CDPH, Wherefore Art Thou?

The California Department of Public Health (“CDPH”) is the state agency that oversees nursing homes. Yet, despite widespread drugging of residents, CDPH has been conspicuously absent regarding the use of psychoactive drugs in nursing homes.

There are many elements to the overdrugging problem in California’s nursing homes, including:

  • Antipsychotic drugs are prescribed without medical justification;
  • Doctors prescribe psychoactive drugs without actually seeing the resident;
  • Doctors and nursing homes don’t tell residents and their families about alternatives to drugging or the dangers of the drugs;
  • Nursing homes often use psychoactive drugs without the consent of the residents or their representative;
  • Nursing homes don’t meaningfully review psychoactive drug use, with an emphasis on reducing their use, as is required by law.

(See “Anatomy of a Drug Problem” for more detailed information about the nature of the drugging problem.)

CDPH has turned a blind eye to these problems. It has no policies for enforcing nursing home informed consent requirements, perhaps the most important resident safeguard for resisting overdrugging. Its abysmal enforcement track record speaks for itself. CDPH has issued only two (!) citations for violations of state informed consent requirements since 2007. California nursing homes continue to use dangerous antipsychotic medications to drug 25,000 residents into submission without any worry that CDPH will enforce the law.

Speaking of the law, CDPH had a major hand in the Governor’s veto of SB 303 (Alquist), a 2009 CANHR sponsored bill that would have strengthened informed consent requirements for nursing home use of psychoactive drugs. Although its official position on the bill is unknown, CDPH’s failure to speak up about the drugging epidemic hurt the bill’s chances and served to protect nursing homes and doctors that subject residents to chemical restraint.

In his veto message on SB 303, the Governor admitted that misuse of antipsychotic drugs is a pervasive problem in nursing homes. He cited a recent study that found more than half of residents on antipsychotics are being drugged outside federal guidelines, and directed CDPH to investigate and respond. Nearly one year later, CDPH has been silent. And the drugging continues unabated.

CDPH’s job is to protect the public health, a mission it took most seriously last year during the swine flu outbreak. It issued numerous advisories and held regular press briefings to keep the public informed and safe. In contrast, it has done almost nothing to stem the tide of drugging in nursing homes, even though antipsychotic drugs are well known to greatly increase residents’ risk of death. When it comes to nursing homes residents, CDPH has shown little interest in their health or well-being.

CDPH’s indifferent approach to California’s drugging crisis is well illustrated by a recent case in Los Angeles where an elderly resident with dementia was given an antipsychotic medication without her consent or the consent of her health care agent for reported “resistance to care.” Despite the lack of informed consent and the clear use of a chemical restraint, DPH refused to issue a citation, claiming that a mere prescription was sufficient to justify the blatant drugging of a resident deemed difficult.

CANHR has attempted to work with CDPH to address the overdrugging problem in California’s nursing homes, but with little result. Click here for details. We call on CDPH to give the nursing home drugging epidemic its due attention and to immediately take strong action to enforce all California and federal laws related to chemical restraints and informed consent.

Please let us know about your experiences with CDPH on this problem.

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Responses to CANHR blog postings do not reflect the opinions of CANHR or its staff members.

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