Failure to Inform Resident of Physician Ineligibility and Denial of Readmission
Penalty
Summary
The facility failed to inform a resident that his chosen physician did not meet the facility's requirements and did not provide the resident with an opportunity to select a new physician while he was hospitalized. The resident, an adult male with a diagnosis of malignant neoplasm of the lung and intact cognition, was initially under the care of the facility's medical director, who terminated the physician-patient relationship due to conflicts with the resident's family. The facility then instructed the resident to identify a new physician or face discharge, and the resident subsequently selected his outpatient physician to oversee his care at the facility. During a subsequent hospitalization, the facility determined that the new physician was not responsive to urgent communications and decided not to readmit the resident upon discharge from the hospital. The facility did not notify the resident or his family of this decision during the hospitalization, nor did they provide written or verbal communication regarding the refusal of readmission. The resident and his family only learned of the refusal through the hospital's case manager, and the facility communicated solely with the ombudsman regarding the situation. Despite the resident's family expressing satisfaction with the new physician and the physician's office confirming ongoing oversight, the facility maintained that the physician did not meet their expectations for responsiveness and refused readmission. The resident's appeal of the discharge was not honored, and the facility did not provide the resident with an opportunity to select another physician prior to the refusal. The lack of communication and failure to allow physician selection led to a delay in the resident's hospital discharge and caused emotional distress.