Mizell Memorial Hospital

CLIA Laboratory Citation Details

3
Total Citations
7
Total Deficiencyies
7
Unique D-Tags
CMS Certification Number 01D0305141
Address 702 N Main Street, Opp, AL, 36467
City Opp
State AL
Zip Code36467
Phone(334) 493-3541

Citation History (3 surveys)

Survey - March 5, 2025

Survey Type: Standard

Survey Event ID: 67U511

Deficiency Tags: D5217 D5445

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 a review of the American Proficiency Institute (API) Proficiency Testing (PT) records, and an interview with the Laboratory Manager, the laboratory failed to implement a mechanism to verify the accuracy of the following non regulated analytes: DAT (direct antiglobulin test) IgG (Immunoglobulin G), CRP ( C-reactive protein), and MALB (Micro-albumin). The surveyor noted the PT evaluation failures occurred in two consecutive events out of six events from 2023-2024. The findings include: 1. A review of the API PT records revealed the laboratory's DAT IgG, CRP, and MALB evaluation scores were unsuccessful due to the following unacceptable scoring events: a) DAT IgG: 2023 Immunohematology 2nd Event 50% and Immunohematology 2023 3rd Event 0%. b) CRP: 2023 Immunology 3rd Event 50% and 2024 Immunology 1st Event 50%. c) MALB: 2023 Chemistry Miscellaneous 2nd Event 0% and 2024 Chemistry Miscellaneous 2nd Event 0%. 2. The Laboratory Manager confirmed the above findings during the exit conference on 03-4-2025 at 11: 59 AM. D5445 CONTROL PROCEDURES CFR(s): 493.1256(d)(1)(2)(g) (d) Unless CMS Approves a procedure, specified in Appendix C of the State Operations Manual (CMS Pub. 7), that provides equivalent quality testing, the laboratory must-- (d)(1) Perform control procedures as defined in this section unless otherwise specified in the additional specialty and subspecialty requirements at 493. 1261 through 493.1278. (d)(2) For each test system, perform control procedures using Statement of Deficiencies (X1) Provider/Supplier/CLIA Identification Number (X3) Date Survey Completed Name of Provider or Supplier Street Address, City, State -- 1 of 2 -- the number and frequency specified by the manufacturer or established by the laboratory when they meet or exceed the requirements in paragraph (d)(3) of this section. (d)(3) At least once each day patient specimens are assayed or examined perform the following for: This STANDARD is not met as evidenced by: Based on a review of the ESR (Erythrocyte Sedimentation Rate) QC (Quality Control) records and an interview with the Laboratory Manager, the Laboratory failed to ensure daily normal and abnormal QC on the ESR eXcyte 20 analyzer were within manufacturer's ranges prior to patient testing. The surveyor noted six out of thirty days in September 2023 when QC exceeded manufacturer's ranges, or was not documented, and patient testing was performed. The findings include: 1. A review of the ESR eXcyte 20 QC records revealed daily abnormal QC exceeded manufacturer's ranges for the following days in September 2023: a) 9/1; 1 patient affected, b) 9/2; 4 patients affected, c) 9/13; 6 patients affected, d) 9/16; 2 patients affected f) 9/27; 3 patients affected. 2. A review of the ESR eXcyte 20 QC records revealed daily normal QC was not documented for September 20, 2023; 5 patients were affected. 2. During an interview on March 4,2025 at 12:57 PM, the Laboratory Manager confirmed the above findings. -- 2 of 2 --

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Survey - January 30, 2019

Survey Type: Special

Survey Event ID: 8KF611

Deficiency Tags: D2016 D2178 D2181 D6090

Summary:

Summary Statement of Deficiencies D2016 SUCCESSFUL PARTICIPATION CFR(s): 493.803(a)(b)(c) (a) Each laboratory performing nonwaived testing must successfully participate in a proficiency testing program approved by CMS, if applicable, as described in subpart I of this part for each specialty, subspecialty, and analyte or test in which the laboratory is certified under CLIA. (b) Except as specified in paragraph (c) of this section, if a laboratory fails to participate successfully in proficiency testing for a given specialty, subspecialty, analyte or test, as defined in this section, or fails to take remedial action when an individual fails gynecologic cytology, CMS imposes sanctions, as specified in subpart R of this part. (c) If a laboratory fails to perform successfully in a CMS- approved proficiency testing program, for the initial unsuccessful performance, CMS may direct the laboratory to undertake training of its personnel or to obtain technical assistance, or both, rather than imposing alternative or principle sanctions except when one or more of the following conditions exists: (1) There is immediate jeopardy to patient health and safety. (2) The laboratory fails to provide CMS or a CMS agent with satisfactory evidence that it has taken steps to correct the problem identified by the unsuccessful proficiency testing performance. (3) The laboratory has a poor compliance history. This CONDITION is not met as evidenced by: Based on a review of CMS CASPER reports (#153 and #155), a review of API (American Proficiency Institute) proficiency testing evaluations, and a telephone interview with the laboratory's testing personnel on January 30, 2019, the surveyor determined the laboratory failed to successfully participate in Immunohematology proficiency testing for two consecutive testing events, Events #2 and #3 of 2018. The two failures resulted in the laboratory's initial unsuccessful proficiency testing participation. The findings include: 1. A review of the CASPER reports and API proficiency testing evaluations revealed the laboratory scored 80 % (percent) for compatibility testing for Event #2, 2018 and zero percent for Event #3. The zero Statement of Deficiencies (X1) Provider/Supplier/CLIA Identification Number (X3) Date Survey Completed Name of Provider or Supplier Street Address, City, State -- 1 of 3 -- percent resulted from a failure to submit the results by the submission deadline, resulting in a "Failure to Participate." 2. In a telephone interview on January 30, 2019 at 2:57 PM, the testing personnel confirmed the laboratory failed to submit the results to API by the submission deadline for Event #3, and confirmed the unsuccessful participation. D2178 COMPATIBILITY TESTING CFR(s): 493.863(c) Failure to return proficiency testing results to the proficiency testing program within the time frame specified by the program is unsatisfactory performance and results in a score of 0 for the testing event. This STANDARD is not met as evidenced by: Based on a review of CMS CASPER reports (#153 and #155), a review of API (American Proficiency Institute) proficiency testing evaluations, and a telephone interview with the laboratory's testing personnel on January 30, 2019, the surveyor determined the laboratory scored a zero percent (%) for Immunohematology testing for Event #3, 2018, due to a "Failure to Participate" (unsatisfactory performance). The findings include: 1. A review of the CASPER reports and API proficiency testing evaluations revealed the laboratory scored zero percent for Immunohematology testing (second failure for compatibility testing) for Event #3, 2018, graded as a "Failure to Participate" by API. 2. The testing personnel confirmed the above noted findings, in a telephone interview on January 30, 2019 at 2:57 PM. The testing personnel stated the laboratory manager failed to submit the results by the submission deadline. D2181 COMPATIBILITY TESTING CFR(s): 493.863(e) Failure to achieve an overall testing event score of satisfactory for two consecutive testing events or two out of three consecutive testing events is unsuccessful performance. This STANDARD is not met as evidenced by: Based on a review of CMS CASPER reports (#153 and #155), a review of API (American Proficiency Institute) proficiency testing evaluations, and a telephone interview with the laboratory's testing personnel on January 30, 2019, the surveyor determined the laboratory failed to perform satisfactorily in compatibility testing (Immunohematology) for two consecutive testing events, Events #2 and #3 of 2018. The two failures resulted in the laboratory's initial unsuccessful proficiency testing participation. The findings include: 1. Refer to D2016. D6090 LABORATORY DIRECTOR RESPONSIBILITIES CFR(s): 493.1445(e)(4)(ii) The laboratory director must ensure the results are returned within the timeframes established by the proficiency testing program. This STANDARD is not met as evidenced by: -- 2 of 3 -- Based on a review of CMS CASPER reports (#153 and #155), a review of API (American Proficiency Institute) proficiency testing evaluations, and a telephone interview with the laboratory's testing personnel on January 30, 2019, the surveyor determined the laboratory director failed to ensure the results for Immunohematology testing Event #3, 2018 were submitted by the submission deadline. As a result of this failure, the laboratory scored a zero percent (%), due to a "Failure to Participate" (unsatisfactory performance). The findings include: 1. A review of the CASPER reports and API proficiency testing evaluations revealed the laboratory scored zero percent for Immunohematology testing for Event #3, 2018, graded as a "Failure to Participate" by API. 2. The testing personnel confirmed the above noted findings, in a telephone interview on January 30, 2019 at 2:57 PM. The testing personnel stated the laboratory manager failed to submit the results by the submission deadline. 22378 Licensure and Certification Supervisor -- 3 of 3 --

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Survey - October 4, 2018

Survey Type: Standard

Survey Event ID: 6D0B11

Deficiency Tags: D5413

Summary:

Summary Statement of Deficiencies D5413 TEST SYSTEMS, EQUIPMENT, INSTRUMENTS, REAGENT CFR(s): 493.1252(b) The laboratory must define criteria for those conditions that are essential for proper storage of reagents and specimens, accurate and reliable test system operation, and test result reporting. The criteria must be consistent with the manufacturer's instructions, if provided. These conditions must be monitored and documented and, if applicable, include the following: (1) Water quality. (2) Temperature. (3) Humidity. (4) Protection of equipment and instruments from fluctuations and interruptions in electrical current that adversely affect patient test results and test reports. This STANDARD is not met as evidenced by: Based on observations, a record review of the 2016-2018 temperature charts, a review of storage requirements for the Biorad QC (Quality Controls) (used for Chemistry, Endocrinology and Toxicology assays) and the Beckman Coulter (BC) Access 2 immunoassay calibrators, and an interview with the Laboratory Manager (also the Technical Consultant), the laboratory failed to define appropriate acceptable ranges (as defined by the manufacturer), and ensure QC and calibrators were stored at temperatures specified by the manufacturer for two of two freezers reviewed. The findings include: 1. A review of the August 2016 thru 4 October 2018 temperature records for Freezer #2 revealed the laboratory specified an acceptable range of less than -12 degrees C (Celsius) on the charts. Temperatures were documented in the specified range, and generally in the range of -14 to -18 degrees C. The surveyor noted Freezer #2 had temperatures documented at -20 degrees C or colder three times (less than one percent of the time) for the period reviewed. 2. A review of temperature records for the Storage Room Freezer for the period 1/18/17 thru 10/4/2018 revealed the laboratory specified an acceptable range of less than -12 degrees C (Celsius) on the charts. Temperatures were documented in the specified range, and generally in the range of -15 to -19 degrees C. The Storage Freezer had temperatures documented at -20 degrees C or colder 27 times (approximately 4 percent of the time) for the period Statement of Deficiencies (X1) Provider/Supplier/CLIA Identification Number (X3) Date Survey Completed Name of Provider or Supplier Street Address, City, State -- 1 of 2 -- reviewed. 3. During an interview with the Laboratory Manager on 10/4/2018 at 9:30 AM, freezer temperatures were reviewed, and then the surveyor inventoried the contents of the freezers. Contents of the Storage Room Freezer included approximately twelve boxes (six vials each) of Biorad QC, and two boxes Biorad Pediatric QC. An icon on the Biorad QC packages specified storage requirements of -20 to -70 degrees C. 4. A review of the contents of Freezer #2 revealed individual bottles Biorad QC (the current lot numbers in use), and fourteen boxes of BC Access 2 immunoassay calibrators, with specified storage requirements of -20 degrees C. 5. As the interview continued, the Laboratory Manager confirmed the freezers were not consistently maintaining temperatures in the range required for the long-term storage of the Biorad QC and calibrators. The surveyor also discussed the concern of the "acceptable ranges" on the freezer logs not reflecting the manufacturer's storage requirements for the items the freezer contained, and the CLIA requirement of following Biorad's QC and Beckman Coulter's calibrator storage instructions. SURVEYOR: Laura T. Williams, BS, MT (ASCP) Licensure and Certification Surveyor -- 2 of 2 --

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