Another sad story of an overworked nurse stealing medications from a resident.  Talisa Milam Haygood was arrested Dec. 20 on a felony charge for allegedly stealing medication from residents in October and falsifying records indicating she had given the drugs.  Haygood is charged with obtaining a controlled substance by fraud, punishable by up to 10 years in prison.

 She was employed at Lakewood Therapy and Living Center when the alleged theft and fraud occurred. According to the probable cause affidavit, the administrator at Lakewood filed a report with police on Oct. 10 after reviewing video surveillance footage at the center following a complaint by a resident about some missing Nexium pills.

In viewing the footage, he reportedly saw a nurse, identified as Haygood, removing a hydrocodone pill from the medication cart shortly before 1:30 p.m. on Oct. 9 and placing it in her mouth. The administrator counted the pills in the cart and compared it to the entries made by Haygood in the prescription log book.

He then spoke to the residents Haygood had indicated received their pain medication and found two residents who had not received any medication. One patient told him Haygood had refused to give her any hydrocodone at the prescribed time but instead gave her a Tylenol pill.

One patient was reportedly not capable of advising if he received any medication, but a review of the security footage showed Haygood never entered the man’s room at the time indicated and only went into his room once during her eight-hour shift for about three seconds.

The administrator noted that in the entry for that patient Haygood had indicated she had crushed the pill up in a solution and injected it into the patient, but the video showed Haygood never retrieved a syringe from the storage closet.

Police Detective Jjesus Anaya spoke to the administrator and one patient who confirmed the same information. The administrator noted he has video evidence of 17 “pill diversions” by Haygood and is still reviewing the footage to compile more evidence.

 

 

Substance abuse among health care professionals (especially nurses in skilled care facilities) has increased significantly over the last decade.  The opioid crisis has dramatically affected nurses and other caregivers. Recently another registered nurse was arrested for stealing pain mediacation and watering down morphine intended for a patient, according to court documents.  Joshua D. Williams worked at Greenbrier Regional Medical Center. He was charged with tampering with a consumer product.

The indictment says Williams was working as a supervisory registered nurse at Greenbrier Regional in August 2018 when he tampered with a bottle of liquid morphine sulfate prescribed to a patient. The indictment says he removed a quantity of the drug and replaced it with a saline solution, diluting its concentration to about 14% of what it was labeled.

Court documents don’t say why Williams allegedly diluted the morphine, but according to media reports and prosecutors in other cases, medical staff oftentimes steal the opiate for personal use.

“The morphine discrepancy … was detected during a routine audit,” R. Bruce McCorkle, Greenbrier Regional’s administrator said in a statement, indicating staff reported the situation to “the appropriate state and federal authorities.”

The department said he is authorized to work in several other states, including Maryland, West Virginia and North Carolina.

 

The Trump administration recently announced getting rid of safety regulations placed on nursing homes.  The administration states that the proposed changes would save nursing homes some $600 million a year, though as NPR noted, the proposed regulation reduction wouldn’t require that any savings be spent on improving patient care or increasing staffing.

One particular proposal, which experts and consumer advocates are concerned about is changing the rules for prescribing danagerous and deadly antipsychotic medications to patients at nursing homesConcerns stem with warnings about antipsychotic drugs – used as a chemical restraint and often off-label – can often raise the risk of death in older individuals, particularly from ones already suffering from dementia, according to the NPR report.

CMS has spent years attempting to get nursing home facilities to reduce the use of antipsychotic drugs.  Under current regulations, nursing home facilities cannot prescribe patients antipsychotic drugs for longer than two weeks without having a doctor reevaluate a patient. Under the new proposed regulations, nursing homes could go as long as one to two months without having a doctor evaluate a patient, according to the NPR report.  There is no medical or nursing rationale for this change.

Richard Mollot, Executive Director of the Long Term Care Community Coalition told NPR that his organization opposes the rule change, and cited a doctor who explained why he likewise opposed the regulation adjustment.

“What he said was that no other insurance company would ever accept that a doctor didn’t have to see a patient before continuing a prescription for medicine,” Mollot said. “But CMS is saying now that that’s okay for nursing homes in this very vulnerable population, and people die from this. They’re affected so catastrophically.”

 

 

 

One of the major issues with America’s health care system is how we treat people with addictions.  Anyone who has been affected by the ongoing opioid crisis can attest to the lack of resources for those addicted to the deadly scourge.  Many are stuck in nursing homes.  This is not an ideal situation for numerous reasons.  Rehabilitation hospitals work with patients to achieve therapy goals. But for long-term care, if a patient isn’t able to live independently in the community, the patient typically goes to a nursing home.

Athena Health Care Systems, a privately owned long-term care company based in Connecticut, has become one of the health care providers to offer programs to care for patients who have a history of addiction on top of the physical care diagnosis for which they are referred.  However, nursing homes are licensed by the state Department of Public Health and are surveyed by DPH to certify that they comply with federal Medicare and Medicaid regulations. They are not regulated as detoxification or addiction recovery centers. Athena-owned facilities are the only ones that have developed partnerships with drug treatment centers and in-house programs to train staff and support patients who also have substance use disorders.

“It’s an excruciating problem,” Peter Zawrotniak, program manager in addiction counseling services at UMass Memorial Medical Center, said about placing patients with substance use disorders in appropriate aftercare, particularly if they need methadone treatment.

Zawrotniak said none of the long-term care facilities in the area is equipped to address the full range of services needed for treatment and recovery. Suboxone, as long as it is prescribed by a physician with a waiver to do so, can be dispensed by nursing home staff and is easier to manage, Zawrotniak said.

Methadone, another form of medication-assisted treatment for opioid addiction, can only be administered to patients at a licensed methadone clinic. Patients must be registered with the clinic, a bureaucratic process that can be time consuming to coordinate. One patient waited in a hospital bed for two weeks. The nursing home must then transport the patient to the methadone clinic every day for their dose.

The state DPH’s Bureau of Health Care Safety and Quality issued a letter in 2016 about admission of residents on medication-assisted treatment for opioid use disorder. According to the letter, patients who have completed detoxification and are receiving medication-assisted treatment, and are otherwise eligible for admission to the long-term care facility, are expected to be admitted and have their treatment continued as prescribed by the patient’s physician or opioid treatment program.

There is no federal guidance on what reasonable accommodations need to be made for patients with substance use disorders. And extra services such as addiction counselors and enhanced security measures are not reimbursed by Medicare or Medicaid.

 

Medication errors are a serious problem in the nursing home industry. Federal law requires skilled nursing facilities to keep errors within a 5% margin. This margin is broadly defined, but includes errors such as not mixing medication as directed, giving medications at the wrong time, or not dosing the last small portion of a medication. Consumer advocates and experts estimate that at least 7 million Americans experience a medication error each year. These mistakes are preventable and costly – estimated at over $21 billion.  Errors within this 5% window don’t impact licensing and they’re the types of medications many people make at home when administering their own medications.

Nursing homes which are often understaffed, medication errors are rampant. Errors are likely underreported and that the medical coding system makes it easy to cover up error-related deaths. Under a different system, the CDC argues that medication errors might be the third most common cause of death among nursing home patients.

If you’re responsible for the health and safety of an older adult,you need to understand medication administration, particularly within nursing home settings.  By building good habits around medication preparation and administration, nursing facilities can improve patient outcomes and help minimize error rates at their facilities.

Given the potential problems stemming from improper medication administration, nursing homes need to invest in better prevention practices. That starts with increasing staffing level, a strategy that could also help prevent nursing home abuse. These facilities are chronically understaffed because of low pay and poor management and have a high rate of turnover. That means staff also aren’t familiar with patients’ care regimens and are more likely to make mistakes.

In addition to increasing staffing levels, nursing homes can decrease error rates by adopting a strong medication reconciliation program.  Reconciliation processes are especially important in nursing homes, as many patients are unable to verify their medications.

Finally, as part of reducing error rates, nursing homes should minimize high-risk behaviors, such as not properly disposing of discontinued medications or medications from discharged patients, improperly transporting medications, or administering medications without fully reviewing the label directions.

Nursing home residents are the most vulnerable members of our community and they deserve safe, careful, and appropriate treatment.

I recently read an incredible heartbreaking story about the suffering and preventable death of Gloria Dunn.  Dunn chose to live at the Bel Aire Assisted Living Facility in Utah County, Utah.  However her health began to suddenly deteriorate while a resident. Previously, she had only had trouble with her kidneys, her family says.

When Gloria Dunn arrived at the emergency room, doctors asked her son if she had cancer. It turned out the cancer-free 75-year-old had been getting large doses of methotrexate, a dangerous chemotherapy drug.

“The problems she was having were all related to that medication,” Joshua Dunn said.

Her family has filed a wrongful death lawsuit against a local pharmacy and her assisted living facility, alleging they gave her the wrong medication that led to her painful death in July 2018.  According to a lawsuit filed, Gloria Dunn had been prescribed metolazone, a common diuretic, but Select Pharmacy in Midvale, Utah, allegedly sent back the wrong drug. The staff at the assisted living facility then repeatedly administered that drug to the 75-year-old.

It took more than a week for doctors to check her medications and realize the mistake, the lawsuit states.

Gloria Dunn’s family says the woman would have wanted answers for what happened to her. Now, more than a year after the 75-year-old’s untimely death, her family is determined to get them.

“She wanted to understand why. She didn’t understand either, and when we knew, it was really powerful to be able to say to her, ‘This is what happened. It wasn’t your fault, and we’re so sorry,’” Griffin said. “The suffering that she endured through a mistake should never happen to anyone else, and that’s what we care about.”

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.