A video of the March 6 death of Donald Keith Smith at Greenville Memorial Hospital’s ER reveals that he punched a security guard in the nose after a verbal exchange and is then subdued by guards who place him face down on a bed for about 10 minutes, records obtained by The Greenville News show.
The video is described in a federal review of the incident by the U.S. Centers for Medicare and Medicaid Services, which threatened to terminate Memorial’s $500 million contract if corrections weren’t made. The hospital submitted a corrective action plan and said the threat to end the contract was lifted.
Smith, 48, died of traumatic asphyxiation because of his positioning on the gurney, Coroner Parks Evans said in ruling it a homicide.
The State Law Enforcement Division is investigating.
Smith, who is referred to as Patient 12, was walking down the hallway after talking on the phone when a security guard entered the unit and walked in the same direction, according to the review of the video obtained through the federal Freedom of Information Act. Smith stopped in the doorway of a patient room and the guard followed, stopping when he reached Smith.
A verbal exchange, which was not audible on the video, ensued, and then Smith hit the guard, the review shows. Smith is then grabbed by the guard, who is bleeding from the nose, when two other security guards arrived to help.
The three hold Smith, who is resisting, and take him to a bed in the hallway and place his upper body face down on the bed while maintaining the hold.
The injured guard steps away and another takes his place, while a staff member assesses the guard’s injury.
Hospital staff in blue scrubs attempt to apply four-point restraints to Smith and administer an injection, according to the review. The guards then place him face down on the bed, then turn him onto his back. Then a staff member “is on the bed performing chest compressions” and Smith is transferred to a room.
Generally, four-point restraints means that a patient’s hands and feet are strapped to the bed. This type of restraint is typically reserved for patients who are dangerous to themselves or others, such as those with severe psychiatric illnesses.
The review acknowledges that for most of the video, Smith cannot be seen except occasionally the top of his head, because he is surrounded by guards and staff.
The review notes that there was no clinical intervention by hospital staff to contain the incident when it initially erupted or during the restraint, “or any clinical interventions by clinical staff during the crisis to assess the patient.”
Multiple hospital staff were watching the incident unfold, according to the review, but there was no supervision or leadership coordinating to ensure Smith’s safety.
The review also includes an interview with a nurse who was at the scene. She reported that another nurse gave Smith an anti-psychotic medication called Geodon and he was put in four-point restraints on his stomach. When he was turned over, according to the nurse’s statement, someone noticed that he wasn’t breathing and another nurse began chest compressions before a code was called.
But according to nursing notes in the review, Smith was verbally aggressive toward the staff and voluntarily took the injection of Geodon.
CMS says the guards failed to perform a safe take-down hold by placing Smith’s upper body face down on the bed for about 10 minutes, based on the video time stamps.
He “died while restrained in an inappropriate hold, 4 point restraints, and receiving an injection without any evaluations of the patient’s condition to ensure the patient’s safety when restrained,” the review concludes.
Evans said that toxicology tests performed on Smith showed no illicit drugs in his system and medications within therapeutic range.
Smith’s family referred calls to their attorney, Charles W. Marchbanks Jr. He could not be reached for comment.
Greenville Health System, which declined to provide details of the incident because of patient privacy laws and the ongoing investigation, submitted a corrective action plan to CMS, which disputes some of the findings and reserves the legal right to offer proof of the inaccuracies.
In its action plan, GHS says it hired outside consultants to assist in developing its corrective measures, which include formation of a task force to look into the incident, and to review policies and procedures.
It also calls for establishment of an ER de-escalation team trained “to respond to patients that present with a mental health crisis or whose behavior could potentially escalate to a behavioral health crisis. The actions of this team will focus first on verbally deescalating the patient while first and foremost ensuring the safety of the patient in crisis and others.”
And it calls for ER staff and security guards to get training in physical hold of patients, positional asphyxia related to restraint, and certification in CPR and training in basic first aid techniques.
According to CMS, Greenville Memorial failed to ensure that the nursing personnel and the contracted security staff followed hospital policies and procedures for aggression management and physician orders related to restraints and holds. The guards failed to perform a safe take-down and Smith was given an injection without a clinical assessment, CMS said.
Smith was a graduate of Carolina High School and a member of Sweet Canaan Baptist Church, according to an obituary on the Watkins Garrett Woods Mortuary website. He formerly worked as a security guard for various companies, the obituary said.