Failure to Provide Timely PT Evaluation as Ordered
Penalty
Summary
The facility failed to provide a required Physical Therapy (PT) evaluation for a resident with significant mobility and range of motion (ROM) concerns, despite a physician's order. The resident, who had a history of brain surgery, muscle weakness, foot drop, and reduced mobility, was admitted with the goal of regaining the ability to walk with a single point cane (SPC) and returning home. Initial PT evaluation and treatment were started but discontinued after a few days due to the facility's understanding that the resident's health insurance would no longer cover therapy services. However, a subsequent physician's order for a PT evaluation and treatment was issued in response to the resident's request, but the evaluation was not performed in a timely manner. The delay in providing the PT evaluation was attributed to the facility's process of waiting for health insurance authorization before proceeding, even though the facility's own policy and procedure (P&P) did not require waiting for such authorization. The case manager did not submit the physician's order for insurance review until several days after it was written, citing workload and absence from work as reasons for the delay. During this period, the resident continued to express a desire for more therapy and showed some improvement in right leg movement, as reported by restorative nursing staff. Despite these developments, the PT evaluation was not completed within the 48-hour timeframe specified by the facility's P&P. Interviews with facility staff, including the Director of Rehabilitation, case manager, and administrator, confirmed that the PT evaluation was not performed as ordered and that the facility's policy did not mandate waiting for insurance authorization. The resident remained dependent on restorative nursing interventions and did not receive the specialized rehabilitative assessment that could have determined eligibility for further therapy to meet her goal of increased mobility and discharge to home.