Failure to Ensure Timely Physician Visits for Resident with Complex Medical Needs
Penalty
Summary
The facility failed to ensure that a resident received timely in-person physician visits as required, specifically every 60 to 70 days, to promote continuity of care and reduce the risk of disease complications. The resident in question had moderate cognitive impairment and multiple medical conditions, including non-traumatic brain dysfunction, heart failure, and schizophrenia, and was prescribed several medications such as antipsychotics and anticoagulants. Despite these complex needs, the medical record showed that the last in-person physician visit was documented over 70 days prior, with the most recent psychiatric progress note dated more than three months earlier. The facility's own policy required physician visits at least every 60 days after the initial 90-day period post-admission. Observations and interviews revealed that the resident had ongoing symptoms, such as chest pain, and was receiving medications for these complaints. Staff, including the DON and consulting pharmacist, confirmed that the resident's primary care was managed by a VA provider and that there was a lapse in scheduling and tracking required physician visits. The DON acknowledged that the resident had not been seen by a physician in the required timeframe and that the facility did not have a system in place to ensure compliance with the 60-day visit requirement, resulting in the resident not being seen as needed.