Original source:
http://www.mercurynews.com/opinion/ci_22328287/anthony-chicotel-medical-board-allows-over-drugging-elderly

Mercury News
Anthony Chicotel
01/08/2013

Finn Christensen was 85 years old, weak and confused when he went to El Camino Hospital in Mountain View in 2009. Within just over 24 hours of his admission, Christensen was physically restrained and prescribed two powerful antipsychotic drugs to control him. Despite a century’s worth of law protecting patients from being drugged without their consent, neither he nor his family was told about his physical and chemical restraint.

Elders with dementia are often drugged indiscriminately with antipsychotic drugs in hospitals and long-term care settings. Despite sometimes-fatal side effects and a lack of efficacy, the drugs remain the treatment of choice for patients who present behavioral challenges resulting from their inability to communicate their needs. The drugs are frequently used as chemical restraints, designed to subdue patients for staff convenience, despite proven non-drug options.

Right now, more than 25,000 nursing home residents are being drugged with antipsychotic drugs. A 2011 federal report found that 83 percent of atypical antipsychotics prescriptions in nursing homes are for uses not approved by the FDA, and that more than half did not meet Medicare reimbursement criteria. As a result, Medicare paid more than $116 million in erroneous claims in a six-month period.

Doctors play a prominent role in the systematic overdrugging of elders in hospitals and nursing homes. Some doctors attempt to address every patient problem with a pill and fail to directly observe the behaviors they are asked to resolve.

California’s Medical Board, the agency charged with protecting the public from poor physician care and practices, has been conspicuously absent in robust efforts to end the overdrugging of California’s elder and dependent adults. Despite clear rules providing patients the right to give or withhold informed consent, the Medical Board has chosen to look the other way when confronted with cases involving drugging without consent.

Christensen was drugged for 16 days at El Camino Hospital and Sunnyvale’s Cedar Crest Rehabilitation Center by three different doctors without his or his family’s knowledge. When the Medical Board was asked to review the case, it found insufficient evidence to investigate. The board stated the drugs were “low dose” and “just at bedtime” and there was no reason for the doctors to concern themselves with informing their patient about the significant health risks or non-drugging alternatives. The board’s findings demonstrate that illegally ignoring critical patients’ rights is considered “the standard of practice of medicine” for doctors.

Similarly, the Medical Board found no reason to act in the case of Diane Buck, a bed-bound, ventilator-dependent North Hollywood nursing home resident. Buck was receiving four psychotropic drugs and was ill from morphine withdrawal when she called 911 for help. As a result of her call, she was prescribed two additional psychotropics by a doctor who had not seen her. There were no clinical indications for use of the drugs and the prescriptions likely violated rules against unnecessary drugging and chemical restraints. Perhaps worst of all, the additional drugs were administered through her feeding tube without her consent.

After her drugging, Buck became nearly comatose and developed tardive dyskinesia, an irreversible condition marked by neurological damage and facial tics. The Medical Board concluded that her doctor’s actions “did not deviate from the standard of practice” and took no enforcement action.

The Medical Board’s reluctance to intervene in cases like this is alarming and undermines all Californians’ right to ultimately control their health care and their own bodies. The board’s inaction suggests that abusing elder or dependent patients is acceptable as long as other doctors are doing it.

Anthony Chicotel is staff attorney for California Advocates for Nursing Home Reform. He wrote this for this newspaper.