Failure to Honor Residents' Right to Choose Attending Physician
Summary
The facility failed to honor the residents' right to choose their attending physician, as evidenced by the lack of communication and documentation regarding the change of primary care physician (PCP) for five residents. The facility did not verbally confirm with the original PCP that he was no longer returning to the facility, nor did they follow their policy to inform residents in writing about the change in their attending physician. This resulted in residents being informed that their physician was changed without their consent or proper notification, disrupting the continuity of care. Resident 1, who lacked the capacity to make decisions, was informed by their responsible party that the PCP was no longer seeing patients at the facility, and a new physician was assigned without a request for change. Resident 2, who was self-responsible, had a progress note from the original PCP expressing confusion over the change, indicating the resident did not request a new doctor. Resident 3, who had decision-making capacity, was informed via text and phone call about the change but did not receive any documentation with the new PCP's contact information. Residents 4 and 5, both self-responsible, also did not receive written notification of the new PCP's contact information. The facility's administrator and director of nursing did not clarify the original PCP's intentions when he expressed frustration and stated he would not return, leading to an assumption that the PCP had left permanently. The facility's policy required written notification of any changes in attending physician, which was not adhered to, resulting in a failure to respect the residents' rights to choose their physician.
Penalty
Resources
Below are regulatory guidelines relevant to this citation:
A resident with severe cognitive impairment and multiple diagnoses was admitted without a signed consent for treatment by facility providers, as the legal guardian insisted on exclusive care by VA providers. Despite this, staff obtained or attempted to obtain medical orders from facility providers on several occasions, contrary to the guardian's directives and without proper authorization.
Failure to Ensure Resident Received Care Only from Approved Physicians
Penalty
Summary
This facility failed to ensure that a resident received care and services only from approved physicians, as required. The resident in question was admitted with diagnoses including Alzheimer's disease, heart disease, and obstructive sleep apnea, and had a severely impaired cognitive status as indicated by a BIMS score of 3 out of 15. The resident's legal guardian, who was also the daughter, refused to sign the facility's consent for treatment and insisted that all medical care be provided exclusively by VA providers. The guardian also took responsibility for scheduling and notifying the VA for all appointments, declining involvement from the facility's medical director or related providers. Despite the lack of consent for treatment by facility providers, there were multiple instances where facility staff either attempted to obtain or did obtain medical orders for the resident. These included a new order for Depakote from a CNP for increased agitation, notification of a provider regarding leg swelling, and a treatment order for a skin injury after the medical director's group was contacted. Interviews with the Administrator and DON confirmed that the facility did not have a signed consent on file and that staff actions were taken without the required authorization from the resident's legal guardian.
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