Articles Posted in Psychotropic Drugs

Elder abuse of any kind is a crime potentially punishable by prison time in California. The recent sentencing of the former Director of Nursing of Kern Valley Healthcare District’s nursing home to three years in prison for “convenience drugging” reminds us that elder abuse extends far beyond neglect, financial or obvious physical abuse.

Charged with chemically restraining patients under her care, while serving as Director of Nursing of Kern Valley Healthcare District’s nursing home, Gwen D. Hughes will spend the next three years in prison for drugging residents into submission using antipsychotic and anti-seizure medications. Ultimately, three patients of the facility died as a result of being over-drugged.

According to a press release from the California Attorney General’s office, “Hughes ordered the administration of psychotropic medications to 23 elderly residents of the skilled nursing facility not for therapeutic reasons, but instead to control and quiet them for the convenience of staff. The drugs were given to patients who were noisy, prone to wandering, who complained about conditions or were argumentative. The drugs hastened three patients’ deaths, according to the investigation, and all 23 suffered some form of adverse physical reaction as a result. Many of the patients were under care for Alzheimer’s or dementia.”

The charges in this case were brought against Hughes and three co-workers in 2009. Hughes was the final defendant to be sentenced and the only defendant sentenced to prison time for her role as the proverbial ringleader. Evidence indicated that Hughes directed the hospital’s director of pharmacy to write doctor’s orders for the unnecessary psychotropic medications.

According to Attorney General Kamala D. Harris “Elder abuse in skilled nursing facilities is a particularly heinous crime because vulnerable victims and their families have placed their trust in the facilities to provide quality care, preserve their dignity and enjoy a better quality of life. This defendant maliciously and dangerously drugged patients for her own personal convenience. This is clearly outrageous conduct that justifies a state prison sentence.”

According to a statement released by the California Advocates for Nursing Home Reform (CANHR), Patricia McGinnis, Executive Director of CANHR stated “three residents died as a result of being over drugged at Kern Valley Healthcare and many more suffered severely. Three years in prison is at least some retribution for their deaths, and hopefully Ms. Hughes’ sentence will be a warning to other facilities who think that drugs can substitute for adequate staffing.”

Elder abuse in California is both a criminal and civil offense. Criminal elder abuse describes the willful infliction of physical or emotional suffering on an elder. Civil elder abuse includes any physical or financial abuse, neglect or abandonment resulting in physical or mental harm.
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The use of physical and chemical restraints in California nursing homes is sometimes a necessary way of protecting patients from injuring themselves and others. When used excessively and, more importantly, without consent, the practice becomes outright abusive. Often this method is used not simply to protect the patient, but rather to make a staff member’s job easier. Overuse of restraints is exacerbated by the growing number of understaffed nursing facilities.

Physical restraints are used to keep patients from wandering around the facility, a potential hazard for the patient and others. A nursing home is required by law to have the resident’s consent before using a physical restraint. Symptoms of physical restraints include sores or bruising on the arms and legs, usually on the ankles and wrists.

Chemical restraints involve the administering of powerful psychotropic drugs to sedate and confine the patient by taking away his or her cognitive abilities. These drugs are not permitted under any circumstances unless the nursing care facility outlines a legitimate medical reason for their use and further provides the frequency and dosage. Because most people are not familiar with the side effects of psychotropic drugs, it can be more difficult to identify chemical restraints than physical restraints.

Psychotropic drugs are administered to nearly 60% of all California nursing home patients, a 30% increase since 2000, according to a report by California Advocates for Nursing Home Reform. A May 2011 study by the Office of Inspector General in the U.S. Department of Health and Human Services found that 305,000, or 14%, of nursing home patients had Medicare claims for atypical antipsychotic drugs. The study was requested by a member of Congress concerned by the number of drugs being prescribed unnecessarily and the cost to taxpayers. The study also determined that 22% of the atypical antipsychotic drugs associated with the claims were not administered in compliance with standards established by the Centers for Medicare and Medicaid Services.

Some common psychoactive drugs are:

  • Anti-Psychotics: These drugs are prescribed for psychosis, schizophrenia, and bipolar disorder. Nursing homes often prescribe anti-psychotics to dementia patients despite the FDA’s strong warnings that they can be fatal to residents with dementia. Haldol, Seroquel, and Zyprexa are common antipsychotics.
  • Anti-Depressants: Common brands are Prozac and Zoloft. Nursing homes have been known to over-prescribe these medications. They can have dangerous side effects such as impaired motor skills, which increase the risk of a patient falling while under a nursing home care.
  • Anti-Anxiety drugs: These drugs also tend to be over-prescribed, and lead to impaired motor skills. Ativan and Valium are popular anti anxiety drugs.
  • Sedatives/hypnotics: Restoril and halcyon are brands commonly administered to patients.

These drugs can be helpful to your loved one’s condition, but it is important that you thoroughly research any prescribed medication and thoroughly interview the prescribing doctor as to why the drug is being prescribed and what its potential side effects are.

If a doctor recommends psychoactive drugs for your loved one, a few questions you will want to ask are:

  • What is the medical condition that necessitates the use of this psychoactive drug?
  • What is the frequency with which the drug will be used?
  • Over what period of time will the drug be used?
  • What are the possible side-effects?
  • Are there any reasonable alternative treatments?
  • What are the interactions with other drugs being used?

Signs of possible psychotropic drug use are: fatigue, impaired motor abilities, unexplained changes in weight, mood swings, deterioration in mental skills, and hallucinations, among others.

If you see these symptoms, and have not given consent to the use of psychoactive drugs, you should consider making inquiries to your doctor and nursing home staff. You or your loved one can refuse medical treatment, or revoke prior consent to any medical treatment. It is important to note that nursing homes are forbidden by law from threatening to evict patients for refusing chemical or physical restraints.
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With the aging of America, more and more older people will be living in nursing homes than ever before. According to available data, there were 39.6 million people in 2009 who were 65 years of age or older. That represented nearly one out of every eight Americans or almost 13% of the U.S. population. Estimates are that there will be roughly 72 million of these older Americans by 2030, causing concerns about the type and extent of prescription medications that are administered to nursing home residents.

Naturally, as we age it is necessary to take various medicines for heart conditions, high blood pressure, high cholesterol levels, diabetes, Parkinson’s and Alzheimer’s, among other things. Because of this most people 75 years of age or more take over 11 different prescription medications during any given period of a year, according to the American Association of Retired Persons (AARP). This requires a committed nursing home staff to see that medications are administered timely and properly.

Problems are encountered when undertrained and undersupervised staff give the wrong medication, an incorrect dosage or overmedicate their residents, leading to often catastrophic results. An unintentional but common error is the mixing up one patient’s medication for another’s during a hectic shift. These mistakes can result in serious drug interactions and even death. Another medication issue is the consistency with which it is administered. Many prescription medications require a consistent, rather than sporadic, dosage, in order to be effective and safe for the patient. Finally, there is an overall tendency in nursing homes across the country to overmedicate those who call these facilities home. Sometimes it is caused unintentionally by undertrained and underqualified staff members, and unfortunately sometimes it is intentional in order to calm and restrain a disoriented or combative resident. The use of prescription medication in the form of anti-psychotic drugs to calm or restrain the elderly can be illegal, but studies have shown that roughly 25% of all nursing home patients are given them. Unfortunately, the Food and Drug Administration (FDA) has reported that more than 15,000 nursing home patients die on an annual basis due to the unnecessary administration of these anti-psychotic medications. For others, the administration of these medications serves to diminish the quality of their life as they remain in a drug induced daze.
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The Department of Health and Human Services recently released a report revealing the excessive amount of “potentially lethal” antipsychotic drugs that nursing homes are dispensing to their residents. Aside from being a huge waste of taxpayer money (Medicare paid and estimated $116 million in unnecessary drugs, during a six-month period in 2007), it presents a dangerous health risk to our elderly population – particularly those who suffer from dementia.

Psychoactive drugs, also referred to as antipsychotic or psychotropic drugs, contain powerful chemicals that affect the brain and have dangerous side effects. These drugs essentially sedate the individual, which directly affects the individual’s personality, behavior and mood. Psychoactive drugs typically fall into four major classes, including: (1) antipsychotics such as Zyprexa and Haldol; (2) anti-anxiety drugs such as Ativan and Valium; (3) anti-depressants such as Prozac and Zoloft; and (4) sedative/hypnotics such as Halcion and Restoril. They are particularly appealing to the nursing home industry because they can serve as a substitute for the individualized care the person truly requires.

Elderly patients with dementia are particularly vulnerable to dangerous side effects, including death. Nevertheless, many nursing home residents with dementia continue to receive psychotropic drugs that are not designed or approved for their condition. According to California Advocates for Nursing Home Reform, it is presently estimated that nearly 60% of California nursing home residents are given psychoactive drugs. The problem has become so critical that the U.S. Food and Drug Administration (FDA) issued a “black box warning” that antipsychotic drugs can cause individuals with dementia to die.

As with any approved drug, its use is not always harmful and the benefits can outweigh the risk. That said, if your loved one is presently taking these drugs, or if their use is being proposed, you have the right to better understand the risks and to decline the drug if you choose. Psychoactive drugs cannot be prescribed without first obtaining informed consent. In California, the key informed consent regulations are found within Title 22 of the California Code of Regulations, sections 72528 and 72527(a)(4-5). Essentially, the health care provider must explain any proposed treatment. This discussion should include the benefits versus risks of the proposed treatment as well as the reason for its use and reasonable alternatives. Furthermore, the resident or legal representative must agree to the treatment. Giving these drugs without first obtaining informed consent is a form of elder abuse and neglect and a direct violation of patient’s rights.
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