2019 4F - Pressure ulcerHAC.FS.60986502 Capital Medical Center 12/6/2019 4F - Pressure ulcerHAC.FS.60986502 Capital Medical Center 12/12/2019 4F - Pressure ulcerHAC.FS.60986502 Capital Medical Center 12/20/2019 4F - Pressure ulcerHAC.FS.60986502 Capital Medical Center 2/10/2020 4F - Pressure ulcerHAC.FS.60986502 Capital Medical Center 2/14/2020 4F - Pressure ulcerHAC.FS.60986502 Capital Medical Center 2/19/2020 4F - Pressure ulcerHAC.FS.60986502 Capital Medical Center 3/25/2020 4F - Pressure ulcerHAC.FS.60986502 Capital Medical Center 4/23/2020 4F - Pressure ulcerHAC.FS.60986502 Capital Medical Center 5/27/2020 4F - Pressure ulcer

15HAC.FS.00000158 Cascade Medical Center Chelan 4/15/2016 1E- Post-operative deathHAC.FS.00000158 Cascade Medical Center 4/29/2016 7C - Sexual abuse/assaultHAC.FS.00000158 Cascade Medical Center 12/1/2016 4F - Pressure ulcerHAC.FS.00000158 Cascade Medical Center 8/22/2018 7D - Physical assault

4HAC.FS.00000106 Cascade Valley Hospital Snohomish 11/25/2009 4A - Medication errorHAC.FS.00000106 Cascade Valley Hospital 7/2/2012 4F - Pressure ulcerHAC.FS.00000106 Cascade Valley Hospital 7/11/2012 4F - Pressure ulcerHAC.FS.00000106 Cascade Valley Hospital 4/29/2015 1D - Unintended retention of foreign objectHAC.FS.00000106 Cascade Valley Hospital 4/29/2015 7C - Sexual abuse/assaultHAC.FS.00000106 Cascade Valley Hospital 2/1/2016 4E - Patient death or serious injury associated with a fall

6HAC.FS.60655126 Cascade Valley Hospital Snohomish 6/21/2018 **1D - Unintended retention of foreign objectHAC.FS.60655126 Cascade Valley Hospital 10/12/2018 **4F - Pressure ulcerHAC.FS.60655126 Cascade Valley Hospital 10/16/2018 **4E - Patient death or serious injury associated with a fallHAC.FS.60655126 Cascade Valley Hospital 3/25/2019 4F - Pressure ulcerHAC.FS.60655126 Cascade Valley Hospital 5/20/2020 **7D - Physical assault

5HAC.FS.00000168 Central Washington Hospital Chelan 7/13/2007 1D - Unintended retention of foreign objectHAC.FS.00000168 Central Washington Hospital 8/23/2007 1D - Unintended retention of foreign objectHAC.FS.00000168 Central Washington Hospital 8/25/2007 1D - Unintended retention of foreign objectHAC.FS.00000168 Central Washington Hospital 9/26/2007 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 7/13/2008 1A - Wrong surgery/invasive procedure siteHAC.FS.00000168 Central Washington Hospital 7/23/2008 1D - Unintended retention of foreign objectHAC.FS.00000168 Central Washington Hospital 10/30/2009 4E - Patient death or serious injury associated with a fallHAC.FS.00000168 Central Washington Hospital 12/2/2009 4E - Patient death or serious injury associated with a fallHAC.FS.00000168 Central Washington Hospital 1/29/2010 4E - Patient death or serious injury associated with a fallHAC.FS.00000168 Central Washington Hospital 3/31/2010 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 2/4/2011 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 6/30/2011 5C - BurnHAC.FS.00000168 Central Washington Hospital 12/23/2011 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 2/6/2012 5C - BurnHAC.FS.00000168 Central Washington Hospital 5/24/2012 1D - Unintended retention of foreign objectHAC.FS.00000168 Central Washington Hospital 7/27/2012 1C - Wrong surgical/invasive procedureHAC.FS.00000168 Central Washington Hospital 11/7/2012 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 12/10/2012 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 12/12/2012 1D - Unintended retention of foreign objectHAC.FS.00000168 Central Washington Hospital 1/3/2013 4E - Patient death or serious injury associated with a fall

Astria Regional Medical Center number of events:

Auburn Regional Medical Center number of events:

Capital Medical Center number of events:

Cascade Medical Center number of events:

Cascade Valley Hospital number of events:

Cascade Valley Hospital number of events:

Capital Medical Center number of events:

Page 2: Adverse Events Facilities and Date of Event Report 2006-2020 · 2020-06-02 · Facilities and Date of Event Report 2006-2020 DOH 689-013 September 2014 Office of Community Health

Adverse EventsFacilities and Date of Event Report 2006-2020

DOH 689-013 September 2014Office of Community Health Systems Page 2 of 62

Adverse Events Quarterly ReportFacility by Date and Event - Q2 2020

Facility Credential Facility Name Facility County Date Confirmed Event TypeHAC.FS.00000168 Central Washington Hospital 2/15/2013 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 3/13/2013 4C - Maternal death or serious injuryHAC.FS.00000168 Central Washington Hospital 3/22/2013 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 3/22/2013 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 4/3/2013 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 4/11/2013 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 4/30/2013 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 5/30/2013 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 6/4/2013 1D - Unintended retention of foreign object HAC.FS.00000168 Central Washington Hospital 6/4/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000168 Central Washington Hospital 6/18/2013 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 8/15/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000168 Central Washington Hospital 8/21/2013 1D - Unintended retention of foreign objectHAC.FS.00000168 Central Washington Hospital 8/22/2013 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 8/28/2013 1D - Unintended retention of foreign objectHAC.FS.00000168 Central Washington Hospital 9/6/2013 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.00000168 Central Washington Hospital 11/6/2013 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 2/13/2014 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 2/13/2014 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 3/7/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000168 Central Washington Hospital 5/13/2014 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 5/29/2014 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 7/1/2014 4A - Medication errorHAC.FS.00000168 Central Washington Hospital 8/19/2014 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 8/19/2014 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 8/19/2014 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 8/19/2014 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 9/30/2014 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 10/24/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000168 Central Washington Hospital 12/4/2014 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 2/12/2015 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 2/12/2015 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 2/13/2015 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 2/26/2015 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 3/25/2015 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 3/25/2015 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 3/25/2015 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 4/30/2015 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 4/30/2015 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 4/30/2015 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 5/5/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000168 Central Washington Hospital 5/22/2015 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 6/30/2015 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 9/2/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000168 Central Washington Hospital 9/29/2015 1D - Unintended retention of foreign objectHAC.FS.00000168 Central Washington Hospital 9/29/2015 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 9/29/2015 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 9/29/2015 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 10/23/2015 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 11/10/2015 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 11/16/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000168 Central Washington Hospital 12/10/2015 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 12/10/2015 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 12/22/2015 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 1/19/2016 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 2/23/2016 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 4/5/2016 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 4/19/2016 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 5/11/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000168 Central Washington Hospital 5/25/2016 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 6/14/2016 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 7/8/2016 7C - Sexual abuse/assaultHAC.FS.00000168 Central Washington Hospital 7/14/2016 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 7/28/2016 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 8/11/2016 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 8/16/2016 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 8/25/2016 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 9/3/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000168 Central Washington Hospital 10/6/2016 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 10/6/2016 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 10/13/2016 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 11/17/2016 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 12/21/2016 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 12/21/2016 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 4/22/2017 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 5/18/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000168 Central Washington Hospital 5/25/2017 1A - Wrong surgery/invasive procedure siteHAC.FS.00000168 Central Washington Hospital 5/25/2017 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 5/25/2017 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 6/29/2017 1A - Wrong surgery/invasive procedure siteHAC.FS.00000168 Central Washington Hospital 7/6/2017 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 7/17/2017 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 7/17/2017 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 7/20/2017 4I - Failure to follow up with test resultsHAC.FS.00000168 Central Washington Hospital 7/27/2017 1A - Wrong surgery/invasive procedure siteHAC.FS.00000168 Central Washington Hospital 7/27/2017 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 7/27/2017 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 9/1/2017 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 11/30/2017 1C - Wrong surgical/invasive procedureHAC.FS.00000168 Central Washington Hospital 11/30/2017 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 11/30/2017 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 12/14/2017 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 12/14/2017 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 12/14/2017 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 1/25/2018 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 1/25/2018 **4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 1/25/2018 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 3/1/2018 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 3/1/2018 5C - BurnHAC.FS.00000168 Central Washington Hospital 4/4/2018 2B - Device function or use

Page 3: Adverse Events Facilities and Date of Event Report 2006-2020 · 2020-06-02 · Facilities and Date of Event Report 2006-2020 DOH 689-013 September 2014 Office of Community Health

Adverse EventsFacilities and Date of Event Report 2006-2020

DOH 689-013 September 2014Office of Community Health Systems Page 3 of 62

Adverse Events Quarterly ReportFacility by Date and Event - Q2 2020

Facility Credential Facility Name Facility County Date Confirmed Event TypeHAC.FS.00000168 Central Washington Hospital 4/4/2018 4I - Failure to follow up with test resultsHAC.FS.00000168 Central Washington Hospital 5/3/2018 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 6/14/2018 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 6/14/2018 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 7/12/2018 1D - Unintended retention of foreign objectHAC.FS.00000168 Central Washington Hospital 7/19/2018 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 7/19/2018 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 8/8/2018 1D - Unintended retention of foreign objectHAC.FS.00000168 Central Washington Hospital 9/12/2018 1D - Unintended retention of foreign objectHAC.FS.00000168 Central Washington Hospital 9/12/2018 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 9/12/2018 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 9/12/2018 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 10/25/2018 2B - Device function or useHAC.FS.00000168 Central Washington Hospital 10/25/2018 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 10/25/2018 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 10/25/2018 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 10/25/2018 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 10/25/2018 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 10/25/2018 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 10/25/2018 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 2/15/2019 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 2/15/2019 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 3/7/2019 1A - Wrong surgery/invasive procedure siteHAC.FS.00000168 Central Washington Hospital 3/7/2019 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 3/7/2019 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 3/7/2019 1D - Unintended retention of foreign objectHAC.FS.00000168 Central Washington Hospital 3/14/2019 1D - Unintended retention of foreign objectHAC.FS.00000168 Central Washington Hospital 3/21/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000168 Central Washington Hospital 3/21/2019 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 4/4/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000168 Central Washington Hospital 4/4/2019 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 5/30/2019 3A - Patient/Resident discharged to unauthorized personHAC.FS.00000168 Central Washington Hospital 6/13/2019 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 7/11/2019 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 7/18/2019 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 8/15/2019 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 8/15/2019 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 8/29/2019 1D - Unintended retention of foreign objectHAC.FS.00000168 Central Washington Hospital 9/19/2019 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 9/19/2019 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 9/26/2019 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 10/24/2019 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 10/31/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000168 Central Washington Hospital 11/7/2019 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 12/5/2019 4A - Medication errorHAC.FS.00000168 Central Washington Hospital 12/19/2019 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 1/2/2020 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 1/10/2020 1A - Wrong surgery/invasive procedure siteHAC.FS.00000168 Central Washington Hospital 1/10/2020 1D - Unintended retention of foreign objectHAC.FS.00000168 Central Washington Hospital 1/16/2020 4E - Patient death or serious injury associated with a fallHAC.FS.00000168 Central Washington Hospital 1/16/2020 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 1/16/2020 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 1/16/2020 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 1/30/2020 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 2/6/2020 1C - Wrong surgical/invasive procedureHAC.FS.00000168 Central Washington Hospital 2/13/2020 4E - Patient death or serious injury associated with a fallHAC.FS.00000168 Central Washington Hospital 4/9/2020 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 4/9/2020 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 4/30/2020 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 5/7/2020 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 5/7/2020 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 5/7/2020 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 5/21/2020 5C - BurnHAC.FS.00000168 Central Washington Hospital 6/25/2020 4F - Pressure ulcerHAC.FS.00000168 Central Washington Hospital 6/25/2020 4F - Pressure ulcer

185HAC.FS.00000045 Columbia Basin Hospital Grant 11/13/2011 4F - Pressure ulcerHAC.FS.00000045 Columbia Basin Hospital 5/1/2012 4F - Pressure ulcerHAC.FS.00000045 Columbia Basin Hospital 12/24/2013 4F - Pressure ulcerHAC.FS.00000045 Columbia Basin Hospital 1/27/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000045 Columbia Basin Hospital 1/27/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000045 Columbia Basin Hospital 11/7/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000045 Columbia Basin Hospital 11/9/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000045 Columbia Basin Hospital 2/14/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000045 Columbia Basin Hospital 1/11/2017 **2B - Device function or useHAC.FS.00000045 Columbia Basin Hospital 2/12/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000045 Columbia Basin Hospital 1/3/2018 **3C - Patient suicide, attempted suicide, or self-harmHAC.FS.00000045 Columbia Basin Hospital 8/27/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000045 Columbia Basin Hospital 1/5/2019 4E - Patient death or serious injury associated with a fall

13HAC.FS.00000150 Coulee Medical Center Grant 12/5/2006 1A - Wrong surgery/invasive procedure siteHAC.FS.00000150 Coulee Medical Center 6/25/2007 4F - Pressure ulcerHAC.FS.00000150 Coulee Medical Center 11/3/2008 1D - Unintended retention of foreign objectHAC.FS.00000150 Coulee Medical Center 3/23/2010 4E - Patient death or serious injury associated with a fallHAC.FS.00000150 Coulee Medical Center 4/2/2010 4E - Patient death or serious injury associated with a fallHAC.FS.00000150 Coulee Medical Center 4/2/2010 4E - Patient death or serious injury associated with a fallHAC.FS.00000150 Coulee Medical Center 4/28/2010 4E - Patient death or serious injury associated with a fallHAC.FS.00000150 Coulee Medical Center 7/27/2010 4A - Medication errorHAC.FS.00000150 Coulee Medical Center 3/26/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000150 Coulee Medical Center 7/20/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000150 Coulee Medical Center 7/20/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000150 Coulee Medical Center 11/20/2014 1A - Wrong surgery/invasive procedure siteHAC.FS.00000150 Coulee Medical Center 8/17/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000150 Coulee Medical Center 8/21/2015 7D - Physical assaultHAC.FS.00000150 Coulee Medical Center 9/6/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000150 Coulee Medical Center 3/14/2017 1D - Unintended retention of foreign objectHAC.FS.00000150 Coulee Medical Center 12/14/2017 4I - Failure to follow up with test resultsHAC.FS.00000150 Coulee Medical Center 1/30/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000150 Coulee Medical Center 7/16/2019 4E - Patient death or serious injury associated with a fall

19

Central Washington Hospital number of events:

Columbia Basin Hospital number of events:

Coulee Medical Center number of events:

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DOH 689-013 September 2014Office of Community Health Systems Page 4 of 62

Adverse Events Quarterly ReportFacility by Date and Event - Q2 2020

Facility Credential Facility Name Facility County Date Confirmed Event TypeHAC.FS.00000141 Dayton General Hospital Columbia 10/7/2010 4E - Patient death or serious injury associated with a fallHAC.FS.00000141 Dayton General Hospital 7/21/2011 4E - Patient death or serious injury associated with a fallHAC.FS.00000141 Dayton General Hospital 6/27/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000141 Dayton General Hospital 10/28/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000141 Dayton General Hospital 3/28/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000141 Dayton General Hospital 11/9/2016 **4F - Pressure ulcerHAC.FS.00000141 Dayton General Hospital 3/13/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000141 Dayton General Hospital 3/25/2018 **4E - Patient death or serious injury associated with a fallHAC.FS.00000141 Dayton General Hospital 8/7/2018 4F - Pressure ulcerHAC.FS.00000141 Dayton General Hospital 4/12/2020 4E - Patient death or serious injury associated with a fall

10HAC.FS.60054542 Deaconess Medical Center Spokane 7/25/2006 4F - Pressure ulcerHAC.FS.60054542 Deaconess Medical Center 8/5/2006 4F - Pressure ulcerHAC.FS.60054542 Deaconess Medical Center 10/5/2006 4F - Pressure ulcerHAC.FS.60054542 Deaconess Medical Center 12/19/2006 4F - Pressure ulcerHAC.FS.60054542 Deaconess Medical Center 1/10/2007 4F - Pressure ulcerHAC.FS.60054542 Deaconess Medical Center 2/23/2007 4F - Pressure ulcerHAC.FS.60054542 Deaconess Medical Center 2/23/2007 4F - Pressure ulcerHAC.FS.60054542 Deaconess Medical Center 6/10/2007 1D - Unintended retention of foreign objectHAC.FS.60054542 Deaconess Medical Center 8/28/2007 4F - Pressure ulcerHAC.FS.60054542 Deaconess Medical Center 2/7/2008 4F - Pressure ulcerHAC.FS.60054542 Deaconess Medical Center 2/22/2008 4F - Pressure ulcerHAC.FS.60054542 Deaconess Medical Center 8/27/2008 4F - Pressure ulcerHAC.FS.60054542 Deaconess Medical Center 8/14/2009 4F - Pressure ulcerHAC.FS.60054542 Deaconess Medical Center 8/14/2009 4F - Pressure ulcerHAC.FS.60054542 Deaconess Medical Center 8/14/2009 4F - Pressure ulcerHAC.FS.60054542 Deaconess Medical Center 8/14/2009 4F - Pressure ulcerHAC.FS.60054542 Deaconess Medical Center 9/21/2009 1D - Unintended retention of foreign objectHAC.FS.60054542 Deaconess Medical Center 9/22/2009 4F - Pressure ulcerHAC.FS.60054542 Deaconess Medical Center 9/25/2009 4F - Pressure ulcerHAC.FS.60054542 Deaconess Medical Center 10/30/2009 1A - Wrong surgery/invasive procedure siteHAC.FS.60054542 Deaconess Medical Center 12/8/2009 4F - Pressure ulcerHAC.FS.60054542 Deaconess Medical Center 1/5/2010 4F - Pressure ulcerHAC.FS.60054542 Deaconess Medical Center 3/2/2010 4F - Pressure ulcerHAC.FS.60054542 Deaconess Medical Center 7/7/2010 4F - Pressure ulcerHAC.FS.60054542 Deaconess Medical Center 7/22/2010 1A - Wrong surgery/invasive procedure siteHAC.FS.60054542 Deaconess Medical Center 8/24/2010 4F - Pressure ulcerHAC.FS.60054542 Deaconess Medical Center 10/7/2010 1A - Wrong surgery/invasive procedure siteHAC.FS.60054542 Deaconess Medical Center 10/11/2010 4E - Patient death or serious injury associated with a fallHAC.FS.60054542 Deaconess Medical Center 12/30/2010 4E - Patient death or serious injury associated with a fallHAC.FS.60054542 Deaconess Medical Center 1/18/2011 4E - Patient death or serious injury associated with a fallHAC.FS.60054542 Deaconess Medical Center 2/22/2011 4E - Patient death or serious injury associated with a fallHAC.FS.60054542 Deaconess Medical Center 8/21/2011 4E - Patient death or serious injury associated with a fallHAC.FS.60054542 Deaconess Medical Center 9/9/2011 4E - Patient death or serious injury associated with a fallHAC.FS.60054542 Deaconess Medical Center 9/13/2011 4E - Patient death or serious injury associated with a fallHAC.FS.60054542 Deaconess Medical Center 9/15/2011 4E - Patient death or serious injury associated with a fallHAC.FS.60054542 Deaconess Medical Center 12/28/2011 1D - Unintended retention of foreign objectHAC.FS.60054542 Deaconess Medical Center 1/24/2012 4F - Pressure ulcerHAC.FS.60054542 Deaconess Medical Center 1/24/2012 4F - Pressure ulcerHAC.FS.60054542 Deaconess Medical Center 4/30/2012 4E - Patient death or serious injury associated with a fallHAC.FS.60054542 Deaconess Medical Center 5/15/2012 1D - Unintended retention of foreign objectHAC.FS.60054542 Deaconess Medical Center 6/27/2012 1D - Unintended retention of foreign objectHAC.FS.60054542 Deaconess Medical Center 9/11/2012 4E - Patient death or serious injury associated with a fallHAC.FS.60054542 Deaconess Medical Center 10/8/2012 1A - Wrong surgery/invasive procedure siteHAC.FS.60054542 Deaconess Medical Center 10/31/2012 1D - Unintended retention of foreign objectHAC.FS.60054542 Deaconess Medical Center 6/4/2013 4E - Patient death or serious injury associated with a fallHAC.FS.60054542 Deaconess Medical Center 7/18/2013 4E - Patient death or serious injury associated with a fallHAC.FS.60054542 Deaconess Medical Center 7/18/2013 4E - Patient death or serious injury associated with a fallHAC.FS.60054542 Deaconess Medical Center 8/4/2013 4E - Patient death or serious injury associated with a fallHAC.FS.60054542 Deaconess Medical Center 9/6/2013 4F - Pressure ulcerHAC.FS.60054542 Deaconess Hospital 4/7/2014 4E - Patient death or serious injury associated with a fallHAC.FS.60054542 Deaconess Hospital 9/5/2014 4E - Patient death or serious injury associated with a fallHAC.FS.60054542 Deaconess Hospital 11/17/2014 4F - Pressure ulcerHAC.FS.60054542 Deaconess Hospital 11/27/2014 4E - Patient death or serious injury associated with a fallHAC.FS.60054542 Deaconess Hospital 12/13/2014 7C - Sexual abuse/assaultHAC.FS.60054542 Deaconess Hospital 12/16/2014 4E - Patient death or serious injury associated with a fallHAC.FS.60054542 Deaconess Hospital 1/12/2015 4F - Pressure ulcerHAC.FS.60054542 Deaconess Hospital 2/20/2015 1C - Wrong surgical/invasive procedureHAC.FS.60054542 Deaconess Hospital 2/25/2015 4F - Pressure ulcerHAC.FS.60054542 Deaconess Hospital 5/7/2015 4F - Pressure ulcerHAC.FS.60054542 Deaconess Hospital 5/22/2015 4F - Pressure ulcerHAC.FS.60054542 Deaconess Hospital 7/13/2015 4F - Pressure ulcerHAC.FS.60054542 Deaconess Hospital 7/17/2015 4F - Pressure ulcerHAC.FS.60054542 Deaconess Hospital 7/20/2015 4F - Pressure ulcerHAC.FS.60054542 Deaconess Hospital 8/27/2015 4E - Patient death or serious injury associated with a fallHAC.FS.60054542 Deaconess Hospital 8/27/2015 4F - Pressure ulcerHAC.FS.60054542 Deaconess Hospital 11/12/2015 4F - Pressure ulcerHAC.FS.60054542 Deaconess Hospital 6/2/2016 4F - Pressure ulcerHAC.FS.60054542 Deaconess Hospital 9/21/2016 4F - Pressure ulcerHAC.FS.60054542 Deaconess Hospital 12/12/2016 4F - Pressure ulcerHAC.FS.60054542 Deaconess Hospital 12/15/2016 4F - Pressure ulcerHAC.FS.60054542 Deaconess Hospital 1/13/2017 4F - Pressure ulcerHAC.FS.60054542 Deaconess Hospital 1/13/2017 4F - Pressure ulcerHAC.FS.60054542 Deaconess Hospital 2/3/2017 4F - Pressure ulcerHAC.FS.60054542 Deaconess Hospital 4/13/2017 4F - Pressure ulcerHAC.FS.60054542 Deaconess Hospital 5/3/2017 4F - Pressure ulcer

75HAC.FS.00000111 East Adams Rural Healthcare Adams 10/2/2011 4E - Patient death or serious injury associated with a fallHAC.FS.00000111 East Adams Rural Healthcare 1/25/2020 **7C - Sexual abuse/assault

2HAC.FS.00000164 Evergreen Hospital Medical Center King 8/26/2006 4E - Patient death or serious injury associated with a fallHAC.FS.00000164 Evergreen Hospital Medical Center 10/8/2007 1D - Unintended retention of foreign objectHAC.FS.00000164 Evergreen Hospital Medical Center 3/17/2008 4F - Pressure ulcerHAC.FS.00000164 Evergreen Hospital Medical Center 6/19/2009 1A - Wrong surgery/invasive procedure siteHAC.FS.00000164 Evergreen Hospital Medical Center 3/18/2010 4F - Pressure ulcerHAC.FS.00000164 Evergreen Hospital Medical Center 5/13/2010 4F - Pressure ulcerHAC.FS.00000164 Evergreen Hospital Medical Center 5/25/2010 4F - Pressure ulcerHAC.FS.00000164 Evergreen Hospital Medical Center 6/15/2010 4F - Pressure ulcerHAC.FS.00000164 Evergreen Hospital Medical Center 6/22/2010 4F - Pressure ulcerHAC.FS.00000164 Evergreen Hospital Medical Center 7/12/2010 4F - Pressure ulcer

Dayton General Hospital number of events:

Deaconess Hospital number of events:

East Adams Rural Hospital number of events:

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Adverse Events Quarterly ReportFacility by Date and Event - Q2 2020

Facility Credential Facility Name Facility County Date Confirmed Event TypeHAC.FS.00000164 Evergreen Hospital Medical Center 11/3/2010 4F - Pressure ulcerHAC.FS.00000164 Evergreen Hospital Medical Center 4/18/2011 4F - Pressure ulcerHAC.FS.00000164 Evergreen Hospital Medical Center 5/16/2011 4F - Pressure ulcerHAC.FS.00000164 Evergreen Hospital Medical Center 8/4/2011 4F - Pressure ulcerHAC.FS.00000164 Evergreen Hospital Medical Center 10/14/2011 4E - Patient death or serious injury associated with a fallHAC.FS.00000164 Evergreen Health Medical Center 5/22/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000164 Evergreen Health Medical Center 6/27/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000164 Evergreen Health Medical Center 7/12/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000164 Evergreen Health Medical Center 10/17/2012 1B - Wrong surgery/invasive procedure patientHAC.FS.00000164 Evergreen Health Medical Center 2/6/2013 4F - Pressure ulcerHAC.FS.00000164 Evergreen Health Medical Center 2/6/2013 4F - Pressure ulcerHAC.FS.00000164 Evergreen Health Medical Center 2/21/2013 4F - Pressure ulcerHAC.FS.00000164 Evergreen Health Medical Center 2/21/2013 4F - Pressure ulcerHAC.FS.00000164 Evergreen Health Medical Center 2/27/2013 4F - Pressure ulcerHAC.FS.00000164 Evergreen Health Medical Center 2/28/2013 4F - Pressure ulcerHAC.FS.00000164 Evergreen Health Medical Center 3/27/2013 5C - BurnHAC.FS.00000164 Evergreen Health Medical Center 6/4/2013 4A - Medication errorHAC.FS.00000164 Evergreen Health Medical Center 7/17/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000164 Evergreen Health Medical Center 7/25/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000164 Evergreen Health Medical Center 8/26/2013 1A - Wrong surgery/invasive procedure siteHAC.FS.00000164 Evergreen Health Medical Center 10/21/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000164 Evergreen Health Medical Center 12/15/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000164 Evergreen Health Medical Center 1/2/2014 4D - Death or serious injury of neonateHAC.FS.00000164 Evergreen Health Medical Center 4/7/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000164 Evergreen Health Medical Center 4/8/2014 4F - Pressure ulcerHAC.FS.00000164 Evergreen Health Medical Center 4/15/2014 4F - Pressure ulcerHAC.FS.00000164 Evergreen Health Medical Center 5/7/2014 5C - BurnHAC.FS.00000164 Evergreen Health Medical Center 6/4/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000164 Evergreen Health Medical Center 6/13/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000164 Evergreen Health Medical Center 9/15/2014 2B - Device function or useHAC.FS.00000164 Evergreen Health Medical Center 9/24/2014 **4E - Patient death or serious injury associated with a fallHAC.FS.00000164 Evergreen Health Medical Center 10/16/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000164 Evergreen Health Medical Center 10/31/2014 2B - Device function or useHAC.FS.00000164 Evergreen Health Medical Center 11/27/2014 1A - Wrong surgery/invasive procedure siteHAC.FS.00000164 Evergreen Health Medical Center 12/24/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000164 Evergreen Health Medical Center 4/9/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000164 Evergreen Health Medical Center 6/1/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000164 Evergreen Health Medical Center 8/3/2015 1D - Unintended retention of foreign objectHAC.FS.00000164 Evergreen Health Medical Center 8/3/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000164 Evergreen Health Medical Center 9/22/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000164 Evergreen Health Medical Center 10/7/2015 7C - Sexual abuse/assaultHAC.FS.00000164 Evergreen Health Medical Center 10/28/2015 1D - Unintended retention of foreign objectHAC.FS.00000164 Evergreen Health Medical Center 11/16/2015 3B - Patient elopement (disappearance)HAC.FS.00000164 Evergreen Health Medical Center 11/24/2015 4F - Pressure ulcerHAC.FS.00000164 Evergreen Health Medical Center 11/30/2015 4F - Pressure ulcerHAC.FS.00000164 Evergreen Health Medical Center 12/12/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000164 Evergreen Health Medical Center 1/15/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000164 Evergreen Health Medical Center 2/15/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000164 Evergreen Health Medical Center 2/15/2016 4F - Pressure ulcerHAC.FS.00000164 Evergreen Health Medical Center 5/21/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000164 Evergreen Health Medical Center 7/13/2016 4F - Pressure ulcerHAC.FS.00000164 Evergreen Health Medical Center 7/21/2016 4F - Pressure ulcerHAC.FS.00000164 Evergreen Health Medical Center 8/22/2016 4F - Pressure ulcerHAC.FS.00000164 Evergreen Health Medical Center 8/25/2016 4F - Pressure ulcerHAC.FS.00000164 Evergreen Health Medical Center 9/19/2016 4F - Pressure ulcerHAC.FS.00000164 Evergreen Health Medical Center 10/28/2016 4F - Pressure ulcerHAC.FS.00000164 Evergreen Health Medical Center 11/23/2016 4A - Medication errorHAC.FS.00000164 Evergreen Health Medical Center 12/8/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000164 EvergreenHealth Medical Center 1/11/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000164 EvergreenHealth Medical Center 2/7/2017 4D - Death or serious injury of neonateHAC.FS.00000164 EvergreenHealth Medical Center 2/7/2017 4I - Failure to follow up with test resultsHAC.FS.00000164 EvergreenHealth Medical Center 3/20/2017 4F - Pressure ulcerHAC.FS.00000164 EvergreenHealth Medical Center 3/21/2017 4F - Pressure ulcerHAC.FS.00000164 EvergreenHealth Medical Center 3/31/2017 4F - Pressure ulcerHAC.FS.00000164 EvergreenHealth Medical Center 3/31/2017 4F - Pressure ulcerHAC.FS.00000164 EvergreenHealth Medical Center 5/15/2017 4F - Pressure ulcerHAC.FS.00000164 EvergreenHealth Medical Center 5/29/2017 4F - Pressure ulcerHAC.FS.00000164 EvergreenHealth Medical Center 6/9/2017 4F - Pressure ulcerHAC.FS.00000164 EvergreenHealth Medical Center 7/14/2017 4A - Medication errorHAC.FS.00000164 EvergreenHealth Medical Center 7/20/2017 4C - Maternal death or serious injuryHAC.FS.00000164 EvergreenHealth Medical Center 8/18/2017 4F - Pressure ulcerHAC.FS.00000164 EvergreenHealth Medical Center 9/5/2017 **4E - Patient death or serious injury associated with a fallHAC.FS.00000164 EvergreenHealth Medical Center 9/11/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000164 EvergreenHealth Medical Center 10/10/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000164 EvergreenHealth Medical Center 10/10/2017 4F - Pressure ulcerHAC.FS.00000164 EvergreenHealth Medical Center 10/25/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000164 EvergreenHealth Medical Center 12/13/2017 4F - Pressure ulcerHAC.FS.00000164 EvergreenHealth Medical Center 1/3/2018 4F - Pressure ulcerHAC.FS.00000164 EvergreenHealth Medical Center 2/5/2018 4C - Maternal death or serious injuryHAC.FS.00000164 EvergreenHealth Medical Center 2/14/2018 4A - Medication errorHAC.FS.00000164 EvergreenHealth Medical Center 3/22/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000164 EvergreenHealth Medical Center 3/27/2018 4F - Pressure ulcerHAC.FS.00000164 EvergreenHealth Medical Center 4/2/2018 4F - Pressure ulcerHAC.FS.00000164 EvergreenHealth Medical Center 4/5/2018 1C - Wrong surgical/invasive procedureHAC.FS.00000164 EvergreenHealth Medical Center 5/29/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000164 EvergreenHealth Medical Center 5/29/2018 4F - Pressure ulcerHAC.FS.00000164 EvergreenHealth Medical Center 6/7/2018 4F - Pressure ulcerHAC.FS.00000164 EvergreenHealth Medical Center 6/11/2018 4F - Pressure ulcerHAC.FS.00000164 EvergreenHealth Medical Center 7/2/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000164 EvergreenHealth Medical Center 7/10/2018 1B - Wrong surgery/invasive procedure patientHAC.FS.00000164 EvergreenHealth Medical Center 7/23/2018 4F - Pressure ulcerHAC.FS.00000164 EvergreenHealth Medical Center 9/26/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000164 EvergreenHealth Medical Center 10/11/2018 4A - Medication errorHAC.FS.00000164 EvergreenHealth Medical Center 11/6/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000164 EvergreenHealth Medical Center 11/7/2018 1D - Unintended retention of foreign objectHAC.FS.00000164 EvergreenHealth Medical Center 1/28/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000164 EvergreenHealth Medical Center 2/1/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000164 EvergreenHealth Medical Center 3/20/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000164 EvergreenHealth Medical Center 4/23/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000164 EvergreenHealth Medical Center 5/3/2019 4E - Patient death or serious injury associated with a fall

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DOH 689-013 September 2014Office of Community Health Systems Page 6 of 62

Adverse Events Quarterly ReportFacility by Date and Event - Q2 2020

Facility Credential Facility Name Facility County Date Confirmed Event TypeHAC.FS.00000164 EvergreenHealth Medical Center 6/14/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000164 EvergreenHealth Medical Center 8/14/2019 1A - Wrong surgery/invasive procedure siteHAC.FS.00000164 EvergreenHealth Medical Center 8/14/2019 1A - Wrong surgery/invasive procedure siteHAC.FS.00000164 EvergreenHealth Medical Center 8/22/2019 4A - Medication errorHAC.FS.00000164 EvergreenHealth Medical Center 8/28/2019 4F - Pressure ulcerHAC.FS.00000164 EvergreenHealth Medical Center 9/3/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000164 EvergreenHealth Medical Center 9/4/2019 4A - Medication errorHAC.FS.00000164 EvergreenHealth Medical Center 11/1/2019 7C - Sexual abuse/assaultHAC.FS.00000164 EvergreenHealth Medical Center 11/5/2019 1A - Wrong surgery/invasive procedure siteHAC.FS.00000164 EvergreenHealth Medical Center 11/8/2019 1D - Unintended retention of foreign objectHAC.FS.00000164 EvergreenHealth Medical Center 12/12/2019 4F - Pressure ulcerHAC.FS.00000164 EvergreenHealth Medical Center 12/18/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000164 EvergreenHealth Medical Center 1/14/2020 4E - Patient death or serious injury associated with a fallHAC.FS.00000164 EvergreenHealth Medical Center 2/7/2020 4E - Patient death or serious injury associated with a fallHAC.FS.00000164 EvergreenHealth Medical Center 2/11/2020 7B - Patient/Resident abductionHAC.FS.00000164 EvergreenHealth Medical Center 2/20/2020 4E - Patient death or serious injury associated with a fallHAC.FS.00000164 EvergreenHealth Medical Center 2/26/2020 4E - Patient death or serious injury associated with a fallHAC.FS.00000164 EvergreenHealth Medical Center 2/27/2020 4F - Pressure ulcerHAC.FS.00000164 EvergreenHealth Medical Center 3/18/2020 4E - Patient death or serious injury associated with a fallHAC.FS.00000164 EvergreenHealth Medical Center 4/2/2020 4F - Pressure ulcerHAC.FS.00000164 EvergreenHealth Medical Center 5/15/2020 4E - Patient death or serious injury associated with a fallHAC.FS.00000164 EvergreenHealth Medical Center 5/15/2020 4F - Pressure ulcerHAC.FS.00000164 EvergreenHealth Medical Center 5/15/2020 4F - Pressure ulcerHAC.FS.00000164 EvergreenHealth Medical Center 5/15/2020 4F - Pressure ulcerHAC.FS.00000164 EvergreenHealth Medical Center 5/15/2020 4F - Pressure ulcerHAC.FS.00000164 EvergreenHealth Medical Center 6/11/2020 4F - Pressure ulcerHAC.FS.00000164 EvergreenHealth Medical Center 6/18/2020 7C - Sexual abuse/assault

137HAC.FS.00000167 Ferry County Memorial Hospital Ferry 5/29/2008 4F - Pressure ulcerHAC.FS.00000167 Ferry County Memorial Hospital 7/17/2016 1A - Wrong surgery/invasive procedure siteHAC.FS.00000167 Ferry County Memorial Hospital 9/1/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000167 Ferry County Memorial Hospital 9/27/2016 4F - Pressure ulcer

4HAC.FS.00000054 Forks Community Hospital Clallam 6/14/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000054 Forks Community Hospital 8/29/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000054 Forks Community Hospital 4/25/2016 4E - Patient death or serious injury associated with a fall

3HAC.FS.00000082 Garfield County Memorial Hospital Garfield 7/3/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000082 Garfield County Memorial Hospital 10/13/2018 **7D - Physical assaultHAC.FS.00000082 Garfield County Memorial Hospital 1/1/2019 **4E - Patient death or serious injury associated with a fallHAC.FS.00000082 Garfield County Memorial Hospital District 12/3/2019 **4E - Patient death or serious injury associated with a fall

4HAC.FS.00000081 Good Samaritan Hospital Pierce 9/22/2006 7C - Sexual abuse/assaultHAC.FS.00000081 Good Samaritan Hospital 1/30/2007 4E - Patient death or serious injury associated with a fallHAC.FS.00000081 Good Samaritan Hospital 2/21/2007 1E- Post-operative deathHAC.FS.00000081 Good Samaritan Hospital 8/24/2007 1A - Wrong surgery/invasive procedure siteHAC.FS.00000081 Good Samaritan Hospital 2/12/2008 1D - Unintended retention of foreign objectHAC.FS.00000081 Good Samaritan Hospital 8/6/2008 1B - Wrong surgery/invasive procedure patientHAC.FS.00000081 Good Samaritan Hospital 10/8/2008 4C - Maternal death or serious injuryHAC.FS.00000081 Good Samaritan Hospital 4/27/2009 4F - Pressure ulcerHAC.FS.00000081 Good Samaritan Hospital 5/12/2009 4F - Pressure ulcerHAC.FS.00000081 Good Samaritan Hospital 5/12/2009 4F - Pressure ulcerHAC.FS.00000081 Good Samaritan Hospital 7/29/2009 4F - Pressure ulcerHAC.FS.00000081 Good Samaritan Hospital 8/20/2009 4E - Patient death or serious injury associated with a fallHAC.FS.00000081 Good Samaritan Hospital 10/30/2009 4F - Pressure ulcerHAC.FS.00000081 Good Samaritan Hospital 6/30/2010 1A - Wrong surgery/invasive procedure siteHAC.FS.00000081 Good Samaritan Hospital 7/12/2010 1A - Wrong surgery/invasive procedure siteHAC.FS.00000081 Good Samaritan Hospital 1/31/2011 4F - Pressure ulcer

16HAC.FS.00000063 Grays Harbor Community Hospital Grays Harbor 12/7/2008 4E - Patient death or serious injury associated with a fallHAC.FS.00000063 Grays Harbor Community Hospital 1/12/2010 1A - Wrong surgery/invasive procedure siteHAC.FS.00000063 Grays Harbor Community Hospital 8/19/2010 1C - Wrong surgical/invasive procedureHAC.FS.00000063 Grays Harbor Community Hospital 11/4/2010 7D - Physical assaultHAC.FS.00000063 Grays Harbor Community Hospital 2/29/2012 1D - Unintended retention of foreign objectHAC.FS.00000063 Grays Harbor Community Hospital 4/19/2013 **4F - Pressure ulcerHAC.FS.00000063 Grays Harbor Community Hospital 12/9/2013 1D - Unintended retention of foreign objectHAC.FS.00000063 Grays Harbor Community Hospital 9/12/2017 **4E - Patient death or serious injury associated with a fallHAC.FS.00000063 Grays Harbor Community Hospital 9/12/2017 **4E - Patient death or serious injury associated with a fallHAC.FS.00000063 Grays Harbor Community Hospital 9/12/2017 **7D - Physical assault

10HAC.FS.00000020 Group Health Central Hospital King 6/5/2007 1C - Wrong surgical/invasive procedureHAC.FS.00000020 Group Health Central Hospital 5/6/2008 1A - Wrong surgery/invasive procedure siteHAC.FS.00000020 Group Health Central Hospital 1/3/2011 1C - Wrong surgical/invasive procedureHAC.FS.00000020 Group Health Central Hospital 9/6/2011 1D - Unintended retention of foreign objectHAC.FS.00000020 Group Health Central Hospital 12/29/2011 1A - Wrong surgery/invasive procedure siteHAC.FS.00000020 Group Health Central Hospital 11/12/2012 1C - Wrong surgical/invasive procedureHAC.FS.00000020 Group Health Central Hospital 9/3/2013 2A - Contaminated drugs, devices, biologicsHAC.FS.00000020 Group Health Central Hospital 4/16/2015 7D - Physical assaultHAC.FS.00000020 Kaiser Permanente Central Hospital^^^ 4/2/2018 **1A - Wrong surgery/invasive procedure siteHAC.FS.00000020 Kaiser Permanente Central Hospital^^^ 6/14/2019 1D - Unintended retention of foreign object

10HAC.FS.00000029 Harborview Medical Center King 6/18/2006 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 6/23/2006 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 6/26/2006 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 7/19/2006 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 7/19/2006 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 7/27/2006 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 7/31/2006 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 8/5/2006 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 8/17/2006 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 9/12/2006 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 9/15/2006 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 9/17/2006 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 9/18/2006 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 9/27/2006 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 10/5/2006 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 10/11/2006 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 10/14/2006 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 10/16/2006 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 10/24/2006 4F - Pressure ulcer

EvergreenHealth Medical Center number of events:

Ferry County Memorial Hospital number of events:

Forks Community Hospital number of events:

Garfield County Memorial Hospital District number of events:

Good Samaritan Hospital number of events:

Grays Harbor Community Hospital number of events:

Kaiser Permanente Central Hospital number of events:

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DOH 689-013 September 2014Office of Community Health Systems Page 7 of 62

Adverse Events Quarterly ReportFacility by Date and Event - Q2 2020

Facility Credential Facility Name Facility County Date Confirmed Event TypeHAC.FS.00000029 Harborview Medical Center 10/29/2006 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 10/30/2006 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 10/30/2006 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 10/31/2006 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 11/16/2006 1C - Wrong surgical/invasive procedureHAC.FS.00000029 Harborview Medical Center 11/26/2006 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 12/4/2006 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 12/5/2006 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 12/16/2006 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 12/17/2006 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 12/21/2006 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 12/27/2006 1D - Unintended retention of foreign objectHAC.FS.00000029 Harborview Medical Center 1/3/2007 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 1/4/2007 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 2/1/2007 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 3/21/2007 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 3/21/2007 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 3/24/2007 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 3/29/2007 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 4/3/2007 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 4/4/2007 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 4/9/2007 1D - Unintended retention of foreign objectHAC.FS.00000029 Harborview Medical Center 4/10/2007 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 4/18/2007 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 4/27/2007 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 5/22/2007 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 5/23/2007 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 5/29/2007 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 6/21/2007 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 6/25/2007 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 7/5/2007 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 7/5/2007 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 7/5/2007 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 7/5/2007 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 7/5/2007 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 7/5/2007 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 7/5/2007 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 7/5/2007 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 7/5/2007 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 7/5/2007 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 9/14/2007 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 11/3/2007 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 12/27/2007 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 12/27/2007 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 12/27/2007 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 12/27/2007 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 12/27/2007 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 12/27/2007 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 12/27/2007 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 12/27/2007 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 12/27/2007 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 12/27/2007 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 12/27/2007 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 12/27/2007 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 12/27/2007 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 12/27/2007 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 12/27/2007 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 2/25/2008 1D - Unintended retention of foreign objectHAC.FS.00000029 Harborview Medical Center 3/6/2008 1D - Unintended retention of foreign objectHAC.FS.00000029 Harborview Medical Center 4/2/2008 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 4/2/2008 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 4/2/2008 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 4/2/2008 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 4/2/2008 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 4/2/2008 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 4/2/2008 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 4/2/2008 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 4/2/2008 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 4/2/2008 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 4/2/2008 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 4/2/2008 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 4/2/2008 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 4/2/2008 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 4/2/2008 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 4/2/2008 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 4/2/2008 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 4/2/2008 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 4/2/2008 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 4/2/2008 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 4/2/2008 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 4/2/2008 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 4/9/2008 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.00000029 Harborview Medical Center 4/17/2008 1D - Unintended retention of foreign objectHAC.FS.00000029 Harborview Medical Center 4/30/2008 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.00000029 Harborview Medical Center 5/15/2008 1B - Wrong surgery/invasive procedure patientHAC.FS.00000029 Harborview Medical Center 6/2/2008 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 7/17/2008 5D - RestraintsHAC.FS.00000029 Harborview Medical Center 7/21/2008 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 9/23/2008 2C - Intravascular air embolismHAC.FS.00000029 Harborview Medical Center 9/23/2008 2C - Intravascular air embolismHAC.FS.00000029 Harborview Medical Center 10/16/2008 1A - Wrong surgery/invasive procedure siteHAC.FS.00000029 Harborview Medical Center 12/19/2008 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 12/29/2008 4A - Medication errorHAC.FS.00000029 Harborview Medical Center 1/26/2009 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 5/1/2009 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 6/2/2009 1A - Wrong surgery/invasive procedure siteHAC.FS.00000029 Harborview Medical Center 6/23/2009 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 6/26/2009 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 6/26/2009 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 7/23/2009 1D - Unintended retention of foreign object

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Adverse Events Quarterly ReportFacility by Date and Event - Q2 2020

Facility Credential Facility Name Facility County Date Confirmed Event TypeHAC.FS.00000029 Harborview Medical Center 7/23/2009 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 9/21/2009 7C - Sexual abuse/assaultHAC.FS.00000029 Harborview Medical Center 10/22/2009 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 12/15/2009 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 2/25/2010 1D - Unintended retention of foreign objectHAC.FS.00000029 Harborview Medical Center 5/14/2010 1C - Wrong surgical/invasive procedureHAC.FS.00000029 Harborview Medical Center 7/23/2010 1C - Wrong surgical/invasive procedureHAC.FS.00000029 Harborview Medical Center 7/23/2010 1D - Unintended retention of foreign objectHAC.FS.00000029 Harborview Medical Center 8/26/2010 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 9/24/2010 1A - Wrong surgery/invasive procedure siteHAC.FS.00000029 Harborview Medical Center 9/24/2010 1A - Wrong surgery/invasive procedure siteHAC.FS.00000029 Harborview Medical Center 10/25/2010 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 10/25/2010 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 12/10/2010 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 12/16/2010 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 1/11/2011 1D - Unintended retention of foreign objectHAC.FS.00000029 Harborview Medical Center 3/11/2011 1D - Unintended retention of foreign objectHAC.FS.00000029 Harborview Medical Center 3/21/2011 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 3/24/2011 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 6/21/2011 2C - Intravascular air embolismHAC.FS.00000029 Harborview Medical Center 8/26/2011 4A - Medication errorHAC.FS.00000029 Harborview Medical Center 8/26/2011 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 12/20/2011 7D - Physical assaultHAC.FS.00000029 Harborview Medical Center 1/26/2012 7C - Sexual abuse/assaultHAC.FS.00000029 Harborview Medical Center 2/17/2012 1A - Wrong surgery/invasive procedure siteHAC.FS.00000029 Harborview Medical Center 2/23/2012 1A - Wrong surgery/invasive procedure siteHAC.FS.00000029 Harborview Medical Center 2/23/2012 5D - RestraintsHAC.FS.00000029 Harborview Medical Center 3/20/2012 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 3/22/2012 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 5/24/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 5/24/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 6/29/2012 1C - Wrong surgical/invasive procedureHAC.FS.00000029 Harborview Medical Center 6/29/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 7/26/2012 1D - Unintended retention of foreign objectHAC.FS.00000029 Harborview Medical Center 9/28/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 10/25/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 10/25/2012 4A - Medication errorHAC.FS.00000029 Harborview Medical Center 12/11/2012 7C - Sexual abuse/assaultHAC.FS.00000029 Harborview Medical Center 12/11/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 12/11/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 3/6/2013 1A - Wrong surgery/invasive procedure siteHAC.FS.00000029 Harborview Medical Center 3/29/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 3/29/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 4/18/2013 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 4/25/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 5/16/2013 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 5/23/2013 1D - Unintended retention of foreign object HAC.FS.00000029 Harborview Medical Center 5/23/2013 1D - Unintended retention of foreign object HAC.FS.00000029 Harborview Medical Center 6/20/2013 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 6/27/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 6/27/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 7/25/2013 1A - Wrong surgery/invasive procedure siteHAC.FS.00000029 Harborview Medical Center 7/25/2013 2B - Device function or useHAC.FS.00000029 Harborview Medical Center 7/25/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 8/22/2013 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 9/18/2013 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 9/26/2013 1B - Wrong surgery/invasive procedure patientHAC.FS.00000029 Harborview Medical Center 10/24/2013 1C - Wrong surgical/invasive procedureHAC.FS.00000029 Harborview Medical Center 10/24/2013 1D - Unintended retention of foreign objectHAC.FS.00000029 Harborview Medical Center 12/6/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 12/6/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 12/6/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 12/6/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 12/19/2013 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 2/20/2014 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 2/20/2014 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 3/27/2014 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 3/27/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 3/27/2014 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 4/24/2014 4A - Medication errorHAC.FS.00000029 Harborview Medical Center 4/24/2014 1A - Wrong surgery/invasive procedure siteHAC.FS.00000029 Harborview Medical Center 4/24/2014 7B - Patient/Resident abductionHAC.FS.00000029 Harborview Medical Center 5/22/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 5/28/2014 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 5/28/2014 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 6/26/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 6/26/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 7/17/2014 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 7/25/2014 7C - Sexual abuse/assaultHAC.FS.00000029 Harborview Medical Center 8/25/2014 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 8/28/2014 1D - Unintended retention of foreign objectHAC.FS.00000029 Harborview Medical Center 9/25/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 9/29/2014 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 10/16/2014 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 10/16/2014 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 10/16/2014 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 10/28/2014 1B - Wrong surgery/invasive procedure patientHAC.FS.00000029 Harborview Medical Center 10/28/2014 2C - Intravascular air embolismHAC.FS.00000029 Harborview Medical Center 11/24/2014 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 12/8/2014 4I - Failure to follow up with test resultsHAC.FS.00000029 Harborview Medical Center 12/22/2014 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 1/26/2015 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 1/26/2015 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 2/25/2015 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 2/26/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 3/3/2015 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 3/26/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 3/27/2015 7C - Sexual abuse/assaultHAC.FS.00000029 Harborview Medical Center 4/1/2015 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 4/1/2015 4F - Pressure ulcer

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Adverse EventsFacilities and Date of Event Report 2006-2020

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Adverse Events Quarterly ReportFacility by Date and Event - Q2 2020

Facility Credential Facility Name Facility County Date Confirmed Event TypeHAC.FS.00000029 Harborview Medical Center 4/16/2015 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 4/23/2015 1A - Wrong surgery/invasive procedure siteHAC.FS.00000029 Harborview Medical Center 4/23/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 4/23/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 5/29/2015 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 5/29/2015 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 5/29/2015 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 5/29/2015 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 6/5/2015 7C - Sexual abuse/assaultHAC.FS.00000029 Harborview Medical Center 6/18/2015 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 7/16/2015 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 7/23/2015 4A - Medication errorHAC.FS.00000029 Harborview Medical Center 8/13/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 8/13/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 8/21/2015 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 8/21/2015 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 8/21/2015 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 8/27/2015 3A - Patient/Resident discharged to unauthorized personHAC.FS.00000029 Harborview Medical Center 8/27/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 8/27/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 9/24/2015 2B - Device function or useHAC.FS.00000029 Harborview Medical Center 10/15/2015 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 10/15/2015 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 10/15/2015 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 11/23/2015 7C - Sexual abuse/assaultHAC.FS.00000029 Harborview Medical Center 12/10/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 12/17/2015 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 12/17/2015 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 12/17/2015 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 2/25/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 3/17/2016 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 3/17/2016 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 3/24/2016 4A - Medication errorHAC.FS.00000029 Harborview Medical Center 3/24/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 3/28/2016 7C - Sexual abuse/assaultHAC.FS.00000029 Harborview Medical Center 4/28/2016 4A - Medication errorHAC.FS.00000029 Harborview Medical Center 4/28/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 5/19/2016 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 5/26/2016 1C - Wrong surgical/invasive procedureHAC.FS.00000029 Harborview Medical Center 5/27/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 6/16/2016 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 6/16/2016 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 6/23/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 6/23/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 6/23/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 6/23/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 7/21/2016 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 7/21/2016 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 7/28/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 8/5/2016 7C - Sexual abuse/assaultHAC.FS.00000029 Harborview Medical Center 8/18/2016 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 9/15/2016 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 9/15/2016 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 9/22/2016 2B - Device function or useHAC.FS.00000029 Harborview Medical Center 9/22/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 10/20/2016 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 10/27/2016 1A - Wrong surgery/invasive procedure siteHAC.FS.00000029 Harborview Medical Center 10/27/2016 1D - Unintended retention of foreign objectHAC.FS.00000029 Harborview Medical Center 11/18/2016 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 11/18/2016 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 11/18/2016 7C - Sexual abuse/assaultHAC.FS.00000029 Harborview Medical Center 12/15/2016 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 12/15/2016 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 12/15/2016 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 12/15/2016 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 12/15/2016 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 12/22/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 12/22/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 1/12/2017 7C - Sexual abuse/assaultHAC.FS.00000029 Harborview Medical Center 1/19/2017 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 2/16/2017 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 3/23/2017 3B - Patient elopement (disappearance)HAC.FS.00000029 Harborview Medical Center 3/23/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 3/23/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 3/23/2017 7C - Sexual abuse/assaultHAC.FS.00000029 Harborview Medical Center 4/20/2017 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 4/27/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 5/25/2017 7C - Sexual abuse/assaultHAC.FS.00000029 Harborview Medical Center 6/19/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 6/22/2017 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 6/22/2017 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 7/27/2017 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 7/27/2017 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 7/27/2017 7C - Sexual abuse/assaultHAC.FS.00000029 Harborview Medical Center 8/24/2017 1A - Wrong surgery/invasive procedure siteHAC.FS.00000029 Harborview Medical Center 8/24/2017 1D - Unintended retention of foreign objectHAC.FS.00000029 Harborview Medical Center 8/24/2017 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 9/28/2017 1C - Wrong surgical/invasive procedureHAC.FS.00000029 Harborview Medical Center 10/26/2017 1A - Wrong surgery/invasive procedure siteHAC.FS.00000029 Harborview Medical Center 10/26/2017 1D - Unintended retention of foreign objectHAC.FS.00000029 Harborview Medical Center 10/26/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 12/5/2017 1C - Wrong surgical/invasive procedureHAC.FS.00000029 Harborview Medical Center 12/5/2017 7C - Sexual abuse/assaultHAC.FS.00000029 Harborview Medical Center 1/25/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 1/25/2018 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 1/25/2018 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 1/25/2018 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 1/25/2018 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 1/25/2018 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 1/25/2018 4F - Pressure ulcer

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Adverse Events Quarterly ReportFacility by Date and Event - Q2 2020

Facility Credential Facility Name Facility County Date Confirmed Event TypeHAC.FS.00000029 Harborview Medical Center 1/25/2018 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 1/25/2018 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 2/22/2018 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 3/22/2018 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 4/26/2018 1C - Wrong surgical/invasive procedureHAC.FS.00000029 Harborview Medical Center 4/26/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 4/26/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 4/26/2018 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 5/24/2018 1D - Unintended retention of foreign objectHAC.FS.00000029 Harborview Medical Center 5/24/2018 4A - Medication errorHAC.FS.00000029 Harborview Medical Center 5/24/2018 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 5/24/2018 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 5/24/2018 7C - Sexual abuse/assaultHAC.FS.00000029 Harborview Medical Center 6/28/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 6/28/2018 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 7/26/2018 1C - Wrong surgical/invasive procedureHAC.FS.00000029 Harborview Medical Center 7/26/2018 1C - Wrong surgical/invasive procedureHAC.FS.00000029 Harborview Medical Center 7/26/2018 1D - Unintended retention of foreign objectHAC.FS.00000029 Harborview Medical Center 7/26/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 7/26/2018 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 7/26/2018 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 7/26/2018 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 7/26/2018 5B - No gas, wrong gas, contaminated gasHAC.FS.00000029 Harborview Medical Center 8/23/2018 1D - Unintended retention of foreign objectHAC.FS.00000029 Harborview Medical Center 8/23/2018 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 8/23/2018 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 9/27/2018 4A - Medication errorHAC.FS.00000029 Harborview Medical Center 9/28/2018 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 10/25/2018 1D - Unintended retention of foreign objectHAC.FS.00000029 Harborview Medical Center 12/7/2018 1A - Wrong surgery/invasive procedure siteHAC.FS.00000029 Harborview Medical Center 12/7/2018 1C - Wrong surgical/invasive procedureHAC.FS.00000029 Harborview Medical Center 12/7/2018 1D - Unintended retention of foreign objectHAC.FS.00000029 Harborview Medical Center 12/7/2018 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 1/24/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 1/24/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 1/24/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 2/28/2019 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.00000029 Harborview Medical Center 2/28/2019 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 2/28/2019 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 2/28/2019 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 2/28/2019 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 2/28/2019 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 2/28/2019 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 2/28/2019 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 3/28/2019 1D - Unintended retention of foreign objectHAC.FS.00000029 Harborview Medical Center 3/28/2019 4A - Medication errorHAC.FS.00000029 Harborview Medical Center 3/28/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 3/28/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 3/28/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 3/28/2019 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 4/25/2019 4A - Medication errorHAC.FS.00000029 Harborview Medical Center 4/25/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 5/23/2019 1A - Wrong surgery/invasive procedure siteHAC.FS.00000029 Harborview Medical Center 5/23/2019 3A - Patient/Resident discharged to unauthorized personHAC.FS.00000029 Harborview Medical Center 5/23/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 5/23/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 6/27/2019 1D - Unintended retention of foreign objectHAC.FS.00000029 Harborview Medical Center 6/27/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 6/27/2019 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 7/25/2019 1D - Unintended retention of foreign objectHAC.FS.00000029 Harborview Medical Center 8/22/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 8/22/2019 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 8/22/2019 4H - Irretrievable loss of irreplaceable biological specimenHAC.FS.00000029 Harborview Medical Center 8/22/2019 7D - Physical assaultHAC.FS.00000029 Harborview Medical Center 9/26/2019 1C - Wrong surgical/invasive procedureHAC.FS.00000029 Harborview Medical Center 9/26/2019 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 10/24/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 12/19/2019 1D - Unintended retention of foreign objectHAC.FS.00000029 Harborview Medical Center 12/19/2019 1D - Unintended retention of foreign objectHAC.FS.00000029 Harborview Medical Center 1/23/2020 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.00000029 Harborview Medical Center 1/23/2020 4A - Medication errorHAC.FS.00000029 Harborview Medical Center 1/23/2020 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 1/23/2020 4E - Patient death or serious injury associated with a fallHAC.FS.00000029 Harborview Medical Center 2/24/2020 1C - Wrong surgical/invasive procedureHAC.FS.00000029 Harborview Medical Center 2/24/2020 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 2/24/2020 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 4/27/2020 1A - Wrong surgery/invasive procedure siteHAC.FS.00000029 Harborview Medical Center 4/27/2020 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.00000029 Harborview Medical Center 4/27/2020 4F - Pressure ulcerHAC.FS.00000029 Harborview Medical Center 5/28/2020 4A - Medication error

399HAC.FS.00000142 Harrison Medical Center Kitsap 4/18/2007 1A - Wrong surgery/invasive procedure siteHAC.FS.00000142 Harrison Medical Center 2/25/2008 7C - Sexual abuse/assaultHAC.FS.00000142 Harrison Medical Center 2/26/2008 7C - Sexual abuse/assaultHAC.FS.00000142 Harrison Medical Center 4/15/2008 1D - Unintended retention of foreign objectHAC.FS.00000142 Harrison Medical Center 8/29/2008 1D - Unintended retention of foreign objectHAC.FS.00000142 Harrison Medical Center 9/5/2008 1D - Unintended retention of foreign objectHAC.FS.00000142 Harrison Medical Center 9/23/2008 5D - RestraintsHAC.FS.00000142 Harrison Medical Center 12/11/2008 1D - Unintended retention of foreign objectHAC.FS.00000142 Harrison Medical Center 3/11/2009 7A - ImpersonationHAC.FS.00000142 Harrison Medical Center 5/29/2009 1C - Wrong surgical/invasive procedureHAC.FS.00000142 Harrison Medical Center 8/6/2009 7C - Sexual abuse/assaultHAC.FS.00000142 Harrison Medical Center 8/19/2009 4E - Patient death or serious injury associated with a fallHAC.FS.00000142 Harrison Medical Center 11/4/2009 4E - Patient death or serious injury associated with a fallHAC.FS.00000142 Harrison Medical Center 11/10/2009 4E - Patient death or serious injury associated with a fallHAC.FS.00000142 Harrison Medical Center 1/21/2010 1D - Unintended retention of foreign objectHAC.FS.00000142 Harrison Medical Center 2/2/2010 1D - Unintended retention of foreign objectHAC.FS.00000142 Harrison Medical Center 2/11/2010 1D - Unintended retention of foreign objectHAC.FS.00000142 Harrison Medical Center 8/23/2010 4E - Patient death or serious injury associated with a fallHAC.FS.00000142 Harrison Medical Center 9/21/2010 3C - Patient suicide, attempted suicide, or self-harm

Harborview Medical Center number of events:

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Adverse Events Quarterly ReportFacility by Date and Event - Q2 2020

Facility Credential Facility Name Facility County Date Confirmed Event TypeHAC.FS.00000142 Harrison Medical Center 10/8/2010 4E - Patient death or serious injury associated with a fallHAC.FS.00000142 Harrison Medical Center 2/14/2011 4E - Patient death or serious injury associated with a fallHAC.FS.00000142 Harrison Medical Center 3/21/2011 7C - Sexual abuse/assaultHAC.FS.00000142 Harrison Medical Center 8/17/2011 7C - Sexual abuse/assaultHAC.FS.00000142 Harrison Medical Center 9/2/2011 7C - Sexual abuse/assaultHAC.FS.00000142 Harrison Medical Center 12/19/2011 1D - Unintended retention of foreign objectHAC.FS.00000142 Harrison Medical Center 1/4/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000142 Harrison Medical Center 1/4/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000142 Harrison Medical Center 6/14/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000142 Harrison Medical Center 10/10/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000142 Harrison Medical Center 2/4/2013 1A - Wrong surgery/invasive procedure siteHAC.FS.00000142 Harrison Medical Center 6/3/2013 4A - Medication errorHAC.FS.00000142 Harrison Medical Center 6/26/2013 4A - Medication errorHAC.FS.00000142 Harrison Medical Center 7/23/2013 3A - Patient/Resident discharged to unauthorized personHAC.FS.00000142 Harrison Medical Center 10/8/2013 5C - BurnHAC.FS.00000142 Harrison Medical Center 11/11/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000142 Harrison Medical Center 1/16/2014 4F - Pressure ulcerHAC.FS.00000142 Harrison Medical Center 1/16/2014 4F - Pressure ulcerHAC.FS.00000142 Harrison Medical Center 1/30/2014 4A - Medication errorHAC.FS.00000142 Harrison Medical Center 6/23/2014 4H - Irretrievable loss of irreplaceable biological specimenHAC.FS.00000142 Harrison Medical Center 6/23/2014 4F - Pressure ulcerHAC.FS.00000142 Harrison Medical Center 6/23/2014 4F - Pressure ulcerHAC.FS.00000142 Harrison Medical Center 6/23/2014 4F - Pressure ulcerHAC.FS.00000142 Harrison Medical Center 7/10/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000142 Harrison Medical Center 7/15/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000142 Harrison Medical Center 10/2/2014 1D - Unintended retention of foreign objectHAC.FS.00000142 Harrison Medical Center 11/4/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000142 Harrison Medical Center 3/6/2015 4F - Pressure ulcerHAC.FS.00000142 Harrison Medical Center 4/23/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000142 Harrison Medical Center 5/22/2015 7D - Physical assaultHAC.FS.00000142 Harrison Medical Center 6/4/2015 1A - Wrong surgery/invasive procedure siteHAC.FS.00000142 Harrison Medical Center 1/12/2016 3A - Patient/Resident discharged to unauthorized personHAC.FS.00000142 Harrison Medical Center 1/12/2016 4F - Pressure ulcerHAC.FS.00000142 Harrison Medical Center 2/12/2016 4F - Pressure ulcerHAC.FS.00000142 Harrison Medical Center 4/18/2016 1B - Wrong surgery/invasive procedure patientHAC.FS.00000142 Harrison Medical Center 4/18/2016 1C - Wrong surgical/invasive procedureHAC.FS.00000142 Harrison Medical Center 4/18/2016 4F - Pressure ulcerHAC.FS.00000142 Harrison Medical Center 4/18/2016 4F - Pressure ulcerHAC.FS.00000142 Harrison Medical Center 6/16/2016 1A - Wrong surgery/invasive procedure siteHAC.FS.00000142 Harrison Medical Center 6/16/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000142 Harrison Medical Center 6/16/2016 4F - Pressure ulcerHAC.FS.00000142 Harrison Medical Center 6/30/2016 4F - Pressure ulcerHAC.FS.00000142 Harrison Medical Center 8/2/2016 4A - Medication errorHAC.FS.00000142 Harrison Medical Center 8/2/2016 4F - Pressure ulcerHAC.FS.00000142 Harrison Medical Center 10/10/2016 4F - Pressure ulcerHAC.FS.00000142 Harrison Medical Center 11/21/2016 2B - Device function or useHAC.FS.00000142 Harrison Medical Center 11/21/2016 4F - Pressure ulcerHAC.FS.00000142 Harrison Medical Center 11/21/2016 4F - Pressure ulcerHAC.FS.00000142 Harrison Medical Center 1/26/2017 4A - Medication errorHAC.FS.00000142 Harrison Medical Center 2/12/2017 4A - Medication errorHAC.FS.00000142 Harrison Medical Center 2/12/2017 4F - Pressure ulcerHAC.FS.00000142 Harrison Medical Center 3/20/2017 2B - Device function or useHAC.FS.00000142 Harrison Medical Center 3/20/2017 2B - Device function or useHAC.FS.00000142 Harrison Medical Center 3/20/2017 2B - Device function or useHAC.FS.00000142 Harrison Medical Center 3/20/2017 4F - Pressure ulcerHAC.FS.00000142 Harrison Medical Center 4/26/2017 1D - Unintended retention of foreign objectHAC.FS.00000142 Harrison Medical Center 4/26/2017 1D - Unintended retention of foreign objectHAC.FS.00000142 Harrison Medical Center 8/16/2017 4F - Pressure ulcerHAC.FS.00000142 Harrison Medical Center 8/30/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000142 Harrison Medical Center 8/30/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000142 Harrison Medical Center 9/25/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000142 Harrison Medical Center 9/25/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000142 Harrison Medical Center 9/28/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000142 Harrison Medical Center 11/2/2017 1D - Unintended retention of foreign objectHAC.FS.00000142 Harrison Medical Center 3/5/2018 4F - Pressure ulcerHAC.FS.00000142 Harrison Medical Center 3/5/2018 4F - Pressure ulcerHAC.FS.00000142 Harrison Medical Center 4/13/2018 4A - Medication errorHAC.FS.00000142 Harrison Medical Center 4/13/2018 4F - Pressure ulcerHAC.FS.00000142 Harrison Medical Center 4/13/2018 4F - Pressure ulcerHAC.FS.00000142 Harrison Medical Center 5/7/2018 4F - Pressure ulcerHAC.FS.00000142 Harrison Medical Center 8/6/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000142 Harrison Medical Center 9/11/2018 4C - Maternal death or serious injuryHAC.FS.00000142 Harrison Medical Center 3/18/2019 2C - Intravascular air embolismHAC.FS.00000142 Harrison Medical Center 3/18/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000142 Harrison Medical Center 3/18/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000142 Harrison Medical Center 3/18/2019 7C - Sexual abuse/assaultHAC.FS.00000142 Harrison Medical Center 7/28/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000142 Harrison Medical Center 7/28/2019 4F - Pressure ulcerHAC.FS.00000142 Harrison Medical Center 7/29/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000142 Harrison Medical Center 7/29/2019 4F - Pressure ulcerHAC.FS.00000142 Harrison Medical Center 3/19/2020 4F - Pressure ulcer

100HAC.FS.00000126 Highline Medical Center King 3/13/2008 4F - Pressure ulcerHAC.FS.00000126 Highline Medical Center 2/2/2009 1A - Wrong surgery/invasive procedure siteHAC.FS.00000126 Highline Medical Center 2/23/2009 4F - Pressure ulcerHAC.FS.00000126 Highline Medical Center 6/24/2009 1D - Unintended retention of foreign objectHAC.FS.00000126 Highline Medical Center 8/9/2010 4A - Medication errorHAC.FS.00000126 Highline Medical Center 8/24/2010 4F - Pressure ulcerHAC.FS.00000126 Highline Medical Center 11/3/2011 4F - Pressure ulcerHAC.FS.00000126 Highline Medical Center 1/28/2013 4F - Pressure ulcerHAC.FS.00000126 Highline Medical Center 3/28/2013 7C - Sexual abuse/assaultHAC.FS.00000126 Highline Medical Center 4/25/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000126 Highline Medical Center 5/2/2013 7D - Physical assaultHAC.FS.00000126 Highline Medical Center 5/2/2013 7D - Physical assaultHAC.FS.00000126 Highline Medical Center 6/5/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000126 Highline Medical Center 6/5/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000126 Highline Medical Center 6/5/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000126 Highline Medical Center 6/5/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000126 Highline Medical Center 6/5/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000126 Highline Medical Center 6/5/2013 4E - Patient death or serious injury associated with a fall

Harrison Medical Center number of events:

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Adverse EventsFacilities and Date of Event Report 2006-2020

DOH 689-013 September 2014Office of Community Health Systems Page 12 of 62

Adverse Events Quarterly ReportFacility by Date and Event - Q2 2020

Facility Credential Facility Name Facility County Date Confirmed Event TypeHAC.FS.00000126 Highline Medical Center 6/5/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000126 Highline Medical Center 6/5/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000126 Highline Medical Center 6/14/2013 2A - Contaminated drugs, devices, biologicsHAC.FS.00000126 Highline Medical Center 9/3/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000126 Highline Medical Center 9/3/2013 4F - Pressure ulcerHAC.FS.00000126 Highline Medical Center 10/31/2013 1D - Unintended retention of foreign objectHAC.FS.00000126 Highline Medical Center 3/24/2014 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.00000126 Highline Medical Center 4/29/2014 1D - Unintended retention of foreign objectHAC.FS.00000126 Highline Medical Center 5/20/2014 1D - Unintended retention of foreign objectHAC.FS.00000126 Highline Medical Center 6/10/2014 4F - Pressure ulcerHAC.FS.00000126 Highline Medical Center 9/4/2014 4D - Death or serious injury of neonateHAC.FS.00000126 Highline Medical Center 10/30/2014 4F - Pressure ulcerHAC.FS.00000126 Highline Medical Center 12/2/2014 1A - Wrong surgery/invasive procedure siteHAC.FS.00000126 Highline Medical Center 12/4/2014 4F - Pressure ulcerHAC.FS.00000126 Highline Medical Center 2/23/2015 4F - Pressure ulcerHAC.FS.00000126 Highline Medical Center 8/21/2015 1C - Wrong surgical/invasive procedureHAC.FS.00000126 Highline Medical Center 10/29/2015 1D - Unintended retention of foreign objectHAC.FS.00000126 Highline Medical Center 11/5/2015 4A - Medication errorHAC.FS.00000126 Highline Medical Center 12/18/2015 4F - Pressure ulcerHAC.FS.00000126 Highline Medical Center 1/11/2016 4F - Pressure ulcerHAC.FS.00000126 Highline Medical Center 6/14/2016 1B - Wrong surgery/invasive procedure patientHAC.FS.00000126 Highline Medical Center 9/26/2016 4A - Medication errorHAC.FS.00000126 Highline Medical Center 12/7/2016 4F - Pressure ulcerHAC.FS.00000126 Highline Medical Center 12/14/2016 4F - Pressure ulcerHAC.FS.00000126 Highline Medical Center 3/17/2017 1A - Wrong surgery/invasive procedure siteHAC.FS.00000126 Highline Medical Center 3/27/2017 4D - Death or serious injury of neonateHAC.FS.00000126 Highline Medical Center 3/27/2017 4F - Pressure ulcerHAC.FS.00000126 Highline Medical Center 3/31/2017 4F - Pressure ulcerHAC.FS.00000126 Highline Medical Center 5/1/2017 1C - Wrong surgical/invasive procedureHAC.FS.00000126 Highline Medical Center 5/8/2017 4F - Pressure ulcerHAC.FS.00000126 Highline Medical Center 10/4/2017 4C - Maternal death or serious injuryHAC.FS.00000126 Highline Medical Center 12/14/2017 4F - Pressure ulcerHAC.FS.00000126 Highline Medical Center 12/21/2017 7C - Sexual abuse/assaultHAC.FS.00000126 Highline Medical Center 2/2/2018 4F - Pressure ulcerHAC.FS.00000126 Highline Medical Center 5/3/2018 1D - Unintended retention of foreign objectHAC.FS.00000126 Highline Medical Center 10/11/2018 4F - Pressure ulcerHAC.FS.00000126 Highline Medical Center 11/27/2018 4C - Maternal death or serious injuryHAC.FS.00000126 Highline Medical Center 2/7/2019 4D - Death or serious injury of neonateHAC.FS.00000126 Highline Medical Center 2/26/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000126 Highline Medical Center 4/16/2019 4F - Pressure ulcerHAC.FS.00000126 Highline Medical Center 5/10/2019 4F - Pressure ulcerHAC.FS.00000126 Highline Medical Center 7/24/2019 1D - Unintended retention of foreign objectHAC.FS.00000126 Highline Medical Center 8/19/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000126 Highline Medical Center 9/10/2019 1D - Unintended retention of foreign objectHAC.FS.00000126 Highline Medical Center 9/10/2019 1D - Unintended retention of foreign objectHAC.FS.00000126 Highline Medical Center 9/11/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000126 Highline Medical Center 9/16/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000126 Highline Medical Center 12/26/2019 4F - Pressure ulcerHAC.FS.00000126 St Anne Hospital 4/2/2020 4F - Pressure ulcerHAC.FS.00000126 St Anne Hospital 4/16/2020 3C - Patient suicide, attempted suicide, or self-harm

68HAC.FS.00000134 Island Hospital Skagit 5/12/2008 1A - Wrong surgery/invasive procedure siteHAC.FS.00000134 Island Hospital 6/28/2010 1D - Unintended retention of foreign objectHAC.FS.00000134 Island Hospital 5/8/2012 4F - Pressure ulcerHAC.FS.00000134 Island Hospital 11/13/2012 7A - ImpersonationHAC.FS.00000134 Island Hospital 11/21/2012 4F - Pressure ulcerHAC.FS.00000134 Island Hospital 9/6/2013 1D - Unintended retention of foreign objectHAC.FS.00000134 Island Hospital 10/1/2014 7A - ImpersonationHAC.FS.00000134 Island Hospital 10/2/2014 7A - ImpersonationHAC.FS.00000134 Island Hospital 5/12/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000134 Island Hospital 5/20/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000134 Island Hospital 9/2/2015 4F - Pressure ulcerHAC.FS.00000134 Island Hospital 9/22/2015 7A - ImpersonationHAC.FS.00000134 Island Hospital 10/26/2015 1D - Unintended retention of foreign objectHAC.FS.00000134 Island Hospital 7/27/2016 4F - Pressure ulcerHAC.FS.00000134 Island Hospital 6/14/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000134 Island Hospital 5/18/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000134 Island Hospital 8/16/2018 1C - Wrong surgical/invasive procedureHAC.FS.00000134 Island Hospital 10/23/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000134 Island Hospital 3/8/2019 1D - Unintended retention of foreign object

19HAC.FS.00000085 Jefferson Healthcare Jefferson 8/7/2007 4E - Patient death or serious injury associated with a fallHAC.FS.00000085 Jefferson Healthcare 5/28/2013 7C - Sexual abuse/assaultHAC.FS.00000085 Jefferson Healthcare 12/26/2013 4F - Pressure ulcerHAC.FS.00000085 Jefferson Healthcare 12/4/2014 1D - Unintended retention of foreign objectHAC.FS.00000085 Jefferson Healthcare 12/22/2014 7D - Physical assaultHAC.FS.00000085 Jefferson Healthcare 2/2/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000085 Jefferson Healthcare 8/26/2016 1D - Unintended retention of foreign objectHAC.FS.00000085 Jefferson Healthcare 10/26/2017 7C - Sexual abuse/assaultHAC.FS.00000085 Jefferson Healthcare 9/17/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000085 Jefferson Healthcare 2/25/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000085 Jefferson Healthcare 11/12/2019 1A - Wrong surgery/invasive procedure siteHAC.FS.00000085 Jefferson Healthcare 6/6/2020 1D - Unintended retention of foreign object

12HAC.FS.00000161 Kadlec Regional Medical Center Benton 2/24/2009 4F - Pressure ulcerHAC.FS.00000161 Kadlec Regional Medical Center 4/8/2009 4F - Pressure ulcerHAC.FS.00000161 Kadlec Regional Medical Center 4/22/2009 1A - Wrong surgery/invasive procedure siteHAC.FS.00000161 Kadlec Regional Medical Center 5/11/2009 4F - Pressure ulcerHAC.FS.00000161 Kadlec Regional Medical Center 5/11/2009 4F - Pressure ulcerHAC.FS.00000161 Kadlec Regional Medical Center 4/8/2010 4F - Pressure ulcerHAC.FS.00000161 Kadlec Regional Medical Center 4/30/2010 1A - Wrong surgery/invasive procedure siteHAC.FS.00000161 Kadlec Regional Medical Center 5/20/2010 4E - Patient death or serious injury associated with a fallHAC.FS.00000161 Kadlec Regional Medical Center 6/25/2010 4E - Patient death or serious injury associated with a fallHAC.FS.00000161 Kadlec Regional Medical Center 8/16/2010 4F - Pressure ulcerHAC.FS.00000161 Kadlec Regional Medical Center 1/5/2011 4E - Patient death or serious injury associated with a fallHAC.FS.00000161 Kadlec Regional Medical Center 2/1/2011 4E - Patient death or serious injury associated with a fallHAC.FS.00000161 Kadlec Regional Medical Center 2/1/2011 4E - Patient death or serious injury associated with a fallHAC.FS.00000161 Kadlec Regional Medical Center 4/25/2011 4E - Patient death or serious injury associated with a fallHAC.FS.00000161 Kadlec Regional Medical Center 8/25/2011 4F - Pressure ulcerHAC.FS.00000161 Kadlec Regional Medical Center 12/20/2011 4E - Patient death or serious injury associated with a fall

Highline Medical Center number of events:

Island Hospital number of events:

Jefferson Healthcare number of events:

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Adverse EventsFacilities and Date of Event Report 2006-2020

DOH 689-013 September 2014Office of Community Health Systems Page 13 of 62

Adverse Events Quarterly ReportFacility by Date and Event - Q2 2020

Facility Credential Facility Name Facility County Date Confirmed Event TypeHAC.FS.00000161 Kadlec Regional Medical Center 1/12/2012 4F - Pressure ulcerHAC.FS.00000161 Kadlec Regional Medical Center 1/30/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000161 Kadlec Regional Medical Center 4/26/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000161 Kadlec Regional Medical Center 7/31/2012 1D - Unintended retention of foreign objectHAC.FS.00000161 Kadlec Regional Medical Center 10/15/2012 1D - Unintended retention of foreign objectHAC.FS.00000161 Kadlec Regional Medical Center 10/29/2012 4A - Medication errorHAC.FS.00000161 Kadlec Regional Medical Center 1/18/2013 1D - Unintended retention of foreign object HAC.FS.00000161 Kadlec Regional Medical Center 1/30/2013 4F - Pressure ulcerHAC.FS.00000161 Kadlec Regional Medical Center 2/11/2013 4A - Medication errorHAC.FS.00000161 Kadlec Regional Medical Center 3/8/2013 4F - Pressure ulcerHAC.FS.00000161 Kadlec Regional Medical Center 8/19/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000161 Kadlec Regional Medical Center 12/12/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000161 Kadlec Regional Medical Center 2/14/2014 1D - Unintended retention of foreign objectHAC.FS.00000161 Kadlec Regional Medical Center 3/26/2014 4A - Medication errorHAC.FS.00000161 Kadlec Regional Medical Center 6/23/2014 1D - Unintended retention of foreign objectHAC.FS.00000161 Kadlec Regional Medical Center 6/27/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000161 Kadlec Regional Medical Center 8/6/2014 4F - Pressure ulcerHAC.FS.00000161 Kadlec Regional Medical Center 12/16/2014 4F - Pressure ulcerHAC.FS.00000161 Kadlec Regional Medical Center 1/12/2015 4F - Pressure ulcerHAC.FS.00000161 Kadlec Regional Medical Center 1/28/2015 4F - Pressure ulcerHAC.FS.00000161 Kadlec Regional Medical Center 2/3/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000161 Kadlec Regional Medical Center 3/25/2015 4F - Pressure ulcerHAC.FS.00000161 Kadlec Regional Medical Center 4/27/2015 4F - Pressure ulcerHAC.FS.00000161 Kadlec Regional Medical Center 6/5/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000161 Kadlec Regional Medical Center 8/4/2015 4F - Pressure ulcerHAC.FS.00000161 Kadlec Regional Medical Center 9/10/2015 4F - Pressure ulcerHAC.FS.00000161 Kadlec Regional Medical Center 10/19/2015 1A - Wrong surgery/invasive procedure siteHAC.FS.00000161 Kadlec Regional Medical Center 10/29/2015 4F - Pressure ulcerHAC.FS.00000161 Kadlec Regional Medical Center 3/3/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000161 Kadlec Regional Medical Center 3/9/2016 4F - Pressure ulcerHAC.FS.00000161 Kadlec Regional Medical Center 4/28/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000161 Kadlec Regional Medical Center 4/28/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000161 Kadlec Regional Medical Center 4/28/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000161 Kadlec Regional Medical Center 6/14/2016 4F - Pressure ulcerHAC.FS.00000161 Kadlec Regional Medical Center 6/30/2016 4F - Pressure ulcerHAC.FS.00000161 Kadlec Regional Medical Center 7/28/2016 4I - Failure to follow up with test resultsHAC.FS.00000161 Kadlec Regional Medical Center 8/1/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000161 Kadlec Regional Medical Center 8/22/2016 1B - Wrong surgery/invasive procedure patientHAC.FS.00000161 Kadlec Regional Medical Center 8/29/2016 4F - Pressure ulcerHAC.FS.00000161 Kadlec Regional Medical Center 10/18/2016 4F - Pressure ulcerHAC.FS.00000161 Kadlec Regional Medical Center 11/7/2016 1D - Unintended retention of foreign objectHAC.FS.00000161 Kadlec Regional Medical Center 11/7/2016 4F - Pressure ulcerHAC.FS.00000161 Kadlec Regional Medical Center 11/28/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000161 Kadlec Regional Medical Center 12/13/2016 4I - Failure to follow up with test resultsHAC.FS.00000161 Kadlec Regional Medical Center 12/28/2016 4F - Pressure ulcerHAC.FS.00000161 Kadlec Regional Medical Center 12/28/2016 4F - Pressure ulcerHAC.FS.00000161 Kadlec Regional Medical Center 1/4/2017 4F - Pressure ulcerHAC.FS.00000161 Kadlec Regional Medical Center 1/16/2017 4F - Pressure ulcerHAC.FS.00000161 Kadlec Regional Medical Center 3/23/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000161 Kadlec Regional Medical Center 4/12/2017 1D - Unintended retention of foreign objectHAC.FS.00000161 Kadlec Regional Medical Center 6/13/2017 1D - Unintended retention of foreign objectHAC.FS.00000161 Kadlec Regional Medical Center 6/21/2017 4F - Pressure ulcerHAC.FS.00000161 Kadlec Regional Medical Center 7/17/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000161 Kadlec Regional Medical Center 7/27/2017 4F - Pressure ulcerHAC.FS.00000161 Kadlec Regional Medical Center 8/9/2017 4F - Pressure ulcerHAC.FS.00000161 Kadlec Regional Medical Center 8/10/2017 1A - Wrong surgery/invasive procedure siteHAC.FS.00000161 Kadlec Regional Medical Center 9/21/2017 4F - Pressure ulcerHAC.FS.00000161 Kadlec Regional Medical Center 9/26/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000161 Kadlec Regional Medical Center 9/29/2017 4F - Pressure ulcerHAC.FS.00000161 Kadlec Regional Medical Center 11/1/2017 4F - Pressure ulcerHAC.FS.00000161 Kadlec Regional Medical Center 11/27/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000161 Kadlec Regional Medical Center 11/29/2017 1D - Unintended retention of foreign objectHAC.FS.00000161 Kadlec Regional Medical Center 12/5/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000161 Kadlec Regional Medical Center 1/10/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000161 Kadlec Regional Medical Center 1/15/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000161 Kadlec Regional Medical Center 1/18/2018 4F - Pressure ulcerHAC.FS.00000161 Kadlec Regional Medical Center 1/23/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000161 Kadlec Regional Medical Center 2/6/2018 4F - Pressure ulcerHAC.FS.00000161 Kadlec Regional Medical Center 3/1/2018 4F - Pressure ulcerHAC.FS.00000161 Kadlec Regional Medical Center 3/22/2018 1D - Unintended retention of foreign objectHAC.FS.00000161 Kadlec Regional Medical Center 3/28/2018 4F - Pressure ulcerHAC.FS.00000161 Kadlec Regional Medical Center 5/21/2018 4F - Pressure ulcerHAC.FS.00000161 Kadlec Regional Medical Center 5/25/2018 4F - Pressure ulcerHAC.FS.00000161 Kadlec Regional Medical Center 6/11/2018 4F - Pressure ulcerHAC.FS.00000161 Kadlec Regional Medical Center 6/25/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000161 Kadlec Regional Medical Center 7/3/2018 1D - Unintended retention of foreign objectHAC.FS.00000161 Kadlec Regional Medical Center 7/10/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000161 Kadlec Regional Medical Center 12/12/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000161 Kadlec Regional Medical Center 1/3/2019 1A - Wrong surgery/invasive procedure siteHAC.FS.00000161 Kadlec Regional Medical Center 1/31/2019 4F - Pressure ulcerHAC.FS.00000161 Kadlec Regional Medical Center 2/4/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000161 Kadlec Regional Medical Center 3/4/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000161 Kadlec Regional Medical Center 3/5/2019 1D - Unintended retention of foreign objectHAC.FS.00000161 Kadlec Regional Medical Center 3/20/2019 1D - Unintended retention of foreign objectHAC.FS.00000161 Kadlec Regional Medical Center 3/26/2019 4F - Pressure ulcerHAC.FS.00000161 Kadlec Regional Medical Center 4/9/2019 1A - Wrong surgery/invasive procedure siteHAC.FS.00000161 Kadlec Regional Medical Center 4/22/2019 4F - Pressure ulcerHAC.FS.00000161 Kadlec Regional Medical Center 5/6/2019 1A - Wrong surgery/invasive procedure siteHAC.FS.00000161 Kadlec Regional Medical Center 6/3/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000161 Kadlec Regional Medical Center 6/3/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000161 Kadlec Regional Medical Center 6/14/2019 4F - Pressure ulcerHAC.FS.00000161 Kadlec Regional Medical Center 6/17/2019 1C - Wrong surgical/invasive procedureHAC.FS.00000161 Kadlec Regional Medical Center 6/17/2019 4F - Pressure ulcerHAC.FS.00000161 Kadlec Regional Medical Center 6/18/2019 1A - Wrong surgery/invasive procedure siteHAC.FS.00000161 Kadlec Regional Medical Center 7/12/2019 4F - Pressure ulcerHAC.FS.00000161 Kadlec Regional Medical Center 7/2/2019 1D - Unintended retention of foreign objectHAC.FS.00000161 Kadlec Regional Medical Center 9/11/2019 4F - Pressure ulcerHAC.FS.00000161 Kadlec Regional Medical Center 9/6/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000161 Kadlec Regional Medical Center 10/16/2019 4F - Pressure ulcerHAC.FS.00000161 Kadlec Regional Medical Center 11/19/2019 5B - No gas, wrong gas, contaminated gas

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DOH 689-013 September 2014Office of Community Health Systems Page 14 of 62

Adverse Events Quarterly ReportFacility by Date and Event - Q2 2020

Facility Credential Facility Name Facility County Date Confirmed Event TypeHAC.FS.00000161 Kadlec Regional Medical Center 12/13/2019 4F - Pressure ulcerHAC.FS.00000161 Kadlec Regional Medical Center 12/20/2019 **4F - Pressure ulcerHAC.FS.00000161 Kadlec Regional Medical Center 1/9/2020 4F - Pressure ulcerHAC.FS.00000161 Kadlec Regional Medical Center 2/12/2020 4F - Pressure ulcerHAC.FS.00000161 Kadlec Regional Medical Center 4/30/2020 4F - Pressure ulcer

121HAC.FS.00000039 Kennewick General Hospital Benton 3/9/2007 4E - Patient death or serious injury associated with a fallHAC.FS.00000039 Kennewick General Hospital 2/9/2009 1D - Unintended retention of foreign objectHAC.FS.00000039 Kennewick General Hospital 3/30/2010 1D - Unintended retention of foreign objectHAC.FS.00000039 Kennewick General Hospital 9/20/2010 1D - Unintended retention of foreign objectHAC.FS.00000039 Kennewick General Hospital 2/15/2011 1D - Unintended retention of foreign objectHAC.FS.00000039 Kennewick General Hospital 12/9/2011 1D - Unintended retention of foreign objectHAC.FS.00000039 Kennewick General Hospital 2/12/2013 4F - Pressure ulcerHAC.FS.00000039 Kennewick General Hospital 3/26/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000039 Kennewick General Hospital 4/29/2013 1D - Unintended retention of foreign object HAC.FS.00000039 Kennewick General Hospital 7/8/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000039 Kennewick General Hospital 7/16/2013 4F - Pressure ulcerHAC.FS.00000039 Trios Health 11/11/2013 1D - Unintended retention of foreign objectHAC.FS.00000039 Trios Health 5/2/2014 4F - Pressure ulcerHAC.FS.00000039 Trios Health 12/12/2014 4A - Medication errorHAC.FS.00000039 Trios Health 1/12/2015 1D - Unintended retention of foreign objectHAC.FS.00000039 Trios Health 1/28/2015 1D - Unintended retention of foreign objectHAC.FS.00000039 Trios Health 3/12/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000039 Trios Health 5/26/2015 1D - Unintended retention of foreign objectHAC.FS.00000039 Trios Health 7/17/2015 4F - Pressure ulcerHAC.FS.00000039 Trios Health 10/16/2015 4F - Pressure ulcerHAC.FS.00000039 Trios Health 5/25/2016 **4E - Patient death or serious injury associated with a fallHAC.FS.00000039 Trios Health 4/24/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000039 Trios Health 12/13/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000039 Trios Health 12/29/2017 1D - Unintended retention of foreign objectHAC.FS.00000039 Trios Health 1/8/2018 6A - Introduction of metallic object into MRI areaHAC.FS.00000039 Trios Health 2/8/2018 4E - Patient death or serious injury associated with a fall

26HAC.FS.00000148 Kindred Hospital King 7/15/2006 7D - Physical assaultHAC.FS.00000148 Kindred Hospital 4/25/2007 4E - Patient death or serious injury associated with a fallHAC.FS.00000148 Kindred Hospital 7/13/2007 4E - Patient death or serious injury associated with a fallHAC.FS.00000148 Kindred Hospital 3/14/2008 4F - Pressure ulcerHAC.FS.00000148 Kindred Hospital 3/14/2008 4F - Pressure ulcerHAC.FS.00000148 Kindred Hospital 5/8/2013 4F - Pressure ulcerHAC.FS.00000148 Kindred Hospital 5/9/2013 4F - Pressure ulcerHAC.FS.00000148 Kindred Hospital 6/11/2013 4F - Pressure ulcerHAC.FS.00000148 Kindred Hospital Seattle - Northgate 7/27/2013 2B - Device function or useHAC.FS.00000148 Kindred Hospital Seattle - Northgate 4/25/2014 4F - Pressure ulcerHAC.FS.00000148 Kindred Hospital Seattle - Northgate 7/18/2014 4F - Pressure ulcerHAC.FS.00000148 Kindred Hospital Seattle - Northgate 9/9/2014 4F - Pressure ulcerHAC.FS.00000148 Kindred Hospital Seattle - Northgate 11/21/2014 4F - Pressure ulcerHAC.FS.00000148 Kindred Hospital Seattle - Northgate 12/29/2014 4F - Pressure ulcerHAC.FS.00000148 Kindred Hospital Seattle - Northgate 2/5/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000148 Kindred Hospital Seattle - Northgate 2/17/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000148 Kindred Hospital Seattle - Northgate 2/25/2015 4F - Pressure ulcerHAC.FS.00000148 Kindred Hospital Seattle - Northgate 2/25/2015 4F - Pressure ulcerHAC.FS.00000148 Kindred Hospital Seattle - Northgate 3/18/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000148 Kindred Hospital Seattle - Northgate 7/20/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000148 Kindred Hospital Seattle - Northgate 7/30/2015 4F - Pressure ulcerHAC.FS.00000148 Kindred Hospital Seattle - Northgate 8/18/2015 4F - Pressure ulcerHAC.FS.00000148 Kindred Hospital Seattle - Northgate 8/18/2015 4F - Pressure ulcerHAC.FS.00000148 Kindred Hospital Seattle - Northgate 12/16/2015 4F - Pressure ulcerHAC.FS.00000148 Kindred Hospital Seattle - Northgate 2/11/2016 4F - Pressure ulcerHAC.FS.00000148 Kindred Hospital Seattle - Northgate 4/4/2016 4F - Pressure ulcerHAC.FS.00000148 Kindred Hospital Seattle - Northgate 4/4/2016 1D - Unintended retention of foreign objectHAC.FS.00000148 Kindred Hospital Seattle - Northgate 4/14/2016 4F - Pressure ulcerHAC.FS.00000148 Kindred Hospital Seattle - Northgate 4/14/2016 4F - Pressure ulcerHAC.FS.00000148 Kindred Hospital Seattle - Northgate 5/16/2016 4F - Pressure ulcerHAC.FS.00000148 Kindred Hospital Seattle - Northgate 6/10/2016 4F - Pressure ulcerHAC.FS.00000148 Kindred Hospital Seattle - Northgate 8/8/2016 4F - Pressure ulcerHAC.FS.00000148 Kindred Hospital Seattle - Northgate 4/20/2017 4F - Pressure ulcerHAC.FS.00000148 Kindred Hospital Seattle - Northgate 5/5/2017 4F - Pressure ulcerHAC.FS.00000148 Kindred Hospital Seattle - Northgate 5/22/2017 4F - Pressure ulcerHAC.FS.00000148 Kindred Hospital Seattle - Northgate 10/10/2017 4F - Pressure ulcerHAC.FS.00000148 Kindred Hospital Seattle - Northgate 10/17/2017 4F - Pressure ulcerHAC.FS.00000148 Kindred Hospital Seattle - Northgate 10/23/2017 4F - Pressure ulcerHAC.FS.00000148 Kindred Hospital Seattle - Northgate 2/28/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000148 Kindred Hospital Seattle - Northgate 4/8/2018 4F - Pressure ulcerHAC.FS.00000148 Kindred Hospital Seattle - Northgate 4/23/2018 4F - Pressure ulcerHAC.FS.00000148 Kindred Hospital Seattle - Northgate 8/6/2018 4F - Pressure ulcerHAC.FS.00000148 Kindred Hospital Seattle - Northgate 8/18/2018 4F - Pressure ulcerHAC.FS.00000148 Kindred Hospital Seattle - Northgate 8/20/2018 4F - Pressure ulcerHAC.FS.00000148 Kindred Hospital Seattle - Northgate 3/4/2019 4F - Pressure ulcerHAC.FS.00000148 Kindred Hospital Seattle - First Hill 4/9/2019 4F - Pressure ulcerHAC.FS.00000148 Kindred Hospital Seattle - First Hill 4/11/2019 4F - Pressure ulcerHAC.FS.00000148 Kindred Hospital Seattle - First Hill 7/5/2019 4F - Pressure ulcerHAC.FS.00000148 Kindred Hospital Seattle - First Hill 7/23/2019 4F - Pressure ulcerHAC.FS.00000148 Kindred Hospital Seattle - First Hill 8/14/2019 **4F - Pressure ulcerHAC.FS.00000148 Kindred Hospital Seattle - First Hill 9/1/2019 **4F - Pressure ulcerHAC.FS.00000148 Kindred Hospital Seattle - First Hill 9/12/2019 **4F - Pressure ulcerHAC.FS.00000148 Kindred Hospital Seattle - First Hill 9/28/2019 **4F - Pressure ulcerHAC.FS.00000148 Kindred Hospital Seattle - First Hill 10/2/2019 4F - Pressure ulcerHAC.FS.00000148 Kindred Hospital Seattle - First Hill 11/28/2019 **4F - Pressure ulcerHAC.FS.00000148 Kindred Hospital Seattle - First Hill 11/28/2019 **4F - Pressure ulcerHAC.FS.00000148 Kindred Hospital Seattle - First Hill 12/13/2019 **4F - Pressure ulcerHAC.FS.00000148 Kindred Hospital Seattle - First Hill 12/15/2019 **4F - Pressure ulcerHAC.FS.00000148 Kindred Hospital Seattle - First Hill 12/28/2019 **4F - Pressure ulcerHAC.FS.00000148 Kindred Hospital Seattle - First Hill 1/10/2020 **4F - Pressure ulcerHAC.FS.00000148 Kindred Hospital Seattle - First Hill 1/14/2020 **4F - Pressure ulcerHAC.FS.00000148 Kindred Hospital Seattle - First Hill 1/21/2020 **4F - Pressure ulcerHAC.FS.00000148 Kindred Hospital Seattle - First Hill 1/21/2020 **4F - Pressure ulcerHAC.FS.00000148 Kindred Hospital Seattle - First Hill 1/29/2020 4F - Pressure ulcerHAC.FS.00000148 Kindred Hospital Seattle - First Hill 1/31/2020 **4F - Pressure ulcerHAC.FS.00000148 Kindred Hospital Seattle - First Hill 2/3/2020 **4F - Pressure ulcerHAC.FS.00000148 Kindred Hospital Seattle - First Hill 2/4/2020 **4F - Pressure ulcer

Kadlec Regional Medical Center number of events:

Trios Health number of events:

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Adverse EventsFacilities and Date of Event Report 2006-2020

DOH 689-013 September 2014Office of Community Health Systems Page 15 of 62

Adverse Events Quarterly ReportFacility by Date and Event - Q2 2020

Facility Credential Facility Name Facility County Date Confirmed Event TypeHAC.FS.00000148 Kindred Hospital Seattle - First Hill 2/4/2020 **4F - Pressure ulcerHAC.FS.00000148 Kindred Hospital Seattle - First Hill 2/7/2020 **4F - Pressure ulcerHAC.FS.00000148 Kindred Hospital Seattle - First Hill 2/13/2020 **4F - Pressure ulcerHAC.FS.00000148 Kindred Hospital Seattle - First Hill 2/19/2020 **4F - Pressure ulcerHAC.FS.00000148 Kindred Hospital Seattle - First Hill 2/28/2020 4F - Pressure ulcerHAC.FS.00000148 Kindred Hospital Seattle - First Hill 3/6/2020 **4F - Pressure ulcerHAC.FS.00000148 Kindred Hospital Seattle - First Hill 3/7/2020 **4F - Pressure ulcerHAC.FS.00000148 Kindred Hospital Seattle - First Hill 3/21/2020 **4F - Pressure ulcerHAC.FS.00000148 Kindred Hospital Seattle - First Hill 3/28/2020 **4F - Pressure ulcerHAC.FS.00000148 Kindred Hospital Seattle - First Hill 6/23/2020 4F - Pressure ulcer

77HAC.FS.00000140 Kittitas Valley Healthcare Hospital Kittitas 1/21/2011 4E - Patient death or serious injury associated with a fallHAC.FS.00000140 Kittitas Valley Healthcare Hospital 3/14/2011 1C - Wrong surgical/invasive procedureHAC.FS.00000140 Kittitas Valley Healthcare Hospital 7/15/2015 **1D - Unintended retention of foreign objectHAC.FS.00000140 Kittitas Valley Healthcare Hospital 2/5/2019 4E - Patient death or serious injury associated with a fall

4HAC.FS.00000008 Klickitat Valley Health Klickitat 10/13/2009 4F - Pressure ulcerHAC.FS.00000008 Klickitat Valley Health 4/6/2018 4I - Failure to follow up with test results

2HAC.FS.00000165 Lake Chelan Community Hospital Chelan 3/12/2007 1C - Wrong surgical/invasive procedureHAC.FS.00000165 Lake Chelan Community Hospital 1/21/2010 4A - Medication errorHAC.FS.00000165 Lake Chelan Community Hospital 8/2/2011 5C - BurnHAC.FS.00000165 Lake Chelan Community Hospital 4/26/2016 **4E - Patient death or serious injury associated with a fallHAC.FS.00000165 Lake Chelan Community Hospital 5/24/2016 4F - Pressure ulcerHAC.FS.00000165 Lake Chelan Community Hospital 8/21/2016 4D - Death or serious injury of neonateHAC.FS.00000165 Lake Chelan Community Hospital 9/7/2017 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.00000165 Lake Chelan Community Hospital 12/14/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000165 Lake Chelan Community Hospital 4/19/2019 4E - Patient death or serious injury associated with a fall

9HAC.FS.00000208 Legacy Salmon Creek Hospital/Legacy Salmon Creek Medical Ctr Clark 5/11/2007 1D - Unintended retention of foreign objectHAC.FS.00000208 Legacy Salmon Creek Hospital/Legacy Salmon Creek Medical Ctr 7/12/2007 4F - Pressure ulcerHAC.FS.00000208 Legacy Salmon Creek Hospital/Legacy Salmon Creek Medical Ctr 8/9/2007 1D - Unintended retention of foreign objectHAC.FS.00000208 Legacy Salmon Creek Hospital/Legacy Salmon Creek Medical Ctr 8/16/2007 1D - Unintended retention of foreign objectHAC.FS.00000208 Legacy Salmon Creek Hospital/Legacy Salmon Creek Medical Ctr 3/24/2008 1A - Wrong surgery/invasive procedure siteHAC.FS.00000208 Legacy Salmon Creek Hospital/Legacy Salmon Creek Medical Ctr 12/11/2009 **1D - Unintended retention of foreign objectHAC.FS.00000208 Legacy Salmon Creek Hospital/Legacy Salmon Creek Medical Ctr 2/4/2010 4E - Patient death or serious injury associated with a fallHAC.FS.00000208 Legacy Salmon Creek Hospital/Legacy Salmon Creek Medical Ctr 2/10/2010 4E - Patient death or serious injury associated with a fallHAC.FS.00000208 Legacy Salmon Creek Hospital/Legacy Salmon Creek Medical Ctr 2/22/2010 4E - Patient death or serious injury associated with a fallHAC.FS.00000208 Legacy Salmon Creek Hospital/Legacy Salmon Creek Medical Ctr 1/18/2011 1A - Wrong surgery/invasive procedure siteHAC.FS.00000208 Legacy Salmon Creek Hospital/Legacy Salmon Creek Medical Ctr 6/27/2011 4F - Pressure ulcerHAC.FS.00000208 Legacy Salmon Creek Hospital/Legacy Salmon Creek Medical Ctr 12/8/2011 1A - Wrong surgery/invasive procedure siteHAC.FS.00000208 Legacy Salmon Creek Hospital/Legacy Salmon Creek Medical Ctr 3/16/2012 4F - Pressure ulcerHAC.FS.00000208 Legacy Salmon Creek Hospital/Legacy Salmon Creek Medical Ctr 3/27/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000208 Legacy Salmon Creek Hospital/Legacy Salmon Creek Medical Ctr 6/5/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000208 Legacy Salmon Creek Hospital/Legacy Salmon Creek Medical Ctr 7/22/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000208 Legacy Salmon Creek Hospital/Legacy Salmon Creek Medical Ctr 9/26/2012 **4E - Patient death or serious injury associated with a fallHAC.FS.00000208 Legacy Salmon Creek Hospital/Legacy Salmon Creek Medical Ctr 3/1/2013 1D - Unintended retention of foreign object HAC.FS.00000208 Legacy Salmon Creek Hospital/Legacy Salmon Creek Medical Ctr 10/9/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000208 Legacy Salmon Creek Hospital/Legacy Salmon Creek Medical Ctr 10/24/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000208 Legacy Salmon Creek Hospital/Legacy Salmon Creek Medical Ctr 11/20/2013 4F - Pressure ulcerHAC.FS.00000208 Legacy Salmon Creek Hospital/Legacy Salmon Creek Medical Ctr 1/22/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000208 Legacy Salmon Creek Hospital/Legacy Salmon Creek Medical Ctr 3/27/2014 2C - Intravascular air embolismHAC.FS.00000208 Legacy Salmon Creek Hospital/Legacy Salmon Creek Medical Ctr 4/18/2014 4F - Pressure ulcerHAC.FS.00000208 Legacy Salmon Creek Hospital/Legacy Salmon Creek Medical Ctr 5/8/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000208 Legacy Salmon Creek Hospital/Legacy Salmon Creek Medical Ctr 5/12/2014 4F - Pressure ulcerHAC.FS.00000208 Legacy Salmon Creek Hospital/Legacy Salmon Creek Medical Ctr 5/21/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000208 Legacy Salmon Creek Hospital/Legacy Salmon Creek Medical Ctr 7/2/2014 4F - Pressure ulcerHAC.FS.00000208 Legacy Salmon Creek Hospital/Legacy Salmon Creek Medical Ctr 9/25/2014 1D - Unintended retention of foreign objectHAC.FS.00000208 Legacy Salmon Creek Hospital/Legacy Salmon Creek Medical Ctr 10/13/2014 4F - Pressure ulcerHAC.FS.00000208 Legacy Salmon Creek Hospital/Legacy Salmon Creek Medical Ctr 1/5/2015 4F - Pressure ulcerHAC.FS.00000208 Legacy Salmon Creek Hospital/Legacy Salmon Creek Medical Ctr 7/23/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000208 Legacy Salmon Creek Hospital/Legacy Salmon Creek Medical Ctr 9/15/2015 4F - Pressure ulcerHAC.FS.00000208 Legacy Salmon Creek Hospital/Legacy Salmon Creek Medical Ctr 9/15/2015 4F - Pressure ulcerHAC.FS.00000208 Legacy Salmon Creek Hospital/Legacy Salmon Creek Medical Ctr 9/15/2015 4F - Pressure ulcerHAC.FS.00000208 Legacy Salmon Creek Hospital/Legacy Salmon Creek Medical Ctr 11/6/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000208 Legacy Salmon Creek Hospital/Legacy Salmon Creek Medical Ctr 12/9/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000208 Legacy Salmon Creek Hospital/Legacy Salmon Creek Medical Ctr 12/9/2015 4F - Pressure ulcerHAC.FS.00000208 Legacy Salmon Creek Hospital/Legacy Salmon Creek Medical Ctr 1/19/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000208 Legacy Salmon Creek Hospital/Legacy Salmon Creek Medical Ctr 2/29/2016 1A - Wrong surgery/invasive procedure siteHAC.FS.00000208 Legacy Salmon Creek Hospital/Legacy Salmon Creek Medical Ctr 4/11/2016 4F - Pressure ulcerHAC.FS.00000208 Legacy Salmon Creek Hospital/Legacy Salmon Creek Medical Ctr 5/24/2016 4F - Pressure ulcerHAC.FS.00000208 Legacy Salmon Creek Hospital/Legacy Salmon Creek Medical Ctr 5/26/2016 4F - Pressure ulcerHAC.FS.00000208 Legacy Salmon Creek Hospital/Legacy Salmon Creek Medical Ctr 6/20/2016 4F - Pressure ulcerHAC.FS.00000208 Legacy Salmon Creek Hospital/Legacy Salmon Creek Medical Ctr 7/5/2016 1D - Unintended retention of foreign objectHAC.FS.00000208 Legacy Salmon Creek Hospital/Legacy Salmon Creek Medical Ctr 7/27/2016 4F - Pressure ulcerHAC.FS.00000208 Legacy Salmon Creek Hospital/Legacy Salmon Creek Medical Ctr 9/6/2016 4F - Pressure ulcerHAC.FS.00000208 Legacy Salmon Creek Hospital/Legacy Salmon Creek Medical Ctr 12/21/2016 4F - Pressure ulcerHAC.FS.00000208 Legacy Salmon Creek Hospital/Legacy Salmon Creek Medical Ctr 12/29/2016 4F - Pressure ulcerHAC.FS.00000208 Legacy Salmon Creek Hospital/Legacy Salmon Creek Medical Ctr 2/17/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000208 Legacy Salmon Creek Hospital/Legacy Salmon Creek Medical Ctr 2/22/2017 4F - Pressure ulcerHAC.FS.00000208 Legacy Salmon Creek Hospital/Legacy Salmon Creek Medical Ctr 8/27/2017 4F - Pressure ulcerHAC.FS.00000208 Legacy Salmon Creek Hospital/Legacy Salmon Creek Medical Ctr 10/26/2017 4F - Pressure ulcerHAC.FS.00000208 Legacy Salmon Creek Hospital/Legacy Salmon Creek Medical Ctr 10/26/2017 4F - Pressure ulcerHAC.FS.00000208 Legacy Salmon Creek Hospital/Legacy Salmon Creek Medical Ctr 12/1/2017 4F - Pressure ulcerHAC.FS.00000208 Legacy Salmon Creek Hospital/Legacy Salmon Creek Medical Ctr 12/11/2017 4F - Pressure ulcerHAC.FS.00000208 Legacy Salmon Creek Hospital/Legacy Salmon Creek Medical Ctr 12/14/2017 4F - Pressure ulcerHAC.FS.00000208 Legacy Salmon Creek Hospital/Legacy Salmon Creek Medical Ctr 12/18/2017 4F - Pressure ulcerHAC.FS.00000208 Legacy Salmon Creek Hospital/Legacy Salmon Creek Medical Ctr 4/27/2018 4F - Pressure ulcerHAC.FS.00000208 Legacy Salmon Creek Hospital/Legacy Salmon Creek Medical Ctr 4/27/2018 4F - Pressure ulcerHAC.FS.00000208 Legacy Salmon Creek Hospital/Legacy Salmon Creek Medical Ctr 6/6/2019 1D - Unintended retention of foreign objectHAC.FS.00000208 Legacy Salmon Creek Hospital/Legacy Salmon Creek Medical Ctr 7/1/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000208 Legacy Salmon Creek Hospital/Legacy Salmon Creek Medical Ctr 7/19/2019 4F - Pressure ulcerHAC.FS.00000208 Legacy Salmon Creek Hospital/Legacy Salmon Creek Medical Ctr 10/15/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000208 Legacy Salmon Creek Hospital/Legacy Salmon Creek Medical Ctr 1/3/2020 4F - Pressure ulcerHAC.FS.00000208 Legacy Salmon Creek Hospital/Legacy Salmon Creek Medical Ctr 5/21/2020 1A - Wrong surgery/invasive procedure site

66HAC.FS.00000137 Lincoln Hospital Lincoln 11/8/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000137 Lincoln Hospital 11/28/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000137 Lincoln Hospital 3/15/2017 **4E - Patient death or serious injury associated with a fallHAC.FS.00000137 Lincoln Hospital 3/16/2017 4F - Pressure ulcer

Kittitas Valley Healthcare Hospital number of events:

Klickitat Valley Health number of events:

Lake Chelan Community Hospital number of events:

Legacy Salmon Creek Hospital/Legacy Salmon Creek Medical Center number of events:

Kindred Hospital Seattle - Northgate number of events:

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DOH 689-013 September 2014Office of Community Health Systems Page 16 of 62

Adverse Events Quarterly ReportFacility by Date and Event - Q2 2020

Facility Credential Facility Name Facility County Date Confirmed Event TypeHAC.FS.00000137 Lincoln Hospital 7/23/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000137 Lincoln Hospital 10/1/2018 **4E - Patient death or serious injury associated with a fallHAC.FS.00000137 Lincoln Hospital 10/25/2019 4E - Patient death or serious injury associated with a fall

7HAC.FS.00000022 Lourdes Medical Center Franklin 1/29/2008 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.00000022 Lourdes Medical Center 3/11/2011 1D - Unintended retention of foreign objectHAC.FS.00000022 Lourdes Medical Center 3/26/2013 1A - Wrong surgery/invasive procedure site

3HAC.FS.00000152 Mason General Hospital & Family of Clinics Mason 7/10/2008 4A - Medication errorHAC.FS.00000152 Mason General Hospital & Family of Clinics 5/16/2016 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.00000152 Mason General Hospital & Family of Clinics 5/17/2017 4D - Death or serious injury of neonateHAC.FS.00000152 Mason General Hospital & Family of Clinics 3/14/2018 4D - Death or serious injury of neonateHAC.FS.00000152 Mason General Hospital & Family of Clinics 11/30/2018 1A - Wrong surgery/invasive procedure siteHAC.FS.00000152 Mason General Hospital & Family of Clinics 3/27/2019 1A - Wrong surgery/invasive procedure siteHAC.FS.00000152 Mason General Hospital & Family of Clinics 11/21/2019 4I - Failure to follow up with test results

7HAC.FS.00000173 Morton General Hospital Lewis 1/3/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000173 Morton General Hospital 3/14/2018 4E - Patient death or serious injury associated with a fall

2HAC.FS.00000147 Mid-Valley Hospital Okanogan 4/29/2008 4A - Medication errorHAC.FS.00000147 Mid-Valley Hospital 4/29/2008 4A - Medication errorHAC.FS.00000147 Mid-Valley Hospital 6/9/2009 4F - Pressure ulcerHAC.FS.00000147 Mid-Valley Hospital 12/25/2009 4E - Patient death or serious injury associated with a fallHAC.FS.00000147 Mid-Valley Hospital 5/16/2017 3C - Patient suicide, attempted suicide, or self-harm

5HAC.FS.60311052 MultiCare Auburn Medical Centeri King 10/23/2012 4E - Patient death or serious injury associated with a fallHAC.FS.60311052 MultiCare Auburn Medical Centeri 10/26/2012 1D - Unintended retention of foreign objectHAC.FS.60311052 MultiCare Auburn Medical Centeri 1/4/2013 4E - Patient death or serious injury associated with a fallHAC.FS.60311052 MultiCare Auburn Medical Centeri 2/1/2013 4F - Pressure ulcerHAC.FS.60311052 MultiCare Auburn Medical Centeri 2/1/2013 4F - Pressure ulcerHAC.FS.60311052 MultiCare Auburn Medical Centeri 4/1/2013 4E - Patient death or serious injury associated with a fallHAC.FS.60311052 MultiCare Auburn Medical Centeri 6/26/2013 4F - Pressure ulcerHAC.FS.60311052 MultiCare Auburn Medical Centeri 7/1/2013 2B - Device function or useHAC.FS.60311052 MultiCare Auburn Medical Centeri 8/15/2013 4F - Pressure ulcerHAC.FS.60311052 MultiCare Auburn Medical Centeri 8/15/2013 4F - Pressure ulcerHAC.FS.60311052 MultiCare Auburn Medical Centeri 8/15/2013 4F - Pressure ulcerHAC.FS.60311052 MultiCare Auburn Medical Centeri 11/15/2013 4F - Pressure ulcerHAC.FS.60311052 MultiCare Auburn Medical Centeri 11/27/2013 4F - Pressure ulcerHAC.FS.60311052 MultiCare Auburn Medical Centeri 2/13/2014 4F - Pressure ulcerHAC.FS.60311052 MultiCare Auburn Medical Centeri 4/24/2014 4E - Patient death or serious injury associated with a fallHAC.FS.60311052 MultiCare Auburn Medical Centeri 6/6/2014 1D - Unintended retention of foreign objectHAC.FS.60311052 MultiCare Auburn Medical Centeri 6/17/2014 4F - Pressure ulcerHAC.FS.60311052 MultiCare Auburn Medical Centeri 6/17/2014 4F - Pressure ulcerHAC.FS.60311052 MultiCare Auburn Medical Centeri 10/16/2014 4F - Pressure ulcerHAC.FS.60311052 MultiCare Auburn Medical Centeri 10/30/2014 4F - Pressure ulcerHAC.FS.60311052 MultiCare Auburn Medical Centeri 11/4/2014 4F - Pressure ulcerHAC.FS.60311052 MultiCare Auburn Medical Centeri 11/20/2014 4F - Pressure ulcerHAC.FS.60311052 MultiCare Auburn Medical Centeri 12/5/2014 4F - Pressure ulcerHAC.FS.60311052 MultiCare Auburn Medical Centeri 12/6/2014 4F - Pressure ulcerHAC.FS.60311052 MultiCare Auburn Medical Centeri 12/19/2014 4E - Patient death or serious injury associated with a fallHAC.FS.60311052 MultiCare Auburn Medical Centeri 1/9/2015 4E - Patient death or serious injury associated with a fallHAC.FS.60311052 MultiCare Auburn Medical Centeri 5/21/2015 4E - Patient death or serious injury associated with a fallHAC.FS.60311052 MultiCare Auburn Medical Centeri 6/12/2015 4F - Pressure ulcerHAC.FS.60311052 MultiCare Auburn Medical Centeri 7/10/2015 4E - Patient death or serious injury associated with a fallHAC.FS.60311052 MultiCare Auburn Medical Centeri 7/17/2015 4F - Pressure ulcerHAC.FS.60311052 MultiCare Auburn Medical Centeri 7/24/2015 4F - Pressure ulcerHAC.FS.60311052 MultiCare Auburn Medical Centeri 8/7/2015 4F - Pressure ulcerHAC.FS.60311052 MultiCare Auburn Medical Centeri 9/25/2015 7C - Sexual abuse/assaultHAC.FS.60311052 MultiCare Auburn Medical Centeri 10/2/2015 4F - Pressure ulcerHAC.FS.60311052 MultiCare Auburn Medical Centeri 10/16/2015 4F - Pressure ulcerHAC.FS.60311052 MultiCare Auburn Medical Centeri 10/23/2015 4E - Patient death or serious injury associated with a fallHAC.FS.60311052 MultiCare Auburn Medical Centeri 11/13/2015 4E - Patient death or serious injury associated with a fallHAC.FS.60311052 MultiCare Auburn Medical Centeri 11/13/2015 4F - Pressure ulcerHAC.FS.60311052 MultiCare Auburn Medical Centeri 12/6/2015 4F - Pressure ulcerHAC.FS.60311052 MultiCare Auburn Medical Centeri 12/11/2015 4F - Pressure ulcerHAC.FS.60311052 MultiCare Auburn Medical Centeri 12/18/2015 4F - Pressure ulcerHAC.FS.60311052 MultiCare Auburn Medical Centeri 2/12/2016 4E - Patient death or serious injury associated with a fallHAC.FS.60311052 MultiCare Auburn Medical Centeri 2/12/2016 4F - Pressure ulcerHAC.FS.60311052 MultiCare Auburn Medical Centeri 2/26/2016 4I - Failure to follow up with test resultsHAC.FS.60311052 MultiCare Auburn Medical Centeri 3/1/2016 4B - Wrong blood productHAC.FS.60311052 MultiCare Auburn Medical Centeri 4/22/2016 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.60311052 MultiCare Auburn Medical Centeri 4/22/2016 4E - Patient death or serious injury associated with a fallHAC.FS.60311052 MultiCare Auburn Medical Centeri 4/22/2016 4E - Patient death or serious injury associated with a fallHAC.FS.60311052 MultiCare Auburn Medical Centeri 4/22/2016 4E - Patient death or serious injury associated with a fallHAC.FS.60311052 MultiCare Auburn Medical Centeri 4/29/2016 4E - Patient death or serious injury associated with a fallHAC.FS.60311052 MultiCare Auburn Medical Centeri 6/17/2016 4E - Patient death or serious injury associated with a fallHAC.FS.60311052 MultiCare Auburn Medical Centeri 8/5/2016 4F - Pressure ulcerHAC.FS.60311052 MultiCare Auburn Medical Centeri 9/16/2016 4E - Patient death or serious injury associated with a fallHAC.FS.60311052 MultiCare Auburn Medical Centeri 1/13/2017 4E - Patient death or serious injury associated with a fallHAC.FS.60311052 MultiCare Auburn Medical Centeri 1/13/2017 4F - Pressure ulcerHAC.FS.60311052 MultiCare Auburn Medical Centeri 1/20/2017 4A - Medication errorHAC.FS.60311052 MultiCare Auburn Medical Centeri 1/20/2017 4E - Patient death or serious injury associated with a fallHAC.FS.60311052 MultiCare Auburn Medical Centeri 4/26/2017 7D - Physical assaultHAC.FS.60311052 MultiCare Auburn Medical Centeri 12/1/2017 4E - Patient death or serious injury associated with a fallHAC.FS.60311052 MultiCare Auburn Medical Centeri 12/20/2017 4E - Patient death or serious injury associated with a fallHAC.FS.60311052 MultiCare Auburn Medical Centeri 12/20/2017 4E - Patient death or serious injury associated with a fallHAC.FS.60311052 MultiCare Auburn Medical Centeri 12/20/2017 4F - Pressure ulcerHAC.FS.60311052 MultiCare Auburn Medical Centeri 1/16/2018 7C - Sexual abuse/assaultHAC.FS.60311052 MultiCare Auburn Medical Centeri 3/26/2018 4E - Patient death or serious injury associated with a fallHAC.FS.60311052 MultiCare Auburn Medical Centeri 3/26/2018 4F - Pressure ulcerHAC.FS.60311052 MultiCare Auburn Medical Centeri 3/26/2018 4F - Pressure ulcerHAC.FS.60311052 MultiCare Auburn Medical Centeri 3/26/2018 4F - Pressure ulcerHAC.FS.60311052 MultiCare Auburn Medical Centeri 3/26/2018 4F - Pressure ulcerHAC.FS.60311052 MultiCare Auburn Medical Centeri 6/4/2018 4F - Pressure ulcerHAC.FS.60311052 MultiCare Auburn Medical Centeri 6/26/2018 4F - Pressure ulcerHAC.FS.60311052 MultiCare Auburn Medical Centeri 6/26/2018 4F - Pressure ulcerHAC.FS.60311052 MultiCare Auburn Medical Centeri 6/26/2018 4F - Pressure ulcerHAC.FS.60311052 MultiCare Auburn Medical Centeri 6/26/2018 4F - Pressure ulcerHAC.FS.60311052 MultiCare Auburn Medical Centeri 11/27/2018 4E - Patient death or serious injury associated with a fallHAC.FS.60311052 MultiCare Auburn Medical Centeri 11/27/2018 4F - Pressure ulcer

Lincoln Hospital number of events

Lourdes Medical Center number of events:

Mason General Hospital & Family Clinics number of events:

Morton General Hospital number of events:

Mid-Valley Hospital number of events:

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DOH 689-013 September 2014Office of Community Health Systems Page 17 of 62

Adverse Events Quarterly ReportFacility by Date and Event - Q2 2020

Facility Credential Facility Name Facility County Date Confirmed Event TypeHAC.FS.60311052 MultiCare Auburn Medical Centeri 1/31/2019 4E - Patient death or serious injury associated with a fallHAC.FS.60311052 MultiCare Auburn Medical Centeri 1/31/2019 4F - Pressure ulcerHAC.FS.60311052 MultiCare Auburn Medical Centeri 1/31/2019 4F - Pressure ulcerHAC.FS.60311052 MultiCare Auburn Medical Centeri 3/11/2019 7C - Sexual abuse/assaultHAC.FS.60311052 MultiCare Auburn Medical Centeri 3/11/2019 7C - Sexual abuse/assaultHAC.FS.60311052 MultiCare Auburn Medical Centeri 3/11/2019 7C - Sexual abuse/assaultHAC.FS.60311052 MultiCare Auburn Medical Centeri 3/25/2019 4F - Pressure ulcerHAC.FS.60311052 MultiCare Auburn Medical Centeri 3/25/2019 4F - Pressure ulcerHAC.FS.60311052 MultiCare Auburn Medical Centeri 4/30/2019 4E - Patient death or serious injury associated with a fallHAC.FS.60311052 MultiCare Auburn Medical Centeri 8/29/2019 3A - Patient/resident discharged to unauthorized personHAC.FS.60311052 MultiCare Auburn Medical Centeri 8/29/2019 4F - Pressure ulcerHAC.FS.60311052 MultiCare Auburn Medical Centeri 8/29/2019 4F - Pressure ulcerHAC.FS.60311052 MultiCare Auburn Medical Centeri 10/3/2019 4F - Pressure ulcerHAC.FS.60311052 MultiCare Auburn Medical Centeri 10/3/2019 4F - Pressure ulcerHAC.FS.60311052 MultiCare Auburn Medical Centeri 10/3/2019 4H - Irretrievable loss of irreplaceable biological specimenHAC.FS.60311052 MultiCare Auburn Medical Centeri 1/30/2020 4A - Medication errorHAC.FS.60311052 MultiCare Auburn Medical Centeri 1/30/2020 7C - Sexual abuse/assaultHAC.FS.60311052 MultiCare Auburn Medical Centeri 1/30/2020 7D - Physical assaultHAC.FS.60311052 MultiCare Auburn Medical Centeri 3/10/2020 4I - Failure to follow up with test resultsHAC.FS.60311052 MultiCare Auburn Medical Centeri 3/30/2020 4F - Pressure ulcerHAC.FS.60311052 MultiCare Auburn Medical Centeri 3/30/2020 4F - Pressure ulcerHAC.FS.60311052 MultiCare Auburn Medical Centeri 3/30/2020 4F - Pressure ulcerHAC.FS.60311052 MultiCare Auburn Medical Centeri 4/30/2020 4E - Patient death or serious injury associated with a fallHAC.FS.60311052 MultiCare Auburn Medical Centeri 5/28/2020 4E - Patient death or serious injury associated with a fallHAC.FS.60311052 MultiCare Auburn Medical Centeri 5/28/2020 4F - Pressure ulcer

100HAC.FS.60803817 Multicare Covington Medical Center King 3/18/2019 4F - Pressure ulcerHAC.FS.60803817 Multicare Covington Medical Center 11/18/2019 4E - Patient death or serious injury associated with a fallHAC.FS.60803817 Multicare Covington Medical Center 6/29/2020 4F - Pressure ulcer

3HAC.FS.60769397 MultiCare Deaconess Hospital^ Spokane 7/25/2017 4F - Pressure ulcerHAC.FS.60769397 MultiCare Deaconess Hospital^ 10/10/2017 4E - Patient death or serious injury associated with a fallHAC.FS.60769397 MultiCare Deaconess Hospital^ 11/28/2017 4E - Patient death or serious injury associated with a fallHAC.FS.60769397 MultiCare Deaconess Hospital^ 12/4/2017 4E - Patient death or serious injury associated with a fallHAC.FS.60769397 MultiCare Deaconess Hospital^ 12/4/2017 4E - Patient death or serious injury associated with a fallHAC.FS.60769397 MultiCare Deaconess Hospital^ 12/5/2017 4F - Pressure ulcerHAC.FS.60769397 MultiCare Deaconess Hospital^ 2/13/2018 1D - Unintended retention of foreign objectHAC.FS.60769397 MultiCare Deaconess Hospital^ 2/13/2018 5D - RestraintsHAC.FS.60769397 MultiCare Deaconess Hospital^ 3/13/2018 4F - Pressure ulcerHAC.FS.60769397 MultiCare Deaconess Hospital^ 5/25/2018 4E - Patient death or serious injury associated with a fallHAC.FS.60769397 MultiCare Deaconess Hospital^ 5/28/2018 4F - Pressure ulcerHAC.FS.60769397 MultiCare Deaconess Hospital^ 8/7/2018 4F - Pressure ulcerHAC.FS.60769397 MultiCare Deaconess Hospital^ 8/9/2018 4E - Patient death or serious injury associated with a fallHAC.FS.60769397 MultiCare Deaconess Hospital^ 8/10/2018 1D - Unintended retention of foreign objectHAC.FS.60769397 MultiCare Deaconess Hospital^ 8/21/2018 1A - Wrong surgery/invasive procedure siteHAC.FS.60769397 MultiCare Deaconess Hospital^ 9/4/2018 4E - Patient death or serious injury associated with a fallHAC.FS.60769397 MultiCare Deaconess Hospital^ 9/28/2018 4F - Pressure ulcerHAC.FS.60769397 MultiCare Deaconess Hospital^ 10/4/2018 1D - Unintended retention of foreign objectHAC.FS.60769397 MultiCare Deaconess Hospital^ 12/8/2018 4F - Pressure ulcerHAC.FS.60769397 MultiCare Deaconess Hospital^ 3/29/2019 4F - Pressure ulcerHAC.FS.60769397 MultiCare Deaconess Hospital^ 4/1/2019 4F - Pressure ulcerHAC.FS.60769397 MultiCare Deaconess Hospital^ 4/16/2019 4F - Pressure ulcerHAC.FS.60769397 MultiCare Deaconess Hospital^ 8/22/2019 4F - Pressure ulcerHAC.FS.60769397 MultiCare Deaconess Hospital^ 1/16/2020 4F - Pressure ulcerHAC.FS.60769397 MultiCare Deaconess Hospital^ 1/17/2020 4F - Pressure ulcerHAC.FS.60769397 MultiCare Deaconess Hospital^ 4/13/2020 4F - Pressure ulcerHAC.FS.60769397 MultiCare Deaconess Hospital^ 4/13/2020 4F - Pressure ulcerHAC.FS.60769397 MultiCare Deaconess Hospital^ 5/12/2020 4F - Pressure ulcerHAC.FS.60769397 MultiCare Deaconess Hospital^ 5/14/2020 4F - Pressure ulcerHAC.FS.60769397 MultiCare Deaconess Hospital^ 5/20/2020 4F - Pressure ulcerHAC.FS.60769397 MultiCare Deaconess Hospital^ 5/26/2020 1D - Unintended retention of foreign objectHAC.FS.60769397 MultiCare Deaconess Hospital^ 5/27/2020 1D - Unintended retention of foreign objectHAC.FS.60769397 MultiCare Deaconess Hospital^ 6/13/2020 1D - Unintended retention of foreign object

33HAC.FS.60221541 MultiCare Good Samaritaniiii Pierce 7/21/2011 1D - Unintended retention of foreign objectHAC.FS.60221541 MultiCare Good Samaritaniiii 7/28/2011 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 9/9/2011 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 9/30/2011 4E - Patient death or serious injury associated with a fallHAC.FS.60221541 MultiCare Good Samaritaniiii 10/21/2011 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 11/18/2011 4E - Patient death or serious injury associated with a fallHAC.FS.60221541 MultiCare Good Samaritaniiii 11/18/2011 4E - Patient death or serious injury associated with a fallHAC.FS.60221541 MultiCare Good Samaritaniiii 12/2/2011 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 12/2/2011 4E - Patient death or serious injury associated with a fallHAC.FS.60221541 MultiCare Good Samaritaniiii 12/9/2011 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 12/14/2011 4E - Patient death or serious injury associated with a fallHAC.FS.60221541 MultiCare Good Samaritaniiii 2/17/2012 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 2/17/2012 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 4/13/2012 1A - Wrong surgery/invasive procedure siteHAC.FS.60221541 MultiCare Good Samaritaniiii 4/27/2012 4E - Patient death or serious injury associated with a fallHAC.FS.60221541 MultiCare Good Samaritaniiii 5/11/2012 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 5/29/2012 4E - Patient death or serious injury associated with a fallHAC.FS.60221541 MultiCare Good Samaritaniiii 5/29/2012 4E - Patient death or serious injury associated with a fallHAC.FS.60221541 MultiCare Good Samaritaniiii 8/31/2012 4E - Patient death or serious injury associated with a fallHAC.FS.60221541 MultiCare Good Samaritaniiii 9/7/2012 4E - Patient death or serious injury associated with a fallHAC.FS.60221541 MultiCare Good Samaritaniiii 9/21/2012 4E - Patient death or serious injury associated with a fallHAC.FS.60221541 MultiCare Good Samaritaniiii 9/28/2012 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 10/12/2012 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 10/12/2012 1D - Unintended retention of foreign objectHAC.FS.60221541 MultiCare Good Samaritaniiii 11/16/2012 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 11/16/2012 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 11/16/2012 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 12/7/2012 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 12/14/2012 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 12/21/2012 1D - Unintended retention of foreign objectHAC.FS.60221541 MultiCare Good Samaritaniiii 12/26/2012 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 12/26/2012 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 12/31/2012 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 1/8/2013 1D - Unintended retention of foreign object HAC.FS.60221541 MultiCare Good Samaritaniiii 1/8/2013 2B - Device function or useHAC.FS.60221541 MultiCare Good Samaritaniiii 1/11/2013 4F - Pressure ulcer

MultiCare Auburn Medical Center number of events:

MultiCare Covingtion Medical Center number of events:

MultiCare Deaconess Hospital number of events:

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Adverse EventsFacilities and Date of Event Report 2006-2020

DOH 689-013 September 2014Office of Community Health Systems Page 18 of 62

Adverse Events Quarterly ReportFacility by Date and Event - Q2 2020

Facility Credential Facility Name Facility County Date Confirmed Event TypeHAC.FS.60221541 MultiCare Good Samaritaniiii 1/11/2013 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 1/18/2013 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 2/8/2013 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 2/8/2013 5C - BurnHAC.FS.60221541 MultiCare Good Samaritaniiii 2/15/2013 4E - Patient death or serious injury associated with a fallHAC.FS.60221541 MultiCare Good Samaritaniiii 3/22/2013 4E - Patient death or serious injury associated with a fallHAC.FS.60221541 MultiCare Good Samaritaniiii 3/29/2013 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 3/29/2013 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 5/31/2013 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 5/31/2013 2B - Device function or useHAC.FS.60221541 MultiCare Good Samaritaniiii 6/21/2013 4E - Patient death or serious injury associated with a fallHAC.FS.60221541 MultiCare Good Samaritaniiii 7/26/2013 4A - Medication errorHAC.FS.60221541 MultiCare Good Samaritaniiii 7/26/2013 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 8/16/2013 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 8/23/2013 6A - Introduction of metallic object into MRI areaHAC.FS.60221541 MultiCare Good Samaritaniiii 8/27/2013 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 9/20/2013 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 11/5/2013 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 12/20/2013 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 12/27/2013 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 12/27/2013 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 1/3/2014 4E - Patient death or serious injury associated with a fallHAC.FS.60221541 MultiCare Good Samaritaniiii 1/9/2014 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 1/9/2014 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 1/24/2014 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 1/24/2014 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 1/24/2014 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 1/31/2014 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 1/31/2014 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 1/31/2014 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 2/14/2014 4D - Death or serious injury of neonateHAC.FS.60221541 MultiCare Good Samaritaniiii 2/14/2014 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 2/14/2014 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 2/28/2014 4E - Patient death or serious injury associated with a fallHAC.FS.60221541 MultiCare Good Samaritaniiii 3/14/2014 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 4/7/2014 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 4/7/2014 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 4/7/2014 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 4/7/2014 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 4/7/2014 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 4/11/2014 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 4/11/2014 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 5/16/2014 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 6/4/2014 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 6/4/2014 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 6/4/2014 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 6/4/2014 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 6/9/2014 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 6/9/2014 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 6/9/2014 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 6/9/2014 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 6/9/2014 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 6/11/2014 **7D - Physical assaultHAC.FS.60221541 MultiCare Good Samaritaniiii 6/13/2014 4E - Patient death or serious injury associated with a fallHAC.FS.60221541 MultiCare Good Samaritaniiii 8/7/2014 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 8/29/2014 4E - Patient death or serious injury associated with a fallHAC.FS.60221541 MultiCare Good Samaritaniiii 9/4/2014 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 9/11/2014 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 9/11/2014 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 9/11/2014 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 9/26/2014 4E - Patient death or serious injury associated with a fallHAC.FS.60221541 MultiCare Good Samaritaniiii 9/26/2014 4E - Patient death or serious injury associated with a fallHAC.FS.60221541 MultiCare Good Samaritaniiii 9/30/2014 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 10/30/2014 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 11/8/2014 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 11/11/2014 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 11/11/2014 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 11/11/2014 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 12/5/2014 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.60221541 MultiCare Good Samaritaniiii 12/8/2014 4A - Medication errorHAC.FS.60221541 MultiCare Good Samaritaniiii 2/12/2015 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 2/20/2015 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 3/6/2015 4E - Patient death or serious injury associated with a fallHAC.FS.60221541 MultiCare Good Samaritaniiii 3/10/2015 4E - Patient death or serious injury associated with a fallHAC.FS.60221541 MultiCare Good Samaritaniiii 4/10/2015 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 5/15/2015 4E - Patient death or serious injury associated with a fallHAC.FS.60221541 MultiCare Good Samaritaniiii 5/22/2015 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 6/5/2015 1D - Unintended retention of foreign objectHAC.FS.60221541 MultiCare Good Samaritaniiii 6/12/2015 1A - Wrong surgery/invasive procedure siteHAC.FS.60221541 MultiCare Good Samaritaniiii 6/12/2015 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 6/12/2015 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 6/12/2015 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 6/19/2015 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 6/29/2015 4A - Medication errorHAC.FS.60221541 MultiCare Good Samaritaniiii 7/10/2015 4E - Patient death or serious injury associated with a fallHAC.FS.60221541 MultiCare Good Samaritaniiii 7/10/2015 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 7/31/2015 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 8/7/2015 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 8/14/2015 1D - Unintended retention of foreign objectHAC.FS.60221541 MultiCare Good Samaritaniiii 8/29/2015 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.60221541 MultiCare Good Samaritaniiii 9/14/2015 1D - Unintended retention of foreign objectHAC.FS.60221541 MultiCare Good Samaritaniiii 9/14/2015 4E - Patient death or serious injury associated with a fallHAC.FS.60221541 MultiCare Good Samaritaniiii 9/25/2015 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 10/16/2015 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 12/4/2015 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 12/4/2015 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 12/4/2015 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 12/4/2015 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 12/18/2015 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 12/18/2015 4F - Pressure ulcer

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DOH 689-013 September 2014Office of Community Health Systems Page 19 of 62

Adverse Events Quarterly ReportFacility by Date and Event - Q2 2020

Facility Credential Facility Name Facility County Date Confirmed Event TypeHAC.FS.60221541 MultiCare Good Samaritaniiii 1/8/2016 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 1/8/2016 4E - Patient death or serious injury associated with a fallHAC.FS.60221541 MultiCare Good Samaritaniiii 1/20/2016 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 2/19/2016 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 3/4/2016 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 4/15/2016 4E - Patient death or serious injury associated with a fallHAC.FS.60221541 MultiCare Good Samaritaniiii 4/22/2016 4E - Patient death or serious injury associated with a fallHAC.FS.60221541 MultiCare Good Samaritaniiii 6/24/2016 4E - Patient death or serious injury associated with a fallHAC.FS.60221541 MultiCare Good Samaritaniiii 7/8/2016 1D - Unintended retention of foreign objectHAC.FS.60221541 MultiCare Good Samaritaniiii 7/8/2016 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.60221541 MultiCare Good Samaritaniiii 7/8/2016 4E - Patient death or serious injury associated with a fallHAC.FS.60221541 MultiCare Good Samaritaniiii 7/22/2016 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.60221541 MultiCare Good Samaritaniiii 8/19/2016 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 9/16/2016 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 10/28/2016 1D - Unintended retention of foreign objectHAC.FS.60221541 MultiCare Good Samaritaniiii 12/16/2016 1A - Wrong surgery/invasive procedure siteHAC.FS.60221541 MultiCare Good Samaritaniiii 12/16/2016 4E - Patient death or serious injury associated with a fallHAC.FS.60221541 MultiCare Good Samaritaniiii 3/28/2017 2B - Device function or useHAC.FS.60221541 MultiCare Good Samaritaniiii 4/19/2017 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 4/19/2017 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 6/22/2017 5C - BurnHAC.FS.60221541 MultiCare Good Samaritaniiii 6/22/2017 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.60221541 MultiCare Good Samaritaniiii 6/22/2017 4E - Patient death or serious injury associated with a fallHAC.FS.60221541 MultiCare Good Samaritaniiii 9/19/2017 1A - Wrong surgery/invasive procedure siteHAC.FS.60221541 MultiCare Good Samaritaniiii 1/16/2018 4E - Patient death or serious injury associated with a fallHAC.FS.60221541 MultiCare Good Samaritaniiii 4/26/2018 2A - Contaminated drugs, devices, biologicsHAC.FS.60221541 MultiCare Good Samaritaniiii 5/15/2018 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 5/15/2018 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 5/15/2018 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 6/19/2018 4E - Patient death or serious injury associated with a fallHAC.FS.60221541 MultiCare Good Samaritaniiii 6/19/2018 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 7/17/2018 4E - Patient death or serious injury associated with a fallHAC.FS.60221541 MultiCare Good Samaritaniiii 7/17/2018 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 8/21/2018 4E - Patient death or serious injury associated with a fallHAC.FS.60221541 MultiCare Good Samaritaniiii 8/21/2018 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 9/18/2018 4E - Patient death or serious injury associated with a fallHAC.FS.60221541 MultiCare Good Samaritaniiii 11/20/2018 4A - Medication errorHAC.FS.60221541 MultiCare Good Samaritaniiii 11/20/2018 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 11/20/2018 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 1/16/2019 1A - Wrong surgery/invasive procedure siteHAC.FS.60221541 MultiCare Good Samaritaniiii 1/16/2019 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 1/16/2019 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 1/16/2019 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 3/20/2019 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 3/20/2019 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 3/20/2019 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 3/20/2019 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 6/19/2019 4E - Patient death or serious injury associated with a fallHAC.FS.60221541 MultiCare Good Samaritaniiii 6/19/2019 4E - Patient death or serious injury associated with a fallHAC.FS.60221541 MultiCare Good Samaritaniiii 6/19/2019 4E - Patient death or serious injury associated with a fallHAC.FS.60221541 MultiCare Good Samaritaniiii 6/19/2019 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 7/17/2019 3A - Patient/resident discharged to unauthorized personHAC.FS.60221541 MultiCare Good Samaritaniiii 7/17/2019 3A - Patient/resident discharged to unauthorized personHAC.FS.60221541 MultiCare Good Samaritaniiii 7/17/2019 4E - Patient death or serious injury associated with a fallHAC.FS.60221541 MultiCare Good Samaritaniiii 9/18/2019 4E - Patient death or serious injury associated with a fallHAC.FS.60221541 MultiCare Good Samaritaniiii 9/18/2019 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 9/19/2019 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 10/21/2019 1d - Unintended retention of foreign objectHAC.FS.60221541 MultiCare Good Samaritaniiii 10/21/2019 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 10/21/2019 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 10/21/2019 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 10/21/2019 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 10/21/2019 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 10/21/2019 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 10/21/2019 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 12/27/2019 4E - Patient death or serious injury associated with a fallHAC.FS.60221541 MultiCare Good Samaritaniiii 12/27/2019 4E - Patient death or serious injury associated with a fallHAC.FS.60221541 MultiCare Good Samaritaniiii 12/27/2019 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 12/27/2019 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 12/27/2019 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 12/27/2019 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 1/21/2020 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 1/21/2020 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 2/28/2020 4E - Patient death or serious injury associated with a fallHAC.FS.60221541 MultiCare Good Samaritaniiii 2/28/2020 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 2/28/2020 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 2/28/2020 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 4/28/2020 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 4/28/2020 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 4/28/2020 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 4/28/2020 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 4/28/2020 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 4/28/2020 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 4/28/2020 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 4/28/2020 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 4/28/2020 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 6/18/2020 4E - Patient death or serious injury associated with a fallHAC.FS.60221541 MultiCare Good Samaritaniiii 6/18/2020 4E - Patient death or serious injury associated with a fallHAC.FS.60221541 MultiCare Good Samaritaniiii 6/18/2020 4E - Patient death or serious injury associated with a fallHAC.FS.60221541 MultiCare Good Samaritaniiii 6/18/2020 4E - Patient death or serious injury associated with a fallHAC.FS.60221541 MultiCare Good Samaritaniiii 6/18/2020 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 6/18/2020 4F - Pressure ulcerHAC.FS.60221541 MultiCare Good Samaritaniiii 6/20/2020 4F - Pressure ulcer

229HAC.FS.60769398 MultiCare Valley Hospital Spokane 1/11/2018 4E - Patient death or serious injury associated with a fallHAC.FS.60769398 MultiCare Valley Hospital 6/28/2018 4A - Medication errorHAC.FS.60769398 MultiCare Valley Hospital 7/2/2018 1D - Unintended retention of foreign objectHAC.FS.60769398 MultiCare Valley Hospital 9/26/2019 4F - Pressure ulcerHAC.FS.60769398 MultiCare Valley Hospital 1/3/2020 4A - Medication errorHAC.FS.60769398 MultiCare Valley Hospital 2/11/2020 1A - Wrong surgery/invasive procedure site

Multicare Good Samaritan number of events:

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DOH 689-013 September 2014Office of Community Health Systems Page 20 of 62

Adverse Events Quarterly ReportFacility by Date and Event - Q2 2020

Facility Credential Facility Name Facility County Date Confirmed Event TypeHAC.FS.60769398 MultiCare Valley Hospital 4/13/2020 4F - Pressure ulcerHAC.FS.60769398 MultiCare Valley Hospital 4/20/2020 4F - Pressure ulcerHAC.FS.60769398 MultiCare Valley Hospital 5/4/2020 4E - Patient death or serious injury associated with a fallHAC.FS.60769398 MultiCare Valley Hospital 6/30/2020 4F - Pressure ulcer

10HAC.FS.00000175 MHS Mary Bridge Children's Hospital Pierce 12/8/2009 4F - Pressure ulcerHAC.FS.00000175 MHS Mary Bridge Children's Hospital 4/9/2010 4F - Pressure ulcerHAC.FS.00000175 MHS Mary Bridge Children's Hospital 8/12/2010 4E - Patient death or serious injury associated with a fallHAC.FS.00000175 MHS Mary Bridge Children's Hospital 9/9/2011 4F - Pressure ulcerHAC.FS.00000175 MHS Mary Bridge Children's Hospital 10/31/2011 1A - Wrong surgery/invasive procedure siteHAC.FS.00000175 Mary Bridge Childrens Hospital and Health Center 5/4/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000175 Mary Bridge Childrens Hospital and Health Center 8/31/2012 4F - Pressure ulcerHAC.FS.00000175 Mary Bridge Childrens Hospital and Health Center 3/14/2014 4F - Pressure ulcerHAC.FS.00000175 Mary Bridge Childrens Hospital and Health Center 4/7/2014 4F - Pressure ulcerHAC.FS.00000175 Mary Bridge Childrens Hospital and Health Center 4/11/2014 4F - Pressure ulcerHAC.FS.00000175 Mary Bridge Childrens Hospital and Health Center 7/10/2015 4F - Pressure ulcerHAC.FS.00000175 Mary Bridge Childrens Hospital and Health Center 7/10/2015 4F - Pressure ulcerHAC.FS.00000175 Mary Bridge Childrens Hospital and Health Center 1/8/2016 7D - Physical assaultHAC.FS.00000175 Mary Bridge Childrens Hospital and Health Center 2/12/2016 4F - Pressure ulcerHAC.FS.00000175 Mary Bridge Childrens Hospital and Health Center 3/25/2016 4F - Pressure ulcerHAC.FS.00000175 Mary Bridge Childrens Hospital and Health Center 11/18/2016 4F - Pressure ulcerHAC.FS.00000175 Mary Bridge Childrens Hospital and Health Center 3/15/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000175 Mary Bridge Childrens Hospital and Health Center 8/21/2017 1D - Unintended retention of foreign objectHAC.FS.00000175 Mary Bridge Childrens Hospital and Health Center 12/21/2017 4A - Medication errorHAC.FS.00000175 Mary Bridge Childrens Hospital and Health Center 7/30/2018 4F - Pressure ulcerHAC.FS.00000175 Mary Bridge Childrens Hospital and Health Center 7/30/2018 4F - Pressure ulcerHAC.FS.00000175 Mary Bridge Childrens Hospital and Health Center 9/17/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000175 Mary Bridge Childrens Hospital and Health Center 7/16/2019 1D - Unintended retention of foreign object

23HAC.FS.00000021 Newport Hospital and Health Services Pend Oreille 2/23/2011 4E - Patient death or serious injury associated with a fallHAC.FS.00000021 Newport Hospital and Health Services 6/23/2011 4E - Patient death or serious injury associated with a fallHAC.FS.00000021 Newport Hospital and Health Services 6/28/2011 4E - Patient death or serious injury associated with a fallHAC.FS.00000021 Newport Hospital and Health Services 2/2/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000021 Newport Hospital and Health Services 3/20/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000021 Newport Hospital and Health Services 8/10/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000021 Newport Hospital and Health Services 4/12/2016 7D - Physical assaultHAC.FS.00000021 Newport Hospital and Health Services 7/18/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000021 Newport Hospital and Health Services 1/3/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000021 Newport Hospital and Health Services 12/4/2017 7D - Physical assaultHAC.FS.00000021 Newport Hospital and Health Services 2/6/2020 **4E - Patient death or serious injury associated with a fall

11HAC.FS.00000107 North Valley Hospital and LTC Division of OCPHD #4 Okanogan 11/4/2008 4F - Pressure ulcerHAC.FS.00000107 North Valley Hospital and LTC Division of OCPHD #4 4/24/2013 1A - Wrong surgery/invasive procedure siteHAC.FS.00000107 North Valley Hospital and LTC Division of OCPHD #4 9/3/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000107 North Valley Hospital and LTC Division of OCPHD #4 11/13/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000107 North Valley Hospital and LTC Division of OCPHD #4 5/7/2019 4F - Pressure ulcerHAC.FS.00000107 North Valley Hospital and LTC Division of OCPHD #4 9/10/2019 4F - Pressure ulcer

6HAC.FS.00000130 Northwest Hospital & Medical Center King 5/7/2007 1A - Wrong surgery/invasive procedure siteHAC.FS.00000130 Northwest Hospital & Medical Center 7/28/2008 1A - Wrong surgery/invasive procedure siteHAC.FS.00000130 Northwest Hospital & Medical Center 7/29/2008 1D - Unintended retention of foreign objectHAC.FS.00000130 Northwest Hospital & Medical Center 10/28/2009 1A - Wrong surgery/invasive procedure siteHAC.FS.00000130 Northwest Hospital & Medical Center 2/23/2010 7D - Physical assaultHAC.FS.00000130 Northwest Hospital & Medical Center 3/28/2011 1A - Wrong surgery/invasive procedure siteHAC.FS.00000130 Northwest Hospital & Medical Center 5/12/2011 4E - Patient death or serious injury associated with a fallHAC.FS.00000130 Northwest Hospital & Medical Center 7/25/2011 4E - Patient death or serious injury associated with a fallHAC.FS.00000130 Northwest Hospital & Medical Center 7/27/2011 4E - Patient death or serious injury associated with a fallHAC.FS.00000130 Northwest Hospital & Medical Center 10/12/2011 1D - Unintended retention of foreign objectHAC.FS.00000130 Northwest Hospital & Medical Center 11/8/2011 4E - Patient death or serious injury associated with a fallHAC.FS.00000130 Northwest Hospital & Medical Center 11/29/2011 4E - Patient death or serious injury associated with a fallHAC.FS.00000130 Northwest Hospital & Medical Center 1/23/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000130 Northwest Hospital & Medical Center 2/28/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000130 Northwest Hospital & Medical Center 6/13/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000130 Northwest Hospital & Medical Center 8/10/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000130 Northwest Hospital & Medical Center 4/25/2013 1C - Wrong surgical/invasive procedureHAC.FS.00000130 Northwest Hospital & Medical Center 5/17/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000130 Northwest Hospital & Medical Center 9/20/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000130 UW Medicine/Northwest Hospital 4/21/2014 4F - Pressure ulcerHAC.FS.00000130 UW Medicine/Northwest Hospital 6/9/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000130 UW Medicine/Northwest Hospital 7/21/2014 1D - Unintended retention of foreign objectHAC.FS.00000130 UW Medicine/Northwest Hospital 7/21/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000130 UW Medicine/Northwest Hospital 8/2/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000130 UW Medicine/Northwest Hospital 12/1/2014 3A - Patient/Resident discharged to unauthorized personHAC.FS.00000130 UW Medicine/Northwest Hospital 2/20/2015 1D - Unintended retention of foreign objectHAC.FS.00000130 UW Medicine/Northwest Hospital 2/20/2015 1D - Unintended retention of foreign objectHAC.FS.00000130 UW Medicine/Northwest Hospital 2/20/2015 4A - Medication errorHAC.FS.00000130 UW Medicine/Northwest Hospital 3/20/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000130 UW Medicine/Northwest Hospital 3/20/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000130 UW Medicine/Northwest Hospital 5/20/2015 1D - Unintended retention of foreign objectHAC.FS.00000130 UW Medicine/Northwest Hospital 5/20/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000130 UW Medicine/Northwest Hospital 6/1/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000130 UW Medicine/Northwest Hospital 6/5/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000130 UW Medicine/Northwest Hospital 3/18/2016 **4E - Patient death or serious injury associated with a fallHAC.FS.00000130 UW Medicine/Northwest Hospital 3/18/2016 **4F - Pressure ulcerHAC.FS.00000130 UW Medicine/Northwest Hospital 6/17/2016 1D - Unintended retention of foreign objectHAC.FS.00000130 UW Medicine/Northwest Hospital 6/17/2016 1D - Unintended retention of foreign objectHAC.FS.00000130 UW Medicine/Northwest Hospital 10/21/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000130 UW Medicine/Northwest Hospital 10/21/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000130 UW Medicine/Northwest Hospital 11/18/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000130 UW Medicine/Northwest Hospital 12/16/2016 4F - Pressure ulcerHAC.FS.00000130 UW Medicine/Northwest Hospital 1/20/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000130 UW Medicine/Northwest Hospital 2/17/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000130 UW Medicine/Northwest Hospital 2/17/2017 4F - Pressure ulcerHAC.FS.00000130 UW Medicine/Northwest Hospital 3/17/2017 **4A - Medication errorHAC.FS.00000130 UW Medicine/Northwest Hospital 3/17/2017 4F - Pressure ulcerHAC.FS.00000130 UW Medicine/Northwest Hospital 5/19/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000130 UW Medicine/Northwest Hospital 5/19/2017 4F - Pressure ulcerHAC.FS.00000130 UW Medicine/Northwest Hospital 6/16/2017 **4F - Pressure ulcerHAC.FS.00000130 UW Medicine/Northwest Hospital 6/16/2017 4F - Pressure ulcerHAC.FS.00000130 UW Medicine/Northwest Hospital 9/15/2017 1A - Wrong surgery/invasive procedure site

Multicare Valley Hospital number of events:

Mary Bridge Childrens Hospital & Health Center number of events:

Newport Hospital and Health Services number of events:

North Valley Hospital and LTC Division of OCPHD #4 number of events:

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Adverse Events Quarterly ReportFacility by Date and Event - Q2 2020

Facility Credential Facility Name Facility County Date Confirmed Event TypeHAC.FS.00000130 UW Medicine/Northwest Hospital 10/20/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000130 UW Medicine/Northwest Hospital 11/17/2017 4D - Death or serious injury of neonateHAC.FS.00000130 UW Medicine/Northwest Hospital 11/17/2017 4F - Pressure ulcerHAC.FS.00000130 UW Medicine/Northwest Hospital 1/19/2018 1A - Wrong surgery/invasive procedure siteHAC.FS.00000130 UW Medicine/Northwest Hospital 2/16/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000130 UW Medicine/Northwest Hospital 3/16/2018 4D - Death or serious injury of neonateHAC.FS.00000130 UW Medicine/Northwest Hospital 3/16/2018 4F - Pressure ulcerHAC.FS.00000130 UW Medicine/Northwest Hospital 4/20/2018 1B - Wrong surgery/invasive procedure patientHAC.FS.00000130 UW Medicine/Northwest Hospital 4/20/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000130 UW Medicine/Northwest Hospital 4/20/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000130 UW Medicine/Northwest Hospital 8/16/2018 4D - Death or serious injury of neonateHAC.FS.00000130 UW Medicine/Northwest Hospital 8/17/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000130 UW Medicine/Northwest Hospital 8/17/2018 4F - Pressure ulcerHAC.FS.00000130 UW Medicine/Northwest Hospital 9/21/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000130 UW Medicine/Northwest Hospital 9/21/2018 4F - Pressure ulcerHAC.FS.00000130 UW Medicine/Northwest Hospital 1/18/2019 4A - Medication errorHAC.FS.00000130 UW Medicine/Northwest Hospital 1/18/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000130 UW Medicine/Northwest Hospital 1/18/2019 4F - Pressure ulcerHAC.FS.00000130 UW Medicine/Northwest Hospital 1/18/2019 4F - Pressure ulcerHAC.FS.00000130 UW Medicine/Northwest Hospital 6/24/2019 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.00000130 UW Medicine/Northwest Hospital 9/20/2019 1C - Wrong surgical/invasive procedureHAC.FS.00000130 UW Medicine/Northwest Hospital 10/18/2019 1A - Wrong surgery/invasive procedure site

74HAC.FS.00000080 Odessa Memorial Healthcare Center Lincoln 5/17/2011 4A - Medication errorHAC.FS.00000080 Odessa Memorial Healthcare Center 3/12/2015 2B - Device function or useHAC.FS.00000080 Odessa Memorial Healthcare Center 4/8/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000080 Odessa Memorial Healthcare Center 6/18/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000080 Odessa Memorial Healthcare Center 11/25/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000080 Odessa Memorial Healthcare Center 3/29/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000080 Odessa Memorial Healthcare Center 8/22/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000080 Odessa Memorial Healthcare Center 11/27/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000080 Odessa Memorial Healthcare Center 1/11/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000080 Odessa Memorial Healthcare Center 10/13/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000080 Odessa Memorial Healthcare Center 10/23/2018 4E - Patient death or serious injury associated with a fall

11HAC.FS.00000038 Olympic Medical Center Clallam 12/1/2009 4C - Maternal death or serious injuryHAC.FS.00000038 Olympic Medical Center 12/1/2009 4E - Patient death or serious injury associated with a fallHAC.FS.00000038 Olympic Medical Center 12/1/2009 4E - Patient death or serious injury associated with a fallHAC.FS.00000038 Olympic Medical Center 10/25/2010 4E - Patient death or serious injury associated with a fallHAC.FS.00000038 Olympic Medical Center 4/27/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000038 Olympic Medical Center 11/27/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000038 Olympic Medical Center 4/8/2013 4F - Pressure ulcerHAC.FS.00000038 Olympic Medical Center 3/10/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000038 Olympic Medical Center 3/27/2014 7D - Physical assaultHAC.FS.00000038 Olympic Medical Center 8/11/2014 4D - Death or serious injury of neonateHAC.FS.00000038 Olympic Medical Center 10/8/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000038 Olympic Medical Center 11/25/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000038 Olympic Medical Center 1/5/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000038 Olympic Medical Center 5/7/2015 7D - Physical assaultHAC.FS.00000038 Olympic Medical Center 6/4/2015 7D - Physical assaultHAC.FS.00000038 Olympic Medical Center 11/20/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000038 Olympic Medical Center 11/23/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000038 Olympic Medical Center 3/14/2016 4H - Irretrievable loss of irreplaceable biological specimenHAC.FS.00000038 Olympic Medical Center 5/4/2016 4D - Death or serious injury of neonateHAC.FS.00000038 Olympic Medical Center 5/10/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000038 Olympic Medical Center 9/12/2016 4F - Pressure ulcerHAC.FS.00000038 Olympic Medical Center 3/31/2017 4F - Pressure ulcerHAC.FS.00000038 Olympic Medical Center 7/7/2017 4F - Pressure ulcerHAC.FS.00000038 Olympic Medical Center 11/8/2017 4I - Failure to follow up with test resultsHAC.FS.00000038 Olympic Medical Center 11/20/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000038 Olympic Medical Center 7/6/2018 1D - Unintended retention of foreign objectHAC.FS.00000038 Olympic Medical Center 11/26/2018 1D - Unintended retention of foreign objectHAC.FS.00000038 Olympic Medical Center 6/18/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000038 Olympic Medical Center 12/13/2019 1D - Unintended retention of foreign objectHAC.FS.00000038 Olympic Medical Center 6/10/2020 7D - Physical assault

30HAC.FS.00000131 Overlake Hospital Medical Center King 6/24/2006 7C - Sexual abuse/assaultHAC.FS.00000131 Overlake Hospital Medical Center 7/12/2006 7C - Sexual abuse/assaultHAC.FS.00000131 Overlake Hospital Medical Center 9/5/2006 4F - Pressure ulcerHAC.FS.00000131 Overlake Hospital Medical Center 12/1/2006 1D - Unintended retention of foreign objectHAC.FS.00000131 Overlake Hospital Medical Center 1/12/2007 7C - Sexual abuse/assaultHAC.FS.00000131 Overlake Hospital Medical Center 3/30/2007 1D - Unintended retention of foreign objectHAC.FS.00000131 Overlake Hospital Medical Center 4/6/2007 1C - Wrong surgical/invasive procedureHAC.FS.00000131 Overlake Hospital Medical Center 8/6/2007 4F - Pressure ulcerHAC.FS.00000131 Overlake Hospital Medical Center 1/11/2008 4F - Pressure ulcerHAC.FS.00000131 Overlake Hospital Medical Center 12/9/2008 1D - Unintended retention of foreign objectHAC.FS.00000131 Overlake Hospital Medical Center 1/12/2009 1D - Unintended retention of foreign objectHAC.FS.00000131 Overlake Hospital Medical Center 1/17/2009 1C - Wrong surgical/invasive procedureHAC.FS.00000131 Overlake Hospital Medical Center 3/11/2009 1A - Wrong surgery/invasive procedure siteHAC.FS.00000131 Overlake Hospital Medical Center 3/11/2009 4F - Pressure ulcerHAC.FS.00000131 Overlake Hospital Medical Center 4/20/2009 1A - Wrong surgery/invasive procedure siteHAC.FS.00000131 Overlake Hospital Medical Center 5/6/2009 4F - Pressure ulcerHAC.FS.00000131 Overlake Hospital Medical Center 5/29/2009 4F - Pressure ulcerHAC.FS.00000131 Overlake Hospital Medical Center 10/12/2009 1A - Wrong surgery/invasive procedure siteHAC.FS.00000131 Overlake Hospital Medical Center 12/23/2009 1D - Unintended retention of foreign objectHAC.FS.00000131 Overlake Hospital Medical Center 1/14/2010 1C - Wrong surgical/invasive procedureHAC.FS.00000131 Overlake Hospital Medical Center 4/27/2010 4F - Pressure ulcerHAC.FS.00000131 Overlake Hospital Medical Center 5/4/2010 4F - Pressure ulcerHAC.FS.00000131 Overlake Hospital Medical Center 5/4/2010 4F - Pressure ulcerHAC.FS.00000131 Overlake Hospital Medical Center 5/12/2010 4F - Pressure ulcerHAC.FS.00000131 Overlake Hospital Medical Center 5/27/2010 4F - Pressure ulcerHAC.FS.00000131 Overlake Hospital Medical Center 6/2/2010 1A - Wrong surgery/invasive procedure siteHAC.FS.00000131 Overlake Hospital Medical Center 7/22/2010 4F - Pressure ulcerHAC.FS.00000131 Overlake Hospital Medical Center 9/27/2010 1A - Wrong surgery/invasive procedure siteHAC.FS.00000131 Overlake Hospital Medical Center 1/19/2011 1D - Unintended retention of foreign objectHAC.FS.00000131 Overlake Hospital Medical Center 3/2/2011 4E - Patient death or serious injury associated with a fallHAC.FS.00000131 Overlake Hospital Medical Center 3/16/2011 1D - Unintended retention of foreign objectHAC.FS.00000131 Overlake Hospital Medical Center 5/2/2011 4F - Pressure ulcerHAC.FS.00000131 Overlake Hospital Medical Center 6/22/2011 4F - Pressure ulcerHAC.FS.00000131 Overlake Hospital Medical Center 6/22/2011 4F - Pressure ulcer

Odessa Memorial Healthcare Center number of events:

Olympic Medical Center number of events:

UW Medicine/Northwest Hospital number of events:

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Adverse Events Quarterly ReportFacility by Date and Event - Q2 2020

Facility Credential Facility Name Facility County Date Confirmed Event TypeHAC.FS.00000131 Overlake Hospital Medical Center 8/26/2011 1D - Unintended retention of foreign objectHAC.FS.00000131 Overlake Hospital Medical Center 11/7/2011 4F - Pressure ulcerHAC.FS.00000131 Overlake Hospital Medical Center 12/15/2011 1D - Unintended retention of foreign objectHAC.FS.00000131 Overlake Hospital Medical Center 1/18/2012 7C - Sexual abuse/assaultHAC.FS.00000131 Overlake Hospital Medical Center 8/29/2012 4F - Pressure ulcerHAC.FS.00000131 Overlake Hospital Medical Center 10/31/2012 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.00000131 Overlake Hospital Medical Center 11/13/2012 1A - Wrong surgery/invasive procedure siteHAC.FS.00000131 Overlake Hospital Medical Center 12/5/2012 4F - Pressure ulcerHAC.FS.00000131 Overlake Hospital Medical Center 2/21/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000131 Overlake Hospital Medical Center 2/21/2013 4F - Pressure ulcerHAC.FS.00000131 Overlake Hospital Medical Center 3/7/2013 4F - Pressure ulcerHAC.FS.00000131 Overlake Hospital Medical Center 3/11/2013 4A - Medication errorHAC.FS.00000131 Overlake Hospital Medical Center 5/30/2013 4F - Pressure ulcerHAC.FS.00000131 Overlake Hospital Medical Center 7/17/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000131 Overlake Hospital Medical Center 7/17/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000131 Overlake Hospital Medical Center 8/13/2013 4F - Pressure ulcerHAC.FS.00000131 Overlake Hospital Medical Center 8/26/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000131 Overlake Hospital Medical Center 9/2/2013 4F - Pressure ulcerHAC.FS.00000131 Overlake Hospital Medical Center 9/19/2013 4F - Pressure ulcerHAC.FS.00000131 Overlake Hospital Medical Center 10/7/2013 1D - Unintended retention of foreign objectHAC.FS.00000131 Overlake Hospital Medical Center 10/10/2013 1A - Wrong surgery/invasive procedure siteHAC.FS.00000131 Overlake Hospital Medical Center 11/14/2013 4F - Pressure ulcerHAC.FS.00000131 Overlake Hospital Medical Center 1/7/2014 4D - Death or serious injury of neonateHAC.FS.00000131 Overlake Hospital Medical Center 2/17/2014 1D - Unintended retention of foreign objectHAC.FS.00000131 Overlake Hospital Medical Center 3/18/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000131 Overlake Hospital Medical Center 5/8/2014 1D - Unintended retention of foreign objectHAC.FS.00000131 Overlake Hospital Medical Center 5/18/2014 4F - Pressure ulcerHAC.FS.00000131 Overlake Hospital Medical Center 6/5/2014 1D - Unintended retention of foreign objectHAC.FS.00000131 Overlake Hospital Medical Center 8/29/2014 4F - Pressure ulcerHAC.FS.00000131 Overlake Hospital Medical Center 10/24/2014 7C - Sexual abuse/assaultHAC.FS.00000131 Overlake Hospital Medical Center 11/17/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000131 Overlake Hospital Medical Center 11/20/2014 1A - Wrong surgery/invasive procedure siteHAC.FS.00000131 Overlake Hospital Medical Center 1/8/2015 4F - Pressure ulcerHAC.FS.00000131 Overlake Hospital Medical Center 2/17/2015 1A - Wrong surgery/invasive procedure siteHAC.FS.00000131 Overlake Hospital Medical Center 2/25/2015 1D - Unintended retention of foreign objectHAC.FS.00000131 Overlake Hospital Medical Center 4/24/2015 1C - Wrong surgical/invasive procedureHAC.FS.00000131 Overlake Hospital Medical Center 6/1/2015 1A - Wrong surgery/invasive procedure siteHAC.FS.00000131 Overlake Hospital Medical Center 6/11/2015 1C - Wrong surgical/invasive procedureHAC.FS.00000131 Overlake Hospital Medical Center 6/16/2015 7D - Physical assaultHAC.FS.00000131 Overlake Hospital Medical Center 7/25/2015 1C - Wrong surgical/invasive procedureHAC.FS.00000131 Overlake Hospital Medical Center 8/24/2015 1D - Unintended retention of foreign objectHAC.FS.00000131 Overlake Hospital Medical Center 9/10/2015 1D - Unintended retention of foreign objectHAC.FS.00000131 Overlake Hospital Medical Center 1/1/2016 4D - Death or serious injury of neonateHAC.FS.00000131 Overlake Hospital Medical Center 1/5/2016 2B - Device function or useHAC.FS.00000131 Overlake Hospital Medical Center 1/8/2016 1D - Unintended retention of foreign objectHAC.FS.00000131 Overlake Hospital Medical Center 2/3/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000131 Overlake Hospital Medical Center 2/10/2016 1D - Unintended retention of foreign objectHAC.FS.00000131 Overlake Hospital Medical Center 2/26/2016 1D - Unintended retention of foreign objectHAC.FS.00000131 Overlake Hospital Medical Center 3/14/2016 4F - Pressure ulcerHAC.FS.00000131 Overlake Hospital Medical Center 5/14/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000131 Overlake Hospital Medical Center 7/12/2016 1A - Wrong surgery/invasive procedure siteHAC.FS.00000131 Overlake Hospital Medical Center 7/20/2016 1A - Wrong surgery/invasive procedure siteHAC.FS.00000131 Overlake Hospital Medical Center 9/19/2016 2B - Device function or useHAC.FS.00000131 Overlake Hospital Medical Center 11/16/2016 4I - Failure to follow up with test resultsHAC.FS.00000131 Overlake Hospital Medical Center 11/16/2016 7C - Sexual abuse/assaultHAC.FS.00000131 Overlake Hospital Medical Center 1/18/2017 4A - Medication errorHAC.FS.00000131 Overlake Hospital Medical Center 5/3/2017 2B - Device function or useHAC.FS.00000131 Overlake Hospital Medical Center 6/6/2017 4A - Medication errorHAC.FS.00000131 Overlake Hospital Medical Center 7/20/2017 4F - Pressure ulcerHAC.FS.00000131 Overlake Hospital Medical Center 11/20/2017 4D - Death or serious injury of neonateHAC.FS.00000131 Overlake Hospital Medical Center 4/3/2018 1A - Wrong surgery/invasive procedure siteHAC.FS.00000131 Overlake Hospital Medical Center 5/21/2018 4A - Medication errorHAC.FS.00000131 Overlake Hospital Medical Center 6/1/2018 4F - Pressure ulcerHAC.FS.00000131 Overlake Hospital Medical Center 9/4/2018 4F - Pressure ulcerHAC.FS.00000131 Overlake Hospital Medical Center 9/26/2018 1D - Unintended retention of foreign objectHAC.FS.00000131 Overlake Hospital Medical Center 11/26/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000131 Overlake Hospital Medical Center 2/4/2019 4F - Pressure ulcerHAC.FS.00000131 Overlake Hospital Medical Center 2/20/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000131 Overlake Hospital Medical Center 2/25/2019 1D - Unintended retention of foreign objectHAC.FS.00000131 Overlake Hospital Medical Center 2/25/2019 4F - Pressure ulcerHAC.FS.00000131 Overlake Hospital Medical Center 3/14/2019 4A - Medication errorHAC.FS.00000131 Overlake Hospital Medical Center 3/21/2019 4F - Pressure ulcerHAC.FS.00000131 Overlake Hospital Medical Center 3/22/2019 1A - Wrong surgery/invasive procedure siteHAC.FS.00000131 Overlake Hospital Medical Center 4/4/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000131 Overlake Hospital Medical Center 4/16/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000131 Overlake Hospital Medical Center 4/25/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000131 Overlake Hospital Medical Center 8/9/2019 4F - Pressure ulcerHAC.FS.00000131 Overlake Hospital Medical Center 9/3/2019 1D - Unintended retention of foreign objectHAC.FS.00000131 Overlake Hospital Medical Center 9/18/2019 1D - Unintended retention of foreign objectHAC.FS.00000131 Overlake Hospital Medical Center 9/20/2019 1D - Unintended retention of foreign objectHAC.FS.00000131 Overlake Hospital Medical Center 10/1/2019 6A - Introduction of metallic object into MRI areaHAC.FS.00000131 Overlake Hospital Medical Center 1/6/2020 4F - Pressure ulcerHAC.FS.00000131 Overlake Hospital Medical Center 3/12/2020 1D - Unintended retention of foreign objectHAC.FS.00000131 Overlake Hospital Medical Center 4/2/2020 4F - Pressure ulcerHAC.FS.00000131 Overlake Hospital Medical Center 4/13/2020 4F - Pressure ulcerHAC.FS.00000131 Overlake Hospital Medical Center 5/26/2020 4F - Pressure ulcer

120HAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ Clark 11/29/2006 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 12/6/2006 1D - Unintended retention of foreign objectHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 12/6/2006 1D - Unintended retention of foreign objectHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 1/31/2007 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 3/16/2007 1B - Wrong surgery/invasive procedure patientHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 12/19/2007 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 12/19/2007 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 2/6/2008 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 4/2/2008 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 4/2/2008 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 8/20/2008 1D - Unintended retention of foreign objectHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 9/24/2008 1D - Unintended retention of foreign objectHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 12/4/2008 4F - Pressure ulcer

Overlake Hospital Medical Center number of events:

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DOH 689-013 September 2014Office of Community Health Systems Page 23 of 62

Adverse Events Quarterly ReportFacility by Date and Event - Q2 2020

Facility Credential Facility Name Facility County Date Confirmed Event TypeHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 1/30/2009 1D - Unintended retention of foreign objectHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 4/8/2009 1A - Wrong surgery/invasive procedure siteHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 4/29/2009 1A - Wrong surgery/invasive procedure siteHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 5/27/2009 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 10/21/2009 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 1/13/2010 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 2/24/2010 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 3/31/2010 1A - Wrong surgery/invasive procedure siteHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 3/31/2010 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 7/28/2010 1D - Unintended retention of foreign objectHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 9/20/2010 1D - Unintended retention of foreign objectHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 1/5/2011 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 2/16/2011 1D - Unintended retention of foreign objectHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 2/16/2011 1D - Unintended retention of foreign objectHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 8/24/2011 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 9/19/2011 1A - Wrong surgery/invasive procedure siteHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 12/21/2011 1A - Wrong surgery/invasive procedure siteHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 1/4/2012 1D - Unintended retention of foreign objectHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 3/21/2012 1C - Wrong surgical/invasive procedureHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 5/23/2012 1A - Wrong surgery/invasive procedure siteHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 9/13/2012 1D - Unintended retention of foreign objectHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 6/27/2013 1A - Wrong surgery/invasive procedure siteHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 7/3/2013 1D - Unintended retention of foreign objectHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 7/3/2013 1A - Wrong surgery/invasive procedure siteHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 9/4/2013 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 11/20/2013 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 11/20/2013 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 12/11/2013 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 12/11/2013 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 12/11/2013 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 12/11/2013 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 1/15/2014 4E - Patient death or serious injury associated with a fallHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 3/5/2014 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 3/5/2014 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 3/5/2014 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 3/12/2014 1A - Wrong surgery/invasive procedure siteHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 4/23/2014 4E - Patient death or serious injury associated with a fallHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 7/16/2014 4E - Patient death or serious injury associated with a fallHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 7/30/2014 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 9/10/2014 4E - Patient death or serious injury associated with a fallHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 10/8/2014 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 10/8/2014 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 11/5/2014 1A - Wrong surgery/invasive procedure siteHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 11/5/2014 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 11/12/2014 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 12/31/2014 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 12/31/2014 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 1/7/2015 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 1/7/2015 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 1/7/2015 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 1/7/2015 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 1/7/2015 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 1/7/2015 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 1/7/2015 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 1/7/2015 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 1/7/2015 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 1/7/2015 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 1/7/2015 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 1/7/2015 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 2/4/2015 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 2/4/2015 1A - Wrong surgery/invasive procedure siteHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 2/11/2015 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 2/11/2015 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 3/4/2015 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 3/4/2015 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 4/17/2015 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 4/30/2015 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 4/30/2015 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 5/6/2015 4D - Death or serious injury of neonateHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 5/20/2015 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 5/20/2015 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 5/20/2015 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 6/10/2015 4E - Patient death or serious injury associated with a fallHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 7/29/2015 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 7/29/2015 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 7/29/2015 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 8/12/2015 4E - Patient death or serious injury associated with a fallHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 8/12/2015 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 8/19/2015 4E - Patient death or serious injury associated with a fallHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 10/14/2015 1D - Unintended retention of foreign objectHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 10/14/2015 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 10/21/2015 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 11/4/2015 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 11/20/2015 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 11/20/2015 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 12/9/2015 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 12/9/2015 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 12/16/2015 4E - Patient death or serious injury associated with a fallHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 12/16/2015 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 1/6/2016 4E - Patient death or serious injury associated with a fallHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 1/6/2016 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 2/3/2016 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 2/3/2016 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 2/3/2016 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 3/2/2016 4E - Patient death or serious injury associated with a fallHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 3/9/2016 4E - Patient death or serious injury associated with a fallHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 3/9/2016 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 3/9/2016 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 3/9/2016 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 3/9/2016 4F - Pressure ulcer

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Adverse Events Quarterly ReportFacility by Date and Event - Q2 2020

Facility Credential Facility Name Facility County Date Confirmed Event TypeHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 3/16/2016 4A - Medication errorHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 3/16/2016 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 3/16/2016 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 3/30/2016 4E - Patient death or serious injury associated with a fallHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 3/30/2016 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 3/30/2016 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 4/6/2016 1A - Wrong surgery/invasive procedure siteHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 4/13/2016 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 4/13/2016 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 4/20/2016 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 4/20/2016 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 5/4/2016 4E - Patient death or serious injury associated with a fallHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 5/11/2016 4E - Patient death or serious injury associated with a fallHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 6/29/2016 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 6/29/2016 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 6/29/2016 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 7/13/2016 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 7/25/2016 1A - Wrong surgery/invasive procedure siteHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 7/25/2016 4A - Medication errorHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 8/10/2016 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 8/17/2016 1D - Unintended retention of foreign objectHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 9/7/2016 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 9/27/2016 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 9/28/2016 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 9/28/2016 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 10/5/2016 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 11/2/2016 4D - Death or serious injury of neonateHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 11/2/2016 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 1/20/2017 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 1/20/2017 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 1/23/2017 4E - Patient death or serious injury associated with a fallHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 1/27/2017 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 2/10/2017 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 2/15/2017 4A - Medication errorHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 2/17/2017 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 4/3/2017 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 4/19/2017 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 4/24/2017 4A - Medication errorHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 5/1/2017 4E - Patient death or serious injury associated with a fallHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 5/1/2017 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 5/1/2017 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 5/1/2017 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 5/3/2017 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 5/22/2017 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 5/31/2017 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 6/21/2017 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 7/5/2017 1A - Wrong surgery/invasive procedure siteHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 7/5/2017 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 7/12/2017 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 7/19/2017 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 7/25/2017 1A - Wrong surgery/invasive procedure siteHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 8/2/2017 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 8/2/2017 4I - Failure to follow up with test resultsHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 8/9/2017 1C - Wrong surgical/invasive procedureHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 8/16/2017 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 8/30/2017 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 9/6/2017 4E - Patient death or serious injury associated with a fallHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 10/3/2017 4E - Patient death or serious injury associated with a fallHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 10/18/2017 3A - Patient/Resident discharged to unauthorized personHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 10/24/2017 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 11/15/2017 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 11/15/2017 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 12/13/2017 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 12/13/2017 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 1/3/2018 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 1/10/2018 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 1/10/2018 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 1/22/2018 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 1/25/2018 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 1/26/2018 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 1/29/2018 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 2/7/2018 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 2/11/2018 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 2/12/2018 1D - Unintended retention of foreign objectHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 2/12/2018 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 2/14/2018 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 2/19/2018 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 3/7/2018 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 3/15/2018 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 4/22/2018 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 5/16/2018 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 5/26/2018 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 5/29/2018 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 5/30/2018 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 6/1/2018 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 6/7/2018 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 6/11/2018 1D - Unintended retention of foreign objectHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 6/14/2018 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 6/22/2018 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 6/25/2018 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 7/16/2018 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 7/21/2018 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 7/24/2018 4E - Patient death or serious injury associated with a fallHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 8/13/2018 1A - Wrong surgery/invasive procedure siteHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 8/17/2018 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 8/20/2018 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 8/27/2018 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 9/6/2018 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 10/5/2018 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 10/8/2018 4F - Pressure ulcer

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Adverse Events Quarterly ReportFacility by Date and Event - Q2 2020

Facility Credential Facility Name Facility County Date Confirmed Event TypeHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 10/25/2018 4H - Irretrievable loss of irreplaceable biological specimenHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 11/1/2018 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 11/1/2018 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 11/12/2018 4E - Patient death or serious injury associated with a fallHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 11/12/2018 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 11/16/2018 3A - Patient/Resident discharged to unauthorized personHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 12/11/2018 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 12/11/2018 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 1/28/2019 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 2/14/2019 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 2/24/2019 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 3/15/2019 7D - Physical assaultHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 3/29/2019 4E - Patient death or serious injury associated with a fallHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 5/14/2019 2B - Device function or useHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 6/27/2019 4E - Patient death or serious injury associated with a fallHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 7/17/2019 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 7/22/2019 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 8/16/2019 4E - Patient death or serious injury associated with a fallHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 10/3/2019 1A - Wrong surgery/invasive procedure siteHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 12/3/2019 4F - Pressure ulcerHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 3/5/2020 1D - Unintended retention of foreign objectHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 3/5/2020 4A - Medication errorHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 3/6/2020 4E - Patient death or serious injury associated with a fallHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 3/31/2020 1A - Wrong surgery/invasive procedure siteHAC.FS.60435729 PeaceHealth Southwest Medical Centerⁱⁱ 5/11/2020 4F - Pressure ulcer

238HAC.FS.00000026 PeaceHealth St John Medical Center Cowlitz 1/18/2007 4F - Pressure ulcerHAC.FS.00000026 PeaceHealth St John Medical Center 1/26/2007 1D - Unintended retention of foreign objectHAC.FS.00000026 PeaceHealth St John Medical Center 2/23/2008 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.00000026 PeaceHealth St John Medical Center 10/16/2008 1A - Wrong surgery/invasive procedure siteHAC.FS.00000026 PeaceHealth St John Medical Center 10/27/2009 1D - Unintended retention of foreign objectHAC.FS.00000026 PeaceHealth St John Medical Center 1/4/2010 4E - Patient death or serious injury associated with a fallHAC.FS.00000026 PeaceHealth St John Medical Center 3/8/2010 4E - Patient death or serious injury associated with a fallHAC.FS.00000026 PeaceHealth St John Medical Center 5/11/2010 3B - Patient elopement (disappearance)HAC.FS.00000026 PeaceHealth St John Medical Center 5/14/2010 1C - Wrong surgical/invasive procedureHAC.FS.00000026 PeaceHealth St John Medical Center 8/26/2010 1C - Wrong surgical/invasive procedureHAC.FS.00000026 PeaceHealth St John Medical Center 3/3/2011 4E - Patient death or serious injury associated with a fallHAC.FS.00000026 PeaceHealth St John Medical Center 4/13/2011 1A - Wrong surgery/invasive procedure siteHAC.FS.00000026 PeaceHealth St John Medical Center 1/25/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000026 PeaceHealth St John Medical Center 2/7/2012 1D - Unintended retention of foreign objectHAC.FS.00000026 PeaceHealth St John Medical Center 11/8/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000026 PeaceHealth St John Medical Center 9/18/2013 1D - Unintended retention of foreign objectHAC.FS.00000026 PeaceHealth St John Medical Center 9/26/2013 1D - Unintended retention of foreign objectHAC.FS.00000026 PeaceHealth St John Medical Center 11/12/2013 1A - Wrong surgery/invasive procedure siteHAC.FS.00000026 PeaceHealth St John Medical Center 1/29/2014 4F - Pressure ulcerHAC.FS.00000026 PeaceHealth St John Medical Center 3/3/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000026 PeaceHealth St John Medical Center 4/7/2014 4F - Pressure ulcerHAC.FS.00000026 PeaceHealth St John Medical Center 4/21/2014 7C - Sexual abuse/assaultHAC.FS.00000026 PeaceHealth St John Medical Center 9/12/2014 4F - Pressure ulcerHAC.FS.00000026 PeaceHealth St John Medical Center 11/1/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000026 PeaceHealth St John Medical Center 2/6/2015 1D - Unintended retention of foreign objectHAC.FS.00000026 PeaceHealth St John Medical Center 5/19/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000026 PeaceHealth St John Medical Center 6/16/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000026 PeaceHealth St John Medical Center 6/26/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000026 PeaceHealth St John Medical Center 7/21/2015 4A - Medication errorHAC.FS.00000026 PeaceHealth St John Medical Center 9/24/2015 4F - Pressure ulcerHAC.FS.00000026 PeaceHealth St John Medical Center 11/9/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000026 PeaceHealth St John Medical Center 11/24/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000026 PeaceHealth St John Medical Center 12/1/2015 4F - Pressure ulcerHAC.FS.00000026 PeaceHealth St John Medical Center 12/8/2015 1D - Unintended retention of foreign objectHAC.FS.00000026 PeaceHealth St John Medical Center 1/19/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000026 PeaceHealth St John Medical Center 1/26/2016 4I - Failure to follow up with test resultsHAC.FS.00000026 PeaceHealth St John Medical Center 2/23/2016 4I - Failure to follow up with test resultsHAC.FS.00000026 PeaceHealth St John Medical Center 5/9/2016 1A - Wrong surgery/invasive procedure siteHAC.FS.00000026 PeaceHealth St John Medical Center 8/9/2016 2A - Contaminated drugs, devices, biologicsHAC.FS.00000026 PeaceHealth St John Medical Center 8/9/2016 7D - Physical assaultHAC.FS.00000026 PeaceHealth St John Medical Center 3/21/2017 4I - Failure to follow up with test resultsHAC.FS.00000026 PeaceHealth St John Medical Center 4/4/2017 4I - Failure to follow up with test resultsHAC.FS.00000026 PeaceHealth St John Medical Center 8/8/2017 1D - Unintended retention of foreign objectHAC.FS.00000026 PeaceHealth St John Medical Center 8/23/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000026 PeaceHealth St John Medical Center 9/5/2017 4F - Pressure ulcerHAC.FS.00000026 PeaceHealth St John Medical Center 9/19/2017 4F - Pressure ulcerHAC.FS.00000026 PeaceHealth St John Medical Center 10/12/2017 4D - Death or serious injury of neonateHAC.FS.00000026 PeaceHealth St John Medical Center 1/23/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000026 PeaceHealth St John Medical Center 4/24/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000026 PeaceHealth St John Medical Center 11/20/2018 1A - Wrong surgery/invasive procedure siteHAC.FS.00000026 PeaceHealth St John Medical Center 4/8/2019 5B - No gas, wrong gas, contaminated gasHAC.FS.00000026 PeaceHealth St John Medical Center 4/8/2019 5B - No gas, wrong gas, contaminated gasHAC.FS.00000026 PeaceHealth St John Medical Center 6/16/2020 4E - Patient death or serious injury associated with a fall

53HAC.FS.00000145 PeaceHealth St Joseph Medical Center Whatcom 6/19/2006 1D - Unintended retention of foreign objectHAC.FS.00000145 PeaceHealth St Joseph Medical Center 10/24/2006 1A - Wrong surgery/invasive procedure siteHAC.FS.00000145 PeaceHealth St Joseph Medical Center 6/5/2007 1A - Wrong surgery/invasive procedure siteHAC.FS.00000145 PeaceHealth St Joseph Medical Center 10/20/2007 1D - Unintended retention of foreign objectHAC.FS.00000145 PeaceHealth St Joseph Medical Center 1/21/2008 4F - Pressure ulcerHAC.FS.00000145 PeaceHealth St Joseph Medical Center 1/28/2008 1C - Wrong surgical/invasive procedureHAC.FS.00000145 PeaceHealth St Joseph Medical Center 2/12/2008 4F - Pressure ulcerHAC.FS.00000145 PeaceHealth St Joseph Medical Center 2/13/2008 4F - Pressure ulcerHAC.FS.00000145 PeaceHealth St Joseph Medical Center 5/30/2008 4F - Pressure ulcerHAC.FS.00000145 PeaceHealth St Joseph Medical Center 9/15/2008 4F - Pressure ulcerHAC.FS.00000145 PeaceHealth St Joseph Medical Center 10/27/2008 4F - Pressure ulcerHAC.FS.00000145 PeaceHealth St Joseph Medical Center 10/27/2008 4F - Pressure ulcerHAC.FS.00000145 PeaceHealth St Joseph Medical Center 11/3/2008 4F - Pressure ulcerHAC.FS.00000145 PeaceHealth St Joseph Hospital 11/7/2008 4F - Pressure ulcerHAC.FS.00000145 PeaceHealth St Joseph Hospital 1/12/2009 4F - Pressure ulcerHAC.FS.00000145 PeaceHealth St Joseph Hospital 1/15/2009 4F - Pressure ulcerHAC.FS.00000145 PeaceHealth St Joseph Hospital 1/19/2009 4F - Pressure ulcerHAC.FS.00000145 PeaceHealth St Joseph Hospital 4/30/2009 1D - Unintended retention of foreign objectHAC.FS.00000145 PeaceHealth St Joseph Hospital 5/1/2009 4E - Patient death or serious injury associated with a fallHAC.FS.00000145 PeaceHealth St Joseph Hospital 5/18/2009 4E - Patient death or serious injury associated with a fall

PeaceHealth Southwest Medical Center number of events:

PeaceHealth St John Medical Center number of events:

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DOH 689-013 September 2014Office of Community Health Systems Page 26 of 62

Adverse Events Quarterly ReportFacility by Date and Event - Q2 2020

Facility Credential Facility Name Facility County Date Confirmed Event TypeHAC.FS.00000145 PeaceHealth St Joseph Hospital 5/21/2009 4F - Pressure ulcerHAC.FS.00000145 PeaceHealth St Joseph Hospital 5/22/2009 4F - Pressure ulcerHAC.FS.00000145 PeaceHealth St Joseph Hospital 6/9/2009 4F - Pressure ulcerHAC.FS.00000145 PeaceHealth St Joseph Hospital 6/19/2009 1A - Wrong surgery/invasive procedure siteHAC.FS.00000145 PeaceHealth St Joseph Hospital 7/15/2009 1C - Wrong surgical/invasive procedureHAC.FS.00000145 PeaceHealth St Joseph Hospital 7/27/2009 1A - Wrong surgery/invasive procedure siteHAC.FS.00000145 PeaceHealth St Joseph Hospital 8/3/2009 4E - Patient death or serious injury associated with a fallHAC.FS.00000145 PeaceHealth St Joseph Hospital 9/28/2009 1D - Unintended retention of foreign objectHAC.FS.00000145 PeaceHealth St Joseph Hospital 9/30/2009 4E - Patient death or serious injury associated with a fallHAC.FS.00000145 PeaceHealth St Joseph Hospital 11/2/2009 4E - Patient death or serious injury associated with a fallHAC.FS.00000145 PeaceHealth St Joseph Hospital 11/6/2009 4F - Pressure ulcerHAC.FS.00000145 PeaceHealth St Joseph Hospital 3/19/2010 4F - Pressure ulcerHAC.FS.00000145 PeaceHealth St Joseph Hospital 5/3/2010 4E - Patient death or serious injury associated with a fallHAC.FS.00000145 PeaceHealth St Joseph Hospital 8/30/2010 4E - Patient death or serious injury associated with a fallHAC.FS.00000145 PeaceHealth St Joseph Hospital 11/11/2010 1A - Wrong surgery/invasive procedure siteHAC.FS.00000145 PeaceHealth St Joseph Hospital 11/22/2010 4F - Pressure ulcerHAC.FS.00000145 PeaceHealth St Joseph Hospital 11/29/2010 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.00000145 PeaceHealth St Joseph Hospital 2/28/2011 4F - Pressure ulcerHAC.FS.00000145 PeaceHealth St Joseph Hospital 3/7/2011 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.00000145 PeaceHealth St Joseph Hospital 3/24/2011 4E - Patient death or serious injury associated with a fallHAC.FS.00000145 PeaceHealth St Joseph Hospital 4/13/2011 1A - Wrong surgery/invasive procedure siteHAC.FS.00000145 PeaceHealth St Joseph Hospital 4/21/2011 1D - Unintended retention of foreign objectHAC.FS.00000145 PeaceHealth St Joseph Hospital 4/21/2011 4F - Pressure ulcerHAC.FS.00000145 PeaceHealth St Joseph Hospital 8/8/2011 1A - Wrong surgery/invasive procedure siteHAC.FS.00000145 PeaceHealth St Joseph Hospital 8/8/2011 1C - Wrong surgical/invasive procedureHAC.FS.00000145 PeaceHealth St Joseph Hospital 9/15/2011 2C - Intravascular air embolismHAC.FS.00000145 PeaceHealth St Joseph Hospital 12/21/2011 15- HypoglycemiaHAC.FS.00000145 PeaceHealth St Joseph Hospital 1/31/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000145 PeaceHealth St Joseph Hospital 2/20/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000145 PeaceHealth St Joseph Hospital 3/19/2012 4F - Pressure ulcerHAC.FS.00000145 PeaceHealth St Joseph Hospital 3/21/2012 1D - Unintended retention of foreign objectHAC.FS.00000145 PeaceHealth St Joseph Hospital 3/30/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000145 PeaceHealth St Joseph Hospital 4/2/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000145 PeaceHealth St Joseph Hospital 4/6/2012 4F - Pressure ulcerHAC.FS.00000145 PeaceHealth St Joseph Hospital 4/16/2012 5C - BurnHAC.FS.00000145 PeaceHealth St Joseph Hospital 5/21/2012 4F - Pressure ulcerHAC.FS.00000145 PeaceHealth St Joseph Hospital 6/8/2012 1D - Unintended retention of foreign objectHAC.FS.00000145 PeaceHealth St Joseph Hospital 7/13/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000145 PeaceHealth St Joseph Hospital 7/18/2012 1C - Wrong surgical/invasive procedureHAC.FS.00000145 PeaceHealth St Joseph Hospital 8/6/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000145 PeaceHealth St Joseph Hospital 8/13/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000145 PeaceHealth St Joseph Hospital 12/19/2012 4F - Pressure ulcerHAC.FS.00000145 PeaceHealth St Joseph Hospital 1/4/2013 1A - Wrong surgery/invasive procedure siteHAC.FS.00000145 PeaceHealth St Joseph Hospital 4/5/2013 4F - Pressure ulcerHAC.FS.00000145 PeaceHealth St Joseph Hospital 4/11/2013 4F - Pressure ulcerHAC.FS.00000145 PeaceHealth St Joseph Hospital 5/7/2013 4F - Pressure ulcerHAC.FS.00000145 PeaceHealth St Joseph Hospital 6/4/2013 4F - Pressure ulcerHAC.FS.00000145 PeaceHealth St Joseph Hospital 6/21/2013 1A - Wrong surgery/invasive procedure siteHAC.FS.00000145 PeaceHealth St Joseph Hospital 7/1/2013 1A - Wrong surgery/invasive procedure siteHAC.FS.00000145 PeaceHealth St Joseph Hospital 7/29/2013 4F - Pressure ulcerHAC.FS.00000145 PeaceHealth St Joseph Hospital 8/6/2013 4F - Pressure ulcerHAC.FS.00000145 PeaceHealth St Joseph Hospital 8/27/2013 1A - Wrong surgery/invasive procedure siteHAC.FS.00000145 PeaceHealth St Joseph Hospital 9/23/2013 4F - Pressure ulcerHAC.FS.00000145 PeaceHealth St Joseph Hospital 11/6/2013 1D - Unintended retention of foreign objectHAC.FS.00000145 PeaceHealth St Joseph Hospital 11/21/2013 4F - Pressure ulcerHAC.FS.00000145 PeaceHealth St Joseph Hospital 12/6/2013 4F - Pressure ulcerHAC.FS.00000145 PeaceHealth St Joseph Hospital 12/12/2013 4F - Pressure ulcerHAC.FS.00000145 PeaceHealth St Joseph Hospital 12/26/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000145 PeaceHealth St Joseph Hospital 12/30/2013 4F - Pressure ulcerHAC.FS.00000145 PeaceHealth St Joseph Hospital 1/15/2014 4F - Pressure ulcerHAC.FS.00000145 PeaceHealth St Joseph Hospital 3/3/2014 4F - Pressure ulcerHAC.FS.00000145 PeaceHealth St Joseph Hospital 3/28/2014 7C - Sexual abuse/assaultHAC.FS.00000145 PeaceHealth St Joseph Hospital 4/10/2014 1A - Wrong surgery/invasive procedure siteHAC.FS.00000145 PeaceHealth St Joseph Hospital 5/13/2014 4F - Pressure ulcerHAC.FS.00000145 PeaceHealth St Joseph Hospital 7/1/2014 4F - Pressure ulcerHAC.FS.00000145 PeaceHealth St Joseph Hospital 7/28/2014 1A - Wrong surgery/invasive procedure siteHAC.FS.00000145 PeaceHealth St Joseph Hospital 9/3/2014 4F - Pressure ulcerHAC.FS.00000145 PeaceHealth St Joseph Hospital 10/20/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000145 PeaceHealth St Joseph Hospital 11/19/2014 1A - Wrong surgery/invasive procedure siteHAC.FS.00000145 PeaceHealth St Joseph Hospital 1/6/2015 4F - Pressure ulcerHAC.FS.00000145 PeaceHealth St Joseph Hospital 1/14/2015 4F - Pressure ulcerHAC.FS.00000145 PeaceHealth St Joseph Hospital 1/16/2015 4F - Pressure ulcerHAC.FS.00000145 PeaceHealth St Joseph Hospital 3/6/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000145 PeaceHealth St Joseph Hospital 3/26/2015 4F - Pressure ulcerHAC.FS.00000145 PeaceHealth St Joseph Hospital 4/16/2015 4F - Pressure ulcerHAC.FS.00000145 PeaceHealth St Joseph Hospital 5/26/2015 1A - Wrong surgery/invasive procedure siteHAC.FS.00000145 PeaceHealth St Joseph Medical Center 6/4/2015 2B - Device function or useHAC.FS.00000145 PeaceHealth St Joseph Medical Center 6/4/2015 4F - Pressure ulcerHAC.FS.00000145 PeaceHealth St Joseph Medical Center 7/9/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000145 PeaceHealth St Joseph Medical Center 8/18/2015 4F - Pressure ulcerHAC.FS.00000145 PeaceHealth St Joseph Medical Center 9/16/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000145 PeaceHealth St Joseph Medical Center 10/1/2015 1A - Wrong surgery/invasive procedure siteHAC.FS.00000145 PeaceHealth St Joseph Medical Center 1/15/2016 4F - Pressure ulcerHAC.FS.00000145 PeaceHealth St Joseph Medical Center 1/18/2016 1D - Unintended retention of foreign objectHAC.FS.00000145 PeaceHealth St Joseph Medical Center 2/17/2016 4A - Medication errorHAC.FS.00000145 PeaceHealth St Joseph Medical Center 2/24/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000145 PeaceHealth St Joseph Medical Center 3/2/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000145 PeaceHealth St Joseph Medical Center 4/22/2016 4F - Pressure ulcerHAC.FS.00000145 PeaceHealth St Joseph Medical Center 6/1/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000145 PeaceHealth St Joseph Medical Center 6/15/2016 7D - Physical assaultHAC.FS.00000145 PeaceHealth St Joseph Medical Center 6/21/2016 2A - Contaminated drugs, devices, biologicsHAC.FS.00000145 PeaceHealth St Joseph Medical Center 8/1/2016 7D - Physical assaultHAC.FS.00000145 PeaceHealth St Joseph Medical Center 8/23/2016 4F - Pressure ulcerHAC.FS.00000145 PeaceHealth St Joseph Medical Center 8/24/2016 4A - Medication errorHAC.FS.00000145 PeaceHealth St Joseph Medical Center 9/26/2016 4F - Pressure ulcerHAC.FS.00000145 PeaceHealth St Joseph Medical Center 9/26/2016 4F - Pressure ulcerHAC.FS.00000145 PeaceHealth St Joseph Medical Center 10/11/2016 4F - Pressure ulcerHAC.FS.00000145 PeaceHealth St Joseph Medical Center 10/12/2016 4F - Pressure ulcerHAC.FS.00000145 PeaceHealth St Joseph Medical Center 11/16/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000145 PeaceHealth St Joseph Medical Center 1/10/2017 4F - Pressure ulcer

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Adverse Events Quarterly ReportFacility by Date and Event - Q2 2020

Facility Credential Facility Name Facility County Date Confirmed Event TypeHAC.FS.00000145 PeaceHealth St Joseph Medical Center 2/15/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000145 PeaceHealth St Joseph Medical Center 4/19/2017 4F - Pressure ulcerHAC.FS.00000145 PeaceHealth St Joseph Medical Center 5/12/2017 4F - Pressure ulcerHAC.FS.00000145 PeaceHealth St Joseph Medical Center 5/22/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000145 PeaceHealth St Joseph Medical Center 5/31/2017 7D - Physical assaultHAC.FS.00000145 PeaceHealth St Joseph Medical Center 7/21/2017 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.00000145 PeaceHealth St Joseph Medical Center 7/26/2017 4F - Pressure ulcerHAC.FS.00000145 PeaceHealth St Joseph Medical Center 8/9/2017 4I - Failure to follow up with test resultsHAC.FS.00000145 PeaceHealth St Joseph Medical Center 8/24/2017 1D - Unintended retention of foreign objectHAC.FS.00000145 PeaceHealth St Joseph Medical Center 8/31/2017 1A - Wrong surgery/invasive procedure siteHAC.FS.00000145 PeaceHealth St Joseph Medical Center 8/31/2017 7D - Physical assaultHAC.FS.00000145 PeaceHealth St Joseph Medical Center 9/8/2017 7D - Physical assaultHAC.FS.00000145 PeaceHealth St Joseph Medical Center 11/13/2017 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.00000145 PeaceHealth St Joseph Medical Center 12/7/2017 1D - Unintended retention of foreign objectHAC.FS.00000145 PeaceHealth St Joseph Medical Center 1/11/2018 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.00000145 PeaceHealth St Joseph Medical Center 1/30/2018 1D - Unintended retention of foreign objectHAC.FS.00000145 PeaceHealth St Joseph Medical Center 2/19/2018 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.00000145 PeaceHealth St Joseph Medical Center 2/21/2018 4F - Pressure ulcerHAC.FS.00000145 PeaceHealth St Joseph Medical Center 3/21/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000145 PeaceHealth St Joseph Medical Center 4/24/2018 4I - Failure to follow up with test resultsHAC.FS.00000145 PeaceHealth St Joseph Medical Center 5/15/2018 4F - Pressure ulcerHAC.FS.00000145 PeaceHealth St Joseph Medical Center 6/5/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000145 PeaceHealth St Joseph Medical Center 6/20/2018 7D - Physical assaultHAC.FS.00000145 PeaceHealth St Joseph Medical Center 6/22/2018 4F - Pressure ulcerHAC.FS.00000145 PeaceHealth St Joseph Medical Center 7/11/2018 4F - Pressure ulcerHAC.FS.00000145 PeaceHealth St Joseph Medical Center 8/8/2018 4H - Irretrievable loss of irreplaceable biological specimenHAC.FS.00000145 PeaceHealth St Joseph Medical Center 8/17/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000145 PeaceHealth St Joseph Medical Center 8/22/2018 4F - Pressure ulcerHAC.FS.00000145 PeaceHealth St Joseph Medical Center 9/24/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000145 PeaceHealth St Joseph Medical Center 3/28/2019 4F - Pressure ulcerHAC.FS.00000145 PeaceHealth St Joseph Medical Center 4/12/2019 4F - Pressure ulcerHAC.FS.00000145 PeaceHealth St Joseph Medical Center 5/6/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000145 PeaceHealth St Joseph Medical Center 6/27/2019 1D - Unintended retention of foreign objectHAC.FS.00000145 PeaceHealth St Joseph Medical Center 7/29/2019 4F - Pressure ulcerHAC.FS.00000145 PeaceHealth St Joseph Medical Center 10/5/2019 1D - Unintended retention of foreign objectHAC.FS.00000145 PeaceHealth St Joseph Medical Center 10/22/2019 4F - Pressure ulcerHAC.FS.00000145 PeaceHealth St Joseph Medical Center 11/13/2019 1A - Wrong surgery/invasive procedure siteHAC.FS.00000145 PeaceHealth St Joseph Medical Center 12/9/2019 7D - Physical assaultHAC.FS.00000145 PeaceHealth St Joseph Medical Center 3/6/2020 4F - Pressure ulcerHAC.FS.00000145 PeaceHealth St Joseph Medical Center 3/9/2020 1A - Wrong surgery/invasive procedure siteHAC.FS.00000145 PeaceHealth St Joseph Medical Center 3/20/2020 4E - Patient death or serious injury associated with a fallHAC.FS.00000145 PeaceHealth St Joseph Medical Center 5/13/2020 4E - Patient death or serious injury associated with a fallHAC.FS.00000145 PeaceHealth St Joseph Medical Center 6/8/2020 4E - Patient death or serious injury associated with a fallHAC.FS.00000145 PeaceHealth St Joseph Medical Center 6/17/2020 1D - Unintended retention of foreign object

164HAC.FS.60417818 PeaceHealth United General Medical Centeriiiiii Skagit 11/17/2015 4E - Patient death or serious injury associated with a fallHAC.FS.60417818 PeaceHealth United General Medical Centeriiiiii 4/12/2017 1A - Wrong surgery/invasive procedure siteHAC.FS.60417818 PeaceHealth United General Medical Centeriiiiii 7/12/2019 7D - Physical assaultHAC.FS.60417818 PeaceHealth United General Medical Centeriiiiii 1/20/2020 4E - Patient death or serious injury associated with a fall

4HAC.FS.00000046 Prosser Memorial Hospital Benton 6/13/2007 1A - Wrong surgery/invasive procedure siteHAC.FS.00000046 Prosser Memorial Hospital 6/9/2008 4C - Maternal death or serious injuryHAC.FS.00000046 PMH Medical Center 11/6/2008 1D - Unintended retention of foreign objectHAC.FS.00000046 PMH Medical Center 8/27/2019 4E - Patient death or serious injury associated with a fall

4HAC.FS.00000191 Providence Centralia Hospital Lewis 10/7/2006 4F - Pressure ulcerHAC.FS.00000191 Providence Centralia Hospital 1/5/2007 1D - Unintended retention of foreign objectHAC.FS.00000191 Providence Centralia Hospital 5/30/2008 1D - Unintended retention of foreign objectHAC.FS.00000191 Providence Centralia Hospital 9/12/2008 4F - Pressure ulcerHAC.FS.00000191 Providence Centralia Hospital 1/25/2011 1D - Unintended retention of foreign objectHAC.FS.00000191 Providence Centralia Hospital 3/7/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000191 Providence Centralia Hospital 6/22/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000191 Providence Centralia Hospital 4/11/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000191 Providence Centralia Hospital 7/22/2013 1D - Unintended retention of foreign objectHAC.FS.00000191 Providence Centralia Hospital 1/23/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000191 Providence Centralia Hospital 2/3/2014 4F - Pressure ulcerHAC.FS.00000191 Providence Centralia Hospital 11/12/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000191 Providence Centralia Hospital 6/3/2015 4F - Pressure ulcerHAC.FS.00000191 Providence Centralia Hospital 3/30/2016 1A - Wrong surgery/invasive procedure siteHAC.FS.00000191 Providence Centralia Hospital 4/13/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000191 Providence Centralia Hospital 7/5/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000191 Providence Centralia Hospital 7/5/2016 4F - Pressure ulcerHAC.FS.00000191 Providence Centralia Hospital 11/2/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000191 Providence Centralia Hospital 8/11/2017 5D - RestraintsHAC.FS.00000191 Providence Centralia Hospital 1/12/2018 4I - Failure to follow up with test resultsHAC.FS.00000191 Providence Centralia Hospital 2/5/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000191 Providence Centralia Hospital 4/16/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000191 Providence Centralia Hospital 7/2/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000191 Providence Centralia Hospital 7/26/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000191 Providence Centralia Hospital 10/8/2018 7D - Physical assaultHAC.FS.00000191 Providence Centralia Hospital 10/18/2018 1D - Unintended retention of foreign objectHAC.FS.00000191 Providence Centralia Hospital 10/18/2018 7D - Physical assaultHAC.FS.00000191 Providence Centralia Hospital 11/20/2018 4C - Maternal death or serious injuryHAC.FS.00000191 Providence Centralia Hospital 11/29/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000191 Providence Centralia Hospital 12/5/2018 4A - Medication errorHAC.FS.00000191 Providence Centralia Hospital 6/18/2019 1A - Wrong surgery/invasive procedure siteHAC.FS.00000191 Providence Centralia Hospital 6/18/2019 4F - Pressure ulcerHAC.FS.00000191 Providence Centralia Hospital 7/31/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000191 Providence Centralia Hospital 9/12/2019 4F - Pressure ulcerHAC.FS.00000191 Providence Centralia Hospital 12/20/2019 4F - Pressure ulcerHAC.FS.00000191 Providence Centralia Hospital 12/20/2019 4F - Pressure ulcerHAC.FS.00000191 Providence Centralia Hospital 12/23/2019 4A - Medication errorHAC.FS.00000191 Providence Centralia Hospital 2/3/2020 1C - Wrong surgical/invasive procedureHAC.FS.00000191 Providence Centralia Hospital 3/5/2020 4F - Pressure ulcerHAC.FS.00000191 Providence Centralia Hospital 5/1/2020 4F - Pressure ulcer

40HAC.FS.00000139 Providence Holy Family Hospital Spokane 11/17/2006 4F - Pressure ulcerHAC.FS.00000139 Providence Holy Family Hospital 12/14/2006 4F - Pressure ulcerHAC.FS.00000139 Providence Holy Family Hospital 5/12/2008 1D - Unintended retention of foreign objectHAC.FS.00000139 Providence Holy Family Hospital 5/14/2008 1C - Wrong surgical/invasive procedure

United General Hospital number of events:

Prosser Memorial Hospital number of events:

Providence Centralia Hospital number of events:

PeaceHealth St Joseph Hospital number of events:

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Adverse EventsFacilities and Date of Event Report 2006-2020

DOH 689-013 September 2014Office of Community Health Systems Page 28 of 62

Adverse Events Quarterly ReportFacility by Date and Event - Q2 2020

Facility Credential Facility Name Facility County Date Confirmed Event TypeHAC.FS.00000139 Providence Holy Family Hospital 8/25/2008 1A - Wrong surgery/invasive procedure siteHAC.FS.00000139 Providence Holy Family Hospital 11/17/2008 7D - Physical assaultHAC.FS.00000139 Providence Holy Family Hospital 9/14/2009 1A - Wrong surgery/invasive procedure siteHAC.FS.00000139 Providence Holy Family Hospital 2/18/2010 1A - Wrong surgery/invasive procedure siteHAC.FS.00000139 Providence Holy Family Hospital 7/16/2010 4F - Pressure ulcerHAC.FS.00000139 Providence Holy Family Hospital 9/14/2010 4F - Pressure ulcerHAC.FS.00000139 Providence Holy Family Hospital 9/15/2010 4F - Pressure ulcerHAC.FS.00000139 Providence Holy Family Hospital 9/18/2010 4F - Pressure ulcerHAC.FS.00000139 Providence Holy Family Hospital 11/3/2010 1D - Unintended retention of foreign objectHAC.FS.00000139 Providence Holy Family Hospital 11/9/2011 15- HypoglycemiaHAC.FS.00000139 Providence Holy Family Hospital 6/6/2012 4A - Medication errorHAC.FS.00000139 Providence Holy Family Hospital 11/20/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000139 Providence Holy Family Hospital 12/14/2012 4F - Pressure ulcerHAC.FS.00000139 Providence Holy Family Hospital 1/28/2013 4F - Pressure ulcerHAC.FS.00000139 Providence Holy Family Hospital 2/5/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000139 Providence Holy Family Hospital 2/5/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000139 Providence Holy Family Hospital 2/5/2013 4F - Pressure ulcerHAC.FS.00000139 Providence Holy Family Hospital 9/10/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000139 Providence Holy Family Hospital 10/22/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000139 Providence Holy Family Hospital 2/21/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000139 Providence Holy Family Hospital 4/7/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000139 Providence Holy Family Hospital 6/23/2014 1A - Wrong surgery/invasive procedure siteHAC.FS.00000139 Providence Holy Family Hospital 6/27/2014 4F - Pressure ulcerHAC.FS.00000139 Providence Holy Family Hospital 9/8/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000139 Providence Holy Family Hospital 9/26/2014 4F - Pressure ulcerHAC.FS.00000139 Providence Holy Family Hospital 9/26/2014 4F - Pressure ulcerHAC.FS.00000139 Providence Holy Family Hospital 9/30/2014 1D - Unintended retention of foreign objectHAC.FS.00000139 Providence Holy Family Hospital 1/4/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000139 Providence Holy Family Hospital 2/11/2015 4F - Pressure ulcerHAC.FS.00000139 Providence Holy Family Hospital 2/27/2015 4F - Pressure ulcerHAC.FS.00000139 Providence Holy Family Hospital 7/31/2015 1A - Wrong surgery/invasive procedure siteHAC.FS.00000139 Providence Holy Family Hospital 11/18/2015 4F - Pressure ulcerHAC.FS.00000139 Providence Holy Family Hospital 12/9/2015 4F - Pressure ulcerHAC.FS.00000139 Providence Holy Family Hospital 12/9/2015 4F - Pressure ulcerHAC.FS.00000139 Providence Holy Family Hospital 12/28/2015 4F - Pressure ulcerHAC.FS.00000139 Providence Holy Family Hospital 2/8/2016 4A - Medication errorHAC.FS.00000139 Providence Holy Family Hospital 4/6/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000139 Providence Holy Family Hospital 4/6/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000139 Providence Holy Family Hospital 5/4/2016 4F - Pressure ulcerHAC.FS.00000139 Providence Holy Family Hospital 7/6/2016 4F - Pressure ulcerHAC.FS.00000139 Providence Holy Family Hospital 8/16/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000139 Providence Holy Family Hospital 9/14/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000139 Providence Holy Family Hospital 10/13/2016 4H - Irretrievable loss of irreplaceable biological specimenHAC.FS.00000139 Providence Holy Family Hospital 11/2/2016 4F - Pressure ulcerHAC.FS.00000139 Providence Holy Family Hospital 11/28/2016 4F - Pressure ulcerHAC.FS.00000139 Providence Holy Family Hospital 3/22/2017 4F - Pressure ulcerHAC.FS.00000139 Providence Holy Family Hospital 4/26/2017 4F - Pressure ulcerHAC.FS.00000139 Providence Holy Family Hospital 4/26/2017 4F - Pressure ulcerHAC.FS.00000139 Providence Holy Family Hospital 4/26/2017 4F - Pressure ulcerHAC.FS.00000139 Providence Holy Family Hospital 5/10/2017 3B - Patient elopement (disappearance)HAC.FS.00000139 Providence Holy Family Hospital 11/20/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000139 Providence Holy Family Hospital 11/20/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000139 Providence Holy Family Hospital 2/15/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000139 Providence Holy Family Hospital 3/8/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000139 Providence Holy Family Hospital 3/14/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000139 Providence Holy Family Hospital 3/19/2018 4A - Medication errorHAC.FS.00000139 Providence Holy Family Hospital 4/25/2018 4F - Pressure ulcerHAC.FS.00000139 Providence Holy Family Hospital 6/13/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000139 Providence Holy Family Hospital 7/3/2018 4A - Medication errorHAC.FS.00000139 Providence Holy Family Hospital 8/17/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000139 Providence Holy Family Hospital 4/17/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000139 Providence Holy Family Hospital 5/23/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000139 Providence Holy Family Hospital 7/3/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000139 Providence Holy Family Hospital 7/9/2019 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.00000139 Providence Holy Family Hospital 7/10/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000139 Providence Holy Family Hospital 8/9/2019 4F - Pressure ulcerHAC.FS.00000139 Providence Holy Family Hospital 9/18/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000139 Providence Holy Family Hospital 12/23/2019 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.00000139 Providence Holy Family Hospital 4/9/2020 4F - Pressure ulcer

73HAC.FS.00000030 Providence Mount Carmel Hospital Stevens 12/15/2006 7C - Sexual abuse/assaultHAC.FS.00000030 Providence Mount Carmel Hospital 8/22/2007 1D - Unintended retention of foreign objectHAC.FS.00000030 Providence Mount Carmel Hospital 11/25/2009 1C - Wrong surgical/invasive procedureHAC.FS.00000030 Providence Mount Carmel Hospital 1/28/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000030 Providence Mount Carmel Hospital 10/9/2013 4F - Pressure ulcerHAC.FS.00000030 Providence Mount Carmel Hospital 10/23/2013 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.00000030 Providence Mount Carmel Hospital 2/4/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000030 Providence Mount Carmel Hospital 2/13/2015 1C - Wrong surgical/invasive procedureHAC.FS.00000030 Providence Mount Carmel Hospital 11/1/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000030 Providence Mount Carmel Hospital 5/23/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000030 Providence Mount Carmel Hospital 6/7/2018 4F - Pressure ulcerHAC.FS.00000030 Providence Mount Carmel Hospital 9/4/2018 4A - Medication errorHAC.FS.00000030 Providence Mount Carmel Hospital 11/1/2019 4A - Medication errorHAC.FS.00000030 Providence Mount Carmel Hospital 5/12/2020 4I - Failure to follow up with test resultsHAC.FS.00000030 Providence Mount Carmel Hospital 5/29/2020 4E - Patient death or serious injury associated with a fallHAC.FS.00000030 Providence Mount Carmel Hospital 6/12/2020 4E - Patient death or serious injury associated with a fallHAC.FS.00000030 Providence Mount Carmel Hospital 6/26/2020 4E - Patient death or serious injury associated with a fall

17HAC.FS.00000084 Providence Regional Medical Center Everett Snohomish 6/14/2006 1C - Wrong surgical/invasive procedureHAC.FS.00000084 Providence Regional Medical Center Everett 6/14/2006 1C - Wrong surgical/invasive procedureHAC.FS.00000084 Providence Regional Medical Center Everett 6/14/2006 1C - Wrong surgical/invasive procedureHAC.FS.00000084 Providence Regional Medical Center Everett 7/26/2006 1D - Unintended retention of foreign objectHAC.FS.00000084 Providence Regional Medical Center Everett 9/20/2006 1D - Unintended retention of foreign objectHAC.FS.00000084 Providence Regional Medical Center Everett 1/31/2007 1D - Unintended retention of foreign objectHAC.FS.00000084 Providence Regional Medical Center Everett 6/13/2007 1A - Wrong surgery/invasive procedure siteHAC.FS.00000084 Providence Regional Medical Center Everett 7/20/2007 1C - Wrong surgical/invasive procedureHAC.FS.00000084 Providence Regional Medical Center Everett 11/21/2007 1D - Unintended retention of foreign objectHAC.FS.00000084 Providence Regional Medical Center Everett 3/14/2008 1D - Unintended retention of foreign objectHAC.FS.00000084 Providence Regional Medical Center Everett 3/14/2008 4E - Patient death or serious injury associated with a fallHAC.FS.00000084 Providence Regional Medical Center Everett 4/11/2008 5D - Restraints

Providence Holy Family Hospital number of events:

Providence Mount Carmel Hospital number of events:

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Adverse EventsFacilities and Date of Event Report 2006-2020

DOH 689-013 September 2014Office of Community Health Systems Page 29 of 62

Adverse Events Quarterly ReportFacility by Date and Event - Q2 2020

Facility Credential Facility Name Facility County Date Confirmed Event TypeHAC.FS.00000084 Providence Regional Medical Center Everett 6/13/2008 1D - Unintended retention of foreign objectHAC.FS.00000084 Providence Regional Medical Center Everett 8/8/2008 4F - Pressure ulcerHAC.FS.00000084 Providence Regional Medical Center Everett 11/14/2008 4F - Pressure ulcerHAC.FS.00000084 Providence Regional Medical Center Everett 12/12/2008 1C - Wrong surgical/invasive procedureHAC.FS.00000084 Providence Regional Medical Center Everett 4/10/2009 7B - Patient/Resident abductionHAC.FS.00000084 Providence Regional Medical Center Everett 6/15/2009 1D - Unintended retention of foreign objectHAC.FS.00000084 Providence Regional Medical Center Everett 10/9/2009 4E - Patient death or serious injury associated with a fallHAC.FS.00000084 Providence Regional Medical Center Everett 10/9/2009 4E - Patient death or serious injury associated with a fallHAC.FS.00000084 Providence Regional Medical Center Everett 2/12/2010 1D - Unintended retention of foreign objectHAC.FS.00000084 Providence Regional Medical Center Everett 3/12/2010 4F - Pressure ulcerHAC.FS.00000084 Providence Regional Medical Center Everett 3/12/2010 4F - Pressure ulcerHAC.FS.00000084 Providence Regional Medical Center Everett 3/12/2010 4E - Patient death or serious injury associated with a fallHAC.FS.00000084 Providence Regional Medical Center Everett 3/12/2010 4E - Patient death or serious injury associated with a fallHAC.FS.00000084 Providence Regional Medical Center Everett 6/11/2010 4E - Patient death or serious injury associated with a fallHAC.FS.00000084 Providence Regional Medical Center Everett 10/8/2010 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.00000084 Providence Regional Medical Center Everett 12/9/2010 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.00000084 Providence Regional Medical Center Everett 12/10/2010 1D - Unintended retention of foreign objectHAC.FS.00000084 Providence Regional Medical Center Everett 2/11/2011 1D - Unintended retention of foreign objectHAC.FS.00000084 Providence Regional Medical Center Everett 3/16/2011 4E - Patient death or serious injury associated with a fallHAC.FS.00000084 Providence Regional Medical Center Everett 5/13/2011 4E - Patient death or serious injury associated with a fallHAC.FS.00000084 Providence Regional Medical Center Everett 9/9/2011 4E - Patient death or serious injury associated with a fallHAC.FS.00000084 Providence Regional Medical Center Everett 10/14/2011 1A - Wrong surgery/invasive procedure siteHAC.FS.00000084 Providence Regional Medical Center Everett 12/9/2011 4C - Maternal death or serious injuryHAC.FS.00000084 Providence Regional Medical Center Everett 1/17/2012 1A - Wrong surgery/invasive procedure siteHAC.FS.00000084 Providence Regional Medical Center Everett 3/9/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000084 Providence Regional Medical Center Everett 3/9/2012 7A - ImpersonationHAC.FS.00000084 Providence Regional Medical Center Everett 7/13/2012 1C - Wrong surgical/invasive procedureHAC.FS.00000084 Providence Regional Medical Center Everett 7/13/2012 1C - Wrong surgical/invasive procedureHAC.FS.00000084 Providence Regional Medical Center Everett 7/13/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000084 Providence Regional Medical Center Everett 7/13/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000084 Providence Regional Medical Center Everett 7/13/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000084 Providence Regional Medical Center Everett 7/13/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000084 Providence Regional Medical Center Everett 11/9/2012 7B - Patient/Resident abductionHAC.FS.00000084 Providence Regional Medical Center Everett 12/14/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000084 Providence Regional Medical Center Everett 12/14/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000084 Providence Regional Medical Center Everett 2/11/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000084 Providence Regional Medical Center Everett 4/12/2013 4F - Pressure ulcerHAC.FS.00000084 Providence Regional Medical Center Everett 5/10/2013 6A - Introduction of metallic object into MRI areaHAC.FS.00000084 Providence Regional Medical Center Everett 6/14/2013 1D - Unintended retention of foreign object HAC.FS.00000084 Providence Regional Medical Center Everett 6/14/2013 **1A - Wrong surgery/invasive procedure siteHAC.FS.00000084 Providence Regional Medical Center Everett 6/14/2013 1A - Wrong surgery/invasive procedure siteHAC.FS.00000084 Providence Regional Medical Center Everett 8/9/2013 4F - Pressure ulcerHAC.FS.00000084 Providence Regional Medical Center Everett 9/13/2013 4D - Death or serious injury of neonateHAC.FS.00000084 Providence Regional Medical Center Everett 9/13/2013 4I - Failure to follow up with test resultsHAC.FS.00000084 Providence Regional Medical Center Everett 11/8/2013 4D - Death or serious injury of neonateHAC.FS.00000084 Providence Regional Medical Center Everett 12/13/2013 1C - Wrong surgical/invasive procedureHAC.FS.00000084 Providence Regional Medical Center Everett 12/13/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000084 Providence Regional Medical Center Everett 2/14/2014 3B - Patient elopement (disappearance)HAC.FS.00000084 Providence Regional Medical Center Everett 2/14/2014 4A - Medication errorHAC.FS.00000084 Providence Regional Medical Center Everett 3/14/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000084 Providence Regional Medical Center Everett 4/11/2014 2C - Intravascular air embolismHAC.FS.00000084 Providence Regional Medical Center Everett 4/11/2014 4I - Failure to follow up with test resultsHAC.FS.00000084 Providence Regional Medical Center Everett 4/11/2014 1D - Unintended retention of foreign objectHAC.FS.00000084 Providence Regional Medical Center Everett 8/8/2014 4F - Pressure ulcerHAC.FS.00000084 Providence Regional Medical Center Everett 8/8/2014 4F - Pressure ulcerHAC.FS.00000084 Providence Regional Medical Center Everett 9/12/2014 4F - Pressure ulcerHAC.FS.00000084 Providence Regional Medical Center Everett 10/10/2014 4F - Pressure ulcerHAC.FS.00000084 Providence Regional Medical Center Everett 10/10/2014 4D - Death or serious injury of neonateHAC.FS.00000084 Providence Regional Medical Center Everett 10/10/2014 5C - BurnHAC.FS.00000084 Providence Regional Medical Center Everett 11/14/2014 4F - Pressure ulcerHAC.FS.00000084 Providence Regional Medical Center Everett 12/12/2014 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.00000084 Providence Regional Medical Center Everett 12/12/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000084 Providence Regional Medical Center Everett 2/13/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000084 Providence Regional Medical Center Everett 5/1/2015 1D - Unintended retention of foreign objectHAC.FS.00000084 Providence Regional Medical Center Everett 6/10/2015 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.00000084 Providence Regional Medical Center Everett 8/7/2015 4C - Maternal death or serious injuryHAC.FS.00000084 Providence Regional Medical Center Everett 8/7/2015 4C - Maternal death or serious injuryHAC.FS.00000084 Providence Regional Medical Center Everett 8/7/2015 4C - Maternal death or serious injuryHAC.FS.00000084 Providence Regional Medical Center Everett 8/7/2015 4I - Failure to follow up with test resultsHAC.FS.00000084 Providence Regional Medical Center Everett 9/4/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000084 Providence Regional Medical Center Everett 9/4/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000084 Providence Regional Medical Center Everett 9/4/2015 4F - Pressure ulcerHAC.FS.00000084 Providence Regional Medical Center Everett 12/4/2015 1A - Wrong surgery/invasive procedure siteHAC.FS.00000084 Providence Regional Medical Center Everett 12/4/2015 4C - Maternal death or serious injuryHAC.FS.00000084 Providence Regional Medical Center Everett 12/4/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000084 Providence Regional Medical Center Everett 2/5/2016 4F - Pressure ulcerHAC.FS.00000084 Providence Regional Medical Center Everett 2/5/2016 4F - Pressure ulcerHAC.FS.00000084 Providence Regional Medical Center Everett 2/5/2016 4F - Pressure ulcerHAC.FS.00000084 Providence Regional Medical Center Everett 3/4/2016 4F - Pressure ulcerHAC.FS.00000084 Providence Regional Medical Center Everett 5/6/2016 1A - Wrong surgery/invasive procedure siteHAC.FS.00000084 Providence Regional Medical Center Everett 5/6/2016 1A - Wrong surgery/invasive procedure siteHAC.FS.00000084 Providence Regional Medical Center Everett 5/6/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000084 Providence Regional Medical Center Everett 5/6/2016 4F - Pressure ulcerHAC.FS.00000084 Providence Regional Medical Center Everett 7/1/2016 1D - Unintended retention of foreign objectHAC.FS.00000084 Providence Regional Medical Center Everett 7/1/2016 4D - Death or serious injury of neonateHAC.FS.00000084 Providence Regional Medical Center Everett 12/2/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000084 Providence Regional Medical Center Everett 12/2/2016 4F - Pressure ulcerHAC.FS.00000084 Providence Regional Medical Center Everett 2/3/2017 4I - Failure to follow up with test resultsHAC.FS.00000084 Providence Regional Medical Center Everett 5/5/2017 4F - Pressure ulcerHAC.FS.00000084 Providence Regional Medical Center Everett 7/7/2017 1A - Wrong surgery/invasive procedure siteHAC.FS.00000084 Providence Regional Medical Center Everett 7/7/2017 1D - Unintended retention of foreign objectHAC.FS.00000084 Providence Regional Medical Center Everett 8/4/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000084 Providence Regional Medical Center Everett 9/1/2017 4F - Pressure ulcerHAC.FS.00000084 Providence Regional Medical Center Everett 10/6/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000084 Providence Regional Medical Center Everett 2/2/2018 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.00000084 Providence Regional Medical Center Everett 4/6/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000084 Providence Regional Medical Center Everett 5/4/2018 1D - Unintended retention of foreign objectHAC.FS.00000084 Providence Regional Medical Center Everett 5/4/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000084 Providence Regional Medical Center Everett 6/1/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000084 Providence Regional Medical Center Everett 8/3/2018 3A - Patient/Resident discharged to unauthorized person

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DOH 689-013 September 2014Office of Community Health Systems Page 30 of 62

Adverse Events Quarterly ReportFacility by Date and Event - Q2 2020

Facility Credential Facility Name Facility County Date Confirmed Event TypeHAC.FS.00000084 Providence Regional Medical Center Everett 9/7/2018 1D - Unintended retention of foreign objectHAC.FS.00000084 Providence Regional Medical Center Everett 9/7/2018 4F - Pressure ulcerHAC.FS.00000084 Providence Regional Medical Center Everett 11/19/2018 4F - Pressure ulcerHAC.FS.00000084 Providence Regional Medical Center Everett 11/19/2018 4F - Pressure ulcerHAC.FS.00000084 Providence Regional Medical Center Everett 12/7/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000084 Providence Regional Medical Center Everett 12/7/2018 4F - Pressure ulcerHAC.FS.00000084 Providence Regional Medical Center Everett 12/7/2018 4F - Pressure ulcerHAC.FS.00000084 Providence Regional Medical Center Everett 2/3/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000084 Providence Regional Medical Center Everett 2/3/2019 4F - Pressure ulcerHAC.FS.00000084 Providence Regional Medical Center Everett 2/3/2019 4F - Pressure ulcerHAC.FS.00000084 Providence Regional Medical Center Everett 2/4/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000084 Providence Regional Medical Center Everett 3/1/2019 2A - Contaminated drugs, devices, biologicsHAC.FS.00000084 Providence Regional Medical Center Everett 4/5/2019 1D - Unintended retention of foreign objectHAC.FS.00000084 Providence Regional Medical Center Everett 4/5/2019 4A - Medication errorHAC.FS.00000084 Providence Regional Medical Center Everett 4/5/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000084 Providence Regional Medical Center Everett 4/5/2019 4F - Pressure ulcerHAC.FS.00000084 Providence Regional Medical Center Everett 5/3/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000084 Providence Regional Medical Center Everett 5/7/2019 4F - Pressure ulcerHAC.FS.00000084 Providence Regional Medical Center Everett 8/2/2019 4I - Failure to follow up with test resultsHAC.FS.00000084 Providence Regional Medical Center Everett 9/6/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000084 Providence Regional Medical Center Everett 9/6/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000084 Providence Regional Medical Center Everett 9/6/2019 4F - Pressure ulcerHAC.FS.00000084 Providence Regional Medical Center Everett 9/6/2019 4F - Pressure ulcerHAC.FS.00000084 Providence Regional Medical Center Everett 9/6/2019 4F - Pressure ulcerHAC.FS.00000084 Providence Regional Medical Center Everett 1/3/2020 4F - Pressure ulcerHAC.FS.00000084 Providence Regional Medical Center Everett 1/3/2020 4F - Pressure ulcerHAC.FS.00000084 Providence Regional Medical Center Everett 2/7/2020 4E - Patient death or serious injury associated with a fallHAC.FS.00000084 Providence Regional Medical Center Everett 2/7/2020 4E - Patient death or serious injury associated with a fallHAC.FS.00000084 Providence Regional Medical Center Everett 2/7/2020 4F - Pressure ulcerHAC.FS.00000084 Providence Regional Medical Center Everett 5/1/2020 1A - Wrong surgery/invasive procedure siteHAC.FS.00000084 Providence Regional Medical Center Everett 6/5/2020 1A - Wrong surgery/invasive procedure siteHAC.FS.00000084 Providence Regional Medical Center Everett 6/5/2020 3B - Patient elopement (disappearance)HAC.FS.00000084 Providence Regional Medical Center Everett 6/5/2020 4E - Patient death or serious injury associated with a fallHAC.FS.00000084 Providence Regional Medical Center Everett 6/5/2020 4F - Pressure ulcer

146HAC.FS.00000162 Providence Sacred Heart Medical Center Spokane 6/22/2006 1D - Unintended retention of foreign objectHAC.FS.00000162 Providence Sacred Heart Medical Center 10/19/2006 1D - Unintended retention of foreign objectHAC.FS.00000162 Providence Sacred Heart Medical Center 3/5/2007 1A - Wrong surgery/invasive procedure siteHAC.FS.00000162 Providence Sacred Heart Medical Center 3/6/2007 1D - Unintended retention of foreign objectHAC.FS.00000162 Providence Sacred Heart Medical Center 5/7/2007 1A - Wrong surgery/invasive procedure siteHAC.FS.00000162 Providence Sacred Heart Medical Center 1/11/2008 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.00000162 Providence Sacred Heart Medical Center 2/19/2008 1A - Wrong surgery/invasive procedure siteHAC.FS.00000162 Providence Sacred Heart Medical Center 8/26/2008 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center 9/5/2008 1D - Unintended retention of foreign objectHAC.FS.00000162 Providence Sacred Heart Medical Center 9/22/2008 1D - Unintended retention of foreign objectHAC.FS.00000162 Providence Sacred Heart Medical Center 9/23/2008 1D - Unintended retention of foreign objectHAC.FS.00000162 Providence Sacred Heart Medical Center 12/8/2008 1A - Wrong surgery/invasive procedure siteHAC.FS.00000162 Providence Sacred Heart Medical Center 12/8/2008 1D - Unintended retention of foreign objectHAC.FS.00000162 Providence Sacred Heart Medical Center 12/11/2008 1D - Unintended retention of foreign objectHAC.FS.00000162 Providence Sacred Heart Medical Center 12/17/2008 1A - Wrong surgery/invasive procedure siteHAC.FS.00000162 Providence Sacred Heart Medical Center 10/7/2009 1D - Unintended retention of foreign objectHAC.FS.00000162 Providence Sacred Heart Medical Center 11/18/2009 1D - Unintended retention of foreign objectHAC.FS.00000162 Providence Sacred Heart Medical Center 3/16/2010 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center 3/24/2010 15- HypoglycemiaHAC.FS.00000162 Providence Sacred Heart Medical Center 5/12/2010 1D - Unintended retention of foreign objectHAC.FS.00000162 Providence Sacred Heart Medical Center 5/21/2010 1A - Wrong surgery/invasive procedure siteHAC.FS.00000162 Providence Sacred Heart Medical Center & Childrens Hospital 9/16/2010 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center & Childrens Hospital 12/1/2010 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center & Childrens Hospital 3/1/2011 4E - Patient death or serious injury associated with a fallHAC.FS.00000162 Providence Sacred Heart Medical Center & Childrens Hospital 8/10/2011 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center & Childrens Hospital 11/3/2011 2C - Intravascular air embolismHAC.FS.00000162 Providence Sacred Heart Medical Center & Childrens Hospital 4/27/2012 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center & Childrens Hospital 6/27/2012 2C - Intravascular air embolismHAC.FS.00000162 Providence Sacred Heart Medical Center & Childrens Hospital 8/1/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000162 Providence Sacred Heart Medical Center & Childrens Hospital 8/30/2012 5D - RestraintsHAC.FS.00000162 Providence Sacred Heart Medical Center & Childrens Hospital 10/21/2012 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center & Childrens Hospital 11/6/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000162 Providence Sacred Heart Medical Center & Childrens Hospital 11/20/2012 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center & Childrens Hospital 12/14/2012 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center & Childrens Hospital 12/14/2012 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center & Childrens Hospital 12/17/2012 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center & Childrens Hospital 12/17/2012 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center & Childrens Hospital 12/27/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 1/28/2013 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 1/29/2013 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 1/29/2013 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 2/19/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 2/19/2013 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 2/26/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 4/10/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 4/15/2013 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 6/3/2013 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 6/12/2013 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 7/9/2013 7C - Sexual abuse/assaultHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 7/9/2013 7C - Sexual abuse/assaultHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 7/30/2013 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 7/31/2013 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 7/31/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 7/31/2013 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 10/16/2013 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 11/19/2013 1A - Wrong surgery/invasive procedure siteHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 11/19/2013 7D - Physical assaultHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 11/23/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 11/27/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 12/11/2013 1D - Unintended retention of foreign objectHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 2/11/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 2/21/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 4/8/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 4/8/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 6/27/2014 4F - Pressure ulcer

Providence Regional Medical Center Everett number of events:

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DOH 689-013 September 2014Office of Community Health Systems Page 31 of 62

Adverse Events Quarterly ReportFacility by Date and Event - Q2 2020

Facility Credential Facility Name Facility County Date Confirmed Event TypeHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 6/27/2014 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 6/27/2014 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 6/27/2014 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 6/27/2014 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 7/30/2014 1D - Unintended retention of foreign objectHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 9/8/2014 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 9/8/2014 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 9/8/2014 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 9/8/2014 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 9/8/2014 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 12/8/2014 1D - Unintended retention of foreign objectHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 12/19/2014 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 12/19/2014 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 12/19/2014 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 12/19/2014 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 12/19/2014 2C - Intravascular air embolismHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 12/19/2014 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 12/19/2014 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 12/19/2014 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 12/19/2014 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 12/19/2014 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 12/19/2014 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 1/18/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 1/18/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 1/18/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 2/2/2015 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 2/4/2015 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 2/4/2015 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 2/4/2015 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 2/4/2015 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 2/4/2015 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 2/4/2015 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 2/6/2015 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 4/20/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 4/29/2015 5C - BurnHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 6/2/2015 4F - Pressure ulcer HAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 6/3/2015 4A - Medication errorHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 6/17/2015 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 6/17/2015 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 6/17/2015 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 6/26/2015 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 10/12/2015 4A - Medication errorHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 11/19/2015 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 11/20/2015 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 11/23/2015 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 11/23/2015 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 11/23/2015 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 11/23/2015 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 11/27/2015 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 12/11/2015 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 12/11/2015 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 12/11/2015 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 12/16/2015 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 12/16/2015 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 12/21/2015 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 1/5/2016 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 1/5/2016 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 1/12/2016 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 1/18/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 1/18/2016 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 1/19/2016 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 1/22/2016 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 2/5/2016 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 2/8/2016 4A - Medication errorHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 2/12/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 2/12/2016 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 2/15/2016 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 2/24/2016 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 2/24/2016 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 2/24/2016 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 3/10/2016 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 5/4/2016 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 5/4/2016 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 5/4/2016 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 5/4/2016 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 5/4/2016 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 5/4/2016 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 5/4/2016 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 5/4/2016 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 5/4/2016 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 5/4/2016 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 5/4/2016 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 5/18/2016 4A - Medication errorHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 6/27/2016 2B - Device function or useHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 6/27/2016 4A - Medication errorHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 6/28/2016 3A - Patient/Resident discharged to unauthorized personHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 7/6/2016 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 8/17/2016 5C - BurnHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 9/1/2016 1B - Wrong surgery/invasive procedure patientHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 9/1/2016 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 9/1/2016 7C - Sexual abuse/assaultHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 9/7/2016 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 9/7/2016 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 9/7/2016 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 9/13/2016 1B - Wrong surgery/invasive procedure patientHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 11/2/2016 4D - Death or serious injury of neonateHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 11/2/2016 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 11/2/2016 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 11/2/2016 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 11/16/2016 7C - Sexual abuse/assault

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DOH 689-013 September 2014Office of Community Health Systems Page 32 of 62

Adverse Events Quarterly ReportFacility by Date and Event - Q2 2020

Facility Credential Facility Name Facility County Date Confirmed Event TypeHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 12/16/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 1/24/2017 4A - Medication errorHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 2/13/2017 7C - Sexual abuse/assaultHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 3/13/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 3/14/2017 7C - Sexual abuse/assaultHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 3/22/2017 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 3/22/2017 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 3/23/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 3/23/2017 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 3/27/2017 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 4/26/2017 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 4/26/2017 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 5/10/2017 3B - Patient elopement (disappearance)HAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 5/10/2017 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 5/25/2017 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 5/25/2017 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 5/26/2017 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 6/5/2017 4B - Wrong blood productHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 6/26/2017 4A - Medication errorHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 8/15/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 8/23/2017 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 8/23/2017 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 8/23/2017 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 8/23/2017 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 8/23/2017 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 9/5/2017 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 9/28/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 10/25/2017 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 10/25/2017 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 11/3/2017 1A - Wrong surgery/invasive procedure siteHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 11/10/2017 1D - Unintended retention of foreign objectHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 12/1/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 12/4/2017 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 12/11/2017 4H - Irretrievable loss of irreplaceable biological specimenHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 12/12/2017 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 12/13/2017 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 12/29/2017 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 1/17/2018 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 1/18/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 1/24/2018 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 1/24/2018 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 2/20/2018 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 2/28/2018 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 2/28/2018 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 2/28/2018 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 3/19/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 3/28/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 3/28/2018 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 3/28/2018 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 3/28/2018 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 3/28/2018 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 4/23/2018 5C - BurnHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 4/25/2018 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 5/7/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 5/14/2018 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 5/22/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 5/23/2018 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 5/25/2018 1D - Unintended retention of foreign objectHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 5/31/2018 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 6/8/2018 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 7/5/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 7/17/2018 4A - Medication errorHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 7/18/2018 1A - Wrong surgery/invasive procedure siteHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 7/25/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 7/25/2018 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 8/27/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 9/11/2018 4A - Medication errorHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 9/27/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 10/4/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 10/10/2018 1A - Wrong surgery/invasive procedure siteHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 10/24/2018 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 12/3/2018 1B - Wrong surgery/invasive procedure patientHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 12/3/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 12/18/2018 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 1/21/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 1/25/2019 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 1/30/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 1/31/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 2/21/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 2/27/2019 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 2/27/2019 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 3/14/2019 1A - Wrong surgery/invasive procedure siteHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 3/18/2019 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 3/19/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 3/27/2019 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 4/12/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 4/30/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 5/6/2019 4A - Medication errorHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 5/7/2019 1A - Wrong surgery/invasive procedure siteHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 5/22/2019 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 5/22/2019 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 5/22/2019 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 5/30/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 6/11/2019 4A - Medication errorHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 6/26/2019 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 6/26/2019 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 7/1/2019 7C - Sexual abuse/assaultHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 8/14/2019 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 9/16/2019 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 9/23/2019 3C - Patient suicide, attempted suicide, or self-harm

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Adverse EventsFacilities and Date of Event Report 2006-2020

DOH 689-013 September 2014Office of Community Health Systems Page 33 of 62

Adverse Events Quarterly ReportFacility by Date and Event - Q2 2020

Facility Credential Facility Name Facility County Date Confirmed Event TypeHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 10/10/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 10/14/2019 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 10/21/2019 7D - Physical assaultHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 10/23/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 10/23/2019 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 10/23/2019 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 10/29/2019 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 11/6/2019 1B - Wrong surgery/invasive procedure patientHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 11/12/2019 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 11/21/2019 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 12/5/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 12/16/2019 5C - BurnHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 1/17/2020 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 1/20/2020 4E - Patient death or serious injury associated with a fallHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 1/20/2020 4E - Patient death or serious injury associated with a fallHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 1/28/2020 4E - Patient death or serious injury associated with a fallHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 1/28/2020 4E - Patient death or serious injury associated with a fallHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 2/11/2020 4E - Patient death or serious injury associated with a fallHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 2/12/2020 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 2/24/2020 4E - Patient death or serious injury associated with a fallHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 3/20/2020 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 3/25/2020 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 3/25/2020 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 4/22/2020 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 4/22/2020 4f - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 4/24/2020 4E - Patient death or serious injury associated with a fallHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 4/29/2020 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 5/6/2020 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 5/11/2020 7D - Physical assaultHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 5/20/2020 7C - Sexual abuse/assaultHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 6/17/2020 1A - Wrong surgery/invasive procedure siteHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 6/24/2020 4F - Pressure ulcerHAC.FS.00000162 Providence Sacred Heart Medical Center and Children's Hospital 6/24/2020 4F - Pressure ulcer

298HAC.FS.00000194 Providence St Josephs Hospital Stevens 6/12/2013 4F - Pressure ulcerHAC.FS.00000194 Providence St Josephs Hospital 1/14/2015 4F - Pressure ulcerHAC.FS.00000194 Providence St Josephs Hospital 4/1/2017 4A - Medication errorHAC.FS.00000194 Providence St Josephs Hospital 8/7/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000194 Providence St Josephs Hospital 10/3/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000194 Providence St Josephs Hospital 3/6/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000194 Providence St Josephs Hospital 4/12/2018 4F - Pressure ulcerHAC.FS.00000194 Providence St Josephs Hospital 8/6/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000194 Providence St Josephs Hospital 10/11/2018 4F - Pressure ulcerHAC.FS.00000194 Providence St Josephs Hospital 11/26/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000194 Providence St Josephs Hospital 8/8/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000194 Providence St Josephs Hospital 8/15/2019 4E - Patient death or serious injury associated with a fall

12HAC.FS.00000050 Providence St Mary Medical Center Walla Walla 11/16/2006 4F - Pressure ulcerHAC.FS.00000050 Providence St Mary Medical Center 12/21/2006 2B - Device function or useHAC.FS.00000050 Providence St Mary Medical Center 5/2/2007 4E - Patient death or serious injury associated with a fallHAC.FS.00000050 Providence St Mary Medical Center 6/1/2007 1A - Wrong surgery/invasive procedure siteHAC.FS.00000050 Providence St Mary Medical Center 7/10/2007 4F - Pressure ulcerHAC.FS.00000050 Providence St Mary Medical Center 8/21/2007 1D - Unintended retention of foreign objectHAC.FS.00000050 Providence St Mary Medical Center 11/27/2007 1A - Wrong surgery/invasive procedure siteHAC.FS.00000050 Providence St Mary Medical Center 9/17/2008 1D - Unintended retention of foreign objectHAC.FS.00000050 Providence St Mary Medical Center 11/10/2009 1D - Unintended retention of foreign objectHAC.FS.00000050 Providence St Mary Medical Center 4/27/2012 5B - No gas, wrong gas, contaminated gasHAC.FS.00000050 Providence St Mary Medical Center 10/18/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000050 Providence St Mary Medical Center 4/20/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000050 Providence St Mary Medical Center 4/20/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000050 Providence St Mary Medical Center 6/27/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000050 Providence St Mary Medical Center 7/21/2017 1A - Wrong surgery/invasive procedure siteHAC.FS.00000050 Providence St Mary Medical Center 7/21/2017 4F - Pressure ulcerHAC.FS.00000050 Providence St Mary Medical Center 10/3/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000050 Providence St Mary Medical Center 10/7/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000050 Providence St Mary Medical Center 2/6/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000050 Providence St Mary Medical Center 2/6/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000050 Providence St Mary Medical Center 8/20/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000050 Providence St Mary Medical Center 5/31/2019 4F - Pressure ulcerHAC.FS.00000050 Providence St Mary Medical Center 1/31/2020 4E - Patient death or serious injury associated with a fallHAC.FS.00000050 Providence St Mary Medical Center 1/31/2020 4E - Patient death or serious injury associated with a fallHAC.FS.00000050 Providence St Mary Medical Center 1/31/2020 4E - Patient death or serious injury associated with a fall

25HAC.FS.00000050 Providence St Peter Hospital Thurston 12/11/2006 1A - Wrong surgery/invasive procedure siteHAC.FS.00000159 Providence St Peter Hospital 2/1/2007 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 2/1/2007 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 6/12/2007 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 6/12/2007 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 7/26/2007 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 7/26/2007 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 8/6/2007 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 8/29/2007 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 9/4/2007 4A - Medication errorHAC.FS.00000159 Providence St Peter Hospital 9/17/2007 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 10/8/2007 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 11/5/2007 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 11/19/2007 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 4/7/2008 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 5/13/2008 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 11/17/2008 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 12/10/2008 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 3/13/2009 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 4/13/2009 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 7/6/2009 4E - Patient death or serious injury associated with a fallHAC.FS.00000159 Providence St Peter Hospital 8/15/2009 7D - Physical assaultHAC.FS.00000159 Providence St Peter Hospital 10/29/2009 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 12/22/2009 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 12/22/2009 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 2/22/2010 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 2/22/2010 4F - Pressure ulcer

Providence St Mary Medical Center number of events:

Providence Sacred Heart Medical Center and Children's Hospital number of events:

Providence St Joseph's Hospital number of events:

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Adverse Events Quarterly ReportFacility by Date and Event - Q2 2020

Facility Credential Facility Name Facility County Date Confirmed Event TypeHAC.FS.00000159 Providence St Peter Hospital 4/1/2010 4E - Patient death or serious injury associated with a fallHAC.FS.00000159 Providence St Peter Hospital 4/2/2010 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 5/7/2010 4E - Patient death or serious injury associated with a fallHAC.FS.00000159 Providence St Peter Hospital 6/17/2010 5D - RestraintsHAC.FS.00000159 Providence St Peter Hospital 7/1/2010 4E - Patient death or serious injury associated with a fallHAC.FS.00000159 Providence St Peter Hospital 7/20/2010 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 7/26/2010 1A - Wrong surgery/invasive procedure siteHAC.FS.00000159 Providence St Peter Hospital 8/16/2010 4E - Patient death or serious injury associated with a fallHAC.FS.00000159 Providence St Peter Hospital 9/20/2010 4E - Patient death or serious injury associated with a fallHAC.FS.00000159 Providence St Peter Hospital 10/6/2010 4E - Patient death or serious injury associated with a fallHAC.FS.00000159 Providence St Peter Hospital 11/4/2010 4E - Patient death or serious injury associated with a fallHAC.FS.00000159 Providence St Peter Hospital 12/20/2010 1A - Wrong surgery/invasive procedure siteHAC.FS.00000159 Providence St Peter Hospital 12/20/2010 1A - Wrong surgery/invasive procedure siteHAC.FS.00000159 Providence St Peter Hospital 12/20/2010 4E - Patient death or serious injury associated with a fallHAC.FS.00000159 Providence St Peter Hospital 1/27/2011 4E - Patient death or serious injury associated with a fallHAC.FS.00000159 Providence St Peter Hospital 2/7/2011 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 2/7/2011 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 2/23/2011 1D - Unintended retention of foreign objectHAC.FS.00000159 Providence St Peter Hospital 2/24/2011 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 2/24/2011 4E - Patient death or serious injury associated with a fallHAC.FS.00000159 Providence St Peter Hospital 4/18/2011 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 8/12/2011 4E - Patient death or serious injury associated with a fallHAC.FS.00000159 Providence St Peter Hospital 10/11/2011 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 10/17/2012 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 10/30/2012 7C - Sexual abuse/assaultHAC.FS.00000159 Providence St Peter Hospital 2/14/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000159 Providence St Peter Hospital 3/21/2013 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 6/28/2013 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 7/2/2013 1A - Wrong surgery/invasive procedure siteHAC.FS.00000159 Providence St Peter Hospital 8/22/2013 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 8/22/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000159 Providence St Peter Hospital 10/9/2013 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 10/10/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000159 Providence St Peter Hospital 10/10/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000159 Providence St Peter Hospital 11/18/2013 1A - Wrong surgery/invasive procedure siteHAC.FS.00000159 Providence St Peter Hospital 11/18/2013 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 11/27/2013 1A - Wrong surgery/invasive procedure siteHAC.FS.00000159 Providence St Peter Hospital 1/7/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000159 Providence St Peter Hospital 1/30/2014 1A - Wrong surgery/invasive procedure siteHAC.FS.00000159 Providence St Peter Hospital 3/19/2014 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 3/19/2014 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 3/19/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000159 Providence St Peter Hospital 5/14/2014 4D - Death or serious injury of neonateHAC.FS.00000159 Providence St Peter Hospital 6/20/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000159 Providence St Peter Hospital 7/23/2014 1A - Wrong surgery/invasive procedure siteHAC.FS.00000159 Providence St Peter Hospital 8/4/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000159 Providence St Peter Hospital 9/22/2014 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 11/6/2014 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 11/8/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000159 Providence St Peter Hospital 11/14/2014 1D - Unintended retention of foreign objectHAC.FS.00000159 Providence St Peter Hospital 12/3/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000159 Providence St Peter Hospital 3/19/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000159 Providence St Peter Hospital 5/12/2015 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 6/9/2015 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 7/20/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000159 Providence St Peter Hospital 7/20/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000159 Providence St Peter Hospital 8/24/2015 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 8/24/2015 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 8/31/2015 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 10/29/2015 1D - Unintended retention of foreign objectHAC.FS.00000159 Providence St Peter Hospital 12/30/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000159 Providence St Peter Hospital 2/9/2016 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 2/16/2016 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.00000159 Providence St Peter Hospital 2/28/2016 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 6/28/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000159 Providence St Peter Hospital 9/21/2016 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 9/26/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000159 Providence St Peter Hospital 10/5/2016 7C - Sexual abuse/assaultHAC.FS.00000159 Providence St Peter Hospital 10/24/2016 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 11/29/2016 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 12/8/2016 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 1/16/2017 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 1/29/2017 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 2/4/2017 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 3/22/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000159 Providence St Peter Hospital 3/30/2017 1A - Wrong surgery/invasive procedure siteHAC.FS.00000159 Providence St Peter Hospital 5/4/2017 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 5/22/2017 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 5/22/2017 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 6/2/2017 4A - Medication errorHAC.FS.00000159 Providence St Peter Hospital 6/30/2017 1C - Wrong surgical/invasive procedureHAC.FS.00000158 Providence St Peter Hospital 8/25/2017 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 9/11/2017 1A - Wrong surgery/invasive procedure siteHAC.FS.00000159 Providence St Peter Hospital 10/3/2017 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 10/5/2017 1C - Wrong surgical/invasive procedureHAC.FS.00000159 Providence St Peter Hospital 10/20/2017 1D - Unintended retention of foreign objectHAC.FS.00000159 Providence St Peter Hospital 10/25/2017 1D - Unintended retention of foreign objectHAC.FS.00000159 Providence St Peter Hospital 11/27/2017 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 1/24/2018 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 2/7/2018 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 2/13/2018 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 3/5/2018 1D - Unintended retention of foreign objectHAC.FS.00000159 Providence St Peter Hospital 3/27/2018 1A - Wrong surgery/invasive procedure siteHAC.FS.00000159 Providence St Peter Hospital 4/4/2018 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 4/17/2018 4D - Death or serious injury of neonateHAC.FS.00000159 Providence St Peter Hospital 4/24/2018 1D - Unintended retention of foreign objectHAC.FS.00000159 Providence St Peter Hospital 5/23/2018 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 6/1/2018 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 6/12/2018 4A - Medication errorHAC.FS.00000159 Providence St Peter Hospital 7/18/2018 4F - Pressure ulcer

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Adverse Events Quarterly ReportFacility by Date and Event - Q2 2020

Facility Credential Facility Name Facility County Date Confirmed Event TypeHAC.FS.00000159 Providence St Peter Hospital 7/31/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000159 Providence St Peter Hospital 8/10/2018 1D - Unintended retention of foreign objectHAC.FS.00000159 Providence St Peter Hospital 8/13/2018 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 8/22/2018 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 8/22/2018 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 8/23/2018 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 9/19/2018 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 10/18/2018 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 11/21/2018 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 11/21/2018 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 11/29/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000159 Providence St Peter Hospital 12/3/2018 4A - Medication errorHAC.FS.00000159 Providence St Peter Hospital 12/18/2018 1A - Wrong surgery/invasive procedure siteHAC.FS.00000159 Providence St Peter Hospital 12/18/2018 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 12/18/2018 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 12/19/2018 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 3/7/2019 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 3/11/2019 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 3/13/2019 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 3/21/2019 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 3/21/2019 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 3/21/2019 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 3/21/2019 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 5/28/2019 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 5/28/2019 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 5/28/2019 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 6/19/2019 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 7/2/2019 4A - Medication errorHAC.FS.00000159 Providence St Peter Hospital 7/2/2019 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 7/18/2019 7C - Sexual abuse/assaultHAC.FS.00000159 Providence St Peter Hospital 8/12/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000159 Providence St Peter Hospital 8/12/2019 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 8/12/2019 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 9/12/2019 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 9/18/2019 1D - Unintended retention of foreign objectHAC.FS.00000159 Providence St Peter Hospital 9/18/2019 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.00000159 Providence St Peter Hospital 9/18/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000159 Providence St Peter Hospital 9/18/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000159 Providence St Peter Hospital 9/24/2019 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 12/20/2019 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 12/20/2019 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 12/24/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000159 Providence St Peter Hospital 3/5/2020 1D - Unintended retention of foreign objectHAC.FS.00000159 Providence St Peter Hospital 3/10/2020 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 3/26/2020 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 3/26/2020 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 4/30/2020 1C - Wrong surgical/invasive procedureHAC.FS.00000159 Providence St Peter Hospital 6/15/2020 4F - Pressure ulcerHAC.FS.00000159 Providence St Peter Hospital 6/25/2020 4F - Pressure ulcer

176HAC.FS.00000172 Pullman Regional Hospital Whitman 2/29/2008 4A - Medication errorHAC.FS.00000172 Pullman Regional Hospital 1/26/2010 1D - Unintended retention of foreign objectHAC.FS.00000172 Pullman Regional Hospital 12/17/2015 1A - Wrong surgery/invasive procedure siteHAC.FS.00000172 Pullman Regional Hospital 6/14/2017 1D - Unintended retention of foreign objectHAC.FS.00000172 Pullman Regional Hospital 6/2/2018 1D - Unintended retention of foreign object

5HAC.FS.00000129 Quincy Valley Medical Center Grant 12/23/2014 4F - Pressure ulcer

1HAC.FS.00000202 Regional Hospital for Respiratory & Complex Care King 4/19/2007 4F - Pressure ulcerHAC.FS.00000202 Regional Hospital for Respiratory & Complex Care 1/20/2011 4F - Pressure ulcerHAC.FS.00000202 Regional Hospital for Respiratory & Complex Care 6/20/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000202 Regional Hospital 9/8/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000202 Regional Hospital 11/2/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000202 Regional Hospital 3/21/2018 4F - Pressure ulcerHAC.FS.00000202 Regional Hospital 4/14/2018 4F - Pressure ulcerHAC.FS.00000203 Regional Hospital 8/23/2019 4F - Pressure ulcer

8HAC.FS.00000078 Samaritan Hospital Grant 9/21/2007 1E- Post-operative deathHAC.FS.00000078 Samaritan Hospital 11/21/2007 1D - Unintended retention of foreign objectHAC.FS.00000078 Samaritan Hospital 8/9/2008 4A - Medication errorHAC.FS.00000078 Samaritan Hospital 1/15/2009 7D - Physical assaultHAC.FS.00000078 Samaritan Hospital 12/8/2009 4E - Patient death or serious injury associated with a fallHAC.FS.00000078 Samaritan Hospital 6/15/2010 4A - Medication errorHAC.FS.00000078 Samaritan Hospital 8/27/2010 16 - HyperbilirubinemiaHAC.FS.00000078 Samaritan Hospital 10/29/2010 1D - Unintended retention of foreign objectHAC.FS.00000078 Samaritan Hospital 4/28/2012 **4E - Patient death or serious injury associated with a fallHAC.FS.00000078 Samaritan Hospital 11/30/2012 1D - Unintended retention of foreign objectHAC.FS.00000078 Samaritan Hospital 12/18/2012 5C - BurnHAC.FS.00000078 Samaritan Hospital 3/4/2013 1A - Wrong surgery/invasive procedure siteHAC.FS.00000078 Samaritan Hospital 12/13/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000078 Samaritan Healthcare 6/17/2015 4F - Pressure ulcerHAC.FS.00000078 Samaritan Healthcare 11/30/2018 **4E - Patient death or serious injury associated with a fallHAC.FS.00000078 Samaritan Healthcare 11/1/2019 5C - Burn

16HAC.FS.00000204 Seattle Cancer Care Alliance King 2/7/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000204 Seattle Cancer Care Alliance 5/20/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000204 Seattle Cancer Care Alliance 11/21/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000204 Seattle Cancer Care Alliance 8/2/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000204 Seattle Cancer Care Alliance 5/3/2017 1C - Wrong surgical/invasive procedureHAC.FS.00000204 Seattle Cancer Care Alliance 4/13/2018 1C - Wrong surgical/invasive procedureHAC.FS.00000204 Seattle Cancer Care Alliance 7/18/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000204 Seattle Cancer Care Alliance 12/10/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000204 Seattle Cancer Care Alliance 2/22/2019 7C - Sexual abuse/assaultHAC.FS.00000204 Seattle Cancer Care Alliance 4/10/2019 4A - Medication errorHAC.FS.00000204 Seattle Cancer Care Alliance 5/20/2019 4A - Medication errorHAC.FS.00000204 Seattle Cancer Care Alliance 6/6/2019 4A - Medication errorHAC.FS.00000204 Seattle Cancer Care Alliance 6/6/2019 7C - Sexual abuse/assaultHAC.FS.00000204 Seattle Cancer Care Alliance 7/11/2019 4B - Wrong blood productHAC.FS.00000204 Seattle Cancer Care Alliance 7/11/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000204 Seattle Cancer Care Alliance 5/7/2020 7C - Sexual abuse/assault

Regional Hospital number of events:

Samaritan Healthcare number of events:

Providence St Peter Hospital number of events:

Pullman Regional Hospital number of events:

Quincy Valley Medical Center number of events:

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DOH 689-013 September 2014Office of Community Health Systems Page 36 of 62

Adverse Events Quarterly ReportFacility by Date and Event - Q2 2020

Facility Credential Facility Name Facility County Date Confirmed Event Type16

HAC.FS.00000014 Seattle Children's Hospital King 6/20/2006 7B - Patient/Resident abductionHAC.FS.00000014 Seattle Children's Hospital 8/15/2006 7C - Sexual abuse/assaultHAC.FS.00000014 Seattle Children's Hospital 8/17/2006 1D - Unintended retention of foreign objectHAC.FS.00000014 Seattle Children's Hospital 8/21/2006 2B - Device function or useHAC.FS.00000014 Seattle Children's Hospital 10/26/2006 4F - Pressure ulcerHAC.FS.00000014 Seattle Children's Hospital 9/24/2007 4F - Pressure ulcerHAC.FS.00000014 Seattle Children's Hospital 2/5/2008 4F - Pressure ulcerHAC.FS.00000014 Seattle Children's Hospital 7/9/2008 **7D - Physical assaultHAC.FS.00000014 Seattle Children's Hospital 10/3/2008 4F - Pressure ulcerHAC.FS.00000014 Seattle Children's Hospital 1/6/2009 4F - Pressure ulcerHAC.FS.00000014 Seattle Children's Hospital 2/10/2009 4F - Pressure ulcerHAC.FS.00000014 Seattle Children's Hospital 3/9/2009 4F - Pressure ulcerHAC.FS.00000014 Seattle Children's Hospital 3/11/2009 4A - Medication errorHAC.FS.00000014 Seattle Children's Hospital 8/10/2009 4E - Patient death or serious injury associated with a fallHAC.FS.00000014 Seattle Children's Hospital 10/13/2009 7C - Sexual abuse/assaultHAC.FS.00000014 Seattle Children's Hospital 12/8/2009 **1A - Wrong surgery/invasive procedure siteHAC.FS.00000014 Seattle Children's Hospital 12/22/2009 4F - Pressure ulcerHAC.FS.00000014 Seattle Children's Hospital 5/18/2010 **4F - Pressure ulcerHAC.FS.00000014 Seattle Children's Hospital 5/28/2010 **4F - Pressure ulcerHAC.FS.00000014 Seattle Children's Hospital 9/16/2010 4A - Medication errorHAC.FS.00000014 Seattle Children's Hospital 12/13/2010 4F - Pressure ulcerHAC.FS.00000014 Seattle Children's Hospital 1/10/2011 **1A - Wrong surgery/invasive procedure siteHAC.FS.00000014 Seattle Children's Hospital 5/31/2011 1D - Unintended retention of foreign objectHAC.FS.00000014 Seattle Children's Hospital 6/27/2011 4F - Pressure ulcerHAC.FS.00000014 Seattle Children's Hospital 9/8/2011 **7C - Sexual abuse/assaultHAC.FS.00000014 Seattle Children's Hospital 10/28/2011 **1D - Unintended retention of foreign objectHAC.FS.00000014 Seattle Children's Hospital 10/24/2012 **1C - Wrong surgical/invasive procedureHAC.FS.00000014 Seattle Children's Hospital 11/29/2012 4F - Pressure ulcerHAC.FS.00000014 Seattle Children's Hospital 5/6/2013 4F - Pressure ulcerHAC.FS.00000014 Seattle Children's Hospital 5/28/2013 1A - Wrong surgery/invasive procedure siteHAC.FS.00000014 Seattle Children's Hospital 6/12/2013 2B - Device function or useHAC.FS.00000014 Seattle Children's Hospital 6/24/2013 4F - Pressure ulcerHAC.FS.00000014 Seattle Children's Hospital 12/19/2013 1D - Unintended retention of foreign objectHAC.FS.00000014 Seattle Children's Hospital 12/23/2013 4F - Pressure ulcerHAC.FS.00000014 Seattle Children's Hospital 6/11/2014 4F - Pressure ulcerHAC.FS.00000014 Seattle Children's Hospital 7/1/2014 **7C - Sexual abuse/assaultHAC.FS.00000014 Seattle Children's Hospital 8/5/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000014 Seattle Children's Hospital 9/17/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000014 Seattle Children's Hospital 10/1/2014 4F - Pressure ulcerHAC.FS.00000014 Seattle Children's Hospital 10/9/2014 4F - Pressure ulcerHAC.FS.00000014 Seattle Children's Hospital 11/11/2014 4F - Pressure ulcerHAC.FS.00000014 Seattle Children's Hospital 2/18/2015 4F - Pressure ulcerHAC.FS.00000014 Seattle Children's Hospital 2/26/2015 1D - Unintended retention of foreign objectHAC.FS.00000014 Seattle Children's Hospital 3/20/2015 1D - Unintended retention of foreign objectHAC.FS.00000014 Seattle Children's Hospital 8/10/2015 4F - Pressure ulcerHAC.FS.00000014 Seattle Children's Hospital 8/13/2015 4F - Pressure ulcerHAC.FS.00000014 Seattle Children's Hospital 12/21/2015 1C - Wrong surgical/invasive procedureHAC.FS.00000014 Seattle Children's Hospital 2/8/2016 4F - Pressure ulcerHAC.FS.00000014 Seattle Children's Hospital 3/2/2016 4F - Pressure ulcerHAC.FS.00000014 Seattle Children's Hospital 4/7/2016 4F - Pressure ulcerHAC.FS.00000014 Seattle Children's Hospital 4/22/2016 4F - Pressure ulcerHAC.FS.00000014 Seattle Children's Hospital 6/8/2016 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.00000014 Seattle Children's Hospital 6/20/2016 7D - Physical assaultHAC.FS.00000014 Seattle Children's Hospital 9/13/2016 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.00000014 Seattle Children's Hospital 11/10/2016 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.00000014 Seattle Children's Hospital 12/2/2016 1D - Unintended retention of foreign objectHAC.FS.00000014 Seattle Children's Hospital 1/26/2017 4F - Pressure ulcerHAC.FS.00000014 Seattle Childrens Hospital 1/30/2017 4A - Medication errorHAC.FS.00000014 Seattle Childrens Hospital 2/6/2017 1A - Wrong surgery/invasive procedure siteHAC.FS.00000014 Seattle Childrens Hospital 2/6/2017 1D - Unintended retention of foreign objectHAC.FS.00000014 Seattle Childrens Hospital 3/27/2017 1A - Wrong surgery/invasive procedure siteHAC.FS.00000014 Seattle Childrens Hospital 3/28/2017 4F - Pressure ulcerHAC.FS.00000014 Seattle Childrens Hospital 3/30/2017 4A - Medication errorHAC.FS.00000014 Seattle Childrens Hospital 5/18/2017 4F - Pressure ulcerHAC.FS.00000014 Seattle Childrens Hospital 6/26/2017 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.00000014 Seattle Childrens Hospital 6/27/2017 4F - Pressure ulcerHAC.FS.00000014 Seattle Childrens Hospital 7/10/2017 4F - Pressure ulcerHAC.FS.00000014 Seattle Childrens Hospital 7/26/2017 1D - Unintended retention of foreign objectHAC.FS.00000014 Seattle Childrens Hospital 8/23/2017 7B - Patient/Resident abductionHAC.FS.00000014 Seattle Childrens Hospital 9/20/2017 4F - Pressure ulcerHAC.FS.00000014 Seattle Childrens Hospital 11/2/2017 4F - Pressure ulcerHAC.FS.00000014 Seattle Childrens Hospital 11/14/2017 4F - Pressure ulcerHAC.FS.00000014 Seattle Childrens Hospital 1/3/2018 4F - Pressure ulcerHAC.FS.00000014 Seattle Childrens Hospital 1/3/2018 4F - Pressure ulcerHAC.FS.00000014 Seattle Childrens Hospital 1/22/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000014 Seattle Childrens Hospital 2/9/2018 4F - Pressure ulcerHAC.FS.00000014 Seattle Childrens Hospital 2/16/2018 4F - Pressure ulcerHAC.FS.00000014 Seattle Childrens Hospital 2/20/2018 4F - Pressure ulcerHAC.FS.00000014 Seattle Childrens Hospital 2/26/2018 4F - Pressure ulcerHAC.FS.00000014 Seattle Childrens Hospital 3/1/2018 4F - Pressure ulcerHAC.FS.00000014 Seattle Childrens Hospital 4/23/2018 4F - Pressure ulcerHAC.FS.00000014 Seattle Childrens Hospital 5/1/2018 4F - Pressure ulcerHAC.FS.00000014 Seattle Childrens Hospital 5/9/2018 4F - Pressure ulcerHAC.FS.00000014 Seattle Childrens Hospital 5/22/2018 4F - Pressure ulcerHAC.FS.00000014 Seattle Childrens Hospital 5/22/2018 4F - Pressure ulcerHAC.FS.00000014 Seattle Childrens Hospital 5/30/2018 4F - Pressure ulcerHAC.FS.00000014 Seattle Childrens Hospital 7/17/2018 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.00000014 Seattle Childrens Hospital 7/17/2018 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.00000014 Seattle Childrens Hospital 8/14/2018 4F - Pressure ulcerHAC.FS.00000014 Seattle Childrens Hospital 8/14/2018 4F - Pressure ulcerHAC.FS.00000014 Seattle Childrens Hospital 8/14/2018 4F - Pressure ulcerHAC.FS.00000014 Seattle Childrens Hospital 8/29/2018 4I - Failure to follow up with test resultsHAC.FS.00000014 Seattle Childrens Hospital 9/4/2018 1C - Wrong surgical/invasive procedureHAC.FS.00000014 Seattle Childrens Hospital 9/5/2018 4F - Pressure ulcerHAC.FS.00000014 Seattle Childrens Hospital 9/24/2018 4A - Medication errorHAC.FS.00000014 Seattle Childrens Hospital 9/27/2018 4F - Pressure ulcerHAC.FS.00000014 Seattle Childrens Hospital 11/13/2018 4F - Pressure ulcerHAC.FS.00000014 Seattle Childrens Hospital 12/4/2018 4F - Pressure ulcerHAC.FS.00000014 Seattle Childrens Hospital 12/18/2018 4F - Pressure ulcer

Seattle Cancer Care Alliance number of events:

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Adverse Events Quarterly ReportFacility by Date and Event - Q2 2020

Facility Credential Facility Name Facility County Date Confirmed Event TypeHAC.FS.00000014 Seattle Childrens Hospital 1/23/2019 4F - Pressure ulcerHAC.FS.00000014 Seattle Childrens Hospital 2/12/2019 4A - Medication errorHAC.FS.00000014 Seattle Childrens Hospital 3/7/2019 4A - Medication errorHAC.FS.00000014 Seattle Childrens Hospital 4/8/2019 1A - Wrong surgery/invasive procedure siteHAC.FS.00000014 Seattle Childrens Hospital 4/23/2019 4F - Pressure ulcerHAC.FS.00000014 Seattle Childrens Hospital 5/1/2019 1A - Wrong surgery/invasive procedure siteHAC.FS.00000014 Seattle Childrens Hospital 5/21/2019 1D - Unintended retention of foreign object HAC.FS.00000014 Seattle Childrens Hospital 6/4/2019 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.00000014 Seattle Childrens Hospital 7/18/2019 4F - Pressure ulcerHAC.FS.00000014 Seattle Childrens Hospital 8/9/2019 7C - Sexual abuse/assaultHAC.FS.00000014 Seattle Childrens Hospital 8/9/2019 7C - Sexual abuse/assaultHAC.FS.00000014 Seattle Childrens Hospital 9/13/2019 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.00000014 Seattle Childrens Hospital 9/26/2019 **7C - Sexual abuse/assaultHAC.FS.00000014 Seattle Childrens Hospital 10/21/2019 1D - Unintended retention of foreign objectHAC.FS.00000014 Seattle Childrens Hospital 1/7/2020 5B - No gas, wrong gas, contaminated gasHAC.FS.00000014 Seattle Childrens Hospital 1/8/2020 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.00000014 Seattle Childrens Hospital 1/31/2020 4E - Patient death or serious injury associated with a fallHAC.FS.00000014 Seattle Childrens Hospital 2/5/2020 4F - Pressure ulcerHAC.FS.00000014 Seattle Childrens Hospital 3/20/2020 4F - Pressure ulcerHAC.FS.00000014 Seattle Childrens Hospital 3/20/2020 4F - Pressure ulcerHAC.FS.00000014 Seattle Childrens Hospital 4/29/2020 5B - No gas, wrong gas, contaminated gasHAC.FS.00000014 Seattle Childrens Hospital 6/2/2020 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.00000014 Seattle Childrens Hospital 6/10/2020 3C - Patient suicide, attempted suicide, or self-harm

122HAC.FS.00000042 Shriners Hospitals for Children Spokane 6/2/2011 1A - Wrong surgery/invasive procedure siteHAC.FS.00000042 Shriners Hospitals for Children 5/10/2016 1A - Wrong surgery/invasive procedure site

2HAC.FS.00000207 Skagit Valley Hospital Skagit 8/19/2006 4F - Pressure ulcerHAC.FS.00000207 Skagit Valley Hospital 10/19/2006 4E - Patient death or serious injury associated with a fallHAC.FS.00000207 Skagit Valley Hospital 11/4/2007 4F - Pressure ulcerHAC.FS.00000207 Skagit Valley Hospital 1/9/2008 1A - Wrong surgery/invasive procedure siteHAC.FS.00000207 Skagit Valley Hospital 4/9/2008 1D - Unintended retention of foreign objectHAC.FS.00000207 Skagit Valley Hospital 6/13/2008 1D - Unintended retention of foreign objectHAC.FS.00000207 Skagit Valley Hospital 7/7/2008 4E - Patient death or serious injury associated with a fallHAC.FS.00000207 Skagit Valley Hospital 8/19/2008 4B - Wrong blood productHAC.FS.00000207 Skagit Valley Hospital 3/19/2009 4F - Pressure ulcerHAC.FS.00000207 Skagit Valley Hospital 12/30/2009 4E - Patient death or serious injury associated with a fallHAC.FS.00000207 Skagit Valley Hospital 2/19/2010 4E - Patient death or serious injury associated with a fallHAC.FS.00000207 Skagit Valley Hospital 4/6/2010 4E - Patient death or serious injury associated with a fallHAC.FS.00000207 Skagit Valley Hospital 1/13/2011 5D - RestraintsHAC.FS.00000207 Skagit Valley Hospital 5/30/2012 1B - Wrong surgery/invasive procedure patientHAC.FS.00000207 Skagit Valley Hospital 9/27/2012 1C - Wrong surgical/invasive procedureHAC.FS.00000207 Skagit Valley Hospital 10/19/2012 4F - Pressure ulcerHAC.FS.00000207 Skagit Valley Hospital 11/27/2012 4F - Pressure ulcerHAC.FS.00000207 Skagit Valley Hospital 3/29/2013 1D - Unintended retention of foreign object HAC.FS.00000207 Skagit Valley Hospital 6/6/2013 4F - Pressure ulcerHAC.FS.00000207 Skagit Valley Hospital 7/22/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000207 Skagit Valley Hospital 7/22/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000207 Skagit Valley Hospital 12/18/2013 4F - Pressure ulcerHAC.FS.00000207 Skagit Valley Hospital 1/2/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000207 Skagit Valley Hospital 2/26/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000207 Skagit Valley Hospital 12/18/2014 4F - Pressure ulcerHAC.FS.00000207 Skagit Regional Hospital 3/27/2015 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.00000207 Skagit Valley Hospital 5/16/2015 4F - Pressure ulcerHAC.FS.00000207 Skagit Valley Hospital 7/17/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000207 Skagit Valley Hospital 7/18/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000207 Skagit Valley Hospital 8/24/2015 1D - Unintended retention of foreign object HAC.FS.00000207 Skagit Valley Hospital 9/15/2015 4F - Pressure ulcerHAC.FS.00000207 Skagit Valley Hospital 12/17/2015 4F - Pressure ulcerHAC.FS.00000207 Skagit Valley Hospital 3/3/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000207 Skagit Valley Hospital 5/22/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000207 Skagit Valley Hospital 12/12/2016 4A - Medication errorHAC.FS.00000207 Skagit Valley Hospital 1/3/2017 4F - Pressure ulcerHAC.FS.00000207 Skagit Valley Hospital 7/31/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000207 Skagit Valley Hospital 12/8/2017 1A - Wrong surgery/invasive procedure siteHAC.FS.00000207 Skagit Valley Hospital 1/15/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000207 Skagit Valley Hospital 3/27/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000207 Skagit Valley Hospital 7/30/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000207 Skagit Valley Hospital 1/8/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000207 Skagit Regional Hospital 4/16/2019 **1A - Wrong surgery/invasive procedure siteHAC.FS.00000207 Skagit Regional Hospital 7/12/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000207 Skagit Regional Hospital 8/5/2019 4F - Pressure ulcerHAC.FS.00000207 Skagit Regional Hospital 6/4/2020 4E - Patient death or serious injury associated with a fall

46HAC.FS.00000096 Skyline Hospital Klickitat 3/7/2011 **4B - Wrong blood productHAC.FS.00000096 Skyline Hospital 10/28/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000096 Skyline Hospital 7/18/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000096 Skyline Hospital 8/28/2017 4E - Patient death or serious injury associated with a fall

4HAC.FS.00000195 Snoqualmie Valley Hospital Clinics King 11/30/2011 4F - Pressure ulcerHAC.FS.00000195 Snoqualmie Valley Hospital Clinics 10/26/2012 **5B - No gas, wrong gas, contaminated gasHAC.FS.00000195 Snoqualmie Valley Hospital Clinics 11/20/2012 **5B - No gas, wrong gas, contaminated gasHAC.FS.00000195 Snoqualmie Valley Hospital Clinics 9/27/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000195 Snoqualmie Valley Hospital Clinics 1/7/2014 5D - RestraintsHAC.FS.00000195 Snoqualmie Valley Hospital Clinics 6/4/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000195 Snoqualmie Valley Hospital Clinics 5/19/2016 **4E - Patient death or serious injury associated with a fallHAC.FS.00000195 Snoqualmie Valley Hospital Clinics 10/21/2016 **4F - Pressure ulcerHAC.FS.00000195 Snoqualmie Valley Hospital Clinics 8/21/2017 **4F - Pressure ulcerHAC.FS.00000195 Snoqualmie Valley Hospital Clinics 1/29/2018 **4F - Pressure ulcerHAC.FS.00000195 Snoqualmie Valley Hospital Clinics 11/23/2018 4F - Pressure ulcerHAC.FS.00000195 Snoqualmie Valley Hospital Clinics 12/3/2019 4E - Patient death or serious injury associated with a fall

12HAC.FS.60075769 St Anthony Hospital Pierce 5/16/2011 1C - Wrong surgical/invasive procedureHAC.FS.60075769 St Anthony Hospital 8/25/2011 1A - Wrong surgery/invasive procedure siteHAC.FS.60075769 St Anthony Hospital 7/19/2012 1C - Wrong surgical/invasive procedureHAC.FS.60075769 St Anthony Hospital 10/1/2012 4E - Patient death or serious injury associated with a fallHAC.FS.60075769 St Anthony Hospital 3/8/2013 4E - Patient death or serious injury associated with a fallHAC.FS.60075769 St Anthony Hospital 4/24/2014 1C - Wrong surgical/invasive procedureHAC.FS.60075769 St Anthony Hospital 10/24/2014 1B - Wrong surgery/invasive procedure patientHAC.FS.60075769 St Anthony Hospital 10/27/2014 4E - Patient death or serious injury associated with a fall

Skyline Hospital number of events:

Snoqualmie Valley Hospital number of events:

Seattle Childrens Hospital number of events:

Shriners Hospital for Children number of events:

Skagit Valley Hospital number of events:

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Adverse Events Quarterly ReportFacility by Date and Event - Q2 2020

Facility Credential Facility Name Facility County Date Confirmed Event TypeHAC.FS.60075769 St Anthony Hospital 11/4/2014 4E - Patient death or serious injury associated with a fallHAC.FS.60075769 St Anthony Hospital 12/18/2014 4A - Medication errorHAC.FS.60075769 St Anthony Hospital 1/12/2015 4E - Patient death or serious injury associated with a fallHAC.FS.60075769 St Anthony Hospital 2/12/2016 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.60075769 St Anthony Hospital 5/11/2016 5C - BurnHAC.FS.60075769 St Anthony Hospital 6/17/2016 1D - Unintended retention of foreign objectHAC.FS.60075769 St Anthony Hospital 6/17/2016 4E - Patient death or serious injury associated with a fallHAC.FS.60075769 St Anthony Hospital 2/13/2017 1D - Unintended retention of foreign objectHAC.FS.60075769 St Anthony Hospital 3/20/2017 4B - Wrong blood productHAC.FS.60075769 St Anthony Hospital 4/19/2017 1D - Unintended retention of foreign objectHAC.FS.60075769 St Anthony Hospital 8/23/2017 1C - Wrong surgical/invasive procedureHAC.FS.60075769 St Anthony Hospital 9/13/2017 1D - Unintended retention of foreign objectHAC.FS.60075769 St Anthony Hospital 2/5/2018 4F - Pressure ulcerHAC.FS.60075769 St Anthony Hospital 3/8/2018 4F - Pressure ulcerHAC.FS.60075769 St Anthony Hospital 6/5/2018 4F - Pressure ulcerHAC.FS.60075769 St Anthony Hospital 9/19/2018 4A - Medication errorHAC.FS.60075769 St Anthony Hospital 11/11/2019 4E - Patient death or serious injury associated with a fallHAC.FS.60075769 St Anthony Hospital 12/17/2019 4F - Pressure ulcerHAC.FS.60075769 St Anthony Hospital 6/18/2020 4F - Pressure ulcer

27HAC.FS.00000132 St Clare Hospital Pierce 9/20/2006 1A - Wrong surgery/invasive procedure siteHAC.FS.00000132 St Clare Hospital 11/8/2006 2B - Device function or useHAC.FS.00000132 St Clare Hospital 3/19/2009 4F - Pressure ulcerHAC.FS.00000132 St Clare Hospital 7/19/2011 4E - Patient death or serious injury associated with a fallHAC.FS.00000132 St Clare Hospital 6/25/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000132 St Clare Hospital 10/15/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000132 St Clare Hospital 11/25/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000132 St Clare Hospital 1/7/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000132 St Clare Hospital 1/14/2014 4F - Pressure ulcerHAC.FS.00000132 St Clare Hospital 1/31/2014 4F - Pressure ulcerHAC.FS.00000132 St Clare Hospital 4/13/2014 1D - Unintended retention of foreign objectHAC.FS.00000132 St Clare Hospital 5/1/2014 4H - Irretrievable loss of irreplaceable biological specimenHAC.FS.00000132 St Clare Hospital 5/1/2014 4H - Irretrievable loss of irreplaceable biological specimenHAC.FS.00000132 St Clare Hospital 5/1/2014 4H - Irretrievable loss of irreplaceable biological specimenHAC.FS.00000132 St Clare Hospital 6/17/2014 1C - Wrong surgical/invasive procedureHAC.FS.00000132 St Clare Hospital 8/5/2014 1D - Unintended retention of foreign objectHAC.FS.00000132 St Clare Hospital 8/21/2014 1C - Wrong surgical/invasive procedureHAC.FS.00000132 St Clare Hospital 8/21/2014 1C - Wrong surgical/invasive procedureHAC.FS.00000132 St Clare Hospital 9/17/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000132 St Clare Hospital 11/5/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000132 St Clare Hospital 1/15/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000132 St Clare Hospital 2/24/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000132 St Clare Hospital 4/3/2015 1C - Wrong surgical/invasive procedureHAC.FS.00000132 St Clare Hospital 6/4/2015 4F - Pressure ulcerHAC.FS.00000132 St Clare Hospital 6/19/2015 7C - Sexual abuse/assaultHAC.FS.00000132 St Clare Hospital 7/30/2015 4F - Pressure ulcerHAC.FS.00000132 St Clare Hospital 8/15/2015 4F - Pressure ulcerHAC.FS.00000132 St Clare Hospital 9/30/2015 1C - Wrong surgical/invasive procedureHAC.FS.00000132 St Clare Hospital 6/10/2016 4F - Pressure ulcerHAC.FS.00000132 St Clare Hospital 1/17/2017 4A - Medication errorHAC.FS.00000132 St Clare Hospital 6/29/2017 4F - Pressure ulcerHAC.FS.00000132 St Clare Hospital 3/5/2018 1C - Wrong surgical/invasive procedureHAC.FS.00000132 St Clare Hospital 8/3/2018 4A - Medication errorHAC.FS.00000132 St Clare Hospital 11/20/2018 1D - Unintended retention of foreign objectHAC.FS.00000132 St Clare Hospital 1/25/2019 1A - Wrong surgery/invasive procedure siteHAC.FS.00000132 St Clare Hospital 3/19/2019 3B - Patient elopement (disappearance)HAC.FS.00000132 St Clare Hospital 4/4/2019 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.00000132 St Clare Hospital 10/21/2019 4F - Pressure ulcerHAC.FS.00000132 St Clare Hospital 11/7/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000132 St Clare Hospital 11/7/2019 4F - Pressure ulcerHAC.FS.00000132 St Clare Hospital 2/5/2020 1D - Unintended retention of foreign objectHAC.FS.00000132 St Clare Hospital 6/11/2020 7D - Physical assault

42HAC.FS.00000035 St Elizabeth Hospital King 4/3/2014 1C - Wrong surgical/invasive procedureHAC.FS.00000035 St Elizabeth Hospital 3/6/2015 4D - Death or serious injury of neonateHAC.FS.00000035 St Elizabeth Hospital 6/1/2016 4F - Pressure ulcerHAC.FS.00000035 St Elizabeth Hospital 1/3/2018 4A - Medication errorHAC.FS.00000035 St Elizabeth Hospital 6/21/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000035 St Elizabeth Hospital 12/18/2019 4A - Medication errorHAC.FS.00000035 St Elizabeth Hospital 4/17/2020 3B - Patient elopement (disappearance)HAC.FS.00000035 St Elizabeth Hospital 5/14/2020 4E - Patient death or serious injury associated with a fallHAC.FS.00000035 St Elizabeth Hospital 6/5/2020 4E - Patient death or serious injury associated with a fallHAC.FS.00000035 St Elizabeth Hospital 6/23/2020 1D - Unintended retention of foreign object

10HAC.FS.00000201 St Francis Community Hospital King 1/17/2011 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.00000201 St Francis Community Hospital 1/31/2011 1D - Unintended retention of foreign objectHAC.FS.00000201 St Francis Community Hospital 3/25/2011 7C - Sexual abuse/assaultHAC.FS.00000201 St Francis Community Hospital 4/26/2011 7C - Sexual abuse/assaultHAC.FS.00000201 St Francis Community Hospital 10/29/2012 1A - Wrong surgery/invasive procedure siteHAC.FS.00000201 St Francis Community Hospital 11/9/2012 1C - Wrong surgical/invasive procedureHAC.FS.00000201 St Francis Community Hospital 2/6/2013 1A - Wrong surgery/invasive procedure siteHAC.FS.00000201 St Francis Community Hospital 3/14/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000201 St Francis Community Hospital 3/18/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000201 St Francis Community Hospital 3/20/2013 1C - Wrong surgical/invasive procedureHAC.FS.00000201 St Francis Community Hospital 3/22/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000201 St Francis Community Hospital 7/3/2013 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.00000201 St Francis Community Hospital 7/30/2013 1C - Wrong surgical/invasive procedureHAC.FS.00000201 St Francis Community Hospital 11/8/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000201 St Francis Community Hospital 12/10/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000201 St Francis Community Hospital 5/9/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000201 St Francis Community Hospital 7/11/2014 4F - Pressure ulcerHAC.FS.00000201 St Francis Community Hospital 7/16/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000201 St Francis Community Hospital 7/29/2014 4F - Pressure ulcerHAC.FS.00000201 St Francis Community Hospital 9/18/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000201 St Francis Community Hospital 11/3/2014 2A - Contaminated drugs, devices, biologicsHAC.FS.00000201 St Francis Community Hospital 11/18/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000201 St Francis Community Hospital 12/1/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000201 St Francis Community Hospital 12/12/2014 2A - Contaminated drugs, devices, biologicsHAC.FS.00000201 St Francis Community Hospital 12/19/2014 4F - Pressure ulcerHAC.FS.00000201 St Francis Community Hospital 2/23/2015 6A - Introduction of metallic object into MRI area

FHS St Anthony Hospital number of events:

St Clare Hospital number of events:

St Elizabeth Hospital number of events:

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DOH 689-013 September 2014Office of Community Health Systems Page 39 of 62

Adverse Events Quarterly ReportFacility by Date and Event - Q2 2020

Facility Credential Facility Name Facility County Date Confirmed Event TypeHAC.FS.00000201 St Francis Community Hospital 4/14/2015 4A - Medication errorHAC.FS.00000201 St Francis Community Hospital 4/24/2015 7C - Sexual abuse/assaultHAC.FS.00000201 St Francis Community Hospital 4/25/2015 4F - Pressure ulcerHAC.FS.00000201 St Francis Community Hospital 4/25/2015 4F - Pressure ulcerHAC.FS.00000201 St Francis Community Hospital 5/18/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000201 St Francis Community Hospital 7/28/2015 4A - Medication errorHAC.FS.00000201 St Francis Community Hospital 9/14/2015 4F - Pressure ulcerHAC.FS.00000201 St Francis Community Hospital 10/16/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000201 St Francis Hospital 12/11/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000201 St Francis Hospital 12/11/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000201 St Francis Hospital 12/28/2015 5B - No gas, wrong gas, contaminated gasHAC.FS.00000201 St Francis Hospital 1/6/2016 1C - Wrong surgical/invasive procedureHAC.FS.00000201 St Francis Hospital 4/2/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000201 St Francis Hospital 5/11/2016 4F - Pressure ulcerHAC.FS.00000201 St Francis Hospital 6/28/2016 4F - Pressure ulcerHAC.FS.00000201 St Francis Hospital 6/28/2016 4F - Pressure ulcerHAC.FS.00000201 St Francis Hospital 10/19/2016 4F - Pressure ulcerHAC.FS.00000201 St Francis Hospital 1/23/2017 4F - Pressure ulcerHAC.FS.00000201 St Francis Hospital 2/15/2017 4F - Pressure ulcerHAC.FS.00000201 St Francis Hospital 4/5/2017 4F - Pressure ulcerHAC.FS.00000201 St Francis Hospital 1/25/2018 4F - Pressure ulcerHAC.FS.00000201 St Francis Hospital 6/13/2018 4F - Pressure ulcerHAC.FS.00000201 St Francis Hospital 12/10/2018 1D - Unintended retention of foreign objectHAC.FS.00000201 St Francis Hospital 12/13/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000201 St Francis Hospital 5/2/2019 1D - Unintended retention of foreign objectHAC.FS.00000201 St Francis Hospital 10/7/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000201 St Francis Hospital 10/31/2017 4F - Pressure ulcerHAC.FS.00000201 St Francis Hospital 12/13/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000201 St Francis Hospital 12/26/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000201 St Francis Hospital 2/20/2020 4F - Pressure ulcerHAC.FS.00000201 St Francis Hospital 5/7/2020 4F - Pressure ulcerHAC.FS.00000201 St Francis Hospital 6/12/2020 4F - Pressure ulcerHAC.FS.00000201 St Francis Hospital 6/12/2020 4F - Pressure ulcerHAC.FS.00000201 St Francis Hospital 6/18/2020 4C - Maternal death or serious injuryHAC.FS.00000201 St Francis Hospital 6/22/2020 4F - Pressure ulcerHAC.FS.00000201 St Francis Hospital 6/29/2020 1D - Unintended retention of foreign object

62HAC.FS.00000032 St Joseph Medical Center Pierce 7/3/2006 1D - Unintended retention of foreign objectHAC.FS.00000032 St Joseph Medical Center 8/28/2006 4E - Patient death or serious injury associated with a fallHAC.FS.00000032 St Joseph Medical Center 6/6/2007 4F - Pressure ulcerHAC.FS.00000032 St Joseph Medical Center 7/15/2008 4F - Pressure ulcerHAC.FS.00000032 St Joseph Medical Center 8/5/2008 4E - Patient death or serious injury associated with a fallHAC.FS.00000032 St Joseph Medical Center 9/30/2008 4F - Pressure ulcerHAC.FS.00000032 St Joseph Medical Center 1/27/2009 1D - Unintended retention of foreign objectHAC.FS.00000032 St Joseph Medical Center 4/22/2009 1D - Unintended retention of foreign objectHAC.FS.00000032 St Joseph Medical Center 4/27/2009 1D - Unintended retention of foreign objectHAC.FS.00000032 St Joseph Medical Center 5/1/2009 4F - Pressure ulcerHAC.FS.00000032 St Joseph Medical Center 6/11/2009 4E - Patient death or serious injury associated with a fallHAC.FS.00000032 St Joseph Medical Center 6/22/2009 4F - Pressure ulcerHAC.FS.00000032 St Joseph Medical Center 6/25/2009 5B - No gas, wrong gas, contaminated gasHAC.FS.00000032 St Joseph Medical Center 7/30/2009 4F - Pressure ulcerHAC.FS.00000032 St Joseph Medical Center 1/20/2011 1D - Unintended retention of foreign objectHAC.FS.00000032 St Joseph Medical Center 5/13/2011 1D - Unintended retention of foreign objectHAC.FS.00000032 St Joseph Medical Center 6/29/2011 4F - Pressure ulcerHAC.FS.00000032 St Joseph Medical Center 8/9/2011 7C - Sexual abuse/assaultHAC.FS.00000032 St Joseph Medical Center 11/27/2011 1D - Unintended retention of foreign objectHAC.FS.00000032 St Joseph Medical Center 12/13/2011 1D - Unintended retention of foreign objectHAC.FS.00000032 St Joseph Medical Center 3/27/2012 1A - Wrong surgery/invasive procedure siteHAC.FS.00000032 St Joseph Medical Center 2/22/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000032 St Joseph Medical Center 2/26/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000032 St Joseph Medical Center 3/18/2013 4F - Pressure ulcerHAC.FS.00000032 St Joseph Medical Center 3/20/2013 1D - Unintended retention of foreign objectHAC.FS.00000032 St Joseph Medical Center 5/1/2013 1A - Wrong surgery/invasive procedure siteHAC.FS.00000032 St Joseph Medical Center 5/28/2013 1C - Wrong surgical/invasive procedureHAC.FS.00000032 St Joseph Medical Center 6/5/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000032 St Joseph Medical Center 8/9/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000032 St Joseph Medical Center 8/20/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000032 St Joseph Medical Center 8/20/2013 4I - Failure to follow up with test resultsHAC.FS.00000032 St Joseph Medical Center 8/23/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000032 St Joseph Medical Center 9/3/2013 1D - Unintended retention of foreign objectHAC.FS.00000032 St Joseph Medical Center 9/11/2013 1D - Unintended retention of foreign objectHAC.FS.00000032 St Joseph Medical Center 9/11/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000032 St Joseph Medical Center 9/13/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000032 St Joseph Medical Center 10/1/2013 1D - Unintended retention of foreign objectHAC.FS.00000032 St Joseph Medical Center 11/25/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000032 St Joseph Medical Center 11/27/2013 1D - Unintended retention of foreign objectHAC.FS.00000032 St Joseph Medical Center 12/10/2013 4F - Pressure ulcerHAC.FS.00000032 St Joseph Medical Center 2/3/2014 4F - Pressure ulcerHAC.FS.00000032 St Joseph Medical Center 2/5/2014 4F - Pressure ulcerHAC.FS.00000032 St Joseph Medical Center 3/18/2014 1D - Unintended retention of foreign objectHAC.FS.00000032 St Joseph Medical Center 3/25/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000032 St Joseph Medical Center 4/3/2014 1B - Wrong surgery/invasive procedure patientHAC.FS.00000032 St Joseph Medical Center 4/24/2014 4F - Pressure ulcerHAC.FS.00000032 St Joseph Medical Center 7/21/2014 4F - Pressure ulcerHAC.FS.00000032 St Joseph Medical Center 9/18/2014 4F - Pressure ulcerHAC.FS.00000032 St Joseph Medical Center 9/24/2014 1C - Wrong surgical/invasive procedureHAC.FS.00000032 St Joseph Medical Center 9/26/2014 1C - Wrong surgical/invasive procedureHAC.FS.00000032 St Joseph Medical Center 11/20/2014 4A - Medication errorHAC.FS.00000032 St Joseph Medical Center 1/7/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000032 St Joseph Medical Center 1/14/2015 4A - Medication errorHAC.FS.00000032 St Joseph Medical Center 1/17/2015 4A - Medication errorHAC.FS.00000032 St Joseph Medical Center 2/11/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000032 St Joseph Medical Center 3/2/2015 1C - Wrong surgical/invasive procedureHAC.FS.00000032 St Joseph Medical Center 3/11/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000032 St Joseph Medical Center 4/6/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000032 St Joseph Medical Center 6/17/2015 4F - Pressure ulcerHAC.FS.00000032 St Joseph Medical Center 7/2/2015 4F - Pressure ulcerHAC.FS.00000032 St Joseph Medical Center 7/28/2015 4A - Medication errorHAC.FS.00000032 St Joseph Medical Center 7/30/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000032 St Joseph Medical Center 9/23/2015 4E - Patient death or serious injury associated with a fall

St Francis Hospital number of events:

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Adverse EventsFacilities and Date of Event Report 2006-2020

DOH 689-013 September 2014Office of Community Health Systems Page 40 of 62

Adverse Events Quarterly ReportFacility by Date and Event - Q2 2020

Facility Credential Facility Name Facility County Date Confirmed Event TypeHAC.FS.00000032 St Joseph Medical Center 10/20/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000032 St Joseph Medical Center 11/18/2015 4F - Pressure ulcerHAC.FS.00000032 St Joseph Medical Center 11/30/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000032 St Joseph Medical Center 2/1/2016 1D - Unintended retention of foreign objectHAC.FS.00000032 St Joseph Medical Center 2/18/2016 4A - Medication errorHAC.FS.00000032 St Joseph Medical Center 3/3/2016 4F - Pressure ulcerHAC.FS.00000032 St Joseph Medical Center 3/18/2016 4F - Pressure ulcerHAC.FS.00000032 St Joseph Medical Center 5/24/2016 4F - Pressure ulcerHAC.FS.00000032 St Joseph Medical Center 6/3/2016 4F - Pressure ulcerHAC.FS.00000032 St Joseph Medical Center 7/7/2016 4F - Pressure ulcerHAC.FS.00000032 St Joseph Medical Center 7/18/2016 1A - Wrong surgery/invasive procedure siteHAC.FS.00000032 St Joseph Medical Center 7/29/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000032 St Joseph Medical Center 8/2/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000032 St Joseph Medical Center 9/12/2016 4F - Pressure ulcerHAC.FS.00000032 St Joseph Medical Center 9/20/2016 4F - Pressure ulcerHAC.FS.00000032 St Joseph Medical Center 9/29/2016 4A - Medication errorHAC.FS.00000032 St Joseph Medical Center 10/31/2016 4F - Pressure ulcerHAC.FS.00000032 St Joseph Medical Center 10/31/2016 4F - Pressure ulcerHAC.FS.00000032 St Joseph Medical Center 12/14/2016 4F - Pressure ulcerHAC.FS.00000032 St Joseph Medical Center 12/16/2016 4H - Irretrievable loss of irreplaceable biological specimenHAC.FS.00000032 St Joseph Medical Center 12/22/2016 4A - Medication errorHAC.FS.00000032 St Joseph Medical Center 1/5/2017 1C - Wrong surgical/invasive procedureHAC.FS.00000032 St Joseph Medical Center 1/25/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000032 St Joseph Medical Center 2/6/2017 4F - Pressure ulcerHAC.FS.00000032 St Joseph Medical Center 3/14/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000032 St Joseph Medical Center 3/17/2017 1D - Unintended retention of foreign objectHAC.FS.00000032 St Joseph Medical Center 3/21/2017 4F - Pressure ulcerHAC.FS.00000032 St Joseph Medical Center 3/28/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000032 St Joseph Medical Center 3/28/2017 4F - Pressure ulcerHAC.FS.00000032 St Joseph Medical Center 3/28/2017 4F - Pressure ulcerHAC.FS.00000032 St Joseph Medical Center 3/31/2017 4F - Pressure ulcerHAC.FS.00000032 St Joseph Medical Center 3/31/2017 4F - Pressure ulcerHAC.FS.00000032 St Joseph Medical Center 4/2/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000032 St Joseph Medical Center 4/4/2017 4F - Pressure ulcerHAC.FS.00000032 St Joseph Medical Center 4/7/2017 4F - Pressure ulcerHAC.FS.00000032 St Joseph Medical Center 4/12/2017 4F - Pressure ulcerHAC.FS.00000032 St Joseph Medical Center 5/11/2017 4F - Pressure ulcerHAC.FS.00000032 St Joseph Medical Center 5/24/2017 4F - Pressure ulcerHAC.FS.00000032 St Joseph Medical Center 5/24/2017 4F - Pressure ulcerHAC.FS.00000032 St Joseph Medical Center 5/31/2017 4F - Pressure ulcerHAC.FS.00000032 St Joseph Medical Center 6/19/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000032 St Joseph Medical Center 6/19/2017 4F - Pressure ulcerHAC.FS.00000032 St Joseph Medical Center 6/21/2017 1C - Wrong surgical/invasive procedureHAC.FS.00000032 St Joseph Medical Center 7/18/2017 4F - Pressure ulcerHAC.FS.00000033 St Joseph Medical Center 7/25/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000032 St Joseph Medical Center 7/25/2017 4F - Pressure ulcerHAC.FS.00000032 St Joseph Medical Center 10/5/2017 1D - Unintended retention of foreign objectHAC.FS.00000032 St Joseph Medical Center 10/5/2017 4F - Pressure ulcerHAC.FS.00000032 St Joseph Medical Center 10/6/2017 1A - Wrong surgery/invasive procedure siteHAC.FS.00000032 St Joseph Medical Center 11/29/2017 4F - Pressure ulcerHAC.FS.00000032 St Joseph Medical Center 11/30/2017 1A - Wrong surgery/invasive procedure siteHAC.FS.00000032 St Joseph Medical Center 12/6/2017 1D - Unintended retention of foreign objectHAC.FS.00000032 St Joseph Medical Center 12/6/2017 4F - Pressure ulcerHAC.FS.00000032 St Joseph Medical Center 12/6/2017 4F - Pressure ulcerHAC.FS.00000032 St Joseph Medical Center 12/7/2017 1D - Unintended retention of foreign objectHAC.FS.00000032 St Joseph Medical Center 12/14/2017 1A - Wrong surgery/invasive procedure siteHAC.FS.00000032 St Joseph Medical Center 1/9/2018 4F - Pressure ulcerHAC.FS.00000032 St Joseph Medical Center 1/9/2018 4F - Pressure ulcerHAC.FS.00000032 St Joseph Medical Center 1/9/2018 4F - Pressure ulcerHAC.FS.00000032 St Joseph Medical Center 1/11/2018 4F - Pressure ulcerHAC.FS.00000032 St Joseph Medical Center 1/15/2018 1D - Unintended retention of foreign objectHAC.FS.00000032 St Joseph Medical Center 2/6/2018 4F - Pressure ulcerHAC.FS.00000032 St Joseph Medical Center 2/13/2018 4F - Pressure ulcerHAC.FS.00000032 St Joseph Medical Center 2/13/2018 4F - Pressure ulcerHAC.FS.00000032 St Joseph Medical Center 2/16/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000032 St Joseph Medical Center 2/20/2018 4D - Death or serious injury of neonateHAC.FS.00000032 St Joseph Medical Center 3/5/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000032 St Joseph Medical Center 3/14/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000032 St Joseph Medical Center 4/13/2018 1D - Unintended retention of foreign objectHAC.FS.00000032 St Joseph Medical Center 4/13/2018 4C - Maternal death or serious injuryHAC.FS.00000032 St Joseph Medical Center 4/18/2018 1D - Unintended retention of foreign objectHAC.FS.00000032 St Joseph Medical Center 4/18/2018 1D - Unintended retention of foreign objectHAC.FS.00000032 St Joseph Medical Center 5/22/2018 1D - Unintended retention of foreign objectHAC.FS.00000032 St Joseph Medical Center 6/13/2018 4F - Pressure ulcerHAC.FS.00000032 St Joseph Medical Center 7/12/2018 4F - Pressure ulcerHAC.FS.00000032 St Joseph Medical Center 8/20/2018 1D - Unintended retention of foreign objectHAC.FS.00000032 St Joseph Medical Center 8/23/2018 4F - Pressure ulcerHAC.FS.00000032 St Joseph Medical Center 9/11/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000032 St Joseph Medical Center 9/21/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000032 St Joseph Medical Center 10/12/2018 1D - Unintended retention of foreign objectHAC.FS.00000032 St Joseph Medical Center 11/21/2018 4F - Pressure ulcerHAC.FS.00000032 St Joseph Medical Center 12/11/2018 4F - Pressure ulcerHAC.FS.00000032 St Joseph Medical Center 3/25/2019 1C - Wrong surgical/invasive procedureHAC.FS.00000032 St Joseph Medical Center 3/25/2019 1D - Unintended retention of foreign objectHAC.FS.00000032 St Joseph Medical Center 3/25/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000032 St Joseph Medical Center 3/29/2019 4F - Pressure ulcerHAC.FS.00000032 St Joseph Medical Center 4/8/2019 4F - Pressure ulcerHAC.FS.00000032 St Joseph Medical Center 5/6/2019 1C - Wrong surgical/invasive procedureHAC.FS.00000032 St Joseph Medical Center 5/14/2019 4F - Pressure ulcerHAC.FS.00000032 St Joseph Medical Center 5/14/2019 4F - Pressure ulcerHAC.FS.00000032 St Joseph Medical Center 5/28/2019 4F - Pressure ulcerHAC.FS.00000033 St Joseph Medical Center 8/21/2019 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.00000033 St Joseph Medical Center 10/2/2019 4F - Pressure ulcerHAC.FS.00000033 St Joseph Medical Center 10/22/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000033 St Joseph Medical Center 10/22/2019 4F - Pressure ulcerHAC.FS.00000033 St Joseph Medical Center 11/1/2019 4F - Pressure ulcerHAC.FS.00000033 St Joseph Medical Center 11/14/2019 4F - Pressure ulcerHAC.FS.00000033 St Joseph Medical Center 11/14/2019 4F - Pressure ulcerHAC.FS.00000033 St Joseph Medical Center 11/14/2019 4F - Pressure ulcerHAC.FS.00000033 St Joseph Medical Center 11/22/2019 4F - Pressure ulcer

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Adverse EventsFacilities and Date of Event Report 2006-2020

DOH 689-013 September 2014Office of Community Health Systems Page 41 of 62

Adverse Events Quarterly ReportFacility by Date and Event - Q2 2020

Facility Credential Facility Name Facility County Date Confirmed Event TypeHAC.FS.00000033 St Joseph Medical Center 12/18/2019 4F - Pressure ulcerHAC.FS.00000033 St Joseph Medical Center 1/20/2020 4F - Pressure ulcerHAC.FS.00000033 St Joseph Medical Center 3/4/2020 1D - Unintended retention of foreign objectHAC.FS.00000033 St Joseph Medical Center 3/11/2020 1D - Unintended retention of foreign objectHAC.FS.00000033 St Joseph Medical Center 3/18/2020 4F - Pressure ulcerHAC.FS.00000033 St Joseph Medical Center 4/9/2020 **4F - Pressure ulcerHAC.FS.00000033 St Joseph Medical Center 4/23/2020 4F - Pressure ulcerHAC.FS.00000033 St Joseph Medical Center 4/23/2020 4F - Pressure ulcerHAC.FS.00000033 St Joseph Medical Center 5/12/2020 4F - Pressure ulcerHAC.FS.00000033 St Joseph Medical Center 5/12/2020 4F - Pressure ulcerHAC.FS.00000033 St Joseph Medical Center 6/4/2020 4F - Pressure ulcerHAC.FS.00000033 St Joseph Medical Center 6/4/2020 4F - Pressure ulcerHAC.FS.00000033 St Joseph Medical Center 6/26/2020 4F - Pressure ulcer

176HAC.FS.00000157 St Luke's Rehabilitation Institute Spokane 11/4/2006 4E - Patient death or serious injury associated with a fallHAC.FS.00000157 St Luke's Rehabilitation Institute 3/22/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000157 St Luke's Rehabilitation Institute 11/19/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000157 St Luke's Rehabilitation Institute 4/1/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000157 St Luke's Rehabilitation Institute 4/28/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000157 St Luke's Rehabilitation Institute 11/24/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000157 St Luke's Rehabilitation Institute 12/10/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000157 St Luke's Rehabilitation Institute 10/7/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000157 St Luke's Rehabilitation Institute 12/3/2015 4I - Failure to follow up with test resultsHAC.FS.00000157 St Luke's Rehabilitation Institute 9/12/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000157 St Luke's Rehabilitation Institute 8/24/2018 4F - Pressure ulcerHAC.FS.00000157 St Luke's Rehabilitation Institute 6/9/2020 **4E - Patient death or serious injury associated with a fall

12HAC.FS.00000138 Stevens Hospital Snohomish 1/2/2007 1D - Unintended retention of foreign objectHAC.FS.00000138 Stevens Hospital 1/3/2007 1D - Unintended retention of foreign objectHAC.FS.00000138 Stevens Hospital 4/3/2007 1D - Unintended retention of foreign objectHAC.FS.00000138 Stevens Hospital 7/6/2009 4E - Patient death or serious injury associated with a fall

4HAC.FS.00000186 Summit Pacific Medical Center Grays Harbor 2/24/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000186 Summit Pacific Medical Center 11/16/2018 4E - Patient death or serious injury associated with a fall

2HAC.FS.00000198 Sunnyside Community Hospital Yakima 9/14/2006 4A - Medication errorHAC.FS.00000198 Sunnyside Community Hospital 7/24/2008 4E - Patient death or serious injury associated with a fallHAC.FS.00000198 Sunnyside Community Hospital 1/6/2009 2B - Device function or useHAC.FS.00000198 Sunnyside Community Hospital 1/28/2013 1D - Unintended retention of foreign object HAC.FS.00000198 Sunnyside Community Hospital 7/30/2013 4F - Pressure ulcerHAC.FS.00000198 Sunnyside Community Hospital 10/13/2014 1D - Unintended retention of foreign object HAC.FS.00000198 Sunnyside Community Hospital 12/30/2014 1D - Unintended retention of foreign object HAC.FS.00000198 Sunnyside Community Hospital 6/16/2015 4A - Medication errorHAC.FS.00000198 Sunnyside Community Hospital 6/16/2015 4A - Medication errorHAC.FS.00000198 Sunnyside Community Hospital 6/25/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000198 Sunnyside Community Hospital 9/27/2017 1D - Unintended retention of foreign objectHAC.FS.00000198 Sunnyside Community Hospital 10/23/2017 4D - Death or serious injury of neonateHAC.FS.00000198 Astria Sunnyside Hospital^^ 5/1/2018 1A - Wrong surgery/invasive procedure siteHAC.FS.00000198 Astria Sunnyside Hospital^^ 8/27/2018 4D - Death or serious injury of neonateHAC.FS.00000198 Astria Sunnyside Hospital^^ 2/5/2019 4B - Wrong blood productHAC.FS.00000198 Astria Sunnyside Hospital^^ 3/18/2019 **4D - Death or serious injury of neonate

16HAC.FS.60183546 Swedish Edmonds Hospitaliii Snohomish 5/18/2010 **4F - Pressure ulcerHAC.FS.60183546 Swedish Edmonds Hospitaliii 11/11/2010 1D - Unintended retention of foreign objectHAC.FS.60183546 Swedish Edmonds Hospitaliii 1/20/2011 4F - Pressure ulcerHAC.FS.60183546 Swedish Edmonds Hospitaliii 3/14/2011 4F - Pressure ulcerHAC.FS.60183546 Swedish Edmonds Hospitaliii 6/16/2011 4F - Pressure ulcerHAC.FS.60183546 Swedish Edmonds Hospitaliii 8/15/2011 4E - Patient death or serious injury associated with a fallHAC.FS.60183546 Swedish Edmonds Hospitaliii 3/1/2012 4F - Pressure ulcerHAC.FS.60183546 Swedish Edmonds Hospitaliii 6/5/2012 4F - Pressure ulcerHAC.FS.60183546 Swedish Edmonds Hospitaliii 6/19/2012 4F - Pressure ulcerHAC.FS.60183546 Swedish Edmonds Hospitaliii 2/11/2014 4F - Pressure ulcerHAC.FS.60183546 Swedish Edmonds Hospitaliii 3/19/2014 1D - Unintended retention of foreign objectHAC.FS.60183546 Swedish Edmonds Hospitaliii 8/5/2014 4E - Patient death or serious injury associated with a fallHAC.FS.60183546 Swedish Edmonds Hospitaliii 10/28/2014 4C - Maternal death or serious injuryHAC.FS.60183546 Swedish Edmonds Hospitaliii 6/9/2015 4E - Patient death or serious injury associated with a fallHAC.FS.60183546 Swedish Edmonds Hospitaliii 6/9/2015 4F - Pressure ulcerHAC.FS.60183546 Swedish Edmonds Hospitaliii 6/23/2015 1D - Unintended retention of foreign objectHAC.FS.60183546 Swedish Edmonds Hospitaliii 8/18/2015 4F - Pressure ulcerHAC.FS.60183546 Swedish Edmonds Hospitaliii 8/18/2015 4F - Pressure ulcerHAC.FS.60183546 Swedish Edmonds Hospitaliii 8/18/2015 4F - Pressure ulcerHAC.FS.60183546 Swedish Edmonds Hospitaliii 8/18/2015 4F - Pressure ulcerHAC.FS.60183546 Swedish Edmonds Hospitaliii 10/27/2015 4E - Patient death or serious injury associated with a fallHAC.FS.60183546 Swedish Edmonds Hospitaliii 10/27/2015 4E - Patient death or serious injury associated with a fallHAC.FS.60183546 Swedish Edmonds Hospitaliii 11/24/2015 4F - Pressure ulcerHAC.FS.60183546 Swedish Edmonds Hospitaliii 11/24/2015 4F - Pressure ulcerHAC.FS.60183546 Swedish Edmonds Hospitaliii 1/19/2016 4F - Pressure ulcerHAC.FS.60183546 Swedish Edmonds Hospitaliii 1/19/2016 4F - Pressure ulcerHAC.FS.60183546 Swedish Edmonds Hospitaliii 1/19/2016 4F - Pressure ulcerHAC.FS.60183546 Swedish Edmonds Hospitaliii 4/12/2016 1A - Wrong surgery/invasive procedure siteHAC.FS.60183546 Swedish Edmonds Hospitaliii 7/19/2016 4F - Pressure ulcerHAC.FS.60183546 Swedish Edmonds Hospitaliii 7/19/2016 4F - Pressure ulcerHAC.FS.60183546 Swedish Edmonds Hospitaliii 9/27/2016 4E - Patient death or serious injury associated with a fallHAC.FS.60183546 Swedish Edmondsiii 4/11/2017 4E - Patient death or serious injury associated with a fallHAC.FS.60183546 Swedish Edmondsiii 4/11/2017 4E - Patient death or serious injury associated with a fallHAC.FS.60183546 Swedish Edmondsiii 5/9/2017 4F - Pressure ulcerHAC.FS.60183546 Swedish Edmondsiii 5/9/2017 4F - Pressure ulcerHAC.FS.60183546 Swedish Edmondsiii 5/9/2017 4F - Pressure ulcerHAC.FS.60183546 Swedish Edmondsiii 8/15/2017 4F - Pressure ulcerHAC.FS.60183546 Swedish Edmondsiii 1/16/2018 4F - Pressure ulcerHAC.FS.60183546 Swedish Edmondsiii 2/23/2018 4F - Pressure ulcerHAC.FS.60183546 Swedish Edmondsiii 4/25/2018 4F - Pressure ulcerHAC.FS.60183546 Swedish Edmondsiii 6/4/2018 1A - Wrong surgery/invasive procedure siteHAC.FS.60183546 Swedish Edmondsiii 7/23/2018 4F - Pressure ulcerHAC.FS.60183546 Swedish Edmondsiii 10/8/2018 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.60183546 Swedish Edmondsiii 10/15/2018 4F - Pressure ulcerHAC.FS.60183546 Swedish Edmondsiii 10/15/2018 4F - Pressure ulcerHAC.FS.60183546 Swedish Edmondsiii 10/15/2018 4F - Pressure ulcerHAC.FS.60183546 Swedish Edmondsiii 10/29/2018 1D - Unintended retention of foreign objectHAC.FS.60183546 Swedish Edmondsiii 1/16/2019 4F - Pressure ulcer

St Joseph Medical Center number of events:

St Luke's Rehabilitation Institute number of events:

Stevens Hospital number of events:

Summit Pacific Medical Center number of events:

Astria Sunnyside Hospital number of events:

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Adverse EventsFacilities and Date of Event Report 2006-2020

DOH 689-013 September 2014Office of Community Health Systems Page 42 of 62

Adverse Events Quarterly ReportFacility by Date and Event - Q2 2020

Facility Credential Facility Name Facility County Date Confirmed Event TypeHAC.FS.60183546 Swedish Edmondsiii 1/21/2019 3B - Patient elopement (disappearance)HAC.FS.60183546 Swedish Edmondsiii 4/22/2019 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.60183546 Swedish Edmondsiii 4/22/2019 4F - Pressure ulcerHAC.FS.60183546 Swedish Edmondsiii 5/20/2019 4E - Patient death or serious injury associated with a fallHAC.FS.60183546 Swedish Edmondsiii 7/22/2019 4F - Pressure ulcerHAC.FS.60183546 Swedish Edmondsiii 7/22/2019 4F - Pressure ulcerHAC.FS.60183546 Swedish Edmondsiii 7/22/2019 4F - Pressure ulcerHAC.FS.60183546 Swedish Edmondsiii 10/31/2019 4F - Pressure ulcerHAC.FS.60183546 Swedish Edmondsiii 10/31/2019 4F - Pressure ulcerHAC.FS.60183546 Swedish Edmondsiii 10/31/2019 4F - Pressure ulcerHAC.FS.60183546 Swedish Edmondsiii 12/2/2019 7C - Sexual abuse/assaultHAC.FS.60183546 Swedish Edmondsiii 12/9/2019 7D - Physical assaultHAC.FS.60183546 Swedish Edmondsiii 1/13/2020 7D - Physical assaultHAC.FS.60183546 Swedish Edmondsiii 1/20/2020 4F - Pressure ulcerHAC.FS.60183546 Swedish Edmondsiii 1/20/2020 4F - Pressure ulcerHAC.FS.60183546 Swedish Edmondsiii 2/24/2020 1A - Wrong surgery/invasive procedure siteHAC.FS.60183546 Swedish Edmondsiii 2/24/2020 4E - Patient death or serious injury associated with a fallHAC.FS.60183546 Swedish Edmondsiii 4/30/2020 4F - Pressure ulcerHAC.FS.60183546 Swedish Edmondsiii 4/30/2020 4F - Pressure ulcerHAC.FS.60183546 Swedish Edmondsiii 4/30/2020 4F - Pressure ulcerHAC.FS.60183546 Swedish Edmondsiii 4/30/2020 4F - Pressure ulcerHAC.FS.60183546 Swedish Edmondsiii 6/1/2020 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.60183546 Swedish Edmondsiii 6/8/2020 4E - Patient death or serious injury associated with a fallHAC.FS.60183546 Swedish Edmondsiii 6/29/2020 4E - Patient death or serious injury associated with a fall

72HAC.FS.00000003 Swedish Medical Center - Cherry Hill King 8/26/2006 1A - Wrong surgery/invasive procedure siteHAC.FS.00000003 Swedish Medical Center - Cherry Hill 4/16/2007 1D - Unintended retention of foreign objectHAC.FS.00000003 Swedish Medical Center - Cherry Hill 4/16/2007 4F - Pressure ulcerHAC.FS.00000003 Swedish Medical Center - Cherry Hill 6/29/2007 4F - Pressure ulcerHAC.FS.00000003 Swedish Medical Center - Cherry Hill 6/29/2007 4F - Pressure ulcerHAC.FS.00000003 Swedish Medical Center - Cherry Hill 6/29/2007 4F - Pressure ulcerHAC.FS.00000003 Swedish Medical Center - Cherry Hill 6/29/2007 4F - Pressure ulcerHAC.FS.00000003 Swedish Medical Center - Cherry Hill 6/10/2008 4A - Medication errorHAC.FS.00000003 Swedish Medical Center - Cherry Hill 3/5/2010 4E - Patient death or serious injury associated with a fallHAC.FS.00000003 Swedish Medical Center - Cherry Hill 4/21/2010 1D - Unintended retention of foreign objectHAC.FS.00000003 Swedish Medical Center - Cherry Hill 5/19/2010 4F - Pressure ulcerHAC.FS.00000003 Swedish Medical Center - Cherry Hill 10/20/2010 4F - Pressure ulcerHAC.FS.00000003 Swedish Medical Center - Cherry Hill 1/19/2011 4F - Pressure ulcerHAC.FS.00000003 Swedish Medical Center - Cherry Hill 3/22/2011 4F - Pressure ulcerHAC.FS.00000003 Swedish Medical Center - Cherry Hill 7/6/2011 4E - Patient death or serious injury associated with a fallHAC.FS.00000003 Swedish Medical Center - Cherry Hill 1/30/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000003 Swedish Medical Center - Cherry Hill 10/29/2012 4F - Pressure ulcerHAC.FS.00000003 Swedish Medical Center - Cherry Hill 12/6/2012 4E - Patient death or serious injury associated with a fall

18HAC.FS.60329940 Swedish Medical Center - Cherry Hilliiiii King 4/8/2013 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center - Cherry Hilliiiii 12/3/2013 4A - Medication errorHAC.FS.60329940 Swedish Medical Center - Cherry Hilliiiii 2/4/2014 4E - Patient death or serious injury associated with a fallHAC.FS.60329940 Swedish Medical Center - Cherry Hilliiiii 2/4/2014 2B - Device function or useHAC.FS.60329940 Swedish Medical Center - Cherry Hilliiiii 3/4/2014 1D - Unintended retention of foreign objectHAC.FS.60329940 Swedish Medical Center - Cherry Hilliiiii 3/4/2014 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center - Cherry Hilliiiii 6/3/2014 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center - Cherry Hilliiiii 10/28/2014 1D - Unintended retention of foreign objectHAC.FS.60329940 Swedish Medical Center - Cherry Hilliiiii 11/25/2014 4E - Patient death or serious injury associated with a fallHAC.FS.60329940 Swedish Medical Center - Cherry Hilliiiii 12/9/2014 4E - Patient death or serious injury associated with a fallHAC.FS.60329940 Swedish Medical Center - Cherry Hilliiiii 1/6/2015 1D - Unintended retention of foreign objectHAC.FS.60329940 Swedish Medical Center - Cherry Hilliiiii 2/17/2015 2B - Device function or useHAC.FS.60329940 Swedish Medical Center - Cherry Hilliiiii 3/3/2015 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center - Cherry Hilliiiii 7/21/2015 4E - Patient death or serious injury associated with a fallHAC.FS.60329940 Swedish Medical Center - Cherry Hilliiiii 9/15/2015 4E - Patient death or serious injury associated with a fallHAC.FS.60329940 Swedish Medical Center - Cherry Hilliiiii 11/10/2015 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center - Cherry Hilliiiii 11/10/2015 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center - Cherry Hilliiiii 11/10/2015 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center - Cherry Hilliiiii 11/10/2015 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center - Cherry Hilliiiii 11/10/2015 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center - Cherry Hilliiiii 11/10/2015 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center - Cherry Hilliiiii 11/10/2015 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center - Cherry Hilliiiii 11/10/2015 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center - Cherry Hilliiiii 1/5/2016 1A - Wrong surgery/invasive procedure siteHAC.FS.60329940 Swedish Medical Center - Cherry Hilliiiii 1/19/2016 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center - Cherry Hilliiiii 1/19/2016 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center - Cherry Hilliiiii 1/19/2016 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center - Cherry Hilliiiii 1/19/2016 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center - Cherry Hilliiiii 1/19/2016 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center - Cherry Hilliiiii 1/19/2016 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center - Cherry Hilliiiii 3/15/2016 4E - Patient death or serious injury associated with a fallHAC.FS.60329940 Swedish Medical Center - Cherry Hilliiiii 3/29/2016 2C - Intravascular air embolismHAC.FS.60329940 Swedish Medical Center - Cherry Hilliiiii 3/29/2016 4A - Medication errorHAC.FS.60329940 Swedish Medical Center - Cherry Hilliiiii 4/12/2016 4I - Failure to follow up with test resultsHAC.FS.60329940 Swedish Medical Center - Cherry Hilliiiii 4/26/2016 1D - Unintended retention of foreign objectHAC.FS.60329940 Swedish Medical Center - Cherry Hilliiiii 5/24/2016 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center - Cherry Hilliiiii 5/24/2016 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center - Cherry Hilliiiii 5/24/2016 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center - Cherry Hilliiiii 5/24/2016 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center - Cherry Hilliiiii 5/24/2016 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center - Cherry Hilliiiii 5/24/2016 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center - Cherry Hilliiiii 5/24/2016 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center - Cherry Hilliiiii 5/24/2016 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center - Cherry Hilliiiii 5/24/2016 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center - Cherry Hilliiiii 7/19/2016 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center - Cherry Hilliiiii 9/27/2016 4A - Medication errorHAC.FS.60329940 Swedish Medical Center - Cherry Hilliiiii 10/25/2016 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center - Cherry Hilliiiii 10/25/2016 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center - Cherry Hilliiiii 10/25/2016 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center - Cherry Hilliiiii 10/25/2016 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center - Cherry Hilliiiii 11/9/2016 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 1/31/2017 1D - Unintended retention of foreign objectHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 2/14/2017 4A - Medication errorHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 4/11/2017 4E - Patient death or serious injury associated with a fallHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 5/9/2017 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 5/9/2017 4F - Pressure ulcer

Swedish Medical Center - Cherry Hill number of events:

Swedish Edmonds number of events:

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Adverse EventsFacilities and Date of Event Report 2006-2020

DOH 689-013 September 2014Office of Community Health Systems Page 43 of 62

Adverse Events Quarterly ReportFacility by Date and Event - Q2 2020

Facility Credential Facility Name Facility County Date Confirmed Event TypeHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 8/15/2017 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 8/15/2017 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 12/19/2017 1D - Unintended retention of foreign objectHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 12/19/2017 4I - Failure to follow up with test resultsHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 1/16/2018 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 1/16/2018 4I - Failure to follow up with test resultsHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 3/21/2018 4E - Patient death or serious injury associated with a fallHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 4/25/2018 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 4/25/2018 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 4/25/2018 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 4/25/2018 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 4/25/2018 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 4/25/2018 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 4/25/2018 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 5/22/2018 4A - Medication errorHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 7/23/2018 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 7/23/2018 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 7/23/2018 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 7/23/2018 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 9/17/2018 4A - Medication errorHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 10/15/2018 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 10/15/2018 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 1/7/2019 4A - Medication errorHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 1/7/2019 4A - Medication errorHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 1/16/2019 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 1/16/2019 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 1/16/2019 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 1/16/2019 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 2/4/2019 4E - Patient death or serious injury associated with a fallHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 4/22/2019 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 4/22/2019 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 4/22/2019 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 4/22/2019 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 4/22/2019 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 4/30/2019 4A - Medication errorHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 5/13/2019 4A - Medication errorHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 5/20/2019 4A - Medication errorHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 7/22/2019 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 7/22/2019 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 7/22/2019 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 7/22/2019 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 7/22/2019 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 7/22/2019 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 7/22/2019 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 9/16/2019 4A - Medication errorHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 10/31/2019 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 10/31/2019 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 10/31/2019 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 10/31/2019 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 10/31/2019 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 10/31/2019 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 10/31/2019 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 10/31/2019 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 10/31/2019 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 10/31/2019 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 1/20/2020 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 1/20/2020 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 1/20/2020 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 1/20/2020 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 1/20/2020 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 3/16/2020 4E - Patient death or serious injury associated with a fallHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 3/16/2020 5C - BurnHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 4/27/2020 4A - Medication errorHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 4/30/2020 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 4/30/2020 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 4/30/2020 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 4/30/2020 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 4/30/2020 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 4/30/2020 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 4/30/2020 4F - Pressure ulcerHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 5/11/2020 1B - Wrong surgery/invasive procedure patientHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 5/11/2020 4E - Patient death or serious injury associated with a fallHAC.FS.60329940 Swedish Medical Center / Cherry Hilliiiii 6/22/2020 4A - Medication error

129HAC.FS.00000001 Swedish Medical Center First Hill King 6/14/2006 4A - Medication errorHAC.FS.00000001 Swedish Medical Center First Hill 9/27/2006 1A - Wrong surgery/invasive procedure siteHAC.FS.00000001 Swedish Medical Center First Hill 12/6/2006 1A - Wrong surgery/invasive procedure siteHAC.FS.00000001 Swedish Medical Center First Hill 4/16/2007 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 4/16/2007 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 4/16/2007 4E - Patient death or serious injury associated with a fallHAC.FS.00000001 Swedish Medical Center First Hill 6/15/2007 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 6/17/2007 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 6/29/2007 4C - Maternal death or serious injuryHAC.FS.00000001 Swedish Medical Center First Hill 6/29/2007 4C - Maternal death or serious injuryHAC.FS.00000001 Swedish Medical Center First Hill 6/29/2007 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 8/9/2007 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 10/2/2007 1D - Unintended retention of foreign objectHAC.FS.00000001 Swedish Medical Center First Hill 11/8/2007 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 11/8/2007 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 11/8/2007 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 11/8/2007 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 1/23/2008 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 2/25/2008 1D - Unintended retention of foreign objectHAC.FS.00000001 Swedish Medical Center First Hill 2/25/2008 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 2/25/2008 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 2/25/2008 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 2/25/2008 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 6/10/2008 1D - Unintended retention of foreign objectHAC.FS.00000001 Swedish Medical Center First Hill 6/10/2008 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 6/10/2008 4F - Pressure ulcer

Swedish Medical Center / Cherry Hill number of events:

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Adverse EventsFacilities and Date of Event Report 2006-2020

DOH 689-013 September 2014Office of Community Health Systems Page 44 of 62

Adverse Events Quarterly ReportFacility by Date and Event - Q2 2020

Facility Credential Facility Name Facility County Date Confirmed Event TypeHAC.FS.00000001 Swedish Medical Center First Hill 6/10/2008 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 6/10/2008 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 7/10/2008 1D - Unintended retention of foreign objectHAC.FS.00000001 Swedish Medical Center First Hill 8/14/2008 1A - Wrong surgery/invasive procedure siteHAC.FS.00000001 Swedish Medical Center First Hill 10/30/2008 4E - Patient death or serious injury associated with a fallHAC.FS.00000001 Swedish Medical Center First Hill 11/3/2008 7C - Sexual abuse/assaultHAC.FS.00000001 Swedish Medical Center First Hill 12/15/2008 4E - Patient death or serious injury associated with a fallHAC.FS.00000001 Swedish Medical Center First Hill 12/31/2008 1D - Unintended retention of foreign objectHAC.FS.00000001 Swedish Medical Center First Hill 8/12/2009 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 8/12/2009 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 8/12/2009 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 11/4/2009 1D - Unintended retention of foreign objectHAC.FS.00000001 Swedish Medical Center First Hill 11/18/2009 1A - Wrong surgery/invasive procedure siteHAC.FS.00000001 Swedish Medical Center First Hill 2/3/2010 1D - Unintended retention of foreign objectHAC.FS.00000001 Swedish Medical Center First Hill 3/3/2010 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 3/3/2010 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 3/3/2010 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 3/3/2010 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 3/3/2010 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 5/18/2010 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 5/19/2010 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 5/19/2010 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 5/19/2010 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 5/19/2010 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 5/19/2010 4E - Patient death or serious injury associated with a fallHAC.FS.00000001 Swedish Medical Center First Hill 6/16/2010 7C - Sexual abuse/assaultHAC.FS.00000001 Swedish Medical Center First Hill 7/21/2010 7C - Sexual abuse/assaultHAC.FS.00000001 Swedish Medical Center First Hill 10/20/2010 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 10/20/2010 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 10/20/2010 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 10/20/2010 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 10/20/2010 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 10/20/2010 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 10/20/2010 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 11/17/2010 1D - Unintended retention of foreign objectHAC.FS.00000001 Swedish Medical Center First Hill 1/19/2011 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 1/19/2011 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 1/19/2011 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 1/19/2011 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 2/2/2011 4A - Medication errorHAC.FS.00000001 Swedish Medical Center First Hill 2/22/2011 4E - Patient death or serious injury associated with a fallHAC.FS.00000001 Swedish Medical Center First Hill 3/22/2011 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 3/22/2011 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 3/22/2011 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 4/6/2011 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 4/6/2011 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 5/18/2011 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 7/6/2011 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 8/3/2011 4E - Patient death or serious injury associated with a fallHAC.FS.00000001 Swedish Medical Center First Hill 8/17/2011 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 8/17/2011 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 9/7/2011 1A - Wrong surgery/invasive procedure siteHAC.FS.00000001 Swedish Medical Center First Hill 9/7/2011 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 10/5/2011 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 10/24/2011 1A - Wrong surgery/invasive procedure siteHAC.FS.00000001 Swedish Medical Center First Hill 11/16/2011 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 12/16/2011 4E - Patient death or serious injury associated with a fallHAC.FS.00000001 Swedish Medical Center First Hill 1/13/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000001 Swedish Medical Center First Hill 1/30/2012 1D - Unintended retention of foreign objectHAC.FS.00000001 Swedish Medical Center First Hill 5/11/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000001 Swedish Medical Center First Hill 6/22/2012 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 7/3/2012 1D - Unintended retention of foreign objectHAC.FS.00000001 Swedish Medical Center First Hill 7/9/2012 1D - Unintended retention of foreign objectHAC.FS.00000001 Swedish Medical Center First Hill 7/11/2012 4A - Medication errorHAC.FS.00000001 Swedish Medical Center First Hill 7/12/2012 1A - Wrong surgery/invasive procedure siteHAC.FS.00000001 Swedish Medical Center First Hill 10/8/2012 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 10/29/2012 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 11/14/2012 1D - Unintended retention of foreign objectHAC.FS.00000001 Swedish Medical Center First Hill 11/26/2012 1A - Wrong surgery/invasive procedure siteHAC.FS.00000001 Swedish Medical Center First Hill 12/1/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000001 Swedish Medical Center First Hill 12/3/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000001 Swedish Medical Center First Hill 12/7/2012 1D - Unintended retention of foreign objectHAC.FS.00000001 Swedish Medical Center First Hill 3/11/2013 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 4/8/2013 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 4/8/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000001 Swedish Medical Center First Hill 5/13/2013 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 5/13/2013 7A - ImpersonationHAC.FS.00000001 Swedish Medical Center First Hill 5/13/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000001 Swedish Medical Center First Hill 6/10/2013 1D - Unintended retention of foreign object HAC.FS.00000001 Swedish Medical Center First Hill 8/6/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000001 Swedish Medical Center First Hill 8/21/2013 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 10/1/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000001 Swedish Medical Center First Hill 11/5/2013 5D - RestraintsHAC.FS.00000001 Swedish Medical Center First Hill 12/3/2013 1D - Unintended retention of foreign objectHAC.FS.00000001 Swedish Medical Center First Hill 1/7/2014 1D - Unintended retention of foreign objectHAC.FS.00000001 Swedish Medical Center First Hill 1/21/2014 1D - Unintended retention of foreign objectHAC.FS.00000001 Swedish Medical Center First Hill 2/4/2014 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 3/4/2014 4C - Maternal death or serious injuryHAC.FS.00000001 Swedish Medical Center First Hill 3/18/2014 1D - Unintended retention of foreign objectHAC.FS.00000001 Swedish Medical Center First Hill 3/18/2014 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 4/1/2014 1A - Wrong surgery/invasive procedure siteHAC.FS.00000001 Swedish Medical Center First Hill 5/6/2014 4D - Death or serious injury of neonateHAC.FS.00000001 Swedish Medical Center First Hill 6/3/2014 4A - Medication errorHAC.FS.00000001 Swedish Medical Center First Hill 7/1/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000001 Swedish Medical Center First Hill 7/1/2014 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 8/5/2014 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 9/16/2014 1D - Unintended retention of foreign objectHAC.FS.00000001 Swedish Medical Center First Hill 9/16/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000001 Swedish Medical Center First Hill 12/9/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000001 Swedish Medical Center First Hill 12/9/2014 4F - Pressure ulcer

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Adverse EventsFacilities and Date of Event Report 2006-2020

DOH 689-013 September 2014Office of Community Health Systems Page 45 of 62

Adverse Events Quarterly ReportFacility by Date and Event - Q2 2020

Facility Credential Facility Name Facility County Date Confirmed Event TypeHAC.FS.00000001 Swedish Medical Center First Hill 12/9/2014 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 12/23/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000001 Swedish Medical Center First Hill 1/6/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000001 Swedish Medical Center First Hill 1/20/2015 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 1/20/2015 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 1/20/2015 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 1/20/2015 1D - Unintended retention of foreign objectHAC.FS.00000001 Swedish Medical Center First Hill 1/20/2015 1D - Unintended retention of foreign objectHAC.FS.00000001 Swedish Medical Center First Hill 2/3/2015 1C - Wrong surgical/invasive procedureHAC.FS.00000001 Swedish Medical Center First Hill 2/3/2015 5D - RestraintsHAC.FS.00000001 Swedish Medical Center First Hill 2/20/2015 4C - Maternal death or serious injuryHAC.FS.00000001 Swedish Medical Center First Hill 3/17/2015 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 4/14/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000001 Swedish Medical Center First Hill 4/28/2015 5C - BurnHAC.FS.00000001 Swedish Medical Center First Hill 5/12/2015 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 5/12/2015 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 5/12/2015 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 5/12/2015 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 5/12/2015 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 5/26/2015 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.00000001 Swedish Medical Center First Hill 5/26/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000001 Swedish Medical Center First Hill 5/26/2015 5C - BurnHAC.FS.00000001 Swedish Medical Center First Hill 6/9/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000001 Swedish Medical Center First Hill 6/23/2015 1D - Unintended retention of foreign objectHAC.FS.00000001 Swedish Medical Center First Hill 7/21/2015 1C - Wrong surgical/invasive procedureHAC.FS.00000001 Swedish Medical Center First Hill 8/18/2015 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 8/18/2015 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 11/10/2015 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 11/10/2015 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 11/10/2015 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 12/8/2015 1D - Unintended retention of foreign objectHAC.FS.00000001 Swedish Medical Center First Hill 12/8/2015 2C - Intravascular air embolismHAC.FS.00000001 Swedish Medical Center First Hill 1/5/2016 1A - Wrong surgery/invasive procedure siteHAC.FS.00000001 Swedish Medical Center First Hill 1/19/2016 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 1/19/2016 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 1/19/2016 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 1/19/2016 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 1/19/2016 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 1/19/2016 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 1/19/2016 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 3/1/2016 1D - Unintended retention of foreign objectHAC.FS.00000001 Swedish Medical Center First Hill 3/1/2016 1D - Unintended retention of foreign objectHAC.FS.00000001 Swedish Medical Center First Hill 3/1/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000001 Swedish Medical Center First Hill 4/12/2016 1D - Unintended retention of foreign objectHAC.FS.00000001 Swedish Medical Center First Hill 5/24/2016 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 5/24/2016 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 5/24/2016 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 5/24/2016 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 5/24/2016 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 5/24/2016 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 5/24/2016 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 5/24/2016 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 5/24/2016 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 5/24/2016 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 5/24/2016 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 5/24/2016 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 7/19/2016 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 8/2/2016 1A - Wrong surgery/invasive procedure siteHAC.FS.00000001 Swedish Medical Center First Hill 8/2/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000001 Swedish Medical Center First Hill 9/13/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000001 Swedish Medical Center First Hill 10/25/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000001 Swedish Medical Center First Hill 10/25/2016 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 10/25/2016 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 10/25/2016 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 10/25/2016 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 10/25/2016 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center First Hill 12/6/2016 4A - Medication errorHAC.FS.00000001 Swedish Medical Center 1/31/2017 1D - Unintended retention of foreign objectHAC.FS.00000001 Swedish Medical Center 1/31/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000001 Swedish Medical Center 3/28/2017 1D - Unintended retention of foreign objectHAC.FS.00000001 Swedish Medical Center 5/9/2017 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 5/9/2017 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 5/9/2017 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 5/9/2017 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 6/6/2017 1A - Wrong surgery/invasive procedure siteHAC.FS.00000001 Swedish Medical Center 6/6/2017 1D - Unintended retention of foreign objectHAC.FS.00000001 Swedish Medical Center 6/18/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000001 Swedish Medical Center 6/20/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000001 Swedish Medical Center 7/18/2017 1A - Wrong surgery/invasive procedure siteHAC.FS.00000001 Swedish Medical Center 7/18/2017 1C - Wrong surgical/invasive procedureHAC.FS.00000001 Swedish Medical Center 7/18/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000001 Swedish Medical Center 8/15/2017 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 8/15/2017 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 8/15/2017 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 8/15/2017 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 8/15/2017 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 8/15/2017 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 9/5/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000001 Swedish Medical Center 10/10/2017 4I - Failure to follow up with test resultsHAC.FS.00000001 Swedish Medical Center 10/24/2017 1D - Unintended retention of foreign objectHAC.FS.00000001 Swedish Medical Center 10/24/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000001 Swedish Medical Center 10/24/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000001 Swedish Medical Center 11/21/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000001 Swedish Medical Center 11/21/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000001 Swedish Medical Center 12/5/2017 4I - Failure to follow up with test resultsHAC.FS.00000001 Swedish Medical Center 12/19/2017 1A - Wrong surgery/invasive procedure siteHAC.FS.00000001 Swedish Medical Center 1/16/2018 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 1/16/2018 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 1/16/2018 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 1/16/2018 4F - Pressure ulcer

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Adverse EventsFacilities and Date of Event Report 2006-2020

DOH 689-013 September 2014Office of Community Health Systems Page 46 of 62

Adverse Events Quarterly ReportFacility by Date and Event - Q2 2020

Facility Credential Facility Name Facility County Date Confirmed Event TypeHAC.FS.00000001 Swedish Medical Center 1/16/2018 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 2/23/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000001 Swedish Medical Center 2/23/2018 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 2/23/2018 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 2/23/2018 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 2/23/2018 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 2/23/2018 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 2/23/2018 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 2/23/2018 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 2/23/2018 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 2/23/2018 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 2/23/2018 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 2/23/2018 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 2/23/2018 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 3/20/2018 1A - Wrong surgery/invasive procedure siteHAC.FS.00000001 Swedish Medical Center 3/27/2018 4D - Death or serious injury of neonateHAC.FS.00000001 Swedish Medical Center 3/28/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000001 Swedish Medical Center 4/3/2018 1D - Unintended retention of foreign objectHAC.FS.00000001 Swedish Medical Center 4/13/2018 1D - Unintended retention of foreign objectHAC.FS.00000001 Swedish Medical Center 4/25/2018 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 4/25/2018 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 4/25/2018 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 4/25/2018 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 4/25/2018 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 6/4/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000001 Swedish Medical Center 7/23/2018 1D - Unintended retention of foreign objectHAC.FS.00000001 Swedish Medical Center 7/23/2018 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 7/23/2018 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 7/23/2018 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 8/20/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000001 Swedish Medical Center 9/24/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000001 Swedish Medical Center 10/8/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000001 Swedish Medical Center 10/15/2018 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 10/15/2018 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 10/15/2018 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 10/15/2018 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 10/15/2018 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 11/5/2018 4A - Medication errorHAC.FS.00000001 Swedish Medical Center 11/19/2018 4I - Failure to follow up with test resultsHAC.FS.00000001 Swedish Medical Center 12/10/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000001 Swedish Medical Center 1/7/2019 1D - Unintended retention of foreign objectHAC.FS.00000001 Swedish Medical Center 1/16/2019 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 1/16/2019 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 1/16/2019 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 1/16/2019 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 1/16/2019 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 1/16/2019 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 1/21/2019 4I - Failure to follow up with test resultsHAC.FS.00000001 Swedish Medical Center 3/4/2019 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.00000001 Swedish Medical Center 3/4/2019 4A - Medication errorHAC.FS.00000001 Swedish Medical Center 4/22/2019 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 4/22/2019 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 4/22/2019 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 4/22/2019 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 4/22/2019 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 4/22/2019 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 4/22/2019 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 4/22/2019 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 4/22/2019 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 4/26/2019 7C - Sexual abuse/assaultHAC.FS.00000001 Swedish Medical Center 7/22/2019 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 7/22/2019 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 7/22/2019 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 7/22/2019 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 7/22/2019 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 7/22/2019 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 7/22/2019 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 7/22/2019 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 7/22/2019 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 7/22/2019 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 8/5/2019 1C - Wrong surgical/invasive procedureHAC.FS.00000001 Swedish Medical Center 10/14/2019 5C - BurnHAC.FS.00000001 Swedish Medical Center 10/31/2019 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 10/31/2019 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 10/31/2019 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 10/31/2019 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 10/31/2019 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 10/31/2019 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 10/31/2019 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 10/31/2019 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 11/11/2019 1D - Unintended retention of foreign objectHAC.FS.00000001 Swedish Medical Center 12/9/2019 4A - Medication errorHAC.FS.00000001 Swedish Medical Center 1/20/2020 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 1/20/2020 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 1/20/2020 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 1/20/2020 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 1/20/2020 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 1/20/2020 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 1/20/2020 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 1/20/2020 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 1/20/2020 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 1/20/2020 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 1/20/2020 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 2/24/2020 4E - Patient death or serious injury associated with a fallHAC.FS.00000001 Swedish Medical Center 2/24/2020 7D - Physical assaultHAC.FS.00000001 Swedish Medical Center 3/9/2020 1A - Wrong surgery/invasive procedure site

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Adverse EventsFacilities and Date of Event Report 2006-2020

DOH 689-013 September 2014Office of Community Health Systems Page 47 of 62

Adverse Events Quarterly ReportFacility by Date and Event - Q2 2020

Facility Credential Facility Name Facility County Date Confirmed Event TypeHAC.FS.00000001 Swedish Medical Center 3/16/2020 1C - Wrong surgical/invasive procedureHAC.FS.00000001 Swedish Medical Center 4/27/2020 1D - Unintended retention of foreign objectHAC.FS.00000001 Swedish Medical Center 4/27/2020 1D - Unintended retention of foreign objectHAC.FS.00000001 Swedish Medical Center 4/27/2020 4A - Medication errorHAC.FS.00000001 Swedish Medical Center 4/30/2020 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 4/30/2020 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 4/30/2020 4F - Pressure ulcerHAC.FS.00000001 Swedish Medical Center 5/4/2020 4A - Medication errorHAC.FS.00000001 Swedish Medical Center 5/14/2020 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.00000001 Swedish Medical Center 6/15/2020 4A - Medication error

332HAC.FS.60256001 Swedish Medical Center Issaquah King 5/2/2012 4F - Pressure ulcerHAC.FS.60256001 Swedish Medical Center Issaquah 3/11/2013 4A - Medication errorHAC.FS.60256001 Swedish Medical Center Issaquah 4/8/2013 4E - Patient death or serious injury associated with a fallHAC.FS.60256001 Swedish Medical Center Issaquah 9/3/2013 1D - Unintended retention of foreign objectHAC.FS.60256001 Swedish Medical Center Issaquah 3/4/2014 1A - Wrong surgery/invasive procedure siteHAC.FS.60256001 Swedish Medical Center Issaquah 5/6/2014 1D - Unintended retention of foreign objectHAC.FS.60256001 Swedish Medical Center Issaquah 11/11/2014 4E - Patient death or serious injury associated with a fallHAC.FS.60256001 Swedish Medical Center Issaquah 5/12/2015 4D - Death or serious injury of neonateHAC.FS.60256001 Swedish Medical Center Issaquah 7/21/2015 4F - Pressure ulcerHAC.FS.60256001 Swedish Medical Center - Issaquah Campus 7/19/2016 4A - Medication errorHAC.FS.60256001 Swedish Medical Center - Issaquah Campus 8/2/2016 4E - Patient death or serious injury associated with a fallHAC.FS.60256001 Swedish Medical Center - Issaquah Campus 9/13/2016 1D - Unintended retention of foreign objectHAC.FS.60256001 Swedish Medical Center - Issaquah Campus 11/8/2016 1A - Wrong surgery/invasive procedure siteHAC.FS.60256001 Swedish Medical Center - Issaquah Campus 2/23/2018 4F - Pressure ulcerHAC.FS.60256001 Swedish Medical Center - Issaquah Campus 4/25/2018 4F - Pressure ulcerHAC.FS.60256001 Swedish Medical Center - Issaquah Campus 6/4/2018 1D - Unintended retention of foreign objectHAC.FS.60256001 Swedish Medical Center - Issaquah Campus 6/11/2018 4E - Patient death or serious injury associated with a fallHAC.FS.60256001 Swedish Medical Center - Issaquah Campus 6/11/2018 4E - Patient death or serious injury associated with a fallHAC.FS.60256001 Swedish Medical Center - Issaquah Campus 10/1/2018 1A - Wrong surgery/invasive procedure siteHAC.FS.60256001 Swedish Medical Center - Issaquah Campus 10/15/2018 4F - Pressure ulcerHAC.FS.60256001 Swedish Medical Center - Issaquah Campus 12/3/2018 1C - Wrong surgical/invasive procedureHAC.FS.60256001 Swedish Medical Center - Issaquah Campus 3/25/2019 4E - Patient death or serious injury associated with a fallHAC.FS.60256001 Swedish Medical Center - Issaquah Campus 4/22/2019 4F - Pressure ulcerHAC.FS.60256001 Swedish Medical Center - Issaquah Campus 7/15/2019 4I - Failure to follow up with test resultsHAC.FS.60256001 Swedish Medical Center - Issaquah Campus 7/29/2019 4E - Patient death or serious injury associated with a fallHAC.FS.60256001 Swedish Medical Center - Issaquah Campus 1/20/2020 1D - Unintended retention of foreign objectHAC.FS.60256001 Swedish Medical Center - Issaquah Campus 4/27/2020 1E - Post-operative deathHAC.FS.60256001 Swedish Medical Center - Issaquah Campus 4/27/2020 4E - Patient death or serious injury associated with a fallHAC.FS.60256001 Swedish Medical Center - Issaquah Campus 6/22/2020 4E - Patient death or serious injury associated with a fall

29HAC.FS.00000176 Tacoma General Allenmore Hospital Pierce 10/26/2006 1A - Wrong surgery/invasive procedure siteHAC.FS.00000176 Tacoma General Allenmore Hospital 12/7/2006 1D - Unintended retention of foreign objectHAC.FS.00000176 Tacoma General Allenmore Hospital 5/11/2007 1D - Unintended retention of foreign objectHAC.FS.00000176 Tacoma General Allenmore Hospital 6/20/2007 1D - Unintended retention of foreign objectHAC.FS.00000176 Tacoma General Allenmore Hospital 7/30/2007 4F - Pressure ulcerHAC.FS.00000176 Tacoma General Allenmore Hospital 4/1/2008 1D - Unintended retention of foreign objectHAC.FS.00000176 Tacoma General Allenmore Hospital 6/11/2008 1D - Unintended retention of foreign objectHAC.FS.00000176 Tacoma General Allenmore Hospital 7/16/2008 1D - Unintended retention of foreign objectHAC.FS.00000176 Tacoma General Allenmore Hospital 1/22/2009 4A - Medication errorHAC.FS.00000176 Tacoma General Allenmore Hospital 7/11/2009 1D - Unintended retention of foreign objectHAC.FS.00000176 Tacoma General Allenmore Hospital 8/31/2009 4F - Pressure ulcerHAC.FS.00000176 Tacoma General Allenmore Hospital 8/31/2009 4F - Pressure ulcerHAC.FS.00000176 Tacoma General Allenmore Hospital 9/3/2009 4F - Pressure ulcerHAC.FS.00000176 Tacoma General Allenmore Hospital 9/8/2009 4F - Pressure ulcerHAC.FS.00000176 Tacoma General Allenmore Hospital 9/8/2009 4F - Pressure ulcerHAC.FS.00000176 Tacoma General Allenmore Hospital 9/8/2009 4F - Pressure ulcerHAC.FS.00000176 Tacoma General Allenmore Hospital 12/7/2009 4F - Pressure ulcerHAC.FS.00000176 Tacoma General Allenmore Hospital 1/12/2010 4F - Pressure ulcerHAC.FS.00000176 Tacoma General Allenmore Hospital 1/12/2010 4F - Pressure ulcerHAC.FS.00000176 Tacoma General Allenmore Hospital 1/31/2010 4F - Pressure ulcerHAC.FS.00000176 Tacoma General Allenmore Hospital 2/11/2010 4E - Patient death or serious injury associated with a fallHAC.FS.00000176 Tacoma General Allenmore Hospital 3/24/2010 4E - Patient death or serious injury associated with a fallHAC.FS.00000176 Tacoma General Allenmore Hospital 4/19/2010 4F - Pressure ulcerHAC.FS.00000176 Tacoma General Allenmore Hospital 4/26/2010 4F - Pressure ulcerHAC.FS.00000176 Tacoma General Allenmore Hospital 5/13/2010 4E - Patient death or serious injury associated with a fallHAC.FS.00000176 Tacoma General Allenmore Hospital 7/19/2010 1D - Unintended retention of foreign objectHAC.FS.00000176 Tacoma General Allenmore Hospital 7/27/2010 1D - Unintended retention of foreign objectHAC.FS.00000176 Tacoma General Allenmore Hospital 8/31/2010 4F - Pressure ulcerHAC.FS.00000176 Tacoma General Allenmore Hospital 8/31/2010 4F - Pressure ulcerHAC.FS.00000176 Tacoma General Allenmore Hospital 12/16/2010 4F - Pressure ulcerHAC.FS.00000176 Tacoma General Allenmore Hospital 1/14/2011 4E - Patient death or serious injury associated with a fallHAC.FS.00000176 Tacoma General Allenmore Hospital 1/18/2011 4F - Pressure ulcerHAC.FS.00000176 Tacoma General Allenmore Hospital 3/21/2011 2B - Device function or useHAC.FS.00000176 Tacoma General Allenmore Hospital 3/21/2011 4F - Pressure ulcerHAC.FS.00000176 Tacoma General Allenmore Hospital 4/1/2011 4E - Patient death or serious injury associated with a fallHAC.FS.00000176 Tacoma General Allenmore Hospital 4/15/2011 4F - Pressure ulcerHAC.FS.00000176 Tacoma General Allenmore Hospital 4/15/2011 4F - Pressure ulcerHAC.FS.00000176 Tacoma General Allenmore Hospital 5/13/2011 4E - Patient death or serious injury associated with a fallHAC.FS.00000176 Tacoma General Allenmore Hospital 6/3/2011 2B - Device function or useHAC.FS.00000176 Tacoma General/Allenmore Hospital 12/2/2011 4E - Patient death or serious injury associated with a fallHAC.FS.00000176 Tacoma General/Allenmore Hospital 12/9/2011 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 2/10/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000176 Tacoma General/Allenmore Hospital 2/24/2012 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 3/16/2012 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 3/23/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000176 Tacoma General/Allenmore Hospital 4/9/2012 1D - Unintended retention of foreign objectHAC.FS.00000176 Tacoma General/Allenmore Hospital 4/18/2012 1D - Unintended retention of foreign objectHAC.FS.00000176 Tacoma General/Allenmore Hospital 4/19/2012 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 5/18/2012 1D - Unintended retention of foreign objectHAC.FS.00000176 Tacoma General/Allenmore Hospital 6/1/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000176 Tacoma General/Allenmore Hospital 7/6/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000176 Tacoma General/Allenmore Hospital 8/16/2012 1A - Wrong surgery/invasive procedure siteHAC.FS.00000176 Tacoma General/Allenmore Hospital 9/6/2012 1A - Wrong surgery/invasive procedure siteHAC.FS.00000176 Tacoma General/Allenmore Hospital 11/2/2012 1A - Wrong surgery/invasive procedure siteHAC.FS.00000176 Tacoma General/Allenmore Hospital 11/16/2012 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 12/28/2012 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 1/29/2013 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 2/8/2013 4F - Pressure ulcer

Swedish Medical Center number of events:

Swedish Medical Center - Issaquah Campus number of events:

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DOH 689-013 September 2014Office of Community Health Systems Page 48 of 62

Adverse Events Quarterly ReportFacility by Date and Event - Q2 2020

Facility Credential Facility Name Facility County Date Confirmed Event TypeHAC.FS.00000176 Tacoma General/Allenmore Hospital 2/15/2013 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 2/15/2013 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 3/1/2013 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 3/8/2013 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 3/8/2013 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 4/5/2013 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 4/22/2013 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 4/26/2013 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 4/26/2013 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 4/26/2013 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 6/28/2013 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 6/28/2013 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 7/12/2013 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 7/26/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000176 Tacoma General/Allenmore Hospital 9/27/2013 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 11/1/2013 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 11/15/2013 1A - Wrong surgery/invasive procedure siteHAC.FS.00000176 Tacoma General/Allenmore Hospital 12/5/2013 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 12/6/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000176 Tacoma General/Allenmore Hospital 1/3/2014 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 1/10/2014 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 1/22/2014 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 1/31/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000176 Tacoma General/Allenmore Hospital 2/27/2014 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 4/4/2014 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 4/18/2014 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 4/18/2014 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 4/21/2014 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 4/21/2014 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 4/22/2014 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 5/16/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000176 Tacoma General/Allenmore Hospital 5/22/2014 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 5/22/2014 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 5/30/2014 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 6/6/2014 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 6/6/2014 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 6/6/2014 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 6/11/2014 **7D - Physical assaultHAC.FS.00000176 Tacoma General/Allenmore Hospital 6/23/2014 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 7/11/2014 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 9/17/2014 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 9/19/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000176 Tacoma General/Allenmore Hospital 10/6/2014 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 10/6/2014 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 10/24/2014 4A - Medication errorHAC.FS.00000176 Tacoma General/Allenmore Hospital 11/4/2014 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 12/16/2014 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 1/13/2015 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 1/19/2015 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 2/5/2015 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 2/18/2015 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 2/27/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000176 Tacoma General/Allenmore Hospital 3/13/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000176 Tacoma General/Allenmore Hospital 3/27/2015 1D - Unintended retention of foreign objectHAC.FS.00000176 Tacoma General/Allenmore Hospital 3/27/2015 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 4/17/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000176 Tacoma General/Allenmore Hospital 4/17/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000176 Tacoma General/Allenmore Hospital 4/17/2015 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 4/17/2015 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 4/17/2015 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 4/24/2015 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 4/24/2015 5C - BurnHAC.FS.00000176 Tacoma General/Allenmore Hospital 5/1/2015 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 5/15/2015 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 6/19/2015 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 7/24/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000176 Tacoma General/Allenmore Hospital 8/7/2015 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 8/14/2015 7D - Physical assaultHAC.FS.00000176 Tacoma General/Allenmore Hospital 8/14/2015 7D - Physical assaultHAC.FS.00000176 Tacoma General/Allenmore Hospital 8/21/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000176 Tacoma General/Allenmore Hospital 8/28/2015 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 9/11/2015 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 9/11/2015 5C - BurnHAC.FS.00000176 Tacoma General/Allenmore Hospital 9/18/2015 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 9/18/2015 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 9/18/2015 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 9/25/2015 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 9/25/2015 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 10/9/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000176 Tacoma General/Allenmore Hospital 10/9/2015 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 10/16/2015 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 10/16/2015 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 10/30/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000176 Tacoma General/Allenmore Hospital 10/30/2015 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 11/13/2015 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 11/20/2015 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 11/20/2015 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 11/20/2015 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 11/20/2015 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 12/11/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000176 Tacoma General/Allenmore Hospital 12/11/2015 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 12/18/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000176 Tacoma General/Allenmore Hospital 12/18/2015 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 12/18/2015 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 1/15/2016 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 1/15/2016 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 1/22/2016 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 1/22/2016 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 1/22/2016 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 1/29/2016 4F - Pressure ulcer

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Adverse Events Quarterly ReportFacility by Date and Event - Q2 2020

Facility Credential Facility Name Facility County Date Confirmed Event TypeHAC.FS.00000176 Tacoma General/Allenmore Hospital 1/29/2016 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 1/29/2016 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 1/29/2016 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 2/5/2016 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 2/5/2016 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 2/12/2016 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 2/12/2016 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 2/19/2016 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 2/26/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000176 Tacoma General/Allenmore Hospital 2/26/2016 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 3/4/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000176 Tacoma General/Allenmore Hospital 3/4/2016 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 3/4/2016 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 3/4/2016 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 3/18/2016 4A - Medication errorHAC.FS.00000176 Tacoma General/Allenmore Hospital 3/18/2016 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 4/1/2016 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 4/22/2016 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 4/22/2016 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 4/22/2016 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 4/22/2016 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 4/22/2016 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 4/22/2016 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 5/6/2016 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 5/6/2016 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 5/13/2016 1D - Unintended retention of foreign objectHAC.FS.00000176 Tacoma General/Allenmore Hospital 5/13/2016 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 5/13/2016 4H - Irretrievable loss of irreplaceable biological specimenHAC.FS.00000176 Tacoma General/Allenmore Hospital 5/20/2016 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 6/14/2016 1A - Wrong surgery/invasive procedure siteHAC.FS.00000176 Tacoma General/Allenmore Hospital 6/17/2016 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 7/8/2016 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 7/8/2016 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 7/8/2016 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 7/8/2016 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 7/8/2016 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 7/22/2016 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 9/16/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000176 Tacoma General/Allenmore Hospital 9/16/2016 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 10/7/2016 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 10/14/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000176 Tacoma General/Allenmore Hospital 10/28/2016 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 10/28/2016 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 11/4/2016 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 11/18/2016 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 11/22/2016 1D - Unintended retention of foreign objectHAC.FS.00000176 Tacoma General/Allenmore Hospital 12/29/2016 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 1/6/2017 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 1/13/2017 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 1/16/2017 4A - Medication errorHAC.FS.00000176 Tacoma General/Allenmore Hospital 1/16/2017 4A - Medication errorHAC.FS.00000176 Tacoma General/Allenmore Hospital 1/27/2017 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 3/27/2017 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 3/27/2017 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 3/27/2017 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 3/27/2017 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 4/24/2017 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 5/22/2017 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 5/22/2017 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 5/22/2017 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 5/22/2017 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 5/22/2017 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 5/22/2017 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 6/26/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000176 Tacoma General/Allenmore Hospital 6/26/2017 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 6/26/2017 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 6/26/2017 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 6/26/2017 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 8/3/2017 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 8/28/2017 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 9/25/2017 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 9/25/2017 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 9/25/2017 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 9/25/2017 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 9/25/2017 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 9/25/2017 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 10/26/2017 4A - Medication errorHAC.FS.00000176 Tacoma General/Allenmore Hospital 11/27/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000176 Tacoma General/Allenmore Hospital 11/27/2017 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 11/27/2017 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 11/27/2017 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 11/27/2017 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 11/27/2017 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 11/27/2017 4I - Failure to follow up with test resultsHAC.FS.00000176 Tacoma General/Allenmore Hospital 1/25/2018 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 2/16/2018 2B - Device function or useHAC.FS.00000176 Tacoma General/Allenmore Hospital 2/16/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000176 Tacoma General/Allenmore Hospital 2/22/2018 1D - Unintended retention of foreign objectHAC.FS.00000176 Tacoma General/Allenmore Hospital 3/13/2018 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 3/13/2018 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 3/13/2018 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 3/13/2018 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 3/26/2018 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 3/26/2018 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 3/26/2018 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 3/26/2018 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 4/23/2018 2B - Device function or useHAC.FS.00000176 Tacoma General/Allenmore Hospital 4/23/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000176 Tacoma General/Allenmore Hospital 4/26/2018 1A - Wrong surgery/invasive procedure siteHAC.FS.00000176 Tacoma General/Allenmore Hospital 5/9/2018 4E - Patient death or serious injury associated with a fall

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DOH 689-013 September 2014Office of Community Health Systems Page 50 of 62

Adverse Events Quarterly ReportFacility by Date and Event - Q2 2020

Facility Credential Facility Name Facility County Date Confirmed Event TypeHAC.FS.00000176 Tacoma General/Allenmore Hospital 5/9/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000176 Tacoma General/Allenmore Hospital 5/9/2018 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 5/9/2018 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 5/29/2018 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 5/31/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000176 Tacoma General/Allenmore Hospital 6/25/2018 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 6/25/2018 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 6/25/2018 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 6/25/2018 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 6/28/2018 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 7/23/2018 1D - Unintended retention of foreign objectHAC.FS.00000176 Tacoma General/Allenmore Hospital 7/23/2018 4A - Medication errorHAC.FS.00000176 Tacoma General/Allenmore Hospital 8/30/2018 4A - Medication errorHAC.FS.00000176 Tacoma General/Allenmore Hospital 9/21/2018 1D - Unintended retention of foreign objectHAC.FS.00000176 Tacoma General/Allenmore Hospital 9/24/2018 1A - Wrong surgery/invasive procedure siteHAC.FS.00000176 Tacoma General/Allenmore Hospital 10/22/2018 4A - Medication errorHAC.FS.00000176 Tacoma General/Allenmore Hospital 10/22/2018 4A - Medication errorHAC.FS.00000176 Tacoma General/Allenmore Hospital 10/22/2018 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 10/22/2018 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 10/22/2018 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 10/22/2018 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 10/22/2018 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 10/22/2018 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 10/22/2018 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 11/7/2018 1A - Wrong surgery/invasive procedure siteHAC.FS.00000176 Tacoma General/Allenmore Hospital 11/28/2018 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 11/28/2018 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 1/28/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000176 Tacoma General/Allenmore Hospital 1/28/2019 5C - BurnHAC.FS.00000176 Tacoma General/Allenmore Hospital 1/28/2019 7D - Physical assaultHAC.FS.00000176 Tacoma General/Allenmore Hospital 2/25/2019 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 2/25/2019 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 2/25/2019 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 2/25/2019 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 2/25/2019 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 2/25/2019 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 2/25/2019 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 2/25/2019 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 2/25/2019 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 2/25/2019 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 2/25/2019 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 2/26/2019 7C - Sexual abuse/assaultHAC.FS.00000176 Tacoma General/Allenmore Hospital 3/22/2019 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 3/22/2019 7D - Physical assaultHAC.FS.00000176 Tacoma General/Allenmore Hospital 4/25/2019 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 5/17/2019 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 5/17/2019 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 5/30/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000176 Tacoma General/Allenmore Hospital 7/8/2019 2B - Device function or useHAC.FS.00000176 Tacoma General/Allenmore Hospital 7/8/2019 2B - Device function or useHAC.FS.00000176 Tacoma General/Allenmore Hospital 7/8/2019 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 7/8/2019 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 7/9/2019 1D - Unintended retention of foreign objectHAC.FS.00000176 Tacoma General/Allenmore Hospital 9/20/2019 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 9/20/2019 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 9/20/2019 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 9/20/2019 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 11/26/2019 1D - Unintended retention of foreign objectHAC.FS.00000176 Tacoma General/Allenmore Hospital 11/26/2019 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 1/17/2020 1A - Wrong surgery/invasive procedure siteHAC.FS.00000176 Tacoma General/Allenmore Hospital 1/17/2020 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 1/17/2020 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 1/17/2020 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 2/27/2020 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 2/27/2020 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 2/27/2020 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 2/27/2020 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 4/27/2020 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 5/19/2020 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 5/28/2020 5D - RestraintsHAC.FS.00000176 Tacoma General/Allenmore Hospital 6/19/2020 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 6/19/2020 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 6/19/2020 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 6/19/2020 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 6/19/2020 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 6/19/2020 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 6/19/2020 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 6/19/2020 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 6/19/2020 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 6/19/2020 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 6/19/2020 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 6/19/2020 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 6/19/2020 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 6/19/2020 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 6/19/2020 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 6/19/2020 4F - Pressure ulcerHAC.FS.00000176 Tacoma General/Allenmore Hospital 6/19/2020 4F - Pressure ulcer

345HAC.FS.00000023 Three Rivers Hospital Okanogan 5/9/2015 4I - Failure to follow up with test resultsHAC.FS.00000023 Three Rivers Hospital 8/7/2018 4E - Patient death or serious injury associated with a fall

2HAC.FS.00000199 Toppenish Community Hospital Yakima 12/27/2012 **4A - Medication errorHAC.FS.00000199 Toppenish Community Hospital 9/23/2013 4A - Medication errorHAC.FS.00000199 Toppenish Community Hospital 12/8/2014 4I - Failure to follow up with test resultsHAC.FS.00000199 Toppenish Community Hospital 3/29/2017 4E - Patient death or serious injury associated with a fall

4HAC.FS.60867574 Trios Health Benton 10/9/2019 4E - Patient death or serious injury associated with a fallHAC.FS.60867574 Trios Health 12/12/2019 7D - Physical assault

2HAC.FS.00000108 Tri-State Memorial Hospital Asotin 12/9/2014 1A - Wrong surgery/invasive procedure site

Toppenish Community Hospital number of events

MHS Tacoma General/Allenmore Hospital number of events:

Three Rivers Hospital number of events

Trios Health number of events:

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Adverse EventsFacilities and Date of Event Report 2006-2020

DOH 689-013 September 2014Office of Community Health Systems Page 51 of 62

Adverse Events Quarterly ReportFacility by Date and Event - Q2 2020

Facility Credential Facility Name Facility County Date Confirmed Event TypeHAC.FS.00000108 Tri-State Memorial Hospital 5/15/2017 1A - Wrong surgery/invasive procedure siteHAC.FS.00000108 Tri-State Memorial Hospital 5/15/2017 1A - Wrong surgery/invasive procedure siteHAC.FS.00000108 Tri-State Memorial Hospital 9/19/2019 **1A - Wrong surgery/invasive procedure site

4HAC.FS.00000206 United General Hospital Skagit 10/27/2006 4A - Medication errorHAC.FS.00000206 United General Hospital 7/21/2008 4E - Patient death or serious injury associated with a fallHAC.FS.00000206 United General Hospital 9/3/2013 4A - Medication errorHAC.FS.00000206 United General Hospital 9/3/2013 4A - Medication errorHAC.FS.00000206 United General Hospital 11/20/2013 **4E - Patient death or serious injury associated with a fall

5HAC.FS.00000128 University of Washington Medical Center King 7/4/2006 1D - Unintended retention of foreign objectHAC.FS.00000128 University of Washington Medical Center 7/11/2006 1A - Wrong surgery/invasive procedure siteHAC.FS.00000128 University of Washington Medical Center 8/12/2006 4A - Medication errorHAC.FS.00000128 University of Washington Medical Center 10/5/2006 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 11/21/2006 4A - Medication errorHAC.FS.00000128 University of Washington Medical Center 12/19/2006 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 1/5/2007 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 1/8/2007 1A - Wrong surgery/invasive procedure siteHAC.FS.00000128 University of Washington Medical Center 2/12/2007 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 2/21/2007 4E - Patient death or serious injury associated with a fallHAC.FS.00000128 University of Washington Medical Center 3/5/2007 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 3/9/2007 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 3/29/2007 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 3/29/2007 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 3/29/2007 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 3/29/2007 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 5/3/2007 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 5/22/2007 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 5/22/2007 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 6/25/2007 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 6/29/2007 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 7/20/2007 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 7/21/2007 1D - Unintended retention of foreign objectHAC.FS.00000128 University of Washington Medical Center 7/27/2007 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 7/27/2007 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 8/3/2007 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 8/17/2007 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 8/20/2007 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 8/22/2007 1D - Unintended retention of foreign objectHAC.FS.00000128 University of Washington Medical Center 9/18/2007 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 9/19/2007 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 9/20/2007 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 9/25/2007 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 9/25/2007 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 9/27/2007 1C - Wrong surgical/invasive procedureHAC.FS.00000128 University of Washington Medical Center 9/27/2007 4E - Patient death or serious injury associated with a fallHAC.FS.00000128 University of Washington Medical Center 10/10/2007 1D - Unintended retention of foreign objectHAC.FS.00000128 University of Washington Medical Center 10/16/2007 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 10/18/2007 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 10/26/2007 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 11/29/2007 2B - Device function or useHAC.FS.00000128 University of Washington Medical Center 12/12/2007 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 12/26/2007 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 1/4/2008 1D - Unintended retention of foreign objectHAC.FS.00000128 University of Washington Medical Center 1/8/2008 4A - Medication errorHAC.FS.00000128 University of Washington Medical Center 1/8/2008 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 1/14/2008 1D - Unintended retention of foreign objectHAC.FS.00000128 University of Washington Medical Center 1/14/2008 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 1/16/2008 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 1/23/2008 1D - Unintended retention of foreign objectHAC.FS.00000128 University of Washington Medical Center 1/30/2008 2B - Device function or useHAC.FS.00000128 University of Washington Medical Center 3/4/2008 1A - Wrong surgery/invasive procedure siteHAC.FS.00000128 University of Washington Medical Center 3/13/2008 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 3/13/2008 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 3/24/2008 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 4/2/2008 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 4/2/2008 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 5/20/2008 4A - Medication errorHAC.FS.00000128 University of Washington Medical Center 6/4/2008 1D - Unintended retention of foreign objectHAC.FS.00000128 University of Washington Medical Center 6/19/2008 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 7/1/2008 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 7/1/2008 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 7/3/2008 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 7/10/2008 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 7/23/2008 1C - Wrong surgical/invasive procedureHAC.FS.00000128 University of Washington Medical Center 7/24/2008 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 8/8/2008 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 8/21/2008 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 8/28/2008 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 9/9/2008 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 9/11/2008 1D - Unintended retention of foreign objectHAC.FS.00000128 University of Washington Medical Center 9/23/2008 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 9/23/2008 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 9/23/2008 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 9/30/2008 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 10/8/2008 1D - Unintended retention of foreign objectHAC.FS.00000128 University of Washington Medical Center 10/9/2008 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 10/27/2008 1C - Wrong surgical/invasive procedureHAC.FS.00000128 University of Washington Medical Center 12/15/2008 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 1/8/2009 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 1/13/2009 1D - Unintended retention of foreign objectHAC.FS.00000128 University of Washington Medical Center 1/20/2009 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 1/21/2009 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 2/9/2009 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 2/18/2009 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 3/31/2009 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 3/31/2009 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 4/6/2009 1D - Unintended retention of foreign objectHAC.FS.00000128 University of Washington Medical Center 4/7/2009 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 4/20/2009 1D - Unintended retention of foreign object

Tri-State Memorial Hospital number of events

United General Hospital number of events:

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Adverse Events Quarterly ReportFacility by Date and Event - Q2 2020

Facility Credential Facility Name Facility County Date Confirmed Event TypeHAC.FS.00000128 University of Washington Medical Center 5/4/2009 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 5/11/2009 1D - Unintended retention of foreign objectHAC.FS.00000128 University of Washington Medical Center 6/16/2009 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 6/16/2009 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 6/26/2009 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 6/26/2009 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 7/1/2009 1A - Wrong surgery/invasive procedure siteHAC.FS.00000128 University of Washington Medical Center 7/8/2009 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 7/10/2009 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 7/14/2009 1B - Wrong surgery/invasive procedure patientHAC.FS.00000128 University of Washington Medical Center 7/24/2009 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 7/24/2009 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 8/19/2009 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 8/20/2009 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 9/22/2009 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 10/5/2009 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 10/14/2009 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 10/16/2009 1D - Unintended retention of foreign objectHAC.FS.00000128 University of Washington Medical Center 10/23/2009 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 11/9/2009 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 11/25/2009 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 12/2/2009 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 12/3/2009 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 12/8/2009 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 12/9/2009 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 1/6/2010 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 1/8/2010 1D - Unintended retention of foreign objectHAC.FS.00000128 University of Washington Medical Center 1/12/2010 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 1/13/2010 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 1/25/2010 1D - Unintended retention of foreign objectHAC.FS.00000128 University of Washington Medical Center 1/28/2010 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 2/1/2010 1D - Unintended retention of foreign objectHAC.FS.00000128 University of Washington Medical Center 2/2/2010 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 2/2/2010 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 2/3/2010 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 2/9/2010 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 2/9/2010 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 2/16/2010 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 2/16/2010 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 2/17/2010 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 3/25/2010 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 3/31/2010 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 4/16/2010 1D - Unintended retention of foreign objectHAC.FS.00000128 University of Washington Medical Center 4/20/2010 1A - Wrong surgery/invasive procedure siteHAC.FS.00000128 University of Washington Medical Center 5/14/2010 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 5/14/2010 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 5/21/2010 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 6/8/2010 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 6/8/2010 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 6/9/2010 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 6/15/2010 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 8/6/2010 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 8/10/2010 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 8/18/2010 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 8/18/2010 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 8/24/2010 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 8/24/2010 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 8/24/2010 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 9/14/2010 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 9/23/2010 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 11/18/2010 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 11/18/2010 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 11/18/2010 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 11/22/2010 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 11/22/2010 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 12/8/2010 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 12/29/2010 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 1/28/2011 1D - Unintended retention of foreign objectHAC.FS.00000128 University of Washington Medical Center 2/10/2011 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 2/15/2011 1D - Unintended retention of foreign objectHAC.FS.00000128 University of Washington Medical Center 2/28/2011 4E - Patient death or serious injury associated with a fallHAC.FS.00000128 University of Washington Medical Center 4/14/2011 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 4/26/2011 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 5/11/2011 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 5/19/2011 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 6/22/2011 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 7/13/2011 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 7/20/2011 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 7/27/2011 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 7/27/2011 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 8/17/2011 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 8/17/2011 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 8/19/2011 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 8/26/2011 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 8/26/2011 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 9/9/2011 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 9/9/2011 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 10/11/2011 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 10/11/2011 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 10/11/2011 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 10/26/2011 1D - Unintended retention of foreign objectHAC.FS.00000128 University of Washington Medical Center 10/28/2011 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 10/28/2011 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 10/28/2011 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 11/14/2011 1D - Unintended retention of foreign objectHAC.FS.00000128 University of Washington Medical Center 11/22/2011 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 11/22/2011 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 11/30/2011 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 12/29/2011 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 12/29/2011 4F - Pressure ulcer

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Adverse Events Quarterly ReportFacility by Date and Event - Q2 2020

Facility Credential Facility Name Facility County Date Confirmed Event TypeHAC.FS.00000128 University of Washington Medical Center 12/29/2011 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 12/29/2011 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 1/18/2012 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 1/18/2012 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 2/6/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000128 University of Washington Medical Center 2/9/2012 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 2/29/2012 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 3/15/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000128 University of Washington Medical Center 3/16/2012 1A - Wrong surgery/invasive procedure siteHAC.FS.00000128 University of Washington Medical Center 3/20/2012 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 4/2/2012 1A - Wrong surgery/invasive procedure siteHAC.FS.00000128 University of Washington Medical Center 4/15/2012 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 4/30/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000128 University of Washington Medical Center 5/16/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000128 University of Washington Medical Center 5/21/2012 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 5/21/2012 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 6/26/2012 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 6/29/2012 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 6/29/2012 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 6/29/2012 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 6/29/2012 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 8/22/2012 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 8/22/2012 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 8/28/2012 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 10/19/2012 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 10/19/2012 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 11/30/2012 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 12/10/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000128 University of Washington Medical Center 1/25/2013 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 3/11/2013 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 3/22/2013 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 4/23/2013 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 5/10/2013 1A - Wrong surgery/invasive procedure siteHAC.FS.00000128 University of Washington Medical Center 6/12/2013 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 6/12/2013 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 6/13/2013 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 6/27/2013 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 6/27/2013 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 6/27/2013 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 6/27/2013 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 6/27/2013 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 7/24/2013 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 7/30/2013 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 8/9/2013 2B - Device function or useHAC.FS.00000128 University of Washington Medical Center 8/9/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000128 University of Washington Medical Center 8/21/2013 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 8/21/2013 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 8/28/2013 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 8/29/2013 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 8/29/2013 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 9/13/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000128 University of Washington Medical Center 10/11/2013 1D - Unintended retention of foreign objectHAC.FS.00000128 University of Washington Medical Center 10/11/2013 4D - Death or serious injury of neonateHAC.FS.00000128 University of Washington Medical Center 10/11/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000128 University of Washington Medical Center 10/15/2013 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 10/15/2013 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 11/8/2013 4D - Death or serious injury of neonateHAC.FS.00000128 University of Washington Medical Center 12/19/2013 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 1/28/2014 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 2/10/2014 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 2/14/2014 1D - Unintended retention of foreign objectHAC.FS.00000128 University of Washington Medical Center 2/14/2014 4A - Medication errorHAC.FS.00000128 University of Washington Medical Center 2/14/2014 4A - Medication errorHAC.FS.00000128 University of Washington Medical Center 2/28/2014 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 2/28/2014 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 3/14/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000128 University of Washington Medical Center 4/3/2014 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 4/11/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000128 University of Washington Medical Center 5/14/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000128 University of Washington Medical Center 5/23/2014 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 7/8/2014 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 7/11/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000128 University of Washington Medical Center 8/18/2014 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 8/18/2014 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 8/19/2014 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 8/19/2014 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 8/19/2014 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 8/25/2014 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 9/10/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000128 University of Washington Medical Center 9/16/2014 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 9/30/2014 1D - Unintended retention of foreign objectHAC.FS.00000128 University of Washington Medical Center 10/28/2014 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 10/28/2014 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 11/20/2014 1A - Wrong surgery/invasive procedure siteHAC.FS.00000128 University of Washington Medical Center 1/8/2015 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 1/14/2015 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 3/25/2015 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 3/27/2015 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 4/18/2015 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 4/28/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000128 University of Washington Medical Center 5/12/2015 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 5/13/2015 1D - Unintended retention of foreign objectHAC.FS.00000128 University of Washington Medical Center 6/10/2015 1A - Wrong surgery/invasive procedure siteHAC.FS.00000128 University of Washington Medical Center 6/30/2015 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 8/13/2015 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 8/13/2015 1A - Wrong surgery/invasive procedure siteHAC.FS.00000128 University of Washington Medical Center 9/15/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000128 University of Washington Medical Center 9/15/2015 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 9/15/2015 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 9/16/2015 4F - Pressure ulcer

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Adverse Events Quarterly ReportFacility by Date and Event - Q2 2020

Facility Credential Facility Name Facility County Date Confirmed Event TypeHAC.FS.00000128 University of Washington Medical Center 11/16/2015 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 12/3/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000128 University of Washington Medical Center 12/4/2015 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 1/13/2016 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 1/19/2016 4A - Medication errorHAC.FS.00000128 University of Washington Medical Center 2/8/2016 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 2/18/2016 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 3/9/2016 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 3/9/2016 2B - Device function or useHAC.FS.00000128 University of Washington Medical Center 3/9/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000128 University of Washington Medical Center 3/9/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000128 University of Washington Medical Center 3/10/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000128 University of Washington Medical Center 3/15/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000128 University of Washington Medical Center 4/15/2016 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 5/11/2016 4H - Irretrievable loss of irreplaceable biological specimenHAC.FS.00000128 University of Washington Medical Center 5/24/2016 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 6/30/2016 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 7/13/2016 4D - Death or serious injury of neonateHAC.FS.00000128 University of Washington Medical Center 7/13/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000128 University of Washington Medical Center 8/10/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000128 University of Washington Medical Center 8/30/2016 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 9/14/2016 1D - Unintended retention of foreign objectHAC.FS.00000128 University of Washington Medical Center 9/22/2016 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 10/12/2016 1C - Wrong surgical/invasive procedureHAC.FS.00000128 University of Washington Medical Center 11/8/2016 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 11/8/2016 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 11/9/2016 1A - Wrong surgery/invasive procedure siteHAC.FS.00000128 University of Washington Medical Center 12/14/2016 1A - Wrong surgery/invasive procedure siteHAC.FS.00000128 University of Washington Medical Center 12/27/2016 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 1/11/2017 4A - Medication errorHAC.FS.00000128 University of Washington Medical Center 1/11/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000128 University of Washington Medical Center 1/23/2017 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 1/24/2017 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 2/8/2017 4A - Medication errorHAC.FS.00000128 University of Washington Medical Center 2/9/2017 4D - Death or serious injury of neonateHAC.FS.00000128 University of Washington Medical Center 3/22/2017 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 4/12/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000128 University of Washington Medical Center 5/16/2017 1D - Unintended retention of foreign objectHAC.FS.00000128 University of Washington Medical Center 5/23/2017 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 5/23/2017 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 5/24/2017 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 6/5/2017 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 6/14/2017 1D - Unintended retention of foreign objectHAC.FS.00000128 University of Washington Medical Center 6/14/2017 4I - Failure to follow up with test resultsHAC.FS.00000128 University of Washington Medical Center 7/12/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000128 University of Washington Medical Center 7/14/2017 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 8/8/2017 4D - Death or serious injury of neonateHAC.FS.00000128 University of Washington Medical Center 8/8/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000128 University of Washington Medical Center 8/8/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000128 University of Washington Medical Center 8/9/2017 7C - Sexual abuse/assaultHAC.FS.00000128 University of Washington Medical Center 8/22/2017 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 9/15/2017 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 9/15/2017 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 9/26/2017 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 11/8/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000128 University of Washington Medical Center 11/14/2017 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 12/13/2017 2B - Device function or useHAC.FS.00000128 University of Washington Medical Center 12/13/2017 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.00000128 University of Washington Medical Center 1/10/2018 7C - Sexual abuse/assaultHAC.FS.00000128 University of Washington Medical Center 1/10/2018 7C - Sexual abuse/assaultHAC.FS.00000128 University of Washington Medical Center 2/14/2018 1D - Unintended retention of foreign objectHAC.FS.00000128 University of Washington Medical Center 3/26/2018 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 4/10/2018 1D - Unintended retention of foreign objectHAC.FS.00000128 University of Washington Medical Center 4/11/2018 1D - Unintended retention of foreign objectHAC.FS.00000128 University of Washington Medical Center 4/11/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000128 University of Washington Medical Center 5/9/2018 1C - Wrong surgical/invasive procedureHAC.FS.00000128 University of Washington Medical Center 5/9/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000128 University of Washington Medical Center 5/23/2018 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 6/21/2018 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 7/11/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000128 University of Washington Medical Center 8/8/2018 1D - Unintended retention of foreign objectHAC.FS.00000128 University of Washington Medical Center 8/8/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000128 University of Washington Medical Center 8/8/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000128 University of Washington Medical Center 8/22/2018 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 8/24/2018 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 9/12/2018 4A - Medication errorHAC.FS.00000128 University of Washington Medical Center 9/20/2018 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 10/10/2018 1D - Unintended retention of foreign objectHAC.FS.00000128 University of Washington Medical Center 11/15/2018 1D - Unintended retention of foreign objectHAC.FS.00000128 University of Washington Medical Center 12/12/2018 4A - Medication errorHAC.FS.00000128 University of Washington Medical Center 12/19/2018 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 1/15/2019 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 2/13/2019 4A - Medication errorHAC.FS.00000128 University of Washington Medical Center 2/13/2019 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 2/13/2019 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 3/13/2019 4A - Medication errorHAC.FS.00000128 University of Washington Medical Center 3/13/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000128 University of Washington Medical Center 3/13/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000128 University of Washington Medical Center 4/10/2019 1D - Unintended retention of foreign objectHAC.FS.00000128 University of Washington Medical Center 5/8/2019 4A - Medication errorHAC.FS.00000128 University of Washington Medical Center 5/8/2019 4A - Medication errorHAC.FS.00000128 University of Washington Medical Center 5/13/2019 4A - Medication errorHAC.FS.00000128 University of Washington Medical Center 7/9/2019 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 7/10/2019 1C - Wrong surgical/invasive procedureHAC.FS.00000128 University of Washington Medical Center 7/10/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000128 University of Washington Medical Center 8/14/2019 4A - Medication errorHAC.FS.00000128 University of Washington Medical Center 8/14/2019 4A - Medication errorHAC.FS.00000128 University of Washington Medical Center 8/15/2019 1D - Unintended retention of foreign objectHAC.FS.00000128 University of Washington Medical Center 9/6/2019 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 9/11/2019 4A - Medication error

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Adverse Events Quarterly ReportFacility by Date and Event - Q2 2020

Facility Credential Facility Name Facility County Date Confirmed Event TypeHAC.FS.00000128 University of Washington Medical Center 9/13/2019 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 10/9/2019 4A - Medication errorHAC.FS.00000128 University of Washington Medical Center 10/22/2019 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 11/13/2019 1A - Wrong surgery/invasive procedure siteHAC.FS.00000128 University of Washington Medical Center 11/13/2019 1D - Unintended retention of foreign objectHAC.FS.00000128 University of Washington Medical Center 11/13/2019 4A - Medication errorHAC.FS.00000128 University of Washington Medical Center 11/13/2019 4I - Failure to follow up with test resultsHAC.FS.00000128 University of Washington Medical Center 12/11/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000128 University of Washington Medical Center 12/11/2019 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 12/13/2019 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 1/13/2020 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 2/27/2020 4A - Medication errorHAC.FS.00000128 University of Washington Medical Center 2/27/2020 4E - Patient death or serious injury associated with a fallHAC.FS.00000128 University of Washington Medical Center 3/26/2020 1A - Wrong surgery/invasive procedure siteHAC.FS.00000128 University of Washington Medical Center 4/10/2020 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 5/15/2020 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 5/18/2020 4F - Pressure ulcerHAC.FS.00000128 University of Washington Medical Center 5/28/2020 2C - Intravascular air embolismHAC.FS.00000128 University of Washington Medical Center 5/28/2020 4C - Maternal death or serious injuryHAC.FS.00000128 University of Washington Medical Center 5/28/2020 7C - Sexual abuse/assault

410HAC.FS.00000104 Valley General Hospital Snohomish 6/5/2007 1A - Wrong surgery/invasive procedure siteHAC.FS.00000104 Valley General Hospital 2/19/2008 5D - RestraintsHAC.FS.00000104 Valley General Hospital 4/9/2008 4F - Pressure ulcerHAC.FS.00000104 Valley General Hospital 3/2/2009 1C - Wrong surgical/invasive procedureHAC.FS.00000104 Valley General Hospital 4/13/2010 1D - Unintended retention of foreign objectHAC.FS.00000104 Valley General Hospital 10/19/2010 1D - Unintended retention of foreign objectHAC.FS.00000104 Valley General Hospital 9/9/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000104 EvergreenHealth Monroe 2/6/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000104 EvergreenHealth Monroe 12/20/2019 **4E - Patient death or serious injury associated with a fallHAC.FS.00000104 EvergreenHealth Monroe 6/18/2020 4E - Patient death or serious injury associated with a fall

10HAC.FS.00000180 Valley Hospital and Medical Center Spokane 11/9/2006 4F - Pressure ulcerHAC.FS.00000180 Valley Hospital and Medical Center 10/8/2010 4E - Patient death or serious injury associated with a fallHAC.FS.00000180 Valley Hospital and Medical Center 10/8/2010 4E - Patient death or serious injury associated with a fallHAC.FS.00000180 Valley Hospital and Medical Center 10/8/2010 4E - Patient death or serious injury associated with a fallHAC.FS.00000180 Valley Hospital and Medical Center 10/8/2010 4E - Patient death or serious injury associated with a fallHAC.FS.00000180 Valley Hospital and Medical Center 11/2/2010 4E - Patient death or serious injury associated with a fallHAC.FS.00000180 Valley Hospitaliiiiiii 1/5/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000180 Valley Hospitaliiiiiii 11/19/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000180 Valley Hospitaliiiiiii 11/26/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000180 Valley Hospitaliiiiiii 12/5/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000180 Valley Hospitaliiiiiii 2/8/2013 1D - Unintended retention of foreign object HAC.FS.00000180 Valley Hospitaliiiiiii 4/25/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000180 Valley Hospitaliiiiiii 7/22/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000180 Valley Hospitaliiiiiii 11/5/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000180 Valley Hospitaliiiiiii 1/13/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000180 Valley Hospitaliiiiiii 2/3/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000180 Valley Hospitaliiiiiii 7/21/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000180 Valley Hospitaliiiiiii 8/26/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000180 Valley Hospitaliiiiiii 7/24/2015 4E - Patient death or serious injury associated with a fall

19HAC.FS.60054580 Valley Hospitaliiiiiii Spokane 10/7/2015 1A - Wrong surgery/invasive procedure siteHAC.FS.60054580 Valley Hospitaliiiiiii 10/7/2015 1A - Wrong surgery/invasive procedure siteHAC.FS.60054580 Valley Hospitaliiiiiii 10/22/2015 4F - Pressure ulcerHAC.FS.60054580 Valley Hospitaliiiiiii 2/4/2016 4E - Patient death or serious injury associated with a fall

4HAC.FS.00000155 Valley Medical Center King 6/28/2006 1A - Wrong surgery/invasive procedure siteHAC.FS.00000155 Valley Medical Center 8/18/2006 4F - Pressure ulcerHAC.FS.00000155 Valley Medical Center 9/12/2006 1D - Unintended retention of foreign objectHAC.FS.00000155 Valley Medical Center 9/29/2006 4F - Pressure ulcerHAC.FS.00000155 Valley Medical Center 10/26/2006 4A - Medication errorHAC.FS.00000155 Valley Medical Center 11/24/2006 4F - Pressure ulcerHAC.FS.00000155 Valley Medical Center 8/7/2007 4F - Pressure ulcerHAC.FS.00000155 Valley Medical Center 8/15/2007 4F - Pressure ulcerHAC.FS.00000155 Valley Medical Center 8/24/2007 4F - Pressure ulcerHAC.FS.00000155 Valley Medical Center 10/9/2007 1C - Wrong surgical/invasive procedureHAC.FS.00000155 Valley Medical Center 11/24/2008 4F - Pressure ulcerHAC.FS.00000155 Valley Medical Center 2/17/2009 4E - Patient death or serious injury associated with a fallHAC.FS.00000155 Valley Medical Center 3/18/2009 4F - Pressure ulcerHAC.FS.00000155 Valley Medical Center 4/1/2009 1D - Unintended retention of foreign objectHAC.FS.00000155 Valley Medical Center 5/8/2009 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.00000155 Valley Medical Center 8/24/2009 1D - Unintended retention of foreign objectHAC.FS.00000155 Valley Medical Center 9/23/2009 3B - Patient elopement (disappearance)HAC.FS.00000155 Valley Medical Center 2/2/2010 4F - Pressure ulcerHAC.FS.00000155 Valley Medical Center 2/4/2010 4F - Pressure ulcerHAC.FS.00000155 Valley Medical Center 2/24/2010 4F - Pressure ulcerHAC.FS.00000155 Valley Medical Center 6/29/2010 4F - Pressure ulcerHAC.FS.00000155 Valley Medical Center 11/22/2010 4F - Pressure ulcerHAC.FS.00000155 Valley Medical Center 5/16/2011 1A - Wrong surgery/invasive procedure siteHAC.FS.00000155 Valley Medical Center 6/16/2011 2C - Intravascular air embolismHAC.FS.00000155 Valley Medical Center 11/30/2011 4F - Pressure ulcerHAC.FS.00000155 Valley Medical Center 11/30/2011 4F - Pressure ulcerHAC.FS.00000155 Valley Medical Center 11/30/2011 4F - Pressure ulcerHAC.FS.00000155 Valley Medical Center 11/30/2011 4F - Pressure ulcerHAC.FS.00000155 Valley Medical Center 11/30/2011 4F - Pressure ulcerHAC.FS.00000155 Valley Medical Center 11/30/2011 4E - Patient death or serious injury associated with a fallHAC.FS.00000155 Valley Medical Center 4/22/2012 4F - Pressure ulcerHAC.FS.00000155 Valley Medical Center 7/30/2012 4F - Pressure ulcerHAC.FS.00000155 Valley Medical Center 7/30/2012 4F - Pressure ulcerHAC.FS.00000155 Valley Medical Center 7/30/2012 4F - Pressure ulcerHAC.FS.00000155 Valley Medical Center 9/18/2012 4F - Pressure ulcerHAC.FS.00000155 Valley Medical Center 10/19/2012 3A - Patient/Resident discharged to unauthorized personHAC.FS.00000155 Valley Medical Center 10/29/2012 4F - Pressure ulcerHAC.FS.00000155 Valley Medical Center 10/29/2012 4F - Pressure ulcerHAC.FS.00000155 Valley Medical Center 3/15/2013 3A - Patient/Resident discharged to unauthorized personHAC.FS.00000155 UW Medicine/Valley Medical Center 9/29/2013 **4E - Patient death or serious injury associated with a fallHAC.FS.00000155 UW Medicine/Valley Medical Center 10/2/2013 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 10/2/2013 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 10/2/2013 4F - Pressure ulcer

Valley Hospital number of events:

University of Washington Medical Center number of events:

EvergreenHealth Monroe number of events:

Valley Hospital and Medical Center/Valley Hospital number of events:

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Adverse Events Quarterly ReportFacility by Date and Event - Q2 2020

Facility Credential Facility Name Facility County Date Confirmed Event TypeHAC.FS.00000155 UW Medicine/Valley Medical Center 10/21/2013 1D - Unintended retention of foreign objectHAC.FS.00000155 UW Medicine/Valley Medical Center 11/5/2013 **4E - Patient death or serious injury associated with a fallHAC.FS.00000155 UW Medicine/Valley Medical Center 12/1/2013 **4E - Patient death or serious injury associated with a fallHAC.FS.00000155 UW Medicine/Valley Medical Center 4/30/2014 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 4/30/2014 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 5/9/2014 4A - Medication errorHAC.FS.00000155 UW Medicine/Valley Medical Center 6/30/2014 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 6/30/2014 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 6/30/2014 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 7/16/2014 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 1/30/2015 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 3/16/2015 4A - Medication errorHAC.FS.00000155 UW Medicine/Valley Medical Center 4/8/2015 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 4/8/2015 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 4/8/2015 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 4/8/2015 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 4/8/2015 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 4/8/2015 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 6/10/2015 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 6/10/2015 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 7/22/2015 1D - Unintended retention of foreign objectHAC.FS.00000155 UW Medicine/Valley Medical Center 7/23/2015 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 7/23/2015 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 8/12/2015 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 9/22/2015 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 9/22/2015 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 9/22/2015 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 10/12/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000155 UW Medicine/Valley Medical Center 10/23/2015 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 10/28/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000155 UW Medicine/Valley Medical Center 10/28/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000155 UW Medicine/Valley Medical Center 10/28/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000155 UW Medicine/Valley Medical Center 11/5/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000155 UW Medicine/Valley Medical Center 11/18/2015 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 1/13/2016 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 3/1/2016 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 3/1/2016 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 4/19/2016 1D - Unintended retention of foreign objectHAC.FS.00000155 UW Medicine/Valley Medical Center 6/6/2016 7D - Physical assaultHAC.FS.00000155 UW Medicine/Valley Medical Center 6/16/2016 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 6/27/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000155 UW Medicine/Valley Medical Center 7/14/2016 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 7/14/2016 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 7/14/2016 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 8/26/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000155 UW Medicine/Valley Medical Center 10/20/2016 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 10/20/2016 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 2/9/2017 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 3/16/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000155 UW Medicine/Valley Medical Center 5/4/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000155 UW Medicine/Valley Medical Center 5/17/2017 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 5/18/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000155 UW Medicine/Valley Medical Center 7/3/2017 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 9/21/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000155 UW Medicine/Valley Medical Center 10/19/2017 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 10/25/2017 1A - Wrong surgery/invasive procedure siteHAC.FS.00000155 UW Medicine/Valley Medical Center 11/9/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000155 UW Medicine/Valley Medical Center 11/9/2017 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 11/16/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000155 UW Medicine/Valley Medical Center 12/18/2017 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 12/19/2017 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 12/19/2017 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 12/20/2017 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 1/4/2018 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 1/4/2018 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 1/10/2018 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 1/11/2018 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 1/11/2018 4I - Failure to follow up with test resultsHAC.FS.00000155 UW Medicine/Valley Medical Center 3/29/2018 4A - Medication errorHAC.FS.00000155 UW Medicine/Valley Medical Center 4/12/2018 1A - Wrong surgery/invasive procedure siteHAC.FS.00000155 UW Medicine/Valley Medical Center 4/13/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000155 UW Medicine/Valley Medical Center 5/10/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000155 UW Medicine/Valley Medical Center 5/10/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000155 UW Medicine/Valley Medical Center 5/10/2018 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 5/10/2018 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 5/10/2018 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 5/16/2018 4C - Maternal death or serious injuryHAC.FS.00000155 UW Medicine/Valley Medical Center 5/17/2018 4C - Maternal death or serious injuryHAC.FS.00000155 UW Medicine/Valley Medical Center 6/28/2018 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 8/30/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000155 UW Medicine/Valley Medical Center 9/4/2018 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 9/13/2018 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 9/20/2018 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 10/4/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000155 UW Medicine/Valley Medical Center 11/29/2018 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 12/20/2018 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 1/31/2019 1A - Wrong surgery/invasive procedure siteHAC.FS.00000155 UW Medicine/Valley Medical Center 1/31/2019 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 2/14/2019 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 2/28/2019 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 3/14/2019 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 3/14/2019 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 3/14/2019 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 4/15/2019 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 4/26/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000155 UW Medicine/Valley Medical Center 5/9/2019 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 6/6/2019 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 7/11/2019 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 8/15/2019 4D - Death or serious injury of neonateHAC.FS.00000155 UW Medicine/Valley Medical Center 8/15/2019 4E - Patient death or serious injury associated with a fall

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DOH 689-013 September 2014Office of Community Health Systems Page 57 of 62

Adverse Events Quarterly ReportFacility by Date and Event - Q2 2020

Facility Credential Facility Name Facility County Date Confirmed Event TypeHAC.FS.00000155 UW Medicine/Valley Medical Center 9/12/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000155 UW Medicine/Valley Medical Center 9/12/2019 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 9/19/2019 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 10/17/2019 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 11/7/2019 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 11/22/2019 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 11/27/2019 1D - Unintended retention of foreign objectHAC.FS.00000155 UW Medicine/Valley Medical Center 11/27/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000155 UW Medicine/Valley Medical Center 12/26/2019 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 1/9/2020 2C - Intravascular air embolismHAC.FS.00000155 UW Medicine/Valley Medical Center 1/9/2020 4A - Medication errorHAC.FS.00000155 UW Medicine/Valley Medical Center 1/23/2020 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 1/31/2020 4A - Medication errorHAC.FS.00000155 UW Medicine/Valley Medical Center 2/20/2020 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 3/12/2020 4E - Patient death or serious injury associated with a fallHAC.FS.00000155 UW Medicine/Valley Medical Center 4/17/2020 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 4/23/2020 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 5/7/2020 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 5/14/2020 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 6/5/2020 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 6/11/2020 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 6/11/2020 4F - Pressure ulcerHAC.FS.00000155 UW Medicine/Valley Medical Center 6/25/2020 4F - Pressure ulcer

166HAC.FS.00000010 Virginia Mason Medical Center King 1/26/2007 1A - Wrong surgery/invasive procedure siteHAC.FS.00000010 Virginia Mason Medical Center 4/13/2007 4F - Pressure ulcerHAC.FS.00000010 Virginia Mason Medical Center 5/22/2007 4F - Pressure ulcerHAC.FS.00000010 Virginia Mason Medical Center 5/29/2007 4F - Pressure ulcerHAC.FS.00000010 Virginia Mason Medical Center 5/30/2007 4F - Pressure ulcerHAC.FS.00000010 Virginia Mason Medical Center 6/7/2007 1D - Unintended retention of foreign objectHAC.FS.00000010 Virginia Mason Medical Center 7/3/2007 7C - Sexual abuse/assaultHAC.FS.00000010 Virginia Mason Medical Center 7/6/2007 1D - Unintended retention of foreign objectHAC.FS.00000010 Virginia Mason Medical Center 8/20/2007 1A - Wrong surgery/invasive procedure siteHAC.FS.00000010 Virginia Mason Medical Center 8/31/2007 4F - Pressure ulcerHAC.FS.00000010 Virginia Mason Medical Center 10/17/2007 4F - Pressure ulcerHAC.FS.00000010 Virginia Mason Medical Center 3/4/2008 1A - Wrong surgery/invasive procedure siteHAC.FS.00000010 Virginia Mason Medical Center 3/23/2008 4F - Pressure ulcerHAC.FS.00000010 Virginia Mason Medical Center 5/18/2008 4F - Pressure ulcerHAC.FS.00000010 Virginia Mason Medical Center 6/4/2008 1A - Wrong surgery/invasive procedure siteHAC.FS.00000010 Virginia Mason Medical Center 7/8/2008 1D - Unintended retention of foreign objectHAC.FS.00000010 Virginia Mason Medical Center 8/8/2008 1A - Wrong surgery/invasive procedure siteHAC.FS.00000010 Virginia Mason Medical Center 8/28/2008 4F - Pressure ulcerHAC.FS.00000010 Virginia Mason Medical Center 8/28/2008 4E - Patient death or serious injury associated with a fallHAC.FS.00000010 Virginia Mason Medical Center 10/28/2008 4F - Pressure ulcerHAC.FS.00000010 Virginia Mason Medical Center 1/14/2009 2C - Intravascular air embolismHAC.FS.00000010 Virginia Mason Medical Center 1/27/2009 1D - Unintended retention of foreign objectHAC.FS.00000010 Virginia Mason Medical Center 4/14/2009 4E - Patient death or serious injury associated with a fallHAC.FS.00000010 Virginia Mason Medical Center 7/28/2009 1C - Wrong surgical/invasive procedureHAC.FS.00000010 Virginia Mason Medical Center 7/28/2009 4E - Patient death or serious injury associated with a fallHAC.FS.00000010 Virginia Mason Medical Center 8/11/2009 4F - Pressure ulcerHAC.FS.00000010 Virginia Mason Medical Center 8/11/2009 4F - Pressure ulcerHAC.FS.00000010 Virginia Mason Medical Center 10/21/2009 1D - Unintended retention of foreign objectHAC.FS.00000010 Virginia Mason Medical Center 10/21/2009 1D - Unintended retention of foreign objectHAC.FS.00000010 Virginia Mason Medical Center 12/17/2009 1D - Unintended retention of foreign objectHAC.FS.00000010 Virginia Mason Medical Center 2/9/2010 1C - Wrong surgical/invasive procedureHAC.FS.00000010 Virginia Mason Medical Center 3/2/2010 1D - Unintended retention of foreign objectHAC.FS.00000010 Virginia Mason Medical Center 3/29/2010 4F - Pressure ulcerHAC.FS.00000010 Virginia Mason Medical Center 5/3/2010 4F - Pressure ulcerHAC.FS.00000010 Virginia Mason Medical Center 5/24/2010 4E - Patient death or serious injury associated with a fallHAC.FS.00000010 Virginia Mason Medical Center 7/21/2010 1D - Unintended retention of foreign objectHAC.FS.00000010 Virginia Mason Medical Center 7/21/2010 4E - Patient death or serious injury associated with a fallHAC.FS.00000010 Virginia Mason Medical Center 11/26/2010 4F - Pressure ulcerHAC.FS.00000010 Virginia Mason Medical Center 11/29/2010 4F - Pressure ulcerHAC.FS.00000010 Virginia Mason Medical Center 1/20/2011 **4F - Pressure ulcerHAC.FS.00000010 Virginia Mason Medical Center 2/8/2011 4F - Pressure ulcerHAC.FS.00000010 Virginia Mason Medical Center 6/17/2011 4F - Pressure ulcerHAC.FS.00000010 Virginia Mason Medical Center 7/9/2011 4E - Patient death or serious injury associated with a fallHAC.FS.00000010 Virginia Mason Medical Center 7/11/2011 4E - Patient death or serious injury associated with a fallHAC.FS.00000010 Virginia Mason Medical Center 8/11/2011 4E - Patient death or serious injury associated with a fallHAC.FS.00000010 Virginia Mason Medical Center 10/31/2011 4F - Pressure ulcerHAC.FS.00000010 Virginia Mason Medical Center 12/13/2011 1A - Wrong surgery/invasive procedure siteHAC.FS.00000010 Virginia Mason Medical Center 12/13/2011 2C - Intravascular air embolismHAC.FS.00000010 Virginia Mason Medical Center 12/13/2011 4F - Pressure ulcerHAC.FS.00000010 Virginia Mason Medical Center 12/28/2011 4F - Pressure ulcerHAC.FS.00000010 Virginia Mason Medical Center 12/28/2011 5C - BurnHAC.FS.00000010 Virginia Mason Medical Center 2/9/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000010 Virginia Mason Medical Center 3/9/2012 1A - Wrong surgery/invasive procedure siteHAC.FS.00000010 Virginia Mason Medical Center 6/15/2012 1E- Post-operative deathHAC.FS.00000010 Virginia Mason Medical Center 8/24/2012 1D - Unintended retention of foreign objectHAC.FS.00000010 Virginia Mason Medical Center 8/24/2012 1D - Unintended retention of foreign objectHAC.FS.00000010 Virginia Mason Medical Center 10/11/2012 1A - Wrong surgery/invasive procedure siteHAC.FS.00000010 Virginia Mason Medical Center 11/15/2012 1C - Wrong surgical/invasive procedureHAC.FS.00000010 Virginia Mason Medical Center 7/18/2013 4F - Pressure ulcerHAC.FS.00000010 Virginia Mason Medical Center 7/18/2013 4F - Pressure ulcerHAC.FS.00000010 Virginia Mason Medical Center 12/18/2013 4F - Pressure ulcerHAC.FS.00000010 Virginia Mason Medical Center 1/13/2014 4F - Pressure ulcerHAC.FS.00000010 Virginia Mason Medical Center 3/16/2014 4F - Pressure ulcerHAC.FS.00000010 Virginia Mason Medical Center 6/30/2014 4F - Pressure ulcerHAC.FS.00000010 Virginia Mason Medical Center 1/20/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000010 Virginia Mason Medical Center 1/30/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000010 Virginia Mason Medical Center 6/15/2015 4F - Pressure ulcerHAC.FS.00000010 Virginia Mason Medical Center 7/20/2015 2A - Contaminated drugs, devices, biologicsHAC.FS.00000010 Virginia Mason Medical Center 8/20/2015 4F - Pressure ulcerHAC.FS.00000010 Virginia Mason Medical Center 9/14/2015 4F - Pressure ulcerHAC.FS.00000010 Virginia Mason Medical Center 10/1/2015 1A - Wrong surgery/invasive procedure siteHAC.FS.00000010 Virginia Mason Medical Center 10/1/2015 4A - Medication errorHAC.FS.00000010 Virginia Mason Medical Center 11/5/2015 4F - Pressure ulcerHAC.FS.00000010 Virginia Mason Medical Center 11/5/2015 4F - Pressure ulcerHAC.FS.00000010 Virginia Mason Medical Center 11/25/2015 4F - Pressure ulcerHAC.FS.00000010 Virginia Mason Medical Center 1/8/2016 1A - Wrong surgery/invasive procedure site

UW Medicine/Valley Medical Center number of events:

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Adverse EventsFacilities and Date of Event Report 2006-2020

DOH 689-013 September 2014Office of Community Health Systems Page 58 of 62

Adverse Events Quarterly ReportFacility by Date and Event - Q2 2020

Facility Credential Facility Name Facility County Date Confirmed Event TypeHAC.FS.00000010 Virginia Mason Medical Center 1/8/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000010 Virginia Mason Medical Center 1/8/2016 4F - Pressure ulcerHAC.FS.00000010 Virginia Mason Medical Center 1/10/2016 1A - Wrong surgery/invasive procedure siteHAC.FS.00000010 Virginia Mason Medical Center 1/22/2016 1C - Wrong surgical/invasive procedureHAC.FS.00000010 Virginia Mason Medical Center 1/22/2016 2B - Device function or useHAC.FS.00000010 Virginia Mason Medical Center 2/9/2016 4F - Pressure ulcerHAC.FS.00000010 Virginia Mason Medical Center 2/16/2016 4I - Failure to follow up with test resultsHAC.FS.00000010 Virginia Mason Medical Center 4/12/2016 7C - Sexual abuse/assaultHAC.FS.00000010 Virginia Mason Medical Center 4/29/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000010 Virginia Mason Medical Center 6/3/2016 4F - Pressure ulcerHAC.FS.00000010 Virginia Mason Medical Center 6/3/2016 4F - Pressure ulcerHAC.FS.00000010 Virginia Mason Medical Center 7/5/2016 1D - Unintended retention of foreign objectHAC.FS.00000010 Virginia Mason Medical Center 7/26/2016 4F - Pressure ulcerHAC.FS.00000010 Virginia Mason Medical Center 7/26/2016 4F - Pressure ulcerHAC.FS.00000010 Virginia Mason Medical Center 7/26/2016 4F - Pressure ulcerHAC.FS.00000010 Virginia Mason Medical Center 9/22/2016 4F - Pressure ulcerHAC.FS.00000010 Virginia Mason Medical Center 9/22/2016 4F - Pressure ulcerHAC.FS.00000010 Virginia Mason Medical Center 9/22/2016 4F - Pressure ulcerHAC.FS.00000010 Virginia Mason Medical Center 9/22/2016 4F - Pressure ulcerHAC.FS.00000010 Virginia Mason Medical Center 12/16/2016 4F - Pressure ulcerHAC.FS.00000010 Virginia Mason Medical Center 12/29/2016 1D - Unintended retention of foreign objectHAC.FS.00000010 Virginia Mason Medical Center 1/9/2017 1A - Wrong surgery/invasive procedure siteHAC.FS.00000010 Virginia Mason Medical Center 1/9/2017 4F - Pressure ulcerHAC.FS.00000010 Virginia Mason Medical Center 2/20/2017 4F - Pressure ulcerHAC.FS.00000010 Virginia Mason Medical Center 2/20/2017 4F - Pressure ulcerHAC.FS.00000010 Virginia Mason Medical Center 2/20/2017 4F - Pressure ulcerHAC.FS.00000010 Virginia Mason Medical Center 3/31/2017 4F - Pressure ulcerHAC.FS.00000010 Virginia Mason Medical Center 5/8/2017 4F - Pressure ulcerHAC.FS.00000010 Virginia Mason Medical Center 6/16/2017 4F - Pressure ulcerHAC.FS.00000010 Virginia Mason Medical Center 7/18/2017 4F - Pressure ulcerHAC.FS.00000010 Virginia Mason Medical Center 10/20/2017 4F - Pressure ulcerHAC.FS.00000010 Virginia Mason Medical Center 1/23/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000010 Virginia Mason Medical Center 2/14/2018 1A - Wrong surgery/invasive procedure siteHAC.FS.00000010 Virginia Mason Medical Center 2/14/2018 4F - Pressure ulcerHAC.FS.00000010 Virginia Mason Medical Center 4/10/2018 4F - Pressure ulcerHAC.FS.00000010 Virginia Mason Medical Center 4/25/2018 4F - Pressure ulcerHAC.FS.00000010 Virginia Mason Medical Center 4/25/2018 4F - Pressure ulcerHAC.FS.00000010 Virginia Mason Medical Center 8/29/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000010 Virginia Mason Medical Center 11/1/2018 4F - Pressure ulcerHAC.FS.00000010 Virginia Mason Medical Center 1/24/2019 4F - Pressure ulcerHAC.FS.00000010 Virginia Mason Medical Center 1/24/2019 4F - Pressure ulcerHAC.FS.00000010 Virginia Mason Medical Center 5/13/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000010 Virginia Mason Medical Center 5/13/2019 4F - Pressure ulcerHAC.FS.00000010 Virginia Mason Medical Center 5/13/2019 5C - BurnHAC.FS.00000010 Virginia Mason Medical Center 7/25/2019 4F - Pressure ulcerHAC.FS.00000010 Virginia Mason Medical Center 8/28/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000010 Virginia Mason Medical Center 9/9/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000010 Virginia Mason Medical Center 9/9/2019 4F - Pressure ulcerHAC.FS.00000010 Virginia Mason Medical Center 1/23/2020 4F - Pressure ulcerHAC.FS.00000010 Virginia Mason Medical Center 1/23/2020 4F - Pressure ulcerHAC.FS.00000010 Virginia Mason Medical Center 4/13/2020 4E - Patient death or serious injury associated with a fall

127HAC.FS.00000043 Walla Walla General Hospital Walla Walla 6/18/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000043 Walla Walla General Hospital 6/12/2013 4D - Death or serious injury of neonateHAC.FS.00000043 Adventist Health/Walla Walla General Hospital 7/8/2014 4I - Failure to follow up with test resultsHAC.FS.00000043 Adventist Health/Walla Walla General Hospital 12/24/2014 1D - Unintended retention of foreign objectHAC.FS.00000043 Adventist Health/Walla Walla General Hospital 6/15/2015 4D - Death or serious injury of neonateHAC.FS.00000043 Adventist Health/Walla Walla General Hospital 8/5/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000043 Adventist Health/Walla Walla General Hospital 1/16/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000043 Adventist Health/Walla Walla General Hospital 5/8/2017 4E - Patient death or serious injury associated with a fall

8HAC.FS.00000205 Wenatchee Valley Hospital Chelan 8/14/2013 4E - Patient death or serious injury associated with a fall

1HAC.FS.60424211 Wenatchee Valley Hospital and Clinics Chelan 8/5/2014 4E - Patient death or serious injury associated with a fallHAC.FS.60424211 Wenatchee Valley Hospital and Clinics 6/12/2015 4E - Patient death or serious injury associated with a fallHAC.FS.60424211 Wenatchee Valley Hospital and Clinics 9/19/2016 4E - Patient death or serious injury associated with a fallHAC.FS.60424211 Wenatchee Valley Hospital and Clinics 8/17/2017 **4E - Patient death or serious injury associated with a fallHAC.FS.60424211 Wenatchee Valley Hospital and Clinics 1/25/2018 5C - BurnHAC.FS.60424211 Wenatchee Valley Hospital and Clinics 9/12/2018 4F - Pressure ulcerHAC.FS.60424211 Wenatchee Valley Hospital and Clinics 11/8/2018 5C - BurnHAC.FS.60424211 Wenatchee Valley Hospital and Clinics 2/15/2019 5C - BurnHAC.FS.60424211 Wenatchee Valley Hospital and Clinics 2/15/2019 4F - Pressure ulcerHAC.FS.60424211 Wenatchee Valley Hospital and Clinics 5/30/2019 1D - Unintended retention of foreign objectHAC.FS.60424211 Wenatchee Valley Hospital and Clinics 5/30/2019 3A - Patient/Resident discharged to unauthorized personHAC.FS.60424211 Wenatchee Valley Hospital and Clinics 8/1/2019 1C - Wrong surgical/invasive procedureHAC.FS.60424211 Wenatchee Valley Hospital and Clinics 8/29/2019 1C - Wrong surgical/invasive procedureHAC.FS.60424211 Wenatchee Valley Hospital and Clinics 10/24/2019 1A - Wrong surgery/invasive procedure siteHAC.FS.60424211 Wenatchee Valley Hospital and Clinics 4/9/2020 1A - Wrong surgery/invasive procedure siteHAC.FS.60424211 Wenatchee Valley Hospital and Clinics 4/16/2020 4E - Patient death or serious injury associated with a fall

16HAC.FS.00000156 Whidbey General Hospital Island 6/2/2006 4E - Patient death or serious injury associated with a fallHAC.FS.00000156 Whidbey General Hospital 12/9/2008 1E- Post-operative deathHAC.FS.00000156 Whidbey General Hospital 2/13/2009 4E - Patient death or serious injury associated with a fallHAC.FS.00000156 Whidbey General Hospital 12/28/2010 4F - Pressure ulcerHAC.FS.00000156 Whidbey General Hospital 3/21/2011 4A - Medication errorHAC.FS.00000156 Whidbey General Hospital 8/1/2012 1D - Unintended retention of foreign objectHAC.FS.00000156 Whidbey General Hospital 1/30/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000156 Whidbey General Hospital 4/7/2016 4D - Death or serious injury of neonateHAC.FS.00000156 WhidbeyHealth Medical Center 11/18/2016 1D - Unintended retention of foreign objectHAC.FS.00000156 WhidbeyHealth Medical Center 12/28/2016 4D - Death or serious injury of neonate

10HAC.FS.00000153 Whitman Hospital and Medical Center Whitman 6/14/2017 **2B - Device function or useHAC.FS.00000153 Whitman Hospital and Medical Center 5/3/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000153 Whitman Hospital and Medical Center 3/14/2019 4A - Medication errorHAC.FS.00000153 Whitman Hospital and Medical Center 3/14/2019 4A - Medication errorHAC.FS.00000153 Whitman Hospital and Medical Center 3/27/2020 4E - Patient death or serious injury associated with a fall

5HAC.FS.00000102 Yakima Regional Medical Center Yakima 10/20/2010 4F - Pressure ulcerHAC.FS.00000102 Yakima Regional Medical Center 10/26/2010 1D - Unintended retention of foreign objectHAC.FS.00000102 Yakima Regional Medical Center 7/14/2011 1A - Wrong surgery/invasive procedure site

WhidbeyHealth Medical Center number of events:

Whitman Hospital and Medical Center number of events:

Virginia Mason Medical Center number of events:

Walla Walla General Hospital number of events:

Wenatchee Valley Hospital number of events:

Wenatchee Valley Hospital and Clinics number of events:

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Adverse EventsFacilities and Date of Event Report 2006-2020

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Adverse Events Quarterly ReportFacility by Date and Event - Q2 2020

Facility Credential Facility Name Facility County Date Confirmed Event TypeHAC.FS.00000102 Yakima Regional Medical Center 7/18/2011 4F - Pressure ulcerHAC.FS.00000102 Yakima Regional Medical Center 7/18/2011 4F - Pressure ulcerHAC.FS.00000102 Yakima Regional Medical Center 2/20/2013 1D - Unintended retention of foreign object HAC.FS.00000102 Yakima Regional Medical Center 2/22/2013 1D - Unintended retention of foreign object HAC.FS.00000102 Yakima Regional Medical and Cardiac Center 4/3/2013 1D - Unintended retention of foreign object HAC.FS.00000102 Yakima Regional Medical and Cardiac Center 7/29/2014 4F - Pressure ulcerHAC.FS.00000102 Yakima Regional Medical and Cardiac Center 8/5/2014 4F - Pressure ulcerHAC.FS.00000102 Yakima Regional Medical and Cardiac Center 4/7/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000102 Yakima Regional Medical and Cardiac Center 5/29/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000102 Yakima Regional Medical and Cardiac Center 9/9/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000102 Yakima Regional Medical and Cardiac Center 9/18/2015 4F - Pressure ulcerHAC.FS.00000102 Yakima Regional Medical And Cardiac Center 10/14/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000102 Yakima Regional Medical and Cardiac Center 11/18/2015 4F - Pressure ulcerHAC.FS.00000102 Yakima Regional Medical and Cardiac Center 12/8/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000102 Yakima Regional Medical and Cardiac Center 3/11/2016 1A - Wrong surgery/invasive procedure siteHAC.FS.00000102 Yakima Regional Medical and Cardiac Center 5/10/2016 4E - Patient death or serious injury associated with a fallHAC.FS.00000102 Yakima Regional Medical and Cardiac Center 6/28/2016 4A - Medication errorHAC.FS.00000102 Yakima Regional Medical and Cardiac Center 12/2/2016 4F - Pressure ulcerHAC.FS.00000102 Yakima Regional Medical and Cardiac Center 12/2/2016 4F - Pressure ulcerHAC.FS.00000102 Yakima Regional Medical and Cardiac Center 6/14/2017 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.00000102 Yakima Regional Medical and Cardiac Center 7/12/2017 4F - Pressure ulcerHAC.FS.00000102 Yakima Regional Medical and Cardiac Center 7/28/2017 4F - Pressure ulcer

25HAC.FS.00000058 Yakima Valley Memorial Hospital Yakima 12/28/2006 1D - Unintended retention of foreign objectHAC.FS.00000058 Yakima Valley Memorial Hospital 3/14/2007 1C - Wrong surgical/invasive procedureHAC.FS.00000058 Yakima Valley Memorial Hospital 3/19/2007 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.00000058 Yakima Valley Memorial Hospital 7/19/2007 1D - Unintended retention of foreign objectHAC.FS.00000058 Yakima Valley Memorial Hospital 7/26/2007 4E - Patient death or serious injury associated with a fallHAC.FS.00000058 Yakima Valley Memorial Hospital 3/12/2008 1A - Wrong surgery/invasive procedure siteHAC.FS.00000058 Yakima Valley Memorial Hospital 8/15/2008 1D - Unintended retention of foreign objectHAC.FS.00000058 Yakima Valley Memorial Hospital 5/13/2009 4E - Patient death or serious injury associated with a fallHAC.FS.00000058 Yakima Valley Memorial Hospital 4/6/2010 1D - Unintended retention of foreign objectHAC.FS.00000058 Yakima Valley Memorial Hospital 4/8/2010 4E - Patient death or serious injury associated with a fallHAC.FS.00000058 Yakima Valley Memorial Hospital 10/8/2010 4E - Patient death or serious injury associated with a fallHAC.FS.00000058 Yakima Valley Memorial Hospital 10/25/2010 1D - Unintended retention of foreign objectHAC.FS.00000058 Yakima Valley Memorial Hospital 2/26/2011 4E - Patient death or serious injury associated with a fallHAC.FS.00000058 Yakima Valley Memorial Hospital 3/22/2011 4E - Patient death or serious injury associated with a fallHAC.FS.00000058 Yakima Valley Memorial Hospital 4/20/2011 4E - Patient death or serious injury associated with a fallHAC.FS.00000058 Yakima Valley Memorial Hospital 7/11/2011 **1D - Unintended retention of foreign objectHAC.FS.00000058 Yakima Valley Memorial Hospital 2/2/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000058 Yakima Valley Memorial Hospital 3/20/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000058 Yakima Valley Memorial Hospital 6/7/2012 4F - Pressure ulcerHAC.FS.00000058 Yakima Valley Memorial Hospital 9/28/2012 1A - Wrong surgery/invasive procedure siteHAC.FS.00000058 Yakima Valley Memorial Hospital 10/26/2012 4E - Patient death or serious injury associated with a fallHAC.FS.00000058 Yakima Valley Memorial Hospital 11/13/2012 1C - Wrong surgical/invasive procedureHAC.FS.00000058 Yakima Valley Memorial Hospital 12/10/2012 1C - Wrong surgical/invasive procedureHAC.FS.00000058 Yakima Valley Memorial Hospital 8/27/2013 1D - Unintended retention of foreign objectHAC.FS.00000058 Yakima Valley Memorial Hospital 12/16/2013 4E - Patient death or serious injury associated with a fallHAC.FS.00000058 Yakima Valley Memorial Hospital 1/3/2014 1A - Wrong surgery/invasive procedure siteHAC.FS.00000058 Yakima Valley Memorial Hospital 7/26/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000058 Yakima Valley Memorial Hospital 8/21/2014 1C - Wrong surgical/invasive procedureHAC.FS.00000058 Yakima Valley Memorial Hospital 12/22/2014 4E - Patient death or serious injury associated with a fallHAC.FS.00000058 Yakima Valley Memorial Hospital 3/10/2015 4F - Pressure ulcerHAC.FS.00000058 Yakima Valley Memorial Hospital 4/3/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000058 Yakima Valley Memorial Hospital 9/1/2015 4F - Pressure ulcerHAC.FS.00000058 Yakima Valley Memorial Hospital 11/17/2015 1C - Wrong surgical/invasive procedureHAC.FS.00000058 Yakima Valley Memorial Hospital 12/15/2015 4E - Patient death or serious injury associated with a fallHAC.FS.00000058 Yakima Valley Memorial Hospital 8/29/2016 **4E - Patient death or serious injury associated with a fallHAC.FS.00000058 Yakima Valley Memorial Hospital 11/10/2016 4F - Pressure ulcerHAC.FS.00000058 Yakima Valley Memorial Hospital 1/3/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000058 Yakima Valley Memorial Hospital 1/12/2017 1D - Unintended retention of foreign objectHAC.FS.00000058 Yakima Valley Memorial Hospital 1/18/2017 1D - Unintended retention of foreign objectHAC.FS.00000058 Virginia Mason Memorial*** 5/8/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000058 Virginia Mason Memorial*** 12/1/2017 4E - Patient death or serious injury associated with a fallHAC.FS.00000058 Virginia Mason Memorial*** 2/9/2018 1A - Wrong surgery/invasive procedure siteHAC.FS.00000058 Virginia Mason Memorial*** 2/20/2018 4F - Pressure ulcerHAC.FS.00000058 Virginia Mason Memorial*** 7/20/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000058 Virginia Mason Memorial*** 7/20/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000058 Virginia Mason Memorial*** 10/19/2018 4A - Medication errorHAC.FS.00000058 Virginia Mason Memorial*** 10/19/2018 4A - Medication errorHAC.FS.00000058 Virginia Mason Memorial*** 12/20/2018 4E - Patient death or serious injury associated with a fallHAC.FS.00000058 Virginia Mason Memorial*** 2/5/2019 4F - Pressure ulcerHAC.FS.00000058 Virginia Mason Memorial*** 2/28/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000058 Virginia Mason Memorial*** 6/17/2019 4D - Death or serious injury of neonateHAC.FS.00000058 Virginia Mason Memorial*** 7/8/2019 4F - Pressure ulcerHAC.FS.00000058 Virginia Mason Memorial*** 7/20/2019 4I - Failure to follow up with test resultsHAC.FS.00000058 Virginia Mason Memorial*** 7/25/2019 4F - Pressure ulcerHAC.FS.00000058 Virginia Mason Memorial*** 8/6/2019 7C - Sexual abuse/assaultHAC.FS.00000058 Virginia Mason Memorial*** 8/7/2019 4D - Death or serious injury of neonateHAC.FS.00000058 Virginia Mason Memorial*** 8/9/2019 4A - Medication errorHAC.FS.00000058 Virginia Mason Memorial*** 8/29/2019 7C - Sexual abuse/assaultHAC.FS.00000058 Virginia Mason Memorial*** 10/2/2019 1D - Unintended retention of foreign objectHAC.FS.00000058 Virginia Mason Memorial*** 10/17/2019 4F - Pressure ulcerHAC.FS.00000058 Virginia Mason Memorial*** 11/6/2019 7D - Physical assaultHAC.FS.00000058 Virginia Mason Memorial*** 11/13/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000058 Virginia Mason Memorial*** 11/18/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000058 Virginia Mason Memorial*** 11/27/2019 4E - Patient death or serious injury associated with a fallHAC.FS.00000058 Virginia Mason Memorial*** 1/23/2020 4F - Pressure ulcerHAC.FS.00000058 Virginia Mason Memorial*** 3/24/2020 4E - Patient death or serious injury associated with a fallHAC.FS.00000058 Virginia Mason Memorial*** 5/18/2020 3C - Patient suicide, attempted suicide, or self-harmHAC.FS.00000058 Virginia Mason Memorial*** 5/22/2020 4E - Patient death or serious injury associated with a fall

68Facility Type: Child Birth CenterCBC.FS.60203814 Center For Birth King 5/27/2020 **4C - Maternal death or serious injury

1CBC.FS.00000015 Lakeside Birth Center Pierce 9/13/2017 **4D - Death or serious injury of neonateCBC.FS.00000015 Lakeside Birth Center 9/14/2017 **4D - Death or serious injury of neonate

2CBC.FS.00000005 Seattle Home Maternity and Childbirth Center King 4/3/2016 **4D - Death or serious injury of neonate

1

Yakima Regional Medical and Cardiac Center number of events:

Virginia Mason Memorial number of events:

Seattle Home Maternity and Childbirth Center number of events:

Lakeside Birth Center number of events:

Center For Birth number of events:

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Adverse Events Quarterly ReportFacility by Date and Event - Q2 2020

Facility Credential Facility Name Facility County Date Confirmed Event TypeFacility Type: Psychiatric HospitalHPSY.FS.00000004 BHC Fairfax Hospital King 6/22/2009 7C - Sexual abuse/assaultHPSY.FS.00000004 BHC Fairfax Hospital 7/30/2014 7C - Sexual abuse/assaultHPSY.FS.00000004 BHC Fairfax Hospital 4/25/2017 3B - Patient elopement (disappearance)HPSY.FS.00000004 BHC Fairfax Hospital 11/8/2018 4A - Medication errorHPSY.FS.00000004 BHC Fairfax Hospital 9/25/2019 **3C - Patient suicide, attempted suicide, or self-harm

5HPSY.FS.60429197 Cascade Behavioral Hospital King 5/26/2015 7C - Sexual abuse/assaultHPSY.FS.60429197 Cascade Behavioral Hospital 5/27/2015 4E - Patient death or serious injury associated with a fallHPSY.FS.60429197 Cascade Behavioral Hospital 6/15/2015 4E - Patient death or serious injury associated with a fallHPSY.FS.60429197 Cascade Behavioral Hospital 3/16/2017 7C - Sexual abuse/assaultHPSY.FS.60429197 Cascade Behavioral Hospital 4/7/2017 4E - Patient death or serious injury associated with a fallHPSY.FS.60429197 Cascade Behavioral Hospital 4/20/2017 3C - Patient suicide, attempted suicide, or self-harmHPSY.FS.60429197 Cascade Behavioral Hospital 6/3/2017 4E - Patient death or serious injury associated with a fallHPSY.FS.60429197 Cascade Behavioral Hospital 7/26/2017 4E - Patient death or serious injury associated with a fallHPSY.FS.60429197 Cascade Behavioral Hospital 11/16/2017 4E - Patient death or serious injury associated with a fallHPSY.FS.60429197 Cascade Behavioral Hospital 1/25/2018 4E - Patient death or serious injury associated with a fallHPSY.FS.60429197 Cascade Behavioral Hospital 2/8/2018 4E - Patient death or serious injury associated with a fallHPSY.FS.60429197 Cascade Behavioral Hospital 3/22/2018 4E - Patient death or serious injury associated with a fallHPSY.FS.60429197 Cascade Behavioral Hospital 5/13/2018 4E - Patient death or serious injury associated with a fallHPSY.FS.60429197 Cascade Behavioral Hospital 1/26/2019 7C - Sexual abuse/assaultHPSY.FS.60429197 Cascade Behavioral Hospital 4/20/2019 7C - Sexual abuse/assaultHPSY.FS.60429197 Cascade Behavioral Hospital 7/18/2019 **7C - Sexual abuse/assaultHPSY.FS.60429197 Cascade Behavioral Hospital 12/7/2019 4E - Patient death or serious injury associated with a fallHPSY.FS.60429197 Cascade Behavioral Hospital 4/10/2020 7C - Sexual abuse/assault

18HPSY.FS.60603057 Fairfax Behavioral Health Monroe Snohomish 10/10/2019 4E - Patient death or serious injury associated with a fall

1HPSY.FS.60865270 Lourdes Counseling Center Benton 6/8/2020 3C - Patient suicide, attempted suicide, or self-harm

1HPSY.FS.00000019 Navos King 10/12/2009 3C - Patient suicide, attempted suicide, or self-harmHPSY.FS.00000019 Navos 12/21/2013 7D - Physical assaultHPSY.FS.00000019 Navos 7/30/2016 3B - Patient elopement (disappearance)HPSY.FS.00000019 Navos 3/2/2017 7D - Physical assaultHPSY.FS.00000019 Navos 7/12/2017 4E - Patient death or serious injury associated with a fallHPSY.FS.00000019 Navos 4/22/2019 7C - Sexual abuse/assaultHPSY.FS.00000019 Navos 6/17/2019 4E - Patient death or serious injury associated with a fallHPSY.FS.00000019 Navos 8/26/2019 7D - Physical assaultHPSY.FS.00000019 Navos 2/3/2020 7D - Physical assaultHPSY.FS.00000019 Navos 2/22/2020 7D - Physical assault

10HPSY.FS.60877559 Rainier Springs Clark 10/15/2018 4E - Patient death or serious injury associated with a fallHPSY.FS.60877559 Rainier Springs 10/26/2019 4E - Patient death or serious injury associated with a fallHPSY.FS.60877559 Rainier Springs 11/10/2019 4E - Patient death or serious injury associated with a fallHPSY.FS.60877559 Rainier Springs 1/13/2020 3C - Patient suicide, attempted suicide, or self-harm

4HPSY.FS.60739147 Smokey Point Behavioral Hospital Snohomish 6/18/2018 4E - Patient death or serious injury associated with a fallHPSY.FS.60739147 Smokey Point Behavioral Hospital 8/14/2018 7D - Physical assaultHPSY.FS.60739147 Smokey Point Behavioral Hospital 6/23/2019 4E - Patient death or serious injury associated with a fallHPSY.FS.60739147 Smokey Point Behavioral Hospital 11/18/2019 4E - Patient death or serious injury associated with a fall

4HPSY.FS.60919628 Wellfound Behavioral Health Hospital Pierce 5/13/2020 7D - Physical assaultHPSY.FS.60919628 Wellfound Behavioral Health Hospital 6/14/2020 7D - Physical assault

2Facility Type: Department of Corrections Medical FacilitySI.FS.00003484 Airway Heights Corrections Center Spokane 11/1/2017 5D - RestraintsSI.FS.00003484 Airway Heights Corrections Center 11/13/2018 4A - Medication error

2SI.FS.00004412 Coyote Ridge Corrections Center Franklin 7/21/2017 4E - Patient death or serious injury associated with a fallSI.FS.00004412 Coyote Ridge Corrections Center 8/15/2018 4E - Patient death or serious injury associated with a fallSI.FS.00004412 Coyote Ridge Corrections Center 9/7/2018 3C - Patient suicide, attempted suicide, or self-harmSI.FS.00004412 Coyote Ridge Corrections Center 3/9/2019 3C - Patient suicide, attempted suicide, or self-harmSI.FS.00004412 Coyote Ridge Corrections Center 6/6/2019 4E - Patient death or serious injury associated with a fall

5SI.FS.00000205 Monroe Correctional Complex Snohomish 7/16/2018 4B - Wrong blood productSI.FS.00000205 Monroe Correctional Complex 9/12/2018 3C - Patient suicide, attempted suicide, or self-harmSI.FS.00000205 Monroe Correctional Complex 6/29/2019 **4I - Failure to follow up with test resultsSI.FS.00000205 Monroe Correctional Complex 12/11/2019 **4E - Patient death or serious injury associated with a fall

4SI.FS.00008877 Stafford Creek Corrections Center Grays Harbor 2/23/2012 **4E - Patient death or serious injury associated with a fallSI.FS.00008877 Stafford Creek Corrections Center 2/5/2016 4E - Patient death or serious injury associated with a fallSI.FS.00008877 Stafford Creek Corrections Center 2/6/2016 4E - Patient death or serious injury associated with a fallSI.FS.00008877 Stafford Creek Corrections Center 3/26/2018 4E - Patient death or serious injury associated with a fall

4SI.FS.00004414 Washingtion Corrections Center Mason 7/24/2019 5C - Burn

1SI.FS.00000204 Washington State Penitentiary Walla Walla 6/25/2011 4E - Patient death or serious injury associated with a fall

1Facility Type: Ambulatory Surgical FacilityASF.FS.60100112 ASC/Endoscopy Center King 10/30/2015 1A - Wrong surgery/invasive procedure site

1ASF.FS.60287715 Bellevue Surgery Center King 4/8/2019 1B - Wrong surgery/invasive procedure patient

1ASF.FS.60102997 Bellingham Ambulatory Surgery Center Whatcom 8/11/2014 1A - Wrong surgery/invasive procedure siteASF.FS.60102997 Bellingham Ambulatory Surgery Center 8/11/2014 1C - Wrong surgical/invasive procedureASF.FS.60102997 Bellingham Ambulatory Surgery Center 1/12/2016 1A - Wrong surgery/invasive procedure siteASF.FS.60102997 Bellingham Ambulatory Surgery Center 6/27/2018 1A - Wrong surgery/invasive procedure siteASF.FS.60102997 Bellingham Ambulatory Surgery Center 1/28/2020 1C - Wrong surgical/invasive procedure

5ASF.FS.60099795 Bellingham Surgery Center Whatcom 12/29/2010 1D - Unintended retention of foreign objectASF.FS.60099795 Bellingham Surgery Center 1/21/2014 1A - Wrong surgery/invasive procedure site

2ASF.FS.60627140 Kaiser Permanente Capitol Hill Procedure Center King 6/29/2017 1A - Wrong surgery/invasive procedure site

1ASF.FS.60442571 Cascade Ear Nose and Throat Surgery Center Skagit 5/17/2018 1D - Unintended retention of foreign object

1ASF.FS.60099142 Cascade Surgery Center King 2/15/2011 1A - Wrong surgery/invasive procedure site

1ASF.FS.60101763 Cascade Valley Arlington Surgery Center Snohomish 1/24/2015 7C - Sexual abuse/assault

1

Bellingham Surgery Center number of events:

Capital Hill Procedure Center number of events:

Cascade Ear Nose and Throat Surgery Center number of events:

Cascade Surgery Center number of events:

Cascade Valley Arlington Surgery Center number of events:

Coyote Ridge Corrections Center number of events:

Airway Heights Corrections Center number of events:

Stafford Creek Corrections Center number of events:

Washington State Penitentiary number of events:

ASC/Endoscopy Center number of events:

Bellingham Ambulatory Surgery Center number of events:

Bellevue Surgery Center number of events:

Washingtion Corrections Center number of events:

BHC Fairfax Hospital number of events:

Cascade Behavioral Hospital number of events

Navos number of events:

Rainier Springs number of events:

Smokey Point Behavioral Hospital number of events:

Airway Heights Corrections Center number of events:

Fairfax Behavioral Health Monroe number of events:

Lourdes Counseling Center number of events:

Wellfound Behavioral Health Hospital number of events:

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Adverse Events Quarterly ReportFacility by Date and Event - Q2 2020

Facility Credential Facility Name Facility County Date Confirmed Event TypeASF.FS.60252056 Cedar Laser and Surgery Center Pierce 6/14/2012 **1A - Wrong surgery/invasive procedure siteASF.FS.60252056 Cedar Laser and Surgery Center 1/29/2015 7D - Physical assault

2ASF.FS.60287214 Digestive Disease and Endoscopy Center Kitsap 6/16/2020 1E- Post-operative death

1ASF.FS.60477711 Eastside Surgery Center King 11/18/2015 **1C - Wrong surgical/invasive procedureASF.FS.60477711 Eastside Surgery Center 5/12/2016 **2A - Contaminated drugs, devices, biologics

2ASF.FS.60101035 Edmonds Center for Outpatient Surgery Snohomish 9/19/2013 1D - Unintended retention of foreign object

1ASF.FS.60101038 Everett Bone and Joint Surgery Center King 11/3/2016 1A - Wrong surgery/invasive procedure site

1ASF.FS.60298280 Eye Associates Surgery Center Skagit 7/13/2018 1C - Wrong surgical/invasive procedure

1ASF.FS.60641959 First Hill Surgery Center King 5/14/2018 **1D - Unintended retention of foreign object

1ASF.FS.60100914 Gateway Surgery Center Kitsap 7/30/2014 **1A - Wrong surgery/invasive procedure siteASF.FS.60100914 Gateway Surgery Center 11/4/2016 1D - Unintended retention of foreign object ASF.FS.60100914 Gateway Surgery Center 8/6/2019 **1A - Wrong surgery/invasive procedure site

3ASF.FS.60100954 Kaiser Permanente Bellevue Ambulatory Surgery Center^* King 4/17/2017 1D - Unintended retention of foreign object

1ASF.FS.60107244 Inland Northwest Surgery Center Spokane 2/12/2015 1D - Unintended retention of foreign object

1ASF.FS.60100209 Kemp Surgery Center Snohomish 7/18/2013 2A - Contaminated drugs, devices, biologicsASF.FS.60100209 Kemp Surgery Center 10/15/2013 4A - Medication errorASF.FS.60100209 Kemp Surgery Center 12/7/2017 1D - Unintended retention of foreign object

3ASF.FS.60208682 la Belle Vie Cosmetic Surgery Centers King 3/28/2016 1D - Unintended retention of foreign object

1ASF.FS.60101649 Laser and Surgery Center LLC Thurston 7/14/2014 1C - Wrong surgical/invasive procedure

1ASF.FS.60528629 Northwest Endovascular Surgery Benton 1/17/2018 1A - Wrong surgery/invasive procedure siteASF.FS.60528629 Northwest Endovascular Surgery 7/2/2019 1D - Unintended retention of foreign object ASF.FS.60528629 Northwest Endovascular Surgery 7/8/2019 1A - Wrong surgery/invasive procedure site

3ASF.FS.60101724 Northwest Eye Surgeons, Seattle King 5/8/2013 1D - Unintended retention of foreign object

1ASF.FS.60100039 Northwest Orthopaedic Specialists Spokane 10/19/2012 **1A - Wrong surgery/invasive procedure siteASF.FS.60100039 Northwest Orthopaedic Specialists 10/16/2015 **1A - Wrong surgery/invasive procedure siteASF.FS.60100039 Northwest Orthopaedic Specialists 10/21/2015 1A - Wrong surgery/invasive procedure siteASF.FS.60100039 Northwest Orthopaedic Specialists 11/21/2019 1A - Wrong surgery/invasive procedure site

4ASF.FS.60100946 Olympia Surgery Center, Tumwater Thurston 1/28/2010 1A - Wrong surgery/invasive procedure siteASF.FS.60100946 Olympia Surgery Center, Tumwater 5/27/2010 1D - Unintended retention of foreign object

2ASF.FS.60320652 Olympia Surgery Center Thurston 1/18/2013 1A - Wrong surgery/invasive procedure siteASF.FS.60320652 Olympia Surgery Center 6/18/2013 **1A - Wrong surgery/invasive procedure siteASF.FS.60320652 Olympia Surgery Center 7/11/2014 1D - Unintended retention of foreign object ASF.FS.60320652 Olympia Surgery Center 3/1/2018 1E- Post-operative death

4ASF.FS.60101029 Overlake Surgery Center King 11/25/2015 1C - Wrong surgical/invasive procedure

1ASF.FS.60100149 Pacific Rim Outpatient Surgery Center King 6/4/2013 1C - Wrong surgical/invasive procedureASF.FS.60100149 Pacific Rim Outpatient Surgery Center 11/20/2013 **1A - Wrong surgery/invasive procedure siteASF.FS.60100149 Pacific Rim Outpatient Surgery Center 11/28/2017 1A - Wrong surgery/invasive procedure site

3ASF.FS.60100106 Pacific Surgery Center Kitsap 7/26/2010 1A - Wrong surgery/invasive procedure siteASF.FS.60100106 Pacific Surgery Center 4/20/2011 1C - Wrong surgical/invasive procedureASF.FS.60100106 Pacific Surgery Center 9/16/2013 1A - Wrong surgery/invasive procedure siteASF.FS.60100106 Pacific Surgery Center 4/24/2019 5C - Burn

4ASF.FS.60100067 Pacmed Ambulatory Surgical Clinic King 2/28/2018 **1A - Wrong surgery/invasive procedure site

1ASF.FS.60101051 Proliance Highlands Surgery Center King 4/10/2014 1A - Wrong surgery/invasive procedure site

1ASF.FS.60101083 Proliance Orthopedic Associates Ambulatory Surgery Center King 1/25/2011 1A - Wrong surgery/invasive procedure siteASF.FS.60101083 Proliance Orthopedic Associates Ambulatory Surgery Center 9/29/2015 1A - Wrong surgery/invasive procedure site

2ASF.FS.60109922 EVIVA-Edmonds^^^^ Snohomish 5/27/2010 **1D - Unintended retention of foreign object

1ASF.FS.60100990 Puyallup Endoscopy Center Pierce 9/6/2013 **1E- Post-operative death

1ASF.FS.60099146 Rainier Surgical Center King 7/23/2018 1A - Wrong surgery/invasive procedure site

1ASF.FS.60298108 Rockwood Digestive Health and Endoscopy Services Spokane 8/5/2013 5C - Burn

1ASF.FS.60101710 Salmon Creek Plastic Surgery Clark 5/2/2013 **2B - Device function or use

1ASF.FS.60101072 Seattle Surgery Center King 3/22/2012 1A - Wrong surgery/invasive procedure siteASF.FS.60101072 Seattle Surgery Center 1/7/2015 1A - Wrong surgery/invasive procedure site

2ASF.FS.60100921 South Sound Surgery Center Thurston 11/1/2010 1D - Unintended retention of foreign object

1ASF.FS.60101076 Southwest Seattle Ambulatory Surgery Center King 3/20/2015 1A - Wrong surgery/invasive procedure site

1ASF.FS.60099977 Southwest Washington Regional Surgery Center Clark 6/21/2018 1A - Wrong surgery/invasive procedure siteASF.FS.60099977 Southwest Washington Regional Surgery Center 2/21/2019 1C - Wrong surgical/invasive procedureASF.FS.60099977 Southwest Washington Regional Surgery Center 1/15/2020 4E - Patient death or serious injury associated with a fall

3ASF.FS.60103009 Specialty Eyecare Centre Snohomish 7/24/2012 1A - Wrong surgery/invasive procedure site

1ASF.FS.60100155 Surgery Center of Silverdale Kitsap 1/8/2010 1A - Wrong surgery/invasive procedure siteASF.FS.60100155 Surgery Center of Silverdale 12/8/2010 1D - Unintended retention of foreign object

2ASF.FS.60100949 Kaiser Permanente Tacoma Ambulatory Surgery Center^** Pierce 6/7/2010 1D - Unintended retention of foreign objectASF.FS.60100949 Kaiser Permanente Tacoma Ambulatory Surgery Center^** 10/7/2010 1A - Wrong surgery/invasive procedure siteASF.FS.60100949 Kaiser Permanente Tacoma Ambulatory Surgery Center^** 2/28/2013 1C - Wrong surgical/invasive procedureASF.FS.60100949 Kaiser Permanente Tacoma Ambulatory Surgery Center^** 5/6/2013 1C - Wrong surgical/invasive procedureASF.FS.60100949 Kaiser Permanente Tacoma Ambulatory Surgery Center^** 9/30/2014 1D - Unintended retention of foreign object

Southwest Seattle Ambulatory Surgery Center number of events:

Southwest Washington Regional Surgery Center number of events:

Specialty Eyecare Centre number of events:

Surgery Center of Silverdale number of events:

Puyallup Endoscopy Center number of events:

Rainier Surgical Center number of events:

Rockwood Digestive Health and Endoscopy Services number of events:

Salmon Creek Plastic Surgery number of events:

Seattle Surgery Center number of events:

South Sound Surgery Center number of events:

Pacific Surgery Center number of events:

Pacmed Ambulatory Surgical Clinic number of events:

Proliance Highlands Surgery Center number of events:

Proliance Orthopedic Associates Ambulatory Surgery Center number of events:

EVIVA-Edmonds number of events:

Northwest Eye Surgeons, Seattle number of events:

Northwest Orthopaedic Specialists number of events:

Olympia Surgery Center, Tumwater number of events:

Olympia Surgery Center number of events:

Overlake Surgery Center number of events:

Pacific Rim Outpatient Surgery Center number of events:

Kaiser Permanente Bellevue Ambulatory Surgery Center number of events:

Inland Northwest Surgery Center number of events:

Kemp Surgery Center number of events:

la Belle Vie Cosmetic Surgery Centers number of events:

Laser and Surgery Center LLC number of events:

Northwest Endovascular Surgery number of events:

Eastside Surgery Center number of events:

Edmonds Center for Outpatient Surgery number of events:

Everett Bone and Joint Surgery Center number of events:

Eye Associated Surgery Center number of events:

First Hill Surgery Center number of events:

Gateway Surgery Center number of events:

Cedar Laser and Surgery Center number of events:

Digestive Disease and Endoscopy Center number of events:

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Adverse Events Quarterly ReportFacility by Date and Event - Q2 2020

Facility Credential Facility Name Facility County Date Confirmed Event TypeASF.FS.60100949 Kaiser Permanente Tacoma Ambulatory Surgery Center^** 1/7/2016 1C - Wrong surgical/invasive procedure

6ASF.FS.60099797 TASC Pierce 5/2/2011 1D - Unintended retention of foreign objectASF.FS.60099797 TASC 8/15/2011 **1A - Wrong surgery/invasive procedure site

2ASF.FS.60100079 The Doctors Clinic Ambulatory Surgery Center Kitsap 8/28/2013 1C - Wrong surgical/invasive procedure

1ASF.FS.60100082 The Polyclinic Surgery Endoscopy Centers King 1/9/2014 1A - Wrong surgery/invasive procedure siteASF.FS.60100082 The Polyclinic Surgery Endoscopy Centers 1/10/2014 1A - Wrong surgery/invasive procedure siteASF.FS.60100082 The Polyclinic Surgery Endoscopy Centers 1/28/2016 3A - Patient/Resident discharged to unauthorized personASF.FS.60100082 The Polyclinic Surgery Endoscopy Centers 5/3/2016 1A - Wrong surgery/invasive procedure site

4ASF.FS.60278648 The Retina Surgery Center King 2/15/2017 1A - Wrong surgery/invasive procedure site

1ASF.FS.60101697 The Spokane Eye Surgery Center Spokane 11/16/2010 **1A - Wrong surgery/invasive procedure siteASF.FS.60101697 The Spokane Eye Surgery Center 9/22/2015 **1A - Wrong surgery/invasive procedure siteASF.FS.60101697 The Spokane Eye Surgery Center 1/11/2016 1C - Wrong surgical/invasive procedureASF.FS.60101697 The Spokane Eye Surgery Center 4/27/2018 1A - Wrong surgery/invasive procedure siteASF.FS.60101697 The Spokane Eye Surgery Center 6/4/2019 1A - Wrong surgery/invasive procedure site

5ASF.FS.60101080 The Surgery Center at Rainier Pierce 4/20/2011 1D - Unintended retention of foreign objectASF.FS.60101080 The Surgery Center at Rainier 8/2/2014 1A - Wrong surgery/invasive procedure siteASF.FS.60101080 The Surgery Center at Rainier 12/12/2014 1D - Unintended retention of foreign objectASF.FS.60101080 The Surgery Center at Rainier 6/20/2017 1A - Wrong surgery/invasive procedure site

4ASF.FS.60103037 The Vancouver Clinic Surgery Center Clark 7/8/2010 1A - Wrong surgery/invasive procedure site

1ASF.FS.60100213 Trask Surgery Center Snohomish 7/18/2013 2A - Contaminated drugs, devices, biologicsASF.FS.60100213 Trask Surgery Center 10/17/2014 1C - Wrong surgical/invasive procedureASF.FS.60100213 Trask Surgery Center 1/28/2015 **1D - Unintended retention of foreign object

3ASF.FS.60100019 Tri-City Regional Surgery Center Benton 7/5/2018 1A - Wrong surgery/invasive procedure site

1ASF.FS.60101033 Westwood Eye Surgery and Laser Center**** King 8/3/2015 **1A - Wrong surgery/invasive procedure site

1ASF.FS.60532154 Westwood Eye Surgery and Laser King 2/8/2018 **1A - Wrong surgery/invasive procedure site

1ASF.FS.60103038 Yakima Ambulatory Surgical Center Yakima 2/11/2011 1A - Wrong surgery/invasive procedure siteASF.FS.60103038 Yakima Ambulatory Surgical Center 12/6/2014 1A - Wrong surgery/invasive procedure siteASF.FS.60103038 Yakima Ambulatory Surgical Center 12/6/2014 1A - Wrong surgery/invasive procedure site

35953

Trask Surgery Center number of events:

Tri-City Regional Surgery Center number of events:

Westwood Eye Surgery and Laser Center number of events:

Westwood Eye Surgery and Laser number of events:

Yakima Ambulatory Surgical Center number of events:Total reported adverse events:

The Doctors Clinic Ambulatory Surgery Center number of events:

The Polyclinic Surgery Endoscopy Centers number of events:

The Retina Surgery Center number of events:

The Spokane Eye Surgery Center number of events:

The Surgery Center at Rainier number of events:

The Vancouver Clinic Surgery Center number of events:

Kaiser Permanente Tacoma Ambulatory Surgery Center number of events:

TASC number of events:

Notes:Event 4F (fall) was revised in July 2009 to include serious disability** Event has contextual information form providing additional details