Failure to Provide Timely Dental Services Resulting in Resident Pain and Tooth Extraction
Penalty
Summary
The facility failed to follow its policy to ensure a resident received timely routine and emergency dental services. Despite multiple requests from the resident, staff, and the Ombudsman beginning in May, there was no documented follow-up or dental evaluation until late August. The resident had lost a dental filling in May and repeatedly reported severe pain to various staff members, including the Social Service Director and the Ombudsman, who submitted a grievance on the resident's behalf. Nursing documentation indicated that a request for a dental referral was made in June, and a nursing assessment in July noted broken or carious teeth, but there was no evidence that these concerns were addressed or that the resident was seen by a dentist during this period. The resident's medical record showed a history of multiple chronic conditions, including COPD, dementia, anxiety, hypertension, anemia, and other significant diagnoses. The Minimum Data Set assessment indicated moderate cognitive impairment and a need for assistance with activities of daily living. Despite these vulnerabilities, the facility did not document any dental visits for the resident from April of the previous year until late August, even though a dental exam in April had already recommended urgent extractions of two teeth. There was also no documentation that the resident refused the recommended extractions at that time. When the dentist finally saw the resident in late August, the resident was found to have significant pain, swelling, and infection due to the lost filling. The dentist was unable to perform an extraction immediately because of the infection and prescribed antibiotics, returning a few days later to extract the affected tooth. The dentist confirmed that if the resident had received prompt dental care when the initial concerns were raised, the pain and infection could have been prevented. The facility's own policy required prompt assessment and coordination of dental care, but there was no evidence that these procedures were followed.