Failure to Provide Timely Behavioral Health Services and Psychiatric Consultation
Penalty
Summary
A resident with severe cognitive impairment, as indicated by a BIMS score of 0, exhibited ongoing behavioral symptoms such as yelling out, yelling at staff, and refusing interventions like wearing a helmet or being repositioned. The clinical record shows that as-needed medications were administered, but their effectiveness was limited to about three hours. Despite these persistent behaviors, the resident was not provided with a timely psychiatric consultation as ordered by the physician. Instead, the resident was started on Seroquel, an antipsychotic medication, for anxiety, even though there was no documented diagnosis of schizophrenia, psychosis, bipolar disorder, or major depressive disorder, which are the FDA-approved indications for this medication. Physician progress notes repeatedly documented the need for psychiatric follow-up, but there was no evidence that the resident was actually seen by psychiatric services. The DON confirmed in an interview that the psychiatric consultation had not occurred and could not provide a date for when it would take place. The failure to provide timely behavioral health care and services, specifically the lack of psychiatric evaluation as ordered, led to the deficiency cited in the report.