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Articles Posted in Antipsychotic Drugs

stop-sign1.pngThe California Advocates for Nursing Home Reform (CANHR) has launched a comprehensive website that addresses the growing problem of drug misuse in California nursing homes. Every day, approximately 25,000 California nursing home patients are given an antipsychotic drug. Half of all dementia patients are administered these drugs despite FDA warnings these drugs can kill a dementia patient.

Because of this CANHR has launched a campaign to help end the drugging of California nursing home residents. CANHR states its goal this way:

The goal of the campaign is to stop nursing homes and doctors from misusing dangerous antipsychotic drugs and other types of psychoactive drugs to chemically restrain residents and to replace drugging with individualized care. Through education, advocacy and political action, we seek to bring Californians together to end this harmful practice.

SmartMoney.com has an article out entitled 10 Things Nursing Homes Won’t Tell You. Which has been adapted from the book “1,001 Things They Won’t Tell You: An Insider’s Guide to Spending, Saving, and Living Wisely,” by Jonathan Dahl.

Walton Law Firm thought you might like to see the list:

1. “We’re careless about the drugs we give out.”

Last year, the U.S. Drug Enforcement Administration began investigating allegations that some nursing homes were dispensing powerful narcotics to nursing home residents without a physician order. Because of the new scrutiny, however, nursing home and hospice trade organizations are arguing that many patients are now being left without pain medication as the nursing facilities try to find ways to comply with DEA regulations. Congress has also taken notice, and the subject will be addressed at a Senate hearing today.

The DEA intensified its efforts to battle abuse of prescription drugs in nursing home, after numerous reports of overmedication of patients in nursing facilities, many without prescription, and frequently used as a “chemical restraint,” not to treat a specific illness. In a letter to Congress last December, attorneys for the DEA said that allowing nurses to dispense medications without a doctor’s order, “trivializes the doctor-patient relationship and weakens the quality of care for the frail and infirm.”

Nursing home trade organizations, however, say that long-term care facilities don’t make available enough doctors to issue prescriptions every time. The DEA’s requirement on “hard copy prescriptions,” it says, places burdens on prescribers, pharmacists and nurses, and can lead to extended delays in the administration of pain medication.”

In 2007, Dr. David Graham, a drug safety expert with the FDA, testified before Congress and stated that approximately 15,000 people die each year in U.S. nursing homes from the off-label use of anti-psychotic drugs. Off-label use is the use of the drug for a condition it was not intended. In California, it has been estimated that up to 60% of all nursing home residents are given psychoactive drugs, which is an increase of 30% in only 10 years. It’s no wonder that when we think about nursing homes, we think of isolated elderly people sitting hunched over in wheelchairs, or in bed, segregated from the world. That life is a sad realty for many.

To combat the misuse of psychoactive drugs, the California Advocates for Nursing Home Reform have released a publication called Toxic Medicine – What You Should Know to Fight the Misuse of Psychoactive Drugs in California Nursing Homes. The 20-page booklet provides an overview of what psychoactive drugs are, their purposes, the risks associated with them, and an overview of the resident’s rights.

Primary among those rights is the requirement of consent. Before a psychoactive drug can be used, a physician must inform the resident (or his/her decision-maker) about the drug, why it is being recommended, and the risks associated with it, and then must obtain consent before prescribing it. The guide also provides a list of questions that should be asked of a doctor who is recommending a psychoactive drug, and what to do if it is suspected that the drugs are being used without proper authority.

This story is flat-out disturbing, and started with a concern we have heard many times from the families of our nursing home abuse clients. It began with Phyllis Peters could not wake up her 97-year-old mother, who was residing in Kern Valley Nursing Home. When she complained to Gwen Hughes, the nursing home’s director, Hughes would “chemically restrain” the patient by giving her powerful anti-psychotic drugs to shut her up. Hughes did this to other residents in the nursing home, and three of them died.

In a report from the California Attorney General, Hughes ordered one patient drugged because she “glared” at her. Another was given high doses of an anti-psychotic drug for throwing a carton of milk. Several residents became severely malnourished, and were left in bed drooling and emaciated.

“In a couple cases, elderly people were actually held down, restrained against their will, and given excessive amounts of medicine to keep them quiet,” said AG Jerry Brown.

The Chicago Tribune recently published a brief article called 5 Things to Know about Psychotropics, which I thought I would pass along to you. Here are the five things:

Your rights: A nursing facility cannot administer a psychotropic drug without a physician’s order, which by law requires informed consent and a legitimate diagnosis. The standard of care requires that nursing staff must first try to calm patients, and other possible causes of agitation must be ruled out, such as infection.

The consent: Before psyschtropics can be used consent must be obtained by the “responsible party” of the resident, usually the person with power of attorney. The consent must be in writing.

The administrator of Kern Valley Hospital was charged eight counts of felony elder abuse this week after permitting caregivers to forcibly administer psychotropic drugs to residents out of convenience and not medical necessity. One resident died because of the practice.

Since 2006 the director of nursing at Lake Isabella nursing home has allegedly ordered caregivers to administer high doses of psychotropic medications to Alzheimer’s and dementia patients to control their behavior and make them easier to care for. This use of medications as a “chemical restraint” is illegal, and will likely expose the nursing home to civil lawsuits in addition to the criminal charges that have been filed.

According to news reports, three residents may have died as a result of the practice. The residents who died were Mae Brinkley, 91, Joseph Shepter, 76, and Alexander Zaiko, 85.

Three California nursing home employees were arrested yesterday for allegedly injecting 22 residents with mood-altering drugs to keep them quiet and restrained. According to the criminal complaint, a nursing director, a pharmacist, and a physician drugged the residents in order to keep them compliant and easier to care for. Three of the patients died.

“These are powerful medications that were given, in some cases against people’s will, primarily for management, not health reasons,” said California Attorney General Jerry Brown. “It’s unconscionable behavior and it’s certainly not what people expect when they entrust their parents or grandparents to a skilled nursing home.”

The allegations in the criminal complaint are appalling, including residents becoming “zombie-like” and unable to eat or drink for days, causing severe malnutrition and dehydration. The three residents who died were Fannie May Brinkley, Eddie Dolenc, and Joseph Shepter. At least one civil lawsuit has been filed as a result of the deaths, and more are expected.

New research shows that elderly people suffering from dementia who are given antipsychotic drugs are more likely to end up in a hospital or die, even if the drugs are administered for a very short period of time.

Antipsychotic drugs are frequently used in nursing homes to address the behavioral issues caused by dementia, including aggression, agitation, and delirium. Physicians concede that alternatives to antipsychotics to address this type of behavior are limited.

Many experts feel behavioral interventions should be tried first and antipsychotics used as a last resort, “when the behavior or the psychiatric symptoms are really out of control and causing complete distress not only for the person suffering from Alzheimer’s, but for caregivers all around them,” said Maria Carrillo, director of medical and scientific affairs at the Alzheimer’s Association in Chicago. “It’s important to work these things out with the physician and, of course, do follow-up very closely together, so you can make sure these antipsychotics are having the effect you want and, if not, discontinue them immediately.”

Medicaid spends more money on antipsychotic drugs than any other prescription drug. Physicians are prescribing these powerful drugs in record numbers to nursing home residents in order to control their behavior, not for the treatment of psychotic illness.

It is reported that nearly 30% of the total nursing home population is receiving medication in a practice that is known as “off label use” of prescription drugs. It’s no surprise to lawyers who practice this area that studies also reveal that nearly 21% of nursing facility residents being given these drugs do not have a psychosis diagnosis.

“You walk into facilities where you see residents slumped over in their wheelchairs, their heads are hanging, and they’re out of it, and that is unacceptable,” says Christie Teigland, director of informatics research for the New York Association of Homes and Services for the Aging, a not-for-profit industry group. Her research, which she believes reflects national trends, shows that about one-third of dementia patients in New York’s nursing homes are on antipsychotics; some facilities have rates as high as 60% to 70%. “These drugs are being given way too much to this frail elderly population,” Dr. Teigland says.

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