Feds Hope Hitting Nursing Homes In The Wallet Will Cut Overmedication
Federal prosecutors allege two nursing homes in California have "persistently and severely overmedicated elderly and vulnerable residents." Antipsychotic drugs like risperidone, also known as Risperdal, can be dangerous for elderly people, but are frequently prescribed to nursing home patients.
A federal lawsuit against two Watsonville, Calif., nursing homes may offer a new approach to dealing with the persistent problem of such facilities overmedicating their residents.
The lawsuit details multiple cases when the government says these drugs were inappropriately administered to patients.
For instance when an 86-year-old man identified in the lawsuit as Patient 1 was admitted to Country Villa Watsonville West, he could speak clearly and walked in under his own power. Within days the facility began giving him Haldol and Risperdal, drugs used to treat schizophrenia and bipolar disorder, and he became bedridden, stopped eating and developed bedsores and infections.
"Within days he declined precipitously, to the point where he was read his last rites in the hospital," says Tony Chicotel, a staff attorney with California Advocates for Nursing Home Reform who represented the man and his family in a private suit that was settled out of court.
"He subsequently recovered," says Chicotel, "but all this had been done without his family's knowledge, without his informed consent, without real good clinical indications for the use of the drug."
Antipsychotics like Risperdal and Haldol come with so-called black box warnings that say they could hasten death in elderly patients or people with dementia. Nevertheless, about a fifth of nursing home patients nationwide are prescribed antipsychotic drugs.
The U.S. attorney for Northern California declined to comment on the lawsuit, but it claims that the two nursing homes provided "grossly inadequate, materially substandard and/or worthless services." Meanwhile, they received about $20 million from Medicare and Medicaid for those services. So now the government wants its money back, and then some.
"Under the False Claims Act, the government can ask for triple damages," explains Kelly Bagby, a senior attorney with the AARP Foundation. The nursing homes also could be fined, she says, for each incidence of filing a false report.
"So every time they submitted a form that said, 'Here is Mrs. Jones' needs' and Mrs. Jones' needs were different than that, each one of those forms is a violation," says Bagby.
In a statement, the companies that own the two nursing homes called the charges "untrue and without merit." They also filed their own lawsuit blaming the company they hired to manage the two facilities.
Deborah Pacyna, public affairs director for the California Association of Health Facilities, says that in the past couple years the federal government, in partnership with organizations like hers, has succeeded in reducing the use of antipsychotic drugs in nursing homes.
"But a lot of the regulators, a lot of our critics seem to be ignoring the fact that antipsychotics are being widely prescribed to patients who have dementia who are living at home, who are in the hospital or who are in assisted living settings," Pacyna says. "Skilled nursing (homes) represents a fraction of those that have been impacted by this practice, yet we remain the focus."
Bagby would like to maintain that focus, and thinks this lawsuit can help do that. "If you're going to hit their bottom line, that's really where you change behavior."
Bagby adds that with antipsychotic drugs still so widely prescribed for nursing home residents, there's the potential for more cases like this one across the country.
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Transcript
AUDIE CORNISH, HOST:
In California, two nursing homes are being sued by the federal government for over-medicating residents. The suit also contends that the facilities hid the practice from Medicare and Medicaid and filed false claims for payment. NPR's Ina Jaffe reports.
INA JAFFE, BYLINE: Here is what happened to an 86-year-old man who was admitted to a nursing home called Country Villa Watsonville West. When he arrived, resident number one - as he's called in the lawsuit - could speak clearly and walk into the nursing home on his own power. Within a couple of days, the facility began giving him Haldol and Risperdal - drugs used to treat schizophrenia and bipolar disorder. He became bedridden, stopped eating, developed bed sores and infections.
TONY CHICOTEL: Within days he had declined precipitously to the point where he was read his last rites in the hospital.
JAFFE: That's Tony Chicotel, a staff attorney with California Advocates for Nursing Home Reform. He represented resident number one and his family in a private suit that was settled out-of-court.
CHICOTEL: He subsequently recovered, but all of this had been done without the family's knowledge, without his informed consent, without real, good clinical indications for the use of the drug.
JAFFE: Antipsychotics, like Risperdal and Haldol, come with so-called black box warnings that say they could hasten death in elderly patients or people with dementia. Nevertheless, about a fifth of all nursing home residents nationwide are prescribed antipsychotic drugs. The U.S. attorney for Northern California brought the lawsuit but declined to discuss it. The suit claims that the Watsonville nursing homes provided, quote, "grossly inadequate, materially substandard and/or worthless services." Meanwhile, they received about $20 million from Medicare and Medicaid for those services. So now the government wants its money back - and then some.
KELLY BAGBY: Under the False Claims Act, the government can ask for triple damages, as you say, treble damages as the statute says.
JAFFE: That's Kelly Bagby, a senior attorney at the AARP Foundation. The two nursing homes could also be fined, says Bagby, for each incidence of filing a false report.
BAGBY: So every time they submitted a form that said here is Mrs. Jones' needs - and in fact, Mrs. Jones' needs were entirely different than that. Each one of those forms could be a violation.
JAFFE: In a statement, the companies that own the two nursing homes called the charges untrue and without merit. Deborah Pacyna is with the California Association of Health Facilities which represents most of California's nursing homes. She says the federal government in partnership with organizations like hers has succeeded in reducing the use of antipsychotic drugs in nursing homes.
DEBORAH PACYNA: A lot of our critics seem to be ignoring the fact that antipsychotics are being widely prescribed to patients who have dementia, who are living at home, who are in the hospital, or who are in assisted-living settings. And skilled nursing represents a fraction of those that have been impacted by this practice, yet we remain the focus.
JAFFE: The AARP Foundation's Kelly Bagby would like to maintain that focus. And she thinks this lawsuit can help do that.
BAGBY: If you're going to hit their bottom line, that's really where you change behavior.
JAFFE: And Bagby says with antipsychotic drugs still so widely prescribed for nursing home residents there is a potential for more cases like this one across the country. Ina Jaffe, NPR News. Transcript provided by NPR, Copyright NPR.
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