By Mike Connors
The more things change, the more they stay the same. Or so it seems at the California Department of Public Health (CDPH). As we reported in an earlier commentary, CDPH is doing very little to stem the rampant drugging of nursing home residents throughout California.
CDPH recently invited CANHR to a meeting in Sacramento to hear what it has done to fight the inappropriate use of antipsychotic drugs since Governor Schwarzenegger vetoed SB 303 (Alquist) in October 2009. SB 303 was a CANHR sponsored bill to reduce inappropriate drugging by strengthening informed consent requirements. In his veto statement, the Governor admitted that most nursing home residents on antipsychotics are being drugged outside federal guidelines and directed CDPH to identify nursing homes that are inappropriately using antipsychotic drugs to chemically restrain residents.
According to CDPH, it’s doing a great job. But its actions are at odds with its words. It promised to train all of its inspectors on enforcement of existing informed consent requirements, but hasn’t done so. It also agreed to establish written protocols to help ensure that inspections on informed consent are effective, but now says it won’t even though CANHR developed a model protocol for this purpose. It has current data showing the drugging rates for each nursing home in California, but it is unwilling to help consumers avoid dangerous facilities by posting this information on its website.
So what has CDPH done? It and Medi-Cal established a tiny project to investigate cases where Medi-Cal is paying for two or more antipsychotic drugs for the same nursing home resident. We asked why CDPH is focusing on the small number of residents for whom Medi-Cal is paying for antipsychotics, when Medicare pays for the vast majority of antipsychotic drugs used in nursing homes. Incredibly, CDPH says it cannot target nursing homes that are drugging Medicare beneficiaries because Medicare won’t give it the information to do so.
CDPH says it found numerous violations in the few cases it investigated through its Medi-Cal project, and reports that payment arrangements with the pharmacy consultants who are supposed to monitor nursing home drug use often appear to be corrupt. Par for the course, CDPH didn’t take any enforcement actions, preferring to hope that offending nursing homes will take its gentle message. CANHR is glad CDPH is confirming the illegal use of antipsychotic drugs, but its soft approach and the minute scale of its project speak volumes about its priorities.
Instead of redoubling its efforts, CDPH is casting doubt on the value of informed consent. Unbelievably, its staff told us that informing residents and their families about the dangers of antipsychotic drugs won’t do much good because of low health literacy rates. In other words, CDPH doesn’t think residents (or their families) are smart enough to demand different treatment when doctors tell them they are planning to prescribe a drug that nearly doubles their risk of death.
The growing number of residents being drugged tells the truth. Over 25,000 California nursing home residents – more than one of every four residents – are being drugged with antipsychotics according to the latest data from the federal Centers for Medicare and Medicaid Services (CMS). Nursing home use of chemical restraints would not be on the rise if CDPH took this type of elder abuse seriously.
It appears that nursing home operators who chemically restrain residents with dementia have a good friend in CDPH. Let’s hope the new Governor sees things differently and restores CDPH’s duty to protect the rights of people who live in nursing homes.