Failure to Provide Timely Post-Operative Transportation and Follow-Up
Penalty
Summary
The facility failed to provide timely assistance and post-operative follow-up transportation for a resident who required specialized stretcher transport for multiple medical appointments following a right knee dislocation and surgical intervention. The resident, who was cognitively intact and dependent on staff for all activities of daily living due to significant lower extremity limitations, missed several critical follow-up appointments, including post-surgical evaluations and a scheduled surgery to remove hardware, because the facility did not arrange or cover the necessary transportation. Documentation showed that the facility's process for arranging transportation involved handwritten forms and required approval from the Nursing Home Administrator for costly services, but there was confusion and lack of clarity regarding financial responsibility, resulting in missed appointments and canceled procedures. The resident expressed frustration that he was told by facility staff he would have to pay for transportation himself, leading him to attempt to make his own arrangements. Records confirmed that some appointments were missed or rescheduled due to transportation issues, and at least one transportation bill remained unpaid by the facility. The orthopedic provider's office and infectious disease notes corroborated that timely follow-up was not achieved, and the resident's surgery was canceled due to incomplete pre-operative testing, which was also the facility's responsibility. Interviews with staff, including the Medical Records Coordinator and Discharge Planner, revealed inconsistent practices and understanding regarding who was responsible for arranging and paying for transportation, especially for residents requiring specialized services. Facility guidelines stated that the facility was responsible for ensuring timely services, whether provided internally or through outside resources, but this was not followed in the resident's case, resulting in a failure to meet the resident's post-operative care needs.