Failure to Ensure Timely Podiatry Care for Diabetic Resident
Penalty
Summary
A resident with multiple diagnoses, including dementia, heart failure, and diabetes, was not seen by a podiatrist as ordered by the physician. Nursing progress notes indicated that a referral for diabetic foot care was initiated, and the physician assistant agreed to the podiatry consult. However, there was a significant delay of approximately 10 weeks before the resident was scheduled to be seen by a podiatrist. During this period, observations showed the resident's toenails were thick, yellowish, and misshapen, and the wound nurse reported difficulty in providing nail care due to the condition of the toenails. The delay in scheduling the podiatry appointment was attributed to administrative and procedural issues, including confusion regarding the transfer of care for a veteran patient, incomplete paperwork, and insurance or copay barriers. Staff interviews revealed a lack of awareness about the need to transfer care between VA facilities and challenges in securing an appointment due to staffing shortages at the VA hospital. Attempts to refer the resident to private providers were unsuccessful due to insurance limitations and refusal to pay copays.