Failure to Facilitate Dental Services Due to Missed Medical Consultation
Penalty
Summary
The facility failed to provide necessary assistance to obtain dental services for a resident who required both routine and emergency dental care. The resident, who had a history of seizures, osteoarthritis, and cognitive communication deficit, was prescribed an anticoagulant and was identified by the in-house dental provider as needing a medical consultation for medication adjustment before being added back to the routine dental visit list. Despite multiple notifications from the dental provider to the facility's social workers regarding the need for this consultation, there was no documented response or follow-up, and the required medical consultation was not completed. As a result, the resident was not seen by the dentist for an extended period, even though dental issues such as the need for fillings and extractions were noted. Interviews with facility staff, including social workers, the Assistant Director of Nursing, and the Medical Director, revealed a lack of awareness regarding the dental provider's requests and the resident's need for a medical consultation. The social workers did not recall receiving the emails from the dental provider, and the nursing leadership was unaware of the requirement until much later. The resident's care plan included interventions for dental care coordination, but these were not effectively implemented, resulting in the resident not being scheduled for necessary dental services. The resident experienced an incident involving facial trauma, which led to an emergency department visit. Hospital records and subsequent assessments documented poor dentition and recommended close dental follow-up, but no acute dental infection was found. Observations after the incident showed the resident had facial swelling, missing and discolored teeth, and some discomfort, although he denied significant pain or difficulty eating. Despite these findings and repeated notifications from the dental provider, the facility did not ensure the resident received timely dental assessment and care due to the missed medical consultation.