There have been many articles about the recent deaths at a California nursing home from overmedication or intentional overdose. Here, here, here, here, and here are some articles where I got some information. It is an incredible story that is symbolic of the hiring practices and training of staff in the nursing home industry, and the use of medications as a chemical restraint. The use of chemical restraint in elder-care facilities is not a new problem. However, it’s unethical, and if given without consent of the individual or a healthcare proxy, illegal.
Kern Valley Hospital houses a skilled nursing facility where several employees are accused of killing three patients by force-feeding them psychotropic drugs to keep them calm.
In one allegation, nursing home resident Opal Towery was injected with anti-psychotic drugs after an argument with the nursing director and spent the next week in a zombielike state. In another, Louise Zimmerman was pinned down by four staffers and injected with the same drugs. She never regained full consciousness.
Those were among the disturbing stories in a criminal complaint filed by the California Attorney General’s office that led to the arrests Wednesday of three current and former employees of the Kern Valley Healthcare District’s skilled nursing facility. The complaint alleges a nursing director, pharmacist and physician drugged at least 22 elderly residents with mood-altering medications to quiet and control them, leading to the deaths of three. The alleged druggings occurred between August 2006 and January 2007.
“When I was handed the newspaper by a co-worker, I felt like somebody had slammed me in the stomach,” said Betty Dennison. Her mother-in-law, Beulah Dennison, died Jan. 21, 2007, less than three months after she was placed at the Kern Valley Healthcare District’s skilled nursing facility. Several days before Beulah’s death, a nurse told Dennison her mother-in-law had been drugged to keep her quiet and complacent.
Patti McGarvey’s 74-year-old mother, Norma Lee Cudahy, entered the facility in March 2006 to recover from knee surgery and died in November from a stroke. McGarvey doesn’t know what drugs her mother received but after hearing the alleged druggings targeted patients who complained or acted out, she got worried.
“These are powerful medications that were given, in some cases against people’s will, primarily for management, not health reasons,” Attorney General Edmund G. Brown Jr. said. “It's unconscionable behavior and it’s certainly not what people expect when they entrust their parents or grandparents to a skilled nursing home.”
Gwen Hughes was the director of nursing. Debbi Gayle Hayes was the facility’s pharmacist. Dr. Hoshang M. Pormir was medical director of the skilled nursing facility.
The 27-page complaint describes interviews with facility nurses and medical experts who say Hughes ordered certain patients to receive high and unnecessary doses of anti-psychotic drugs.
Pharmacist Hayes followed her orders, telling investigators she thought Hughes was knowledgeable in the treatment of psychiatric conditions. Pormir, the physician, signed off on the orders after the drugs were administered.
Hughes’ orders often came after residents "acted out" or complained, and were often administered without patient consent. At least two residents were forcibly injected; a third had psychotropic drugs sprinkled on her food. The investigation found none of the residents received a medical exam or diagnosis prior to receiving the powerful doses.
The attorney general’s investigation identified three residents believed to have died as a result of being drugged and neglected:
• Fannie May Brinkley died Dec. 23, 2006, after receiving Depakote, a drug to treat mood disorders. After not eating for six days, she was rushed to the emergency room, where she died.
• Eddie Dolenc was given unnecessary anti-psychotic medication that caused him to become extremely sedated, and unable to eat or drink. He died one month after being admitted to the facility, likely from dehydration or pneumonia.
• Joseph Shepter went to the emergency room on Jan. 14, 2007, for dehydration and died five hours later. He had been given three anti-psychotic drugs.
In addition to the three deaths, the drugged residents suffered serious side effects ranging from severe lethargy that inhibited eating and drinking for long periods to weight loss, drooling and incoherence.
People interviewed by investigators pinned most of the blame on nursing director Hughes, who was fired in 1999 from a Fresno nursing home after the state cited the facility for over-medicating patients. Nurses at the Kern Valley facility said the drugging of patients began when Hughes was hired. She held “interdisciplinary team meetings” in which she and the staff discussed residents' behavior and Hughes told the pharmacist what drugs to prescribe.
Tish Orr, a registered nurse at the Kern Valley facility for 25 years, said the druggings were orchestrated by nursing director Hughes.
Orr recalled Hughes ordering a potent anti-psychotic drug be given to an Alzheimer’s patient.
“I would have him up at the nurses’ station while I was working, and he’d been drinking coffee and eating graham crackers and was happy as could be,” she said. “But he’d say the same thing 140 times in a row and it drove her nuts, and that’s why she had him medicated.”
“From that day on, he didn't eat or drink. He was so weak he couldn't be in his wheelchair anymore.”
The man eventually died.
When the nurses objected or raised concerns, Hughes threatened to fire them and have their nursing license revoked. Several nurses left the facility during Hughes’ tenure. One nurse told investigators she was so distraught by the situation that she was on the verge of “a nervous breakdown.”
Gwen Hughes was fired from two nursing facilities for over-drugging patients yet landed a job at Mercy Hospital in Bakersfield and to this day has a clean nursing record. How did Hughes — facing criminal charges in the deaths of three local nursing home patients — keep getting hired?
Interviews with health care regulators and a former employer showed that nursing homes blame privacy laws despite the firings, the result of twice being implicated in state investigations for over-drugging elderly patients.
It’s public now. Threats kept the truth about what happened at Kern Valley from coming out sooner, said Tish Orr, a registered nurse there for 25 years. When nurses objected to patients receiving heavy doses, Orr said, Hughes threatened to fire them or have their licenses revoked.
“We were so cowed and threatened with losing our jobs and our licenses that after a while we just shut our mouths and did what we had to do,” Orr said.
Nurses who worked under Hughes at the Sunnyside Convalescent Home in Fresno in the late 1990s described a similar situation, Fellen said.
“She would go up to (a nurse) and basically force them to write an order (for medications),” he said. “She threatened to fire them. She could be very intimidating.”
Hughes was fired as nursing director there in 1999 after a state investigation revealed her role in overmedicating patients. She was hired in Kern Valley in 2006. After being terminated from that job, she briefly worked at Mercy Hospitals.
Incredibly, there are no blemishes on Hughes’ nursing record. The Board of Registered Nursing said it will now act to suspend Hughes’ license. A little to late for the dozens of victims of her "care".
Three of the four drugs allegedly over-prescribed to patients at a Lake Isabella nursing home can pose such deadly side effects to the elderly that they bear the U.S. Food and Drug Administration’s “black box” warning label. Zyprexa, Resperidol and Seroquel were developed to treat severe psychotic disorders, such as schizophrenia, but are increasingly given to nursing home residents, often to treat behavioral issues, said Dr. Kathryn Locatell, a geriatric physician who specializes in forensic investigation of elder abuse. Common side effects in the elderly are constipation, risk of falling and difficulty swallowing, which can lead to dehydration, weight loss and other life-threatening problems. In most cases, the risks or prescribing the drugs to elderly patients far outweigh the benefits, Locatell said.
Because the drugs can cause sudden death in elderly patients, said Locatell, they bear the FDA’s strongest designation for medications that may have life-threatening side effects.
The use of anti-psychotic drugs in the elderly can pose serious risks. Geriatric physician Kathryn Locatell and longterm care ombudsman Nona Tolentino said people with a loved one in a nursing home, skilled nursing facility or other residential care setting should asked for detailed information about medications.
Here are some questions to ask:
• What medication is my loved one on?
• What are you trying to treat with this drug? What are the specific behaviors that need treatment?
• How will this drug improve my loved one’s condition?
• How often and how long will it be administered?
• What are the side effects?
• Has a doctor examined my loved one to determine if this is appropriate?
• How will side effects be monitored?
• Why are drugs even being considered?
• What other approaches could be used? What has been tried?
“If you can't get good answers, then ask for a meeting with the director of nursing or the pharmacist,” Tolentino said. Or, seek an outside pharmacist’s opinion. Facilities should also have a “care plan” for each resident or patient. Ask for a meeting to review it with facility staff.
Locatell said national statistics show about 50 percent of nursing home residents are on some form of psychotropic medication. Most are on anti-depressants, which she considers OK since there’s high incidence of depression among nursing home residents. But about 30 percent of residents are now on anti-psychotics, a class of psychotropics designed to treat serious mental illness. The use of those drugs in a nursing home should “raise a flag” for loved ones, she said.
“As far as I’m concerned, it’s replaced the use of physical restraints,” said Nona Tolentino, former director of the county’s adult protective services program who now oversees the long-term care ombudsman program at Greater Bakersfield Legal Assistance. “That’s what I see and that’s what we hear. There are behavioral problems in a nursing home and staff readily presents that to a doctor and the doctors agree to prescribe the drug or increase the dosage.”
