Failure to Ensure Required Physician and Psychiatrist Visits
Penalty
Summary
The facility failed to ensure that a resident received required face-to-face visits from both the attending physician (AP) and the psychiatrist (Psych MD) as mandated. Specifically, the AP did not make an initial face-to-face visit within 30 days of admission during the first 90 days, and the Psych MD did not conduct a required visit as per physician orders. Instead, nurse practitioners (NPs) conducted all visits for both the AP and the Psych MD, with no documentation of direct visits from the physicians themselves. Review of the resident's medical record confirmed the absence of progress notes or history and physical documentation from either the AP or the Psych MD. The resident involved had diagnoses including cerebral ischemia, unspecified dementia, and insomnia, with documentation indicating severely impaired cognitive skills and lack of capacity to make decisions. Despite orders for psychiatric consultation and follow-up, only NPs performed these visits. Interviews with nursing staff and the DON confirmed that the AP and Psych MD did not see the resident, and the facility's policy requiring physician visits was not followed. The DON acknowledged the failure to ensure required physician visits occurred.