Doctors Often Not Punished For Inappropriate Use of Psychotropic Drugs In Nursing Homes

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 and talkative.

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 state.

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 investigators.

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 that often.

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.

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