Failure to Obtain POA Consent for Surgical Procedure
Penalty
Summary
The facility failed to ensure that a resident's power of attorney (POA) was able to exercise the resident's rights to refuse medical treatment. The resident, who had diagnoses including Parkinson's disease, anxiety, and a terminal prognosis, was admitted to hospice care and was rarely or never understood, making the POA responsible for medical decisions. On a specified date, an outside wound management company performed a surgical incision and drainage procedure on the resident's left breast, including the use of a scalpel and local anesthetic, without informing or obtaining consent from the resident's POA. The facility did not notify the family or the hospice team prior to the procedure, and the family only learned of the event from a hospice employee the following day. Interviews with the resident's adult child and hospice staff confirmed that the POA was not informed or given the opportunity to consent, and would not have agreed to the procedure if notified. The resident was unable to provide consent due to cognitive impairment. After the procedure, the resident experienced increased pain and required morphine, and stopped eating. Facility administration acknowledged that they did not seek permission from the POA, believing that a previously signed general consent for wound management services was sufficient and did not consider the procedure to be outside normal care.