As a Houston, Texas medical malpractice attorney, I frequently handle cases involving nursing home and hospital medication errors. Unfortunately, in my experience, it seems that many nursing home healthcare providers use overmedication as a means of silencing patients and keeping them out of their hair.
I recall handling a case against skilled nursing facility (SNF) in the Sugar Land, Texas area. The family members of an elderly patient/resident of the facility told me how their loved one had been experiencing a lot of pain. On one occasion, while she was alone, the patient had been moaning in pain. When family members returned, they found that their loved one had been given strong sedatives and the nursing staff closed her door. When confronted, a nurse said that they closed the door because she was too noisy and it was distracting.
Misuse of antipsychotic drugs
A February 2018 study found that nearly hundred 180,000 nursing home residents are given antipsychotic drugs every week—even though they have no psychiatric diagnosis, like schizophrenia, for which the drugs are designed to treat. Think about the staggering size of that number.
The research leading to the study focused on six states, including Texas, which has more skilled nursing facilities (SNFs) than almost anywhere else in America.
Like sedatives, many patient advocates describe the overuse of antipsychotic drugs as a chemical restraint.
As a former hospital administrator, any time I hear the word “restraint,” I think about the strong regulations and standards of care in place that govern the use of physical restraints. They can only be used with a physician order, for a limited time, and must be removed at certain intervals—and all of this must be documented in the patient’s medical records.
Chemical, or drug, restraints are an entirely different concept. A chemical restraint can sedate a patient in such a way that it has a similar effect to a physical restraint, like a strap or tie. It keeps the patient quiet and out of the way.
The overuse of antipsychotic medications in skilled nursing facilities became so bad that, in 2012, the Centers for Medicare & Medicaid Services started the National Partnership to Improve Dementia Care in Nursing Homes. According to the Centers, since the National Partnership was launched, there has been a significant reduction in antipsychotic medication use in long-stay nursing homes. The goal is to see even more reductions, with the idea of getting healthcare providers to use non-medication approaches to dementia care.
Risk of antipsychotic and sedating medications in the elderly
From my experience in the many medical negligence cases that I have handled, there are two major concerns about the overuse of antipsychotic and sedating medications.
First, these medications blunt the mind and body and can mask signs and symptoms that would otherwise suggest to healthcare providers that something is wrong with the patient. Medical and nursing textbooks teach, for example, that a change in mental status is often an early indicator of a medical condition that needs investigated and treated. If a patient is doped up on sedating medications, it makes it virtually impossible for doctors and nurses to notice these potentially significant changes.
Second, for patients who spend a lot of time in bed, sedating medications pose increased risks. When patients are over-sedated and lying down, they lose the ability to control their airway, leading to respiratory distress. Similarly, overly sedated patients are at risk for breathing food or liquids into the lungs (aspiration), which can cause deadly pneumonia.
What you can do
I recommend that family members of nursing home residents/patients keep a close eye on medications that are prescribed and administered. If there are antipsychotic or sedating medications on the list, find out why. Another common problem in skilled nursing facilities is that more and more medications get added for a patient without any doctor, nurse, or pharmacist asking, “Why?” I have seen several cases where patients have dramatically improved when a physician took the time to review medications and discontinue some.
If you or someone you care for has been seriously injured as a result of medical or nursing home negligence, call Painter Law Firm in Houston, Texas, at 281-580-8800, for a free consultation about your potential case.
Robert Painter is an attorney at Painter Law Firm PLLC, in Houston, Texas, where he handles medical malpractice, wrongful death, and nursing home cases. He is a former hospital administrator who exclusively represents patients and their family members. In 2017, H Texas magazine recognized him as one of Houston’s top lawyers.