Fwd: Nursing Homes Psychotropic Drug Abuse, Chicago Tribune

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ALLIANCE FOR HUMAN RESEARCH PROTECTION A Catalyst for Public Debate: Promoting Openness, Full Disclosure, andAccountability http://www.ahrp.org FYIIn the second half of the twentieth century, Soviet psychiatristscollaborated with their government: Soviet psychiatrists prescribed thefirst generation neuroleptics-Haldol and Thorazine- to coerce politicaldissidents into submission. The drugs were recognized as effectiveinstruments of torture. In the first half of the twenty-first century, U.S. psychiatrists areprescribing the second generation neuroleptics-Zyprexa, Risperdal, Geodon,Seroquel, Abilfy-to coerce innocent children and the elderly intosubmission. Below, an investigative report by the Chicago Tribune which examined morethan 40,000 state and federal inspection reports, found that nursing homesranging from "five-star" establishments on the North Shore to run-downfacilities in urban neighborhoods have been cited for improperlyadministering psychotropic drugs."Frail and vulnerable residents of nursing homes throughout Illinois arebeing dosed with powerful psychotropic drugs, leading to tremors, dangerouslethargy and a higher risk of harmful falls or even death.Thousands of elderly and disabled people have been affected, many of themdrugged without their consent or without a legitimate psychiatric diagnosisthat would justify treatment.""One man on multiple antipsychotics -- without adequate justification --fell 68 times in a four-month span. A blind woman who did not consent totaking Risperdal fell five times after being given the medication..""At VIP Manor near St. Louis in 2006, a woman with Alzheimer's cried andbecame extremely anxious when she had to urinate. She also repeatedly askedto go to the bathroom. Nurses responded by giving her injections of twoantipsychotics, inspection reports state. When that didn't work, the womanwas sent to a hospital for a psychiatric evaluation. The psychiatristreported back that the woman had a urinary tract infection.""Sometimes, when questions are raised about treating a patient withpsychotropics, doctors simply change the person's diagnosis."At Metropolis Nursing and Rehab Center in Metropolis, near the Kentuckyborder, a woman arrived with diagnoses of heart disease and kidney problems.Four months later, the woman's dialysis doctor put her on the antipsychoticRisperdal. Her medical records said she was anxious because of being ondialysis, but she had no history of psychosis, according to the state's 2004citation.When the home's nursing director asked the doctor what diagnosis led to theuse of the antipsychotic drug, the physician told her "insomnia anddepression."The nursing director told the dialysis doctor that those issues did notjustify prescribing a powerful antipsychotic, so the doctor switched thediagnosis. The new one: "organic psychosis."And we delude ourselves that America is a civilized, humane, democracy!Adding insult to injury, it is our taxpayer money that subsidizes grossmedical abuse!A follow-up Infomail will focus on the devastating effects these majortranquilizers / neuroleptics have on children.Contact: Vera Hassner Sharavveracare212-595-8974~~~~~~~~~~~~~~~www.chicagotribune.com/health/chi-nursing-home1-psychotropics-oct27,0,4539632.storychicagotribune.comCHICAGO TRIBUNE WATCHDOG COMPROMISED CAREPsychotropic drugs given to nursing home patients without causeMany Illinois residents get medications they don't need or want. The result?A threat to the lives of our elderly.By Sam RoeOctober 27, 2009Frail and vulnerable residents of nursing homes throughout Illinois arebeing dosed with powerful psychotropic drugs, leading to tremors, dangerouslethargy and a higher risk of harmful falls or even death, a Tribuneinvestigation has found.Thousands of elderly and disabled people have been affected, many of themdrugged without their consent or without a legitimate psychiatric diagnosisthat would justify treatment, state and federal inspection reports show.Lloyd Berkley, 74, was in a nursing home near Peoria for less than a daybefore staff members held him down and injected him with a large amount ofan antipsychotic drug, according to a state citation. A few hours later hefell, suffering a fatal head injury.One woman was given a psychotropic drug partly because she refused to wear abra. Nursing home staff administered an antipsychotic medication to an87-year-old man because he was "easily annoyed."In all, the Tribune identified 1,200 violations at Illinois nursing homesinvolving psychotropic medications since 2001. Those infractions affected2,900 patients.The actual numbers are likely far higher because regulators inspect somefacilities just once every 15 months, and even then they usually check onlya small sample of residents for harm.The Tribune's unprecedented review of more than 40,000 state and federalinspection reports found that nursing homes ranging from "five-star"establishments on the North Shore to run-down facilities in urbanneighborhoods have been cited for improperly administering psychotropicdrugs.The paper's review took into account violations for "chemical restraint" and"unnecessary drugs" as well as cases involving dosages that exceeded safetystandards or falls in which psychotropics possibly played a role.While some nursing home residents suffer from major mental illnesses, suchas schizophrenia, the inspection reports show that many patients harmed byantipsychotic drugs had not been diagnosed with psychosis. They weredisabled by Alzheimer's disease, cancer or Parkinson's disease. Some wereblind or so frail that they could not breathe without the aid of an oxygentank.The findings come at a difficult time for Illinois nursing homes, which arealready under fire for housing violent felons alongside geriatric patientsand for failing to accurately assess the risk posed by the most seriousoffenders.The misuse of psychotropics, which some experts say is a nationwide problemin nursing homes, suggests a troubling future for many seniors. The Tribunefound 12 patients, including Berkley, whose deaths led to nursing homecitations involving misuse of psychotropics.In testimony before Congress two years ago, Food and Drug Administrationscientist Dr. David Graham estimated that thousands of nursing homeresidents die each year because antipsychotic drugs are administered topatients who are not mentally ill. Graham is known for blowing the whistleon Vioxx, the painkiller tied to heart attacks, but his warning on thepsychotropics issue has drawn little attention.New York researcher Christie Teigland, who is analyzing medical data on275,000 nursing home residents with dementia, said she is finding that thoseon psychotropic drugs were more likely to fall or experience general declinethan others.When taken off the medication, the patients improved, she said."These residents come alive," said Teigland, of the nonprofit New YorkAssociation of Homes & Services for the Aging. "It's like they becomefunctional individuals again."Easier to deal with Inspection records show that hundreds of nursing homeresidents in Illinois displaying no psychotic symptoms have been placed onantipsychotic medications for such reasons as "restlessness, anxiety" or"confusion."Why? Often, it's to make them easier to care for, the records show.Some health care workers defend the use of psychotropics in nursing homes,saying they help patients, particularly those with Alzheimer's disease andother forms of dementia, live happier and more independent lives.But the medications can be extremely dangerous. The most commonly usedantipsychotics carry so-called black-box warnings, the FDA's highestadvisory. Side effects may include severe lethargy, permanent involuntarymuscle movements, seizures and sudden death.For decades there were few rules regarding the sedation of nursing homeresidents. But in 1987, Congress passed landmark laws that protectedpatients from unnecessary drugs.Now facilities cannot give psychotropic drugs -- which includeantipsychotics, antidepressants and anti-anxiety medications -- without adoctor's orders, a patient's consent and justification that the treatment isneeded.But a Tribune analysis of inspection reports on 742 Illinois nursing homesthat care for traditional geriatric patients found that two-thirds of themwere cited at least once in the past eight years for incidents involvingpsychotropics. Dozens of homes had violations year after year.The Illinois Department of Public Health, which conducts the vast majorityof the inspections, said in a statement that its ability to regulatepsychotropic drugs in nursing homes "is bound by the extent of the law." Theagency noted that it is a member of the governor's nursing home safety taskforce, formed in response to an ongoing Tribune investigation, and that it"welcomes the opportunity to improve the health and safety of long-term careresidents."State and federal inspectors document violations in reports that do not namepatients but often describe in vivid terms what happened to the elderlyresidents, including side effects.Investigators visiting one facility in northwest Illinois reported findingan 88-year-old woman with Alzheimer's disease who was continually pacing, acommon side effect of the antipsychotic drug she was given. "I'm sorry," thewoman frequently told nursing staff. "I'm so restless and can't help it. Ican't sit still."At a north-central Illinois home, inspectors described a 78-year-old womanwalking around with a blank look on her face. Her eyes were wide open, andshe rarely blinked.When health inspectors checked her medical records, they discovered that thenursing home had been giving her large doses of antipsychotic drugs, eventhough she was not psychotic. The woman could barely speak to inspectors.But with the same blank expression on her face, she did manage to tell themthis: "I want to go home."Drugged for 'yelling out' An 84-year-old blind woman at a nursing facilityin west-central Illinois was given the antipsychotic Abilify because, thehome said, she was "yelling out" and "easily annoyed."A woman with Alzheimer's at a home near East St. Louis was given theantipsychotic Seroquel because of "her inability to perform her personalhygiene."An 86-year-old woman with congestive heart failure at a facility outsidePeoria was started on the antipsychotic Zyprexa because she was teasinganother resident and generally being "nasty."These incidents all resulted in nursing homes being cited for giving drugswithout a proper reason. In all, the Tribune found more than 700 instancessince 2001 of facilities administering psychotropics without just cause.To be sure, some nursing home residents can be extremely difficult tocontrol, especially those with dementia who might repeatedly lash out atstaff or try to leave."Everybody likes to think of the nursing home resident as this nice littleold gray-haired granny who's a sweet little old darling," said RobertHedges, a former nursing home regulator with the Illinois Department ofPublic Health who now co-owns five facilities. "There's a lot of them outthere who are mean and nasty and will spit on employees and other residentsand hit them and carry on."Even then, however, standard nursing practices dictate that workers try toredirect patients' attention, such as by involving them in a new activity,showing them pictures of family or offering them a snack."You try a number of things before you jump to drugs," said Ellen Greif, whooversees regulatory enforcement of Midwest nursing homes for the Centers forMedicare & Medicaid Services. "You always look for the least restrictive andleast invasive approach to care."But the state inspection reports show that nursing home staffs often bypassthe step of trying to calm residents and instead call a patient's doctorseeking a psychotropic drug. The doctors frequently OK the request over thephone without seeing the patient.In some cases, an unwarranted diagnosis of mental illness is added to thepatient's medical record to justify use of the drug. Residents also havebeen treated with psychotropics while the underlying cause of their anxiety,such as pain or an infection, was ignored.At VIP Manor near St. Louis in 2006, a woman with Alzheimer's cried andbecame extremely anxious when she had to urinate. She also repeatedly askedto go to the bathroom. Nurses responded by giving her injections of twoantipsychotics, inspection reports state. When that didn't work, the womanwas sent to a hospital for a psychiatric evaluation. The psychiatristreported back that the woman had a urinary tract infection.VIP Manor's nursing director, whom the report did not identify, told stateinspectors that her staff was still learning to look for medical issuesbefore administering psychotropics. "We aren't there yet, but close," shesaid.Sometimes, when questions are raised about treating a patient withpsychotropics, doctors simply change the person's diagnosis.At Metropolis Nursing and Rehab Center in Metropolis, near the Kentuckyborder, a woman arrived with diagnoses of heart disease and kidney problems.Four months later, the woman's dialysis doctor put her on the antipsychoticRisperdal. Her medical records said she was anxious because of being ondialysis, but she had no history of psychosis, according to the state's 2004citation.When the home's nursing director asked the doctor what diagnosis led to theuse of the antipsychotic drug, the physician told her "insomnia anddepression."The nursing director told the dialysis doctor that those issues did notjustify prescribing a powerful antipsychotic, so the doctor switched thediagnosis. The new one: "organic psychosis."Officials at the home did not respond to the Tribune's requests for comment.Lack of consent For 16 straight days, nurses at Heritage Nursing Home inChicago tried to give an antipsychotic drug to a man who had a history ofheart troubles but no psychotic symptoms. He steadfastly refused themedication.But on the 17th day, according to state inspection records, a nurse gave himthe drug without telling him what it was until after he had swallowed it.State inspection reports reveal more than 600 instances since 2001 ofnursing homes violating regulations by giving residents psychotropic drugswithout permission. Many patients received the medicine after explicitlysaying they did not want it, and some with dementia have been allowed togive consent with little understanding of the consequences.The man at Heritage was given Seroquel against his will last year. Hisdoctor told inspectors that the 56-year-old was not psychotic, and nursingnotes documented no behaviors that would justify the use of the drug.The doctor had ordered the antipsychotic "because he thought it would help(the man's) mood," according to an inspection report. The physician said hedid not know the man refused the drug -- or that permission was even needed."Once I was made aware I discontinued the medication," he said.The state cited the nursing home, which promised to better train staff onthe use of psychotropics. When contacted by the Tribune, Heritage declinedto comment.Some nursing homes cited for giving drugs without permission blame paperworkerrors, saying that when regulators find problems, facilities immediatelyask patients to sign consent forms. But records show that some residents andfamily members who sign releases may not understand the true risks ofpsychotropic drugs because nursing homes downplay the dangers.In 2003, an 83-year-old woman without a diagnosis of mental illness wasplaced on Haldol -- among the most dangerous antipsychotic drugs -- two daysafter being admitted to the Heartland Health Care Center in Moline. Aregistered nurse who administered the drug told inspectors she had asked thewoman whether she wanted medication for her "nervousness," and she agreed.The state cited the home for giving an antipsychotic without reason, and thewoman was taken off the medication. In a statement to the Tribune, the homesaid it "was cleared upon revisit and is currently in compliance with stateand federal regulations."Tics, tremors, lethargy, Abnormal muscle tics, twitches and tremors,involuntary movements of the tongue, a "zoned-out" look -- these sights arefamiliar in nursing home patients, but they are not always caused by oldage. They are another sign of antipsychotic drug use.Hundreds of Illinois residents have suffered these ailments because nursingfacilities have given them too many of the drugs or failed to monitor theside effects, the Tribune's analysis of inspection reports shows.Although nursing homes are required to test for involuntary, repetitivemovements -- a potentially permanent and life-threatening condition calledtardive dyskinesia -- many facilities fail to do so. When they do detectharm, they frequently do not contact doctors to reduce the doses ofantipsychotic drugs. That is critical, medical experts say, because thelonger patients are on the medication, the greater the chance that theabnormal movements will become permanent.At one Downstate nursing home cited for administering unnecessary drugs, anelderly woman was on the same dose of an antipsychotic for five years eventhough she experienced tremors and lethargy. An inspector observed her at9:30 a.m. in bed asleep, her breakfast tray untouched. At 11 a.m. she was inher wheelchair, "slumped over with drool coming out of her mouth." At noonshe tried to drink milk, but she "spilled the milk out of the glass whiletrying to drink due to hand tremors."Some residents on antipsychotic drugs become so lethargic they must behospitalized. They cannot feed themselves, attend physical therapy or talkwith loved ones. Residents once capable of caring for themselves becomeimmobile and incontinent. It is common for nursing staff to struggle to wakeup residents at mealtimes.In addition, the Tribune found, more than 200 nursing home residents wereadministered psychotropic drugs and subsequently fell, at times within hoursof taking the medication. Several died, and dozens broke major bones such aships.Because it is difficult to pinpoint why someone falls, regulators usually donot conclude that psychotropics caused the accidents. But many psychotropicscause drowsiness and confusion, and the reports often cite nursing homes forfailing to consider the drugs as possible causes of the falls.One man on multiple antipsychotics -- without adequate justification -- fell68 times in a four-month span. A blind woman who did not consent to takingRisperdal fell five times after being given the medication.At the Evergreen Nursing & Rehabilitation Center in Effingham, southeast ofSpringfield, a woman who suffered from Alzheimer's and who was on numerouspsychotropics fell eight times in 2006, an inspector reported. After most ofthe falls, the facility did not take new steps to prevent further accidents.Her last fall fractured her spine, and she died 11 days later.The state cited the home for not considering the possibility thatpsychotropics were causing her to fall. In an interview with the Tribune,Hedges, the former regulator and the nursing home's co-owner, called thecase "a very isolated incident" and said there was no evidence thatpsychotropic drugs contributed to the woman's death. He said she had complexmedical and behavioral problems as well as a history of falling."We tried to get her family to agree to physical restraints, and theydeclined," he said. "You cannot have a staff member sitting there andholding a resident in a wheelchair all the time. That's not practical."Nursing homes are required to carefully document instances when patientsdisplay side effects, but the Tribune found that some facilitiesmisrepresented the true condition of their residents.At the Tower Hill Healthcare Center in suburban South Elgin, an inspector in2002 noticed a 78-year-old woman on two antipsychotic medications and citedthe facility for unnecessary drugs. Officials at the Tower Hill facilityrecently declined to comment, saying it is under new ownership.The inspector noted that the woman continually rocked back and forth overfour days. Yet the facility's testing results contended that she showed noabnormal movements.When the inspector pointed out the woman's rocking, the facility updatedrecords to state that she "will rock in chair in attempt to get up."But the inspector didn't buy it."Rocking is completely involuntary and was observed even as she tried tobutter her bread and eat her meal," the inspector wrote. "The behavior wasnot the result of an attempt to rise from the chair."Tribune reporter Nicole Leonhardt contributed to this report.sroeFAIR USE NOTICE: This may contain copyrighted (C ) material the use of whichhas not always been specifically authorized by the copyright owner. Suchmaterial is made available for educational purposes, to advanceunderstanding of human rights, democracy, scientific, moral, ethical, andsocial justice issues, etc. It is believed that this constitutes a 'fairuse' of any such copyrighted material as provided for in Title 17 U.S.C.section 107 of the US Copyright Law. 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