Failure to Honor Residents’ Choice of Attending Physician
Summary
The facility failed to ensure three cognitively intact residents were allowed to choose their own attending physician. Resident #15, Resident #28, and Resident #30 each stated during a group interview that they did not have a choice in who their physician could be while in the facility and that they had to see the facility’s MD. Resident #15 said she had a primary care physician in town that she wanted to continue seeing, but she was told she could not see that physician. Resident #28 and Resident #30 each said they were required to see the facility’s MD instead of choosing their own physician. Record review for each of the three residents, including the admission agreement and EMR, showed no documentation that they were provided a choice of attending physician. Resident #15 had diagnoses including COPD, cirrhosis of the liver, and osteoarthritis, and her MDS showed she was cognitively intact with a BIMS score of 15. Resident #28 had diagnoses including type 2 diabetes mellitus, asthma, osteoarthritis, and TIA/cerebral infarction, and was also cognitively intact with a BIMS score of 15. Resident #30 had diagnoses including type 2 diabetes mellitus, wedge compression fracture of T11-T12 and L3, and hypertension, and his MDS likewise showed a BIMS score of 15. The NHA stated residents were able to choose their attending physician when admitted, but also said the facility had one physician residents could choose from and was not aware that these residents wanted different physicians.
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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