Failure to Honor Residents' Right to Choose Physician
Summary
The facility failed to honor the residents' right to choose their attending physician, as evidenced by the experiences of two residents. One resident, who was cognitively intact, expressed concerns about not being allowed to see her primary care physician and was instead required to see the in-house physician and nurse practitioner. This resident also reported that her medication for food digestion was discontinued by the in-house physician, and she was not informed about the option to choose her own physician. The Director of Nursing was unaware of these concerns and stated that residents could see any provider they wished. Another resident, also cognitively intact, was not aware of her right to choose her physician and had all her physician orders signed by the facility's medical director. This resident missed a nephrology appointment due to a scheduling error and lack of assistance from the staff, and the appointment was not rescheduled. An anonymous complainant reported communication difficulties with this resident and mentioned that she missed a primary care appointment because she was not informed about it.
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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