Ok, this should not be shocking news to anyone. Nursing homes in Virginia have physician(s) who comes in and serve as the Medical director of each nursing home facility.
Under Virginia law, (12VAC5-371-230) the following is required:
A. Each nursing facility shall have a written agreement with one or more physicians licensed by the Virginia Board of Medicine to serve as medical director.
B. The duties of the medical director shall include, but are not limited to:
1. Advising the administrator and the director of nursing on medical issues, including the criteria for residents to be admitted, transferred or discharged from the nursing facility;
2. Advising on the development and execution of policies and procedures that have a direct effect upon the quality of medical and nursing care delivered to residents;
3. Acting as liaison and consulting with the administrator and the attending physician on matters regarding medical and nursing care policies and procedures of the nursing facility;
4. Advising and providing consultation to the nursing facility staff regarding communicable diseases, infection control and isolation procedures, and serving as liaison with local health officials;
5. Providing temporary physician services when the admitting physician is not the attending physician, in order to assure that the resident has temporary medical orders;
6. Providing physician services in case of emergency in the event that the resident’s attending physician cannot be reached; and
7. Advising on the development and execution of an employee health program, which shall include provisions for determining that employees are free of communicable diseases according to current acceptable standards of practice
Hmm.. Interesting. Pretty fluffly language, eh?
What this provision does not state is that almost every nursing home patient’s attending physician IS the Medical Director. Meaning, when Grandma gets moved to the NH, and they ask whether you want their doctor to be her attending physician, you actually have the right to say no and see if Grandma’s primary care physician will do the job. If you agree, then a doctor who serves as the Medical Director will also serve as her attending physician.
Well, that’s ok, isn’t it?
Maybe it is. It is ok if the doctor actually does a decent job of patient care.
If I had a loved one in the NH, I would do the following:
1. I would make an appt. to meet with the Medical Director when he or she is on rounds.
2. I would get a way to contact them directly and ask the MD to be notified of any health care changes in condition.
3. I would ask the MD to look at the actual nursing home chart with you.
4. I would make sure that MD is an advocate for your loved one – not just someone who comes in, looks around, dictates a note once a month and leaves.
Under the Code, they don’t have to do much. As a physician however, they have a duty to provide necessary care. Make sure they do!