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Nursing Homes Increasingly Using Chemical Restraints to Control Patients


Antipsychotic drugs are administered to approximately one out of four patients in California nursing homes, according to a report by the California Advocates for Nursing Home Reform. In many cases, these drugs are prescribed for “off-label” uses, which means the powerful medications are not prescribed to treat schizophrenia or other conditions that the FDA has approved the drugs for, explains a California personal injury attorney. Instead, these medications are prescribed in order to make patients easier to manage and to help control the behavior of patients suffering from dementia.

The use of these antipsychotic medications as a treatment method is growing not just in California but also throughout the entire United States. For instance, in 2011, the Department of Health and Human Services released a report indicating that approximately 14 percent of the 2.1 million individuals living in nursing homes had been prescribed an off-label or “atypical” antipsychotic drug in 2007. The same report also indicated that in 51 percent of Medicare antipsychotic drug claims, there was no record of administration of the drugs or the drugs were not used for medically accepted reasons. This means that Medicare spent an estimated $309 million on atypical psychiatric drugs.

The losses caused by the use of these drugs are not just financial. The FDA has warned that the off-label use of antipsychotics to treat dementia patients can increase the risk of mortality. According to statistics reprinted on the Consumer Voice, the potential consequences and side effects of the off-label use of these medications can increase the risk of heart attack, triple the risk of a stroke, contribute to or cause diabetes, cause fatigue, cause uncontrolled tremors that may lead to falls, cause seizures and cause the residents to lose the ability to perform basic life functions such as bathing, dressing, eating and talking to others. Because of the serious consequences, the unnecessary and atypical use of antipsychotic medications may result in the death of 15,000 nursing home patients every year.

According to a 2006 study referenced in the Consumer Voice, patients who were suffering from Alzheimer’s disease did not show any improvement in terms of either aggression or delusion when they were dosed with an antipsychotic medication. This means that the antipsychotic medications being administered to these thousands of nursing home patients likely do not have any beneficial effect for the patient.

Instead, these medications are used as chemical restraints. According to the California Code of Regulations ยง72018, a chemical restraint is defined as “a drug used to control behavior and used in a manner not required to treat the patient’s medical symptoms.”

Laws on Antipsychotic Drug Abuse

Nursing homes that impose chemical restraints on patients are often acting in violation of federal and state laws. In California, for instance, nursing homes must verify that a doctor has obtained informed consent from either the patient or family members before administering antipsychotic drugs to patients.

On the federal level, the law in 42 CFR 483.25 imposing Medicare/Medicaid requirements for long-term care facilities mandates that “[r]esidents who have not used antipsychotic drugs are not given these drugs unless antipsychotic drug therapy is necessary to treat a specific condition as diagnosed and documented in the clinical record.”

Despite these requirements, a report by California Advocates for Nursing Home Reform indicates that 147 violations of nursing home protection laws were found among 24 facilities. The three major categories of violations included failure to obtain informed consent from residents or family members; the use of unnecessary drugs or excessive doses of drugs; and deficient pharmaceutical consultant services.

Nursing homes that violate the laws protecting patients and that prescribe unnecessary drugs are now finding themselves subject to civil lawsuits by family members of patients as well as by patients who have been subject to chemical restraint. Hopefully, such litigation will serve as a deterrent to using these powerful medications as restraints for care providers in California and throughout the country.

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