Nursing Home: Sanctions for Over-treatment and Under-treatment

In the latest Archives of Internal Medicine, Phillip Bale describes his 99-year-old nursing home patient with sever dementia in whose feet he noticed some gangrenous changes.  Recognizing that the patient had "enjoyed almost no quality of life for many years," the patient's POAs agreed that "only supportive comfort measures should be implemented."  But when Dr. Bale later went on vacation, the nursing home, recently-sanctioned for the death of another patient, started sending Dr. Bale's patient to the local hospital for wound care treatment.  The administrators "felt they could not risk another investigation claiming that they could have done more for the patient."  Apparently, though, the administrators felt they could risk a battery claim, False Claims Act exposure, and citation for violation of patient right COPs.