Tighter Rules Sought for Anti-Psychotic Drug Use in Illinois Nursing Homes
By Wire News Sources on December 20, 2009
This story appeared in the Chicago Tribune.
CHICAGO — Health advocates are calling for tough new rules
on the use of anti-psychotic drugs in Illinois nursing homes, including tighter
controls on doctors who prescribe the powerful medications.
“Medical care should help you get better, not get
worse,” said Wendy Meltzer of Illinois Citizens for Better Care, an
advocacy group for nursing home residents.
A joint ProPublica-Chicago Tribune investigation found one
psychiatrist was providing assembly-line care to thousands of mentally ill
patients. The story was part of a broader Tribune
investigation that showed how many frail and vulnerable Illinois nursing
home residents have been unnecessarily dosed with anti-psychotics, leading to
harm and an increased risk of death.
Advocates want Gov. Pat Quinn’s Nursing Home Safety Task
Force to address these problems. Although the task force has focused on violent
felons housed in nursing facilities, chairman Michael Gelder said the group
will also target the misuse of psychotropic drugs.
“We want people to be safe and cared for in nursing
homes, not threatened or unwillingly sedated,” he said.
Reforming the system likely will be challenging. The FDA has
approved anti-psychotic drugs to treat serious mental illnesses, such as
schizophrenia, but doctors may also prescribe them to geriatric patients with
other conditions, such as dementia, in a common but controversial practice
called “off-label” use.
Meltzer said one way to stop nursing home doctors from using
the drugs to “chemically restrain” residents is for the state to
refuse to pay for certain medications.
For example, if a nursing home doctor wrote a prescription
for an anti-psychotic that can be injected — suggesting the medication is
being used to sedate a resident — the pharmacist would not fill the order
unless the physician received permission from the Illinois Department of
Healthcare and Family Services. Meltzer also said the state should not pay for
multiple antipsychotics for the same resident or for psychotropics at dosages
over recommended limits without prior approval.
In addition, Meltzer called for Illinois to require nursing
homes to use standardized consent forms for each psychotropic drug. Documents
show that hundreds of nursing residents have been given psychotropics without
their permission since 2001. In other cases, facilities downplayed the dangers.
Nursing homes, Meltzer said, should have a formal process of
explaining the benefits and risks of taking psychotropics. Right now, she said,
the goal of many nursing homes is to simply get residents to sign the forms as
opposed to explain the options.
Other possible reforms address problems raised by the
ProPublica-Tribune investigation of Chicago psychiatrist Dr. Michael Reinstein.
Illinois law requires psychiatric hospitals to report
patient deaths, but three deaths of people under Reinstein’s care were never
reported, said Illinois Department of Public Health spokeswoman Melaney Arnold.
The agency grants and revokes the licenses of psychiatric hospitals, but it
cannot levy penalties for lax death reporting because that law is on another
agency’s books.
Advocates said this inconsistency should be fixed, but
Arnold characterized the problem as beyond the scope of her agency. “If
(legislators) want to make a change to the law, they are welcome,” she
said.
Mark Heyrman, a University of Chicago law professor and
mental health advocate, called on Medicaid to consider a doctor’s cumulative
disciplinary record when weighing sanctions. The agency, records show, has
taken repeated action against Reinstein but has not punished him as a repeat
offender. Rather, it has looked at him one audit at a time.
Heyrman said he wondered if it was wise for Medicaid to give
tax dollars to doctors who have had repeated run-ins with the agency. “It
seems to me there should be a higher standard for that,” he said.
But overall, he said, Medicaid pays psychiatrists too
little. “If we want decent care we have to raise the payments,”
Heyrman said.
Advocates also said Illinois should require drugmakers to
publicly disclose payments to doctors so that their patients can be aware of
possible conflicts of interest. One pharmaceutical company gave Reinstein nearly
0,000 to promote a drug that Medicaid records suggest he prescribed
41,000 times. Reinstein has disputed Medicaid’s prescribing figures.
Illinois State Rep. Jack Franks, D-Marengo, has pushed a
bill since 2005 requiring drugmakers to report the amount of money and gifts
they give to doctors, nursing homes and hospitals. The bill has not passed, but
he said he plans to re-introduce it next session.
He called Reinstein “the poster child for why we need
this law.”
Reinstein, through his attorney, said he agrees that drugmakers
should disclose payments. He said he no longer accepts payments from
pharmaceutical manufacturers, and if any are sent to him, he donates them to
charity.
He also said he would cooperate and assist the task force if
asked.
Sam Roe is a Chicago Tribune reporter. Christina Jewett conducted
the joint investigation with Roe while a reporter for ProPublica. She now works with the nonprofit
investigative newsroom California
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