Failure to Provide Ordered Skilled Therapy After Resident Fracture
Penalty
Summary
A resident sustained a left femur fracture after falling during a transfer from bed to wheelchair. Following the fall, the resident experienced significant pain and required a left knee immobilizer. Physician orders were written for both occupational therapy (OT) and physical therapy (PT) evaluations and treatments, specifying the frequency and duration of therapy sessions to address the resident's pain, mobility limitations, and activities of daily living (ADL) needs. The OT and PT plans of care outlined the necessity for skilled therapy to improve the resident's independence, manage pain, and reduce fall risk. Despite these orders and documented clinical needs, there was no evidence in the medical record that the resident received any OT or PT services after the initial evaluations. The rehabilitation director confirmed that therapy had not been provided, citing difficulties in obtaining insurance authorization and a change in the resident's insurance provider. No attempts to secure authorization from the new insurance were documented, resulting in the resident not receiving the required skilled rehabilitative services.