by Michael Connors and Anthony Chicotel, CANHR Advocacy Staff
Can the Department of Public Health (DPH) try any harder to send the message that nothing really has changed about its tolerance for the rampant chemical restraint of nursing home residents? Despite paying lip service to the national initiative to end the misuse of antipsychotic drugs on nursing home residents, DPH continues to treat nursing home drugging offenders with kid gloves.
As examples, let’s examine DPH’s actions at two different nursing homes that have identical names: Parkview Healthcare Center. One is in Bakersfield and the other is in Anaheim. Although they are not affiliated with each other, these two nursing homes have much more in common than just their names.
Let’s consider Parkview of Bakersfield first. On January 10, 2013, DPH issued an inspection report that, among other violations, found that Parkview violated the federal standard prohibiting nursing homes from giving residents unnecessary drugs. The report reveals that one of Parkview’s residents was being given an antipsychotic drug for “unusual thinking.” When asked to explain what was the “unusual thinking,” a nurse said an example would be when the resident called the social services department directly with her cell phone. Other very inappropriate justifications were also offered. The inspection report correctly observes that the facility may have been “administering an antipsychotic medication with no need for it.”
So far, so good. The inspector found misuse of an antipsychotic drug and wrote the facility up for it. However, in its customary fashion, DPH classified this violation at a low level (minimal harm or potential for actual harm), which is supposed to be reserved for low-level offenses that do not have a significant impact on residents. Most violations at this level do not trigger any enforcement. Instead a nursing home merely has to file a plan of correction with DPH.
In addition, the DPH inspection revealed that at least five residents were receiving psychotropic drugs, including antipsychotics, without having given informed consent. Neither the residents nor their legal representatives were consulted about drug side effects, risks, or alternatives. For these multiple transgressions, the facility was issued a single low-level deficiency.
This example epitomizes what is wrong with antipsychotic use in nursing homes. Residents are often given these extraordinarily dangerous drugs, without explanation of the side effects, risks, or viable alternatives, for no reason other than the staff’s desire to control their behavior. If residents can be drugged for “unusual thinking,” none of them are safe. Confronted with this elder abuse, DPH treated it as a minor offense.
Does Parkview of Bakersfield deserve exceptional consideration from DPH? Hardly. It is currently classified as a “special focus facility,” meaning it has one of the worst compliance histories in all of California. This status appears to have triggered federal fines against the facility and more frequent inspections – very appropriate actions – but these remedies do not excuse the way DPH handled the drugging violations.
Now consider Parkview of Anaheim, which was also coincidentally inspected during January 2013. At this Parkview, DPH inspectors reviewed ten resident charts and found that seven of them revealed inappropriate use of psychotropic drugs including use without adequate indications, failure to monitor behaviors that allegedly required the use of the drugs, and failure to implement gradual dose reductions.
One resident received psychotropic drugs for “restlessness,” a classic justification invoked for inappropriate use. Another resident received a psychotropic drug for unknown reasons. When a nurse was asked about the drugging she said it “may be” for crying – an inadequate indication for use.
For these deplorable uses of chemical restraints, Parkview of Anaheim received a few low level deficiencies for causing “minimal harm” as well as one low-level Class B citation for unnecessary drugging.
Does Parkview of Anaheim deserve special consideration from DPH? Hardly. In its survey finding on unnecessary use of drugs (F-329) DPH starts out by reporting: “Review of the facility’s Certification Surveys dated 7/09, 8/10, 7/11 and 5/12, shows the facility has had deficiencies at F-329 (unnecessary drugs) every year.” Moreover, the most recent CMS data shows that the facility is giving antipsychotic drugs to one of every three residents while over two-thirds receive a psychotropic.
Apparently, Parkview of Anaheim’s broad experience in misusing antipsychotics has not translated into knowledge of the legal requirements or the standards of good clinical practice. And, unsurprisingly, DPH’s feeble enforcement actions have not altered the illegal practices in the facility.
Less than a year ago, DPH issued a letter to every nursing home in California trumpeting a major campaign to improve dementia care and reduce unnecessary antipsychotic use. The noble sentiments expressed in the letter are belied by its very timid actions against nursing homes that routinely use drugs to restrain their residents. No one is going to take DPH’s words seriously until it starts treating indiscriminate drugging of nursing home residents as elder abuse and enforces the law accordingly.