Failure to Honor Resident's Choice of Physician
Summary
The facility failed to honor a resident's preference for their personal physician, which violated the resident's right to choose their attending physician. The resident, who was admitted with diagnoses including recurrent enterocolitis, heart disease, major depressive disorder, and anxiety, had the capacity to make her own healthcare decisions. Despite this, the facility canceled her appointment with her regular doctor, insisting she see the facility's doctor instead. This decision was made without confirming the resident's wishes or checking insurance coverage for transportation to her preferred doctor, leading the resident to feel ignored and depressed. The Director of Social Services (SSD) and the Director of Nurses (DON) were involved in the decision to cancel the appointment. The SSD expressed concern about payment issues between the facility's doctor and the resident's chosen doctor, and assumed the resident wanted both doctors without verifying. The DON acknowledged the resident's right to choose her doctor and mentioned that the facility typically provides transportation to medical appointments, but the facility's bus was broken at the time of the resident's appointment. The facility's policy on resident rights supports the resident's choice of physician, but this was not upheld in this instance.
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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