Failure to Facilitate Physician-Ordered Specialist Referral and Transportation
Penalty
Summary
The facility failed to ensure that a physician-ordered referral to a specialist was initiated and facilitated for a resident who required evaluation and possible surgical intervention for severe bilateral hand contractures and a prior thumb amputation. The resident had a documented history of significant hand impairment, including a right thumb amputation and contractures that were not passively correctable. Despite a physician's order for a referral to an academic hand specialist for consideration of a great toe transfer/pollicization, the referral process was not completed, and the resident did not receive the necessary specialist evaluation. The resident reported being unable to attend the scheduled orthopedic appointment at a distant medical center due to lack of transportation, as the facility van only provided local transport. The administrator informed the resident that he would need to arrange his own transportation because the destination was outside the facility's usual service area. Although the resident requested a transfer to another facility closer to the medical center, the social services director sent referrals to several facilities, all of which declined, and no further action or documentation regarding transportation or the specialist referral was found. Interviews with facility staff revealed a lack of clarity and communication regarding responsibility for arranging the referral and transportation. The social services director was not involved in the referral to the medical center and did not maintain records of the attempted facility transfers. The director of nursing was unaware of the status of the referral and had not communicated with the resident's insurance. Documentation of efforts to facilitate the referral and address transportation or payment issues was absent from the care plan and progress notes, indicating a failure to provide necessary medically-related social services to help the resident achieve the highest possible quality of life.