Failure to Involve Full IDT in Arbitration Agreement Process for Residents Lacking Capacity
Penalty
Summary
The facility failed to ensure that the arbitration agreement was properly explained and agreed upon with the appropriate Interdisciplinary Team (IDT) members for three residents who lacked decision-making capacity. According to the facility's policies, the Bioethics Committee, which includes the Administrator, DON, Medical Director, Primary Care Physician, Social Services, and Ombudsman, is responsible for making decisions on behalf of residents without capacity or a responsible party. However, in each case reviewed, the Administrator signed the arbitration agreement as the resident's legal representative without the involvement of the full Bioethics Committee, specifically excluding the Ombudsman. For one resident, medical records indicated the resident could make their needs known but was unable to make medical decisions. The arbitration agreement was signed by the Administrator on behalf of the IDT, but interviews confirmed that the Ombudsman was not present or involved in the decision-making process. The Ombudsman stated she had not participated in any Bioethics Committee meetings or meetings regarding arbitration agreements for over a year. Similar findings were noted for two other residents who also lacked decision-making capacity, with the Administrator signing the agreements without the required participation of the Ombudsman or the full Bioethics Committee. These actions were inconsistent with the facility's own policies, which require the arbitration agreement to be explained in a manner understandable to the resident or their representative, and for the Bioethics Committee to be involved in such decisions for residents lacking capacity. The failure to involve the appropriate IDT members, including the Ombudsman, in the arbitration agreement process was confirmed through interviews and record reviews for all three residents.