Resident Denied Re-Entry After Appointment Due to Improper AMA Discharge Process
Penalty
Summary
The facility failed to follow its discharge policy for a resident who was not allowed to return after leaving for a doctor's appointment. The resident, who had diagnoses including unspecified dementia, rheumatoid arthritis, cerebrovascular disease, hypertension, amnesia, and alcohol dependence, left the facility for an appointment without a physician's order or proper notification. Upon return, the resident was denied re-entry by staff following instructions from the social services director (SSD), who believed the resident had left against medical advice (AMA). The SSD initiated an AMA form and instructed staff not to allow the resident back, despite there being no physician's order for an AMA discharge. Staff interviews revealed that the nurse on duty did not notify the director of nursing (DON) or the physician about the resident's return and simply followed the SSD's instructions. The certified nursing assistant (CNA) provided the resident with an AMA form when he returned, and the resident expressed that he had nowhere to go. The resident remained outside the facility for at least an hour, during which time his sister contacted the police, who then called paramedics to transport the resident to the hospital. There was no documentation that the physician was notified about the situation, and the DON was only informed the following morning. The facility's policy requires immediate notification of the attending physician or on-call provider and proper documentation when a resident leaves AMA. In this case, these procedures were not followed, as there was no physician notification or order, and the resident was not properly assessed or prepared for a safe transfer or discharge. The emergency department's provider note documented the incident as suspected abandonment, highlighting the lack of adherence to required protocols.