Category Archives: Medications

Katie Louise Boll, a nursing home employee, has been charged with allegedly diverting drugs from residents for her own use, according to information filed in federal court.  A grand jury returned an indictment charging Boll with acquiring a controlled substance by deception and tampering with consumer products in Iowa.

At least 13 patients were affected.  She allegedly injured one of the patients when she took part of the patient’s oral morphine sulfate solution and diluted it with mouthwash on Dec. 24, 2018. Later that week, on Dec. 29, 2018, she allegedly used her position to swap codeine, hydrocodone oxycodone, morphine and tramadol medications for at least 10 patients with Tylenol and other medicine.

Boll worked as a nurse at the Good Neighbor Society in Manchester, and between September 2018 and January 2019 she took about 50 hydrocodone pills.  What a waste.  I hope she gets the help she needs, and those poor residents get the justice they deserve.

 

 

Melanie J. Hunter, a caregiver and registered nurse at Dycora Transitional Health, was charged with taking narcotic drugs that were meant to go to nursing home residents.  Hunter is charged with intentionally abusing residents-causing bodily harm. She could face up to six years in prison and a $10,000 fine if convicted of the charge.

This is sad and just one example of how the opioid abuse epidemic can affect everyone.

Texas has slowly reduced the misuse of antipsychotics in nursing homes in recent years, but experts and advocacy groups say more can and should be done. Texas legislators are considering a pair of bills that would require the written consent of a patient or a family member before an antipsychotic drug is given to a nursing-home patient.

Amanda Fredriksen, associate state director at AARP Texas, explained about 12,000 nursing home residents are being given antipsychotic drugs for no legitimate reason, perhaps other than the convenience of staff in caring for patients who otherwise might be difficult. She said these medications are intended to treat schizophrenia, bipolar disease and Tourette’s syndrome, but are dangerous for those with Alzheimer’s and dementia.

“These drugs can increase the risk of falls, increase blood glucose levels, they dramatically increase the risk of stroke – all these risks are well known,” Fredriksen said. “We outlawed physical restraints many, many years ago and now we’ve moved to chemical restraints. It’s fairly barbaric. ”

Fredriksen noted there are other alternatives to antipsychotics, including music and memory therapies and safer medications.

“There are also behavior techniques that can be used to know how to anticipate some of the reactions from residents and intervene with different kinds of behavior techniques that don’t require any drugs at all,” she said.

Kristy Winburn, an employee at Five Star Senior Living assisted living facility in Hartsville, is accused of taking prescription pills from an elderly resident who was left in her care.  One employee advised officers that Winburn had taken 11 Percoset pills from an 80-year-old resident. The employee said Winburn was replacing the missing Percoset pills with vitamins and Tylenol pills and passing it off as “legitimate medication” for the 80-year-old, according to the police report.

When police interviewed Winburn about the stolen prescription pills, she admitted to taking four of the pills.

The offender admitted to taking four of the pills while on duty and was clearly intoxicated as she was almost falling asleep, her head was nodding, and was clearly under the influence,” the police report stated.

The investigation also found that Winburn forged the signature of an employee for providing Tramadol, which is a schedule IV-controlled substance

Winburn faces several charges including failing to report abuse/neglect of a vulnerable adult, petty larceny and forgery.

Tulsa World reported on a bill pending in the Oklahoma House to crack down on the administration of antipsychotic drugs to nursing home residents. Oklahoma ranks first in the nation in giving antipsychotic medication to nursing home residents, according to AARP Oklahoma, which is backing Senate Bill 142, by Sen. Stephanie Bice, R-Oklahoma City.

This legislation will provide a stop to this immoral practice of drugging our seniors,” said Sean Voskuhl, AARP Oklahoma director.  “We rank No. 1 in the country in this category with the high use of antipsychotic drugs,” Voskuhl said. “We owe it to our most frail and vulnerable citizens to provide dignity and care.”

The measure defines antipsychotic drugs as a “drug, sometimes called a major tranquilizer, used to treat symptoms of severe psychiatric disorders, including but not limited to schizophrenia and bipolar disorder.”

Bice said the legislation requires written informed consent from the patient or legal representative.

If the nursing home resident is given the antipsychotic in an emergency situation, a physician would need to do a follow-up exam to ensure the proper diagnosis, according to the measure.

The medications are being prescribed for nonpsychotic reasons, Bice said.

“We want to ensure that if there is a medical diagnosis and they need it, they get it,” she said.

But if a patient doesn’t need it, caregivers must be careful about over prescribing, she said.

Some of the medications have negative side effects, such as sedation, which can increase the risk of a fall, Bice said.

There is a high occurrence of nursing homes giving antipsychotic medication when it is not necessary.

Nico Gomez is president and CEO of Care Providers Oklahoma, which represents about 200 nursing homes. Gomez said his organization is not opposed to the measure.

“It is an issue we have been working hard to improve for a number of years,” Gomez said. “We can understand that people who care for our residents like we do are getting frustrated with the lack of progress that other states have made.”

He said his organization is working to educate its members and with physicians to make sure “we are prescribing the right medications to the right person at the right time.”

Gomez said he didn’t have an answer as to why the state ranks first in the nation on administering the drugs to nursing home residents.

I read the most despicable thing about a nurse named Michelle brown who is charged with multiple felonies after prosecutors said she stole liquid pain medication from residents who needed it to relieve pain.  A grand jury on Friday handed up an indictment charging Brown, a licensed practical nurse, with tampering with drugs, theft, drug possession and illegal processing of drug documents.  This lady needs to be buried under the jail.

This nurse replaced the morphine and the hydromorphone that she stole with water, leaving the diluted doses to be injected into patients at Crestmont North Nursing Home.  Investigators could not determine how much of the medication Brown took, or how diluted she left the medication.

Brown took the bottles as they sat on the medication cart, poured some of it into pill baggies and then put water back into the bottle to bring it back up to the level it was before, prosecutors said.

Other employees at the home reviewed the facility’s surveillance video after they noticed Brown acting suspicious in March, and saw Brown ducking into closets, empty rooms and rooms of patients assigned to other nurses, prosecutors said.

They confronted Brown, who admitted to stealing medication twice, on March 1 and March 7, then taking it home and using it herself, prosecutors said.  Drug addiction is a major problem in the health care field where access and opportunity come together.

McKnight’s had an article on how Eskaton will “work through this” after a jury compensated the family of a former resident $42.5 million in punitive and compensatory damages for neglect that led to her death.  The amount of punitive damages, $35 million, represents more than 10% of nonprofit operator Eskaton’s net worth.

Barbara Lovenstein moved into Eskaton FountainWood Lodge, an assisted living facility in 2012. The resident had an epilepsy diagnosis and had a prescription for the sedative lorazepam (Ativan) that was to be given only when she had “seizure-like activity,” the complaint said.

FountainWood staff members, however, began administering lorazepam to Lovenstein daily as a chemical restraint even after her primary care physician denied their request for a prescription for routine dosage.  As a consequence, Lovenstein choked and was taken to a hospital emergency department, where it was determined that she had aspiration pneumonia, and died April 11, 2012.

The state Department of Social Services, after a 2012 investigation, concluded: “Primary care physician medication orders and communication were not followed.” The state also found that “resident medication [was] not given as prescribed.

“The jury was presented with evidence that Eskaton engaged in this practice not just with Ms. Lovenstein but throughout the memory care unit of its facility because it was dangerously understaffed,” “Eskaton corporate officers were aware of the understaffing, lack of supervision and numerous other systemic failures at the facility but woefully failed to do anything about it.”

 

The Tribune reported on the lawsuit filed against Bella Vista Transitional Care Center for the neglect and wrongful death of resident Kathleen Hutchinson.  Hutchinson died in April 2018 after she was incorrectly given four doses of diabetes medication during a three-and-a-half-hour period.

She was a patient at Bella Vista for about eight months prior to her death and relied on facility staff for help with nearly all of her daily living activities, according to the lawsuit. The facility had four different administrators during Hutchinson’s eight months as a patient at Bella Vista.

On the day of her death, Hutchinson’s blood sugar was taken at 5:35 a.m. and was found to be dangerously high, prompting a doctor to order 10 units of insulin be administered. Hutchinson’s blood sugar was to be rechecked an hour later.

At 6:06 a.m., additional insulin was administered per Hutchinson’s typical medication schedule, in spite of the fact she’d received a previous dose about half an hour before.

Hutchinson was given more insulin at 7 a.m. after a staff member told the doctor a blood sugar reading taken at 6:06 a.m. showed her levels were still too high.

She was then given a dose of Metformin, a diabetes medication taken in conjunction with insulin, at 8 a.m., per her typical schedule.

At 9:40 a.m., Hutchinson was found not breathing and covered in vomit. Her blood sugar was so low the blood sugar monitor couldn’t read it. Two minutes later, she was pronounced dead.

The lawsuit claims Hutchinson died because staff followed her usual medication schedule on top of doctor-specified doses tailored to her condition the morning of her death.  These errors occurred due to Bella Vista’s understaffing issues according to the complaint.

A Department of Public Health (DPH) investigation into Bella Vista following Hutchinson’s death concluded the facility “(failed) to meet the professional standards of quality in providing care pursuant to care plans and treatment orders,” according to the lawsuit.

DPH also previously cited Bella Vista for failing to meet minimum staffing requirements, failing to ensure call lights were in reach of residents, failing to provide showers and asking certified nursing assistants to perform nursing assessments beyond their scope.

 

 

Charlene Hunter James, President of AARP Texas, wrote the following for TribTalk, a publication of the Texas Tribune.

Imagine the horror of living in a deep fog day in and day out. Your steps, if you’re able to walk, are wobbly. Your memories are confused. Your grasp of reality is lost.

And to discover that you’ve been purposefully sedated for no legitimate reason.

Federal reports show that thousands of nursing home residents in Texas are being inappropriately prescribed antipsychotics. They’re not given the drugs because of psychiatric conditions for which they can legitimately be prescribed. Rather, they are being administered for other causes. Sometimes, it’s merely for the convenience of nursing home staff.

It’s called a chemical restraint and it’s akin to the way people were handled in the Dark Ages.

This is a misuse of one of the most powerful classes of psychiatric drugs. For those with dementia, which is not uncommon among nursing home residents, receiving antipsychotics is especially dangerous, even deadly. That’s why the Food and Drug Administration gives these medicines a black-box warning: an alert of an increased risk of death among people with dementia.

No one disputes that providing daily care for nursing home residents is a patience- and stamina-testing ordeal. Attending to these moms, dads, grandparents and other loved ones is a truly honorable profession. Working with those who have Alzheimer’s and other dementia adds greatly to the frustrations.

Through music and memory programs, and other therapies, Texas and some other states have made progress over recent years in reducing inappropriate use of antipsychotics among nursing home residents. But this crisis in care has by no means been eradicated.

So, it’s exasperating that lobbyists for the nursing home and medical industries this legislative session are opposing reasonable proposals to rectify the problem.

Today, the law says that nursing home residents must give consent for antipsychotics to be administered. And yet, all too often, family members of nursing home residents still report a lack of awareness of these drugs being administered. They see sudden and solemn changes in the mental well-being of their loved ones. Later they learn — or come to suspect — a culprit: antipsychotics being administered without their knowledge.

A stronger consent law that would require written consent of a nursing home resident or a legal decision-maker. And that’s essentially what’s offered in Senate Bill 1212 by Sen. Kelly Hancock, R-North Richland Hills and House Bill 2050 by Rep. Chris Paddie, R-Marshall.

To improve nursing home safety, please ask your state representative and senator to support those bills.

Disclosure: AARP has been a financial supporter of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune’s journalism. 

McKnight’s had another great article on medical marijuana; this time, in Virginia.  As a bill that expands access to medical cannabis becomes law, associations representing assisted living operators in Virginia are looking for guidance on whether it applies to assisted living residents and their caregivers, as the Virginia chapter of the National Organization for the Reform of Marijuana Laws maintains.  The legislation was passed unanimously in both the state House of Delegates and the state Senate.

SB 1719 allows for “registered agents” to pick up or receive delivery of medical cannabis — specifically, cannabidiol (CBD) oil and THC-A oil — for people who physically are unable to do so for themselves. The bill language does not reference assisted living, but Virginia NORML said the bill applies to assisted living communities and hospices as well as home healthcare providers.

Virginia Assisted Living Association Executive Director Judy M. Hackler told McKnight’s Senior Living that the organization has contacted state regulators to see how the bill, if signed, will be implemented in long-term care settings.  “We have been telling our providers that we know that it’s coming, that all the laws are changing for all the states,” she said. “And so we’re asking them all to be proactive in developing company policies as far as what they want to have allowed and, of course, full disclosure to residents and staff. You’ve got to think about who is going to be administering it for the residents and whether there are going to be any side effects to the employees. …There need to be some safety measures in place.”

The Virginia Health Care Association / Virginia Center for Assisted Living also is taking a closer look at the legislation to see how assisted living communities could be affected, said Amy Hewett, CAE, the group’s vice president of strategy and communications.

“We have plans to meet with representatives of the Virginia Board of Pharmacy to learn more,” she said. Agents must register with the pharmacy board.

LeadingAge Virginia President and CEO Melissa Andrews said the bill is “a step toward our mission of ensuring positive aging for every Virginian.”

The organization, she added, “supports legislation that enables older adults to have access to all necessary prescribed medication, regardless of their physical ability or location. We are pleased that our legislature is taking this positive step and are confident that regulations will be promulgated to ensure the health, welfare and safety of residents within these communities.”