Indiana Pain & Spine Clinic

CLIA Laboratory Citation Details

2
Total Citations
12
Total Deficiencyies
12
Unique D-Tags
CMS Certification Number 15D1093361
Address 6915 Fir Road, Granger, IN, 46530
City Granger
State IN
Zip Code46530
Phone(574) 296-3200

Citation History (2 surveys)

Survey - November 19, 2020

Survey Type: Standard

Survey Event ID: 817B11

Deficiency Tags: D5217

Summary:

Summary Statement of Deficiencies D5217 EVALUATION OF PROFICIENCY TESTING PERFORMANCE CFR(s): 493.1236(c)(1) At least twice annually, the laboratory must verify the accuracy of any test or procedure it performs that is not included in subpart I of this part. This STANDARD is not met as evidenced by: Based on document review and interview, the laboratory failed to verify the accuracy of one of twenty-two tests (buprenorphine) performed on the Liquid Chromatography Mass Spectrometry (LCMS) analyzer during 2019. Findings included: 1. Review of accuracy verification documentation for 2019 indicated the following: a. The laboratory performed a comparison with "From Pain To Wellness" laboratory (FPTW) twice for their accuracy verification activities during 2019 for buprenorphine. The laboratory director reviewed the comparison test results on 4-3-2019 for the accuracy verification performed on 3-18-2019. b. During the March, 2019 comparison, the laboratory noted: "There is a discrepant results (sic) for...Buprenorphine," and indicated the laboratory would only report qualitative results "until the issue is resolved." 2. Review of patient records indicated the following: a. Patient #10 had quantitative test results for buprenorphine reported on 3-26-2019 (1037 nanograms per milliliter (ng/mL)); 4-24-2019 (446 ng/mL); and 5-1-2019 (277 ng/mL). b. Patient #11 had quantitative test results for buprenorphine reported on 5-1-2019 (226 ng/mL). c. Patient #12 had quantitative test results for buprenorphine reported on 3-26-2019 (663 ng/mL). 3. In interview on 11-19-2020 at 3:05 PM, SP1, Laboratory Director, acknowledged the buprenorphine accuracy verification was not acceptable during the March, 2019 accuracy verification event. SP1 further acknowledged they reviewed and signed the accuracy verification report on 4-3-2019. SP1 indicated the

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Survey - May 16, 2018

Survey Type: Standard

Survey Event ID: USTC12

Deficiency Tags: D5022 D5301 D5311 D5313 D5403 D5413 D5433 D5447 D6076 D6084 D6094

Summary:

Summary Statement of Deficiencies No Tags No deficiency details available. Statement of Deficiencies (X1) Provider/Supplier/CLIA Identification Number (X3) Date Survey Completed Name of Provider or Supplier Street Address, City, State -- 1 of 1 --

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