Improper Execution of DPOA and Conflict of Interest in Resident Rights
Penalty
Summary
The facility failed to ensure a resident's rights to self-determination and a dignified existence by improperly executing a Statutory Durable Power of Attorney (DPOA). The DPOA was completed with facility staff members named as agents and witnesses, which created a conflict of interest and a dual relationship between the resident and staff. The DPOA was implemented during a period when the resident's capacity to consent was in question, as evidenced by medical documentation indicating severe cognitive impairment and a medical opinion recommending guardianship due to incapacity. Despite this, staff proceeded with the DPOA process without prior legal consultation and without securing an appropriate external agent or guardian. The resident involved had a complex medical history, including a recent femur fracture, type 2 diabetes with a foot ulcer, cerebral infarction, and a cognitive communication deficit. The resident was admitted from an acute care hospital and was listed as his own financial responsible party, with a niece and other contacts declining to serve as POA due to personal or religious reasons. The resident's cognitive status was noted to fluctuate, and assessments showed severe cognitive impairment. Despite these factors, facility staff members were named as agents in the DPOA, and the document was witnessed and notarized by another staff member, further compounding the conflict of interest. Interviews with facility staff revealed that the DPOA was not reviewed by the legal department until after its execution, and the hospital social worker raised concerns about its legality. The facility's legal counsel later advised that guardianship should have been sought instead of staff serving as agents. Documentation also showed that no formal guardianship application had been filed, and the staff members named in the DPOA continued to be listed as legal agents. The facility's own policies emphasized residents' rights to self-determination and participation in care decisions, but these were not upheld in this case due to the improper handling of the DPOA and failure to secure an appropriate decision-maker for the resident.