New York Nursing Home Fined Over Serious Violations of Federal Regulations
After an April 19 inspection by the New York State Health Department, the federal government has levied a fine of $21,393 against a nursing home related to its failure to provide timely emergency care for two residents, placing them in immediate jeopardy. Both of the residents died.
According to the Centers for Medicare & Medicaid Services (CMS), āimmediate jeopardy means a situation in which the provider’s or supplier’s noncompliance with one or more requirements, conditions of participation, conditions for coverage, or conditions for certification has caused, or is likely to cause, serious injury, harm, impairment, or death to a resident or patient.ā The nursing home was also cited for substandard quality of care and failure to treat residents with dignity and respect.
One incident involved a resident with a temperature of 104.4Ā° F. The delay was due to the nursing supervisorās reluctance to transfer the resident because it was Christmas Eve. The resident was finally rushed by ambulance to the hospital, but died two hours later.
Another incident resulted from an 11-hour delay in transferring a resident who was having difficulty breathing and was unresponsive, with low blood sugar and oxygen levels. That resident was hospitalized on December 16 and died December 23.
The April inspection also discovered an incident where a resident with a blood clot in his leg was not given anticoagulant medication for three weeks due to a record-keeping error.
The nursing home was issued a letter on May 14, 2019, requiring submission of a plan to correct deficiencies or be denied Medicare and Medicaid payments for new admissions and face possible termination from Medicare and Medicaid programs.
A plan of correction demonstrating that the nursing home had corrected the deficiencies was submitted on June 11.
Compliance Perspective
Failure to respond to residentsā needs for transfer to a hospital related to their serious changes in conditions and failure to provide ordered medication with demonstrated medical necessity may be interpreted as causing āimmediate jeopardyā to residents as well as provision of substandard quality of care, in violation of state and federal regulations.
Discussion Points:
- Review policies and procedures that address reacting to serious changes in a residentās condition that require immediate response and possible emergency transfer to the hospital.
- Train staff on protocols for responding to serious changes in a residentās condition as well as protocols for correctly entering medication orders into a residentās record.
- Periodically audit residentsā medication orders to determine if there are any errors in transcription and recordkeeping.
