Failure to Provide Emergency Care for Resident with Stroke Symptoms
Penalty
Summary
A resident with a history of dementia, high blood pressure, and cognitive communication deficit experienced a significant change in condition, presenting with stroke-like symptoms including facial drooping, slurred speech, delayed responses, and left-sided weakness. Therapy staff and the DON observed these symptoms during therapy sessions and reported them. The DON contacted the resident's physician, initially requesting a urine sample to rule out a urinary tract infection, and later reported the full set of stroke-like symptoms. However, there was no documentation of a comprehensive assessment following the onset of these symptoms. Despite clear indications of a possible stroke, the DON advised the resident's family that hospital treatment would likely be limited due to the resident's age and suggested that the hospital could do nothing more than the facility. After this conversation, the family declined hospital transfer, and the resident was not sent for emergency evaluation. The facility's policy required immediate clinician notification and action for changes in condition, but the DON did not escalate the situation to the regional nurse until after speaking with the family, and the physician did not recall the conversation. Both the regional nurse and regional director later stated that stroke-like symptoms should have been treated as an emergency requiring hospital transfer. Following the incident, the resident experienced a marked decline in functional abilities, losing the ability to ambulate with a cane or walker, requiring increased assistance for transfers, and becoming dependent on staff for basic mobility and activities of daily living. Subsequent assessments and therapy notes documented severe left-sided weakness and mobility impairment, consistent with a stroke. A later CT scan confirmed a new area of brain infarct. The facility failed to provide care and treatment in accordance with professional standards by not ensuring timely hospital evaluation for the resident's acute neurological symptoms.