The Chicago Tribune recently reported on a disturbing trend: nursing home and other health care facilities which are cited for inappropriate use of antipsychotic drugs while the doctors who prescribe the drugs are not reprimanded at all.
The newspaper shared the story of one woman with Alzheimer's disease. Her family tried to keep her in her house as long as they could. But eventually her disease made that impossible.
When she was placed in a nursing home, she scored 23 out of 30 on
a mental exam and was deemed to be "moderately impaired," state
inspection records show. Nurses found the grandmother to be pleasant
But after she repeatedly had crying spells and tried to wander away,
her doctor prescribed two antipsychotic drugs, even though she was not
psychotic. The doctor doubled the dosage of one medication no fewer
than four times, putting her above the recommended limit, the records
A neurologist, called in after the family complained, found that
she was glassy-eyed and "catatonic," scoring zero on the mental test.
The neurologist urged that the woman be weaned off the drugs. Once again,
she became aware and responsive. "A new person," the neurologist told
State regulators cited the nursing home for the misuse of psychotropic drugs.
Yet in cases like these, the people primarily responsible for the
patients' medication -- the doctors who prescribed the drugs --
typically emerge with no citations, no penalties and spotless public
records, a Chicago Tribune investigation has found.
When the Tribune reviewed 40,000 state and federal inspection reports
filed since 2001 on 742 Illinois nursing homes, numerous instances
emerged in which regulators cited facilities for misusing psychotropics
even though the patients' doctors had created the problems.
When physicians or psychiatrists prescribe a drug for a patient,
facilities must administer it as long as the order is consistent with
state and federal nursing home regulations. If inspectors determine a
violation occurred, they cite the nursing facility, not the doctor.
"There's no downside for the physicians" who order inappropriate
psychotropics, said a former regulator with the Illinois
Department of Public Health who now co-owns five nursing facilities.
"Physicians aren't being fined," he said. "Physicians don't have any citations against them."
The Tribune found that inspectors documented many cases in which
doctors prescribed powerful antipsychotic drugs without adequate
justification or in doses that were too high.
The doctors also sometimes failed to provide adequate follow-up care,
the inspection records show. They are required to see their nursing
home patients only once every 60 days, though some do not visit even
The difficult task of monitoring for side effects is left to nurses,
some of whom, the records show, are poorly trained in the use of
psychotropic drugs. For more, read the story.
Robert W. Carter,
Jr. is a Virginia attorney whose law practice is dedicated to
protecting the rights of the victims of nursing home and assisted
living neglect and abuse in Richmond, Roanoke, Norfolk, Lynchburg,
Danville, Charlottesville, and across Virginia.
Posted on Tue, November 3, 2009
by Robert Carter