Failure of Medical Director to Implement and Coordinate Resident Care Policies
Penalty
Summary
The facility failed to ensure that the Medical Director fulfilled the duties outlined in the Medical Director Agreement and facility policy, specifically regarding the implementation of resident care policies and coordination of medical care. The Medical Director had not reviewed or participated in the development or revision of facility policies and procedures, including those related to diabetes management, and was unaware of key documents such as the Facility Assessment. The Medical Director also had not participated in or developed staff training or educational programs since assuming the role, and had not attended or reviewed materials from QAPI meetings, nor was he aware of the facility's outstanding citations or the extent of medication administration issues. Two residents with insulin-dependent diabetes were admitted without appropriate admission orders for insulin or blood sugar checks, as indicated in their discharge orders, and did not have care plans for diabetes management until several days after admission. There was no evidence that these residents received insulin or had their blood sugars checked in a timely manner, and one resident experienced acute hyperglycemia requiring emergency room care. Providers involved in the residents' care reported a lack of collaboration and communication with the Medical Director, and were not aware of the residents' prior medical history or the facility's protocols for diabetes management. Interviews with facility staff and contracted providers revealed that there was minimal to no collaboration with the Medical Director regarding resident care. The Medical Director was not aware of significant issues such as undrawn laboratory orders, insufficient staffing, and extensive delays or missed medication administration. The lack of oversight and coordination extended to the QAPI program, with the Medical Director not participating in meetings or reviewing relevant reports. These failures resulted in repeat deficiencies and were cited at the immediate jeopardy level.