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Least Drugging
toxic medicine

Care-Plan-In-a-Can Is Not Acceptable Dementia Care

CANHR Website
06/17/2015 by achicotel

In an earlier post, we talked about the CMS “focused surveys” to examine the dementia care provided at a handful of nursing homes in a few states, including California. The survey teams found many examples of poor dementia care by applying enhanced criteria related to antipsychotic use. The application of the criteria could dramatically improve dementia care in nursing homes if CMS and the state survey agencies ever decide to assess real penalties for bad care.

In four of the nursing home surveys completed in California, CMS demanded true person-centered care, finding that pre-packaged care plans with generic check boxes were inconsistent with the individualized attention that people with dementia need to thrive. Good care plans must include proposed interventions that are specifically tailored for each resident, based on their preferences and prior work experience, to maximize their self-expression and socialization. Nursing home staff members must make an effort to not only gather personal information about each resident’s personality and past, they must incorporate that information to enhance the resident’s quality of life.

The focused surveys were noteworthy for scrutinizing other aspects of dementia care that typically get a pass from regulators. Dementia diagnoses require evidence of medical evaluation and careful assessment, and could not be loosely based on a resident’s age and an episode of “confusion” or “forgetfulness.” Staff must act on consultant pharmacist recommendations to reduce or eliminate problematic psychotropic drug use. The use of psych drugs must be continuously re-evaluated, particularly when “symptoms” decrease or side effects are observed. Finally, non-drugging options, including “psychological support,” must be explored before psychotropic drugs are used.

The results of the California focused surveys demonstrate the potential strength and the weakness that have characterized the CMS national initiative to end antipsychotic misuse and improve dementia care in nursing homes. The surveys brought pointed investigation and considerable insight into each evaluation. Poor dementia care that had floated along as the acceptable community standard was held to account and exposed as the myopic, deflating failure that has plagued institutionalized care for decades.

On the other hand, no enforcement actions were taken despite the myriad regulatory violations that were uncovered, including many cited as causing harm to residents. This is typical. Abusive or dangerous drugging practices wielded against resident with dementia almost never lead to enforcement action. It’s nice that CMS took a thorough approach to reviewing dementia care being provided at a few nursing homes but can we expect better care when – even within this token approach – there are virtually no negative consequences for bad care? Over three years have passed since CMS announced its initiative. Millions of dollars have been spent to educate nursing homes on how to meet regulatory standards that have already been around for ages. When are they going to mean something?

A $3.8 Million Bummer

CANHR Website

Last year, we heaped praise on the U.S. Department of Justice for filing a False Claims Act against two Watsonville, California nursing homes that had dangerously drugged multiple residents over several years.

This week, the Department announced the case had been settled. The defendants agreed to pay $3.8 million dollars to settle the false claims allegations, an impressive sum that will send a needed message that poor resident care relying on sedating drugs to “solve” residents’ problems will not be tolerated by the government that often foots the bill.

In addition to the financial settlement, the nursing homes entered into a “corporate integrity agreement” to provide five years of federal oversight to ensure better care. The agreement is quite disappointing. It makes no mention of improved dementia care or reduced use of chemical restraints, even though both issues were at the heart of the false claims case (e.g., “defendants persistently overmedicated elderly and vulnerable residents”). In fact, psychotropic drugs are mentioned only one time in the 55 page agreement: as part of the facilities’ duty to report deaths or injuries to the “independent monitor.”

Unfortunately, the corporate integrity agreement looks like a boilerplate contract whereby the nursing homes agree to set up bureaucratic layers (“compliance officer,” “compliance committee,” “quality of care program”) to make sure they are following the basic laws and regulations already applicable to nursing homes. That seems like a lot of work to achieve standards that have been required for nearly thirty years. We hoped for more.

A look at the drugging rates at the defendant nursing homes indicate the federal lawsuit has had little impact on the quality of care the residents are receiving. Antipsychotic use at one defendant facility rose 22% from the second quarter 2014 (before the lawsuit) to the fourth quarter 2014 (after the lawsuit) to a whopping 27.71% overall while use at the other defendant facility rose 45% in the same period. Clearly, the lawsuit did not trigger any soul-searching in the defendant nursing homes and we do not expect the corporate integrity agreement to either.

We’re pleased the federal government took a stand for quality nursing home care and targeted illegal and immoral drugging practices in the process. We’re also pleased the government received a partial refund for care that was truly grossly inadequate. Nonetheless, we’re disappointed the chemical restraint band likely plays on in Watsonville.

Strong Drug Case Settled

By Tom Kisken
Ventura County Star

A Ventura nursing home will pay $183,000 earmarked for former residents and $472,000 to attorneys in a settlement of a lawsuit alleging that powerful drugs were routinely prescribed without consent.

Ventura Convalescent Hospital also will be watched by an outside monitor, according to the settlement approved this week by Ventura County Superior Court Judge Kent Kellegrew.

It will impose measures to ensure that patients or family members understand the impact of powerful medications, including antipsychotic drugs that advocates for seniors say can be used to restrain patients with dementia.

The action ends litigation filed nearly three years ago alleging that medication was routinely administered without informed consent under the care of a nursing home physician, Dr. Gary Proffett.

The lawsuit involved 305 former patients under Proffett’s care. The powerful senior citizens advocacy group AARP joined the litigation on the plaintiff’s side, with lawyers calling it the first class-action suit.


The patients will receive $600 each in an amount negotiated by the lawyers. As lead plaintiff, Kathi Levine, of Carpinteria, will receive $10,000, which she will donate to the National Disaster Search Dog Foundation in honor of her mother.

Levine’s mother, Patricia Thomas, had Alzheimer’s disease. She was admitted to the nursing home after suffering a fractured bone. Levine said drugs were prescribed without her consent. She said her mother died several weeks after being discharged from the nursing home.

Kellegrew said in hisruling that the settlement reduces the risks faced by nursing home patients.

“It is highly likely the hundreds of patients in ... facilities located in Ventura County would still be receiving psychotropic medications without informed consent,” he said in apparent reference to several other skilled-nursing facilities where Proffett prescribed medicine.

Proffett, also medical director of the SeaView IPA doctors network, was not a defendant in the lawsuit. He was sued separately by Levine in a case settled more than a year ago.

Proffett said in an interview earlier this year that doctors once routinely relied on nursing home staff members to obtain consent because they have more access tofamilies and patients. That has changed.

“The way it’s done now is we follow the letter of the law,” he said.

The settlement states that the nursing home denies all wrongdoing but will be monitored for three years. An injunction in the settlement means officials will have to collect signatures from involved parties ensuring that the doctor has explained medications being used with the patient or family.

Gregory Johnson, a lawyer representing the patients, said Ventura Convalescent already has reduced its use of antipsychotics.

“They have changed the way that they operate dramatically,” he said, noting that many other area nursing homes aredoing the same thing. “Fewer people in this county are getting dangerous drugs, and it’s because facilities are forcing the doctors to have this conversation.”

In an April hearing, a nursing home lawyer, Dawn Phleger, questioned the more than $486,000 being requested by the plaintiffs’ lawyers in fees and costs. She said more of that money should be used on research or efforts directly related to the well-being of nursing home residents.

In his ruling the judge eliminated $13,583 requested in legal costs but approved $450,000 in fees to the plaintiffs’ lawyers.

The amount awarded to the nursing home residents is regulated by the state, Kellegrew said in hisruling. That limit reduces the incentive for lawsuits, meaning that conduct can go unchallenged, he said.

“The risks of a minimal recovery were exceptional yet the harm presented to Ventura County should the subject behavior have remained unchecked was extraordinary,” he said.

Johnson said some of the 305 plaintiffs have died. Their settlement money will go to charities that advocate for reducing the use of antipsychotic medicine in nursing homes.

Levine, the lead plaintiff, said she was happy with the ruling.

“You can’t place a value on people,” she said, adding, “$600 doesn’t really seem like justice, but if it causes other people to be aware, we’ve made a good start.”

What You Should Know to Fight the Misuse of Psychoactive Drugs in California Nursing Homes.

There is rampant misuse of psychoactive drugs in California nursing homes. Nearly 60% of all California nursing home residents are given psychoactive drugs, a 30% increase since 2000. Many psychoactive medications
have dangerous side effects, especially antipsychotic drugs.

Below is a link to the CANHR (Long Term Care Justice and Advocacy) guide in a pdf format so that you may print from your computer.

Toxic Medicine

- PDF printable guide
...... 20 pages.........


Table of Contents

What are Psychoactive Drugs?
Risks Galore, Including Death
Psychoactive Drugs Cannot Be Used Without Informed Consent
Advocacy Tips When Psychoactive Drugs Are Proposed
Who Can Exercise a Resident's Rights?
Right to Refuse
Chemical Restraints and Unnecessary Drugs Are Illegal
Gradual Dose Reduction
Alternatives to Drugs - Always the First Option
Remedies to Illegal Drugging
Laws and Regulations


Long Term Care Services of Ventura County, Inc.
Ombudsman Program

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Ventura CA 93003 

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Funded in part by - Area Agency on Aging

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