SCRANTON, PA - Federal inspectors cited Linwood Nursing and Rehabilitation Center after a resident with a fractured ankle went without proper medical evaluation for four days due to inadequate physician response protocols.
Delayed Medical Response Creates Risk for Vulnerable Resident
The June 2024 inspection revealed serious deficiencies in the facility's physician services when a resident with multiple chronic conditions, including rheumatoid arthritis and Alzheimer's disease, experienced concerning leg swelling that went unaddressed for nearly a week.
On February 17, 2024, the resident's family approached nursing staff expressing concern about significant swelling in their loved one's left leg. They also requested results from an X-ray that had been performed twelve days earlier on February 5th. The nursing staff documented placing a call to the resident's physician and leaving a message, but received no response.
The facility's nursing team made repeated attempts to reach the physician over the following days. On February 18th, nurses called the physician's answering service regarding the ankle swelling and left another voicemail requesting a callback. When no response came, staff made a third attempt on February 21st, again documenting their concerns about the family's worry over the persistent swelling.
It wasn't until February 21st at 3:47 PM - four full days after the initial concern was raised - that the physician finally returned the calls and provided orders for an X-ray of the left ankle.
Critical Diagnosis Reveals Serious Injury
The delayed X-ray revealed what medical professionals should have suspected days earlier: the resident had sustained fractures to the left ankle. The physician immediately ordered treatment including an ace wrap, elevation, ice application, and an urgent orthopedic consultation scheduled for the following day.
The situation escalated quickly once proper medical attention was provided. During the orthopedic appointment on February 22nd, the resident's condition was deemed serious enough to require immediate hospital transfer. The resident was transported directly from the orthopedic office to the emergency department and subsequently admitted for treatment.
Medical records show the resident remained hospitalized for several days, receiving treatment not only for the fractured leg but also for pain management and an exacerbation of a cardiac condition - complications that may have been prevented with earlier intervention.
Medical Standards Require Immediate Response to Acute Changes
Healthcare regulations mandate that nursing facilities ensure 24-hour physician availability for residents experiencing acute medical changes. When a primary physician is unavailable, facilities must have protocols to contact on-call physicians or the facility's medical director to ensure timely medical evaluation.
In residents with conditions like rheumatoid arthritis, sudden swelling can indicate serious complications including fractures, infections, or flare-ups of the underlying autoimmune condition. For individuals with Alzheimer's disease, the inability to clearly communicate pain makes rapid medical assessment even more critical, as these residents cannot adequately describe their symptoms or discomfort.
Ankle fractures in elderly residents with osteoporosis can lead to significant complications if left untreated. Delayed diagnosis increases risks of improper healing, chronic pain, mobility limitations, and secondary complications such as blood clots from immobility. The combination of rheumatoid arthritis and osteoporosis creates a particularly vulnerable situation where bones are already weakened and inflammation can mask or complicate injury symptoms.
Facility's Response Protocol Failures
The inspection revealed that Linwood Nursing and Rehabilitation Center failed to follow proper protocols when the primary physician didn't respond promptly. Despite making multiple attempts to reach the physician over four days, facility staff did not contact an on-call physician or the facility's medical director as backup options.
During interviews with inspectors, the Director of Nursing acknowledged the inadequate response timeline. When questioned on June 28, 2024, the nursing director confirmed that approximately four days had passed before receiving any physician response to their repeated calls about the resident's acute condition change. In a follow-up interview, the Director of Nursing admitted that "the physician failed to respond timely."
This admission highlights a critical gap in the facility's emergency medical protocols. Federal regulations require nursing homes to have systems ensuring that residents receive prompt medical attention for acute changes in condition, regardless of individual physician availability.
Impact on Quality of Care
The delayed medical response had measurable consequences for the resident's health outcomes. What began as concerning swelling developed into a complex medical situation requiring hospitalization for multiple conditions. The resident's cardiac condition became exacerbated during this period, potentially due to the stress of untreated pain and the delayed medical intervention.
Proper protocols would have involved immediate assessment by an available physician, early imaging to identify the fracture, and prompt treatment that could have prevented the need for emergency hospitalization. The four-day delay meant the resident endured unnecessary discomfort and faced increased risks of complications.
Additional Issues Identified
The inspection focused primarily on the physician response deficiency, but the case also highlighted concerns about follow-up on diagnostic tests, as the family had to inquire about X-ray results from twelve days prior. This suggests potential gaps in communication and care coordination that extend beyond the immediate emergency response protocols.
The facility received a citation for failing to provide or arrange emergency care by a doctor 24 hours a day, with inspectors determining this created minimal harm but potential for actual harm to residents. This violation underscores the importance of having robust backup systems when primary physicians are unavailable, particularly in facilities caring for elderly residents with multiple chronic conditions who are at higher risk for medical emergencies.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Linwood Nursing and Rehabilitation Center from 2024-06-28 including all violations, facility responses, and corrective action plans.
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