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Overmedicated and Misinformed
The use of antipsychotic drugs on the elderly has sparked a series of lawsuits and criticism from reform groups and advocates fighting for better regulation and enforcement.
According to federal government statistics, 16 percent of residents in California nursing homes are on antipsychotic drugs. Although these drugs are often used to control and sedate residents, they also pose an increased risk of death in patients with dementia.
To blur the lines even more, the FDA has not approved the use of antipsychotic drugs on elderly patients diagnosed with dementia.
In this segment of "SoCal Connected," reporter Val Zavala reveals the story of retired preschool teacher Aleah Davis, who filed a lawsuit against a nursing home company, Country Villa.
"I always ask what I'm getting, and now I am able to tell when I get the medication what’s in the cup. I've learned to ask and I have learned that I have rights," Davis told KCET's "SoCal Connected."
Current law requires doctors to obtain a patient's informed consent before prescribing antipsychotics. A recent campaign to reduce antipsychotic use in nursing homes has been successful, but reformers say progress is not enough and thousands of nursing home residents are still being overmedicated.
What is being done to change the culture of overmedication within nursing home? Zavala investigates.
Read the Transcript:
Aleah Davis: I had a hallucination that I was at the bottom of a stairwell, lying on the floor and the doctor was in there and he kept telling me that I was alone and that nobody was looking for me and that I might as well give up.
Val Zavala: Aleah Davis lived through a nightmare -- a nightmare that she wasn’t even fully aware of because she was too drugged to know it was happening.
Aleah Davis: They were overmedicating to the point where I didn't know if I was upside down or sideways.
Val Zavala: What happened to Aleah Davis is happening to thousands of elderly residents in nursing homes every day. They are being overmedicated with powerful anti-psychotics, often to keep them docile.
Val Zavala: Do you have any idea why they gave you so many anti-psychotic drugs? Do you know if your behavior was strange or you were difficult? Aleah Davis: I don't remember…knowing me I probably was mouthy.
Val Zavala: Aleah was a pre-school teacher, she loved dogs, and was active in her church. Then at age 68 she fell. After her fall, Aleah came here to a nursing home in Seal Beach. Now at the time, it was owned and run by a company called Country Villa. She was on her own – she didn’t have kids and no relatives nearby.
But she had a close friend -- Jill Dominguez. It wasn’t long before Jill realized something was wrong. Aleah had no history of dementia or mental problems, yet she was confused and unable to communicate. Jill asked to see what drugs Aleah was being given.
Jill: The head nurse named Colleen called me and started reading off drugs and I’m writing them down. I’m in a hotel room and I’m like… ‘Aricept,’ 'Haldol' …. And I'm like why are they giving her all this stuff? What has that got to do with having pneumonia and high blood pressure or diabetes?
Val Zavala: Haldol -- or the generic Haloperidol -- is a powerful anti-psychotic, used to treat schizophrenics. The side effects include confusion, anxiety, and depression. By law, anti-psychotics can only be administered with a doctor’s prescription and permission from the patient or the patient’s representative.
Val Zavala: But it’s a step that’s often skipped in some nursing homes. Matthew Borden is Aleah’s attorney.
Matthew Borden: They literally call up the doctor on the phone and they say…so and so is agitated so and so is upset and the doctor says okay I'm going to prescribe this.
Val Zavala: The “this” in Aleah’s case was Haldol.
Matthew Borden: It’s the drug that they use to knock down..you know the worst criminal violent offenders in the California penal system. And they were giving it to her with no consent. With no process, nobody was reviewing it. It was prescribed essentially over the phone by someone who had never seen her before.
Val Zavala: He also says there are financial incentives to use drugs as “chemical restraints” on difficult residents.
Matthew Borden: When you don't have enough staff, the facility makes more money because it’s an expense for them to hire people – and the people who live in the facility are suffering because these drugs have a terrible impact on them.
Val Zavala: Jill tried to monitor the drugs.
Jill Dominguez: I said, “So who gave you permission to give her these drugs?” I don't know. I said, “Well the doctor didn't see her...you said she is too crazy to be lucid so who gave you permission. You didn't call me.”
Aleah Davis: You were not asked permission to give you the drugs they gave you. No and I knew I wasn't supposed to have them.
Jill Dominguez: The doctor just complied, didn’t even bother to come in and visit her.
Matthew Borden: I would say the doctor has broken the law. I would say the facility has broken the law too if they know the doctor hasn't talked to the patient.
Val Zavala: We contacted Country Villa and asked for an interview. They declined.
Michael Connors: In our view, the rampant misuse of antipsychotics to chemically restrain nursing homes residents is elder abuse on a massive scale.
Val Zavala: Michael Connors is with California Advocates for Nursing Home Reform. One of their priorities is to reduce the use of antipsychotics for dementia patients.
Michael Connors: People are literally left in misery because they've been drugged into a state where nobody can figure out what the real problem is, and what happens is they misinterpret expressions of distress as some sort of mental aberration that requires a psychoactive drug.
Val Zavala: In 2003, the FDA issued a warning. It reads, “Warning: Elderly patients with dementia related psychosis treated with antipsychotics are at an increased risk of death.”
Val Zavala: In fact, the risk of death is almost doubled.
Michael Connors: When somebody has been sedated through use of these drugs those residents are more prone to bed sores, more prone to pneumonia, they are more prone to strokes.
Jocelyn Montgomery: If they’ve got someone with dementia who has these really challenging behaviors, they try everything.
Val Zavala: Jocelyn Montgomery is an RN and a former nursing home inspector. She’s now with a group which represents nursing homes. She says many nursing homes are well run, but admits there is a problem with overmedicating difficult residents.
Jocelyn Montgomery: So our providers are between a rock and a hard place. Now hopefully what they try…and more and more what they try are the non-pharmacological interventions first. So we are trying to teach our providers to see all behaviors is communication. And to say to themselves instead of how do I stop that…to say what are they trying to tell me.
Val Zavala: In 2010, California nursing homes joined a national campaign to reduce inappropriate drugging in nursing homes. It seems to be working. Antipsychotic drug use in California has dropped steadily over the past three years from to 22 percent of long-term residents to 16 percent.
Jocelyn Montgomery: That's an incredible drop so I think we are getting the message in nursing homes and I think the advocates have been very influential. The regulators have been very assertive in doing their job.
Val Zavala: Michael Connors from the nursing home reform group disagrees.
Michael Connors: Federal and state regulators are really not enforcing the law. They are treating this right to be free from chemical restraint -- the right to be free from unnecessary drugs -- as suggestions rather than requirements.
Val Zavala: In early 2011 Jill found a letter that Country Villa had written to the Social Security Administration.
Jill Dominguez: It says, “This patient is no longer to care for herself financially or physically. We are now want you to sign all of her social security benefits to us and we will take care of her.” They just tried to drug this woman, take her money against her will.
Val Zavala: Jill asked the California Department of Public Health to investigate Country Villa. Among other deficiencies, investigators found that on at least six occasions, Country Villa had no documentation to show what and when the use and the side effects of (various antipsychotics) were explained to the patient or the patient’s responsible party. They also found there was no documentation of the reason for the use of the Haldol.
Val Zavala: Aleah’s attorney filed a lawsuit. Country Villa settled, but did not admit guilt. For Aleah, it was still a victory. Did you win?
Aleah Davis: Of course.
Val Zavala: Well not necessarily of course.
Aleah Davis: I know, but Matthew -- he worked his fingers to the bone and he won it.
Val Zavala: In early 2011, Jill moved Aleah to a different nursing home. How do you feel now compared to…how you were feeling in Country Villa?
Aleah Davis: Oh I feel a 100 percent better than I did when I was at Country Villa.
Val Zavala: It’s clear this case holds lessons for anyone with a loved one in a nursing home. No one knows that better than Aleah Davis.
Aleah Davis: I always ask what I'm getting. I’m able to tell when I get the medication what's in the cup. I've learned to ask and I've learned that I have rights. Val Zavala: I’m Val Zavala for “SoCal Connected.” We contacted Country Villa to request an interview. Their attorney declined, saying Country Villa “is in the process of winding down and selling its assets.” In fact, Country Villa is currently in bankruptcy court.