The Duluth News Tribune reported that a Minnesota nurse was recently found to have stolen hundreds of painkillers from 34 residents of a Ecumen nursing home and short-term rehabilitation center.  The thefts, which occurred undetected over a five-moth period, included the high power painkiller, oxycodone, among other drugs and totaled over 760 pills. The stealing was only brought to the attention of the facility after a resident who was not administered her oxycodone complained that she was “having extreme pain” without it.  It was found that the nurse who was taking the pills was signing out the pills without ever administering them to her residents.

It is maddening to think that almost three dozen residents could have suffered in pain without their medicine while this selfish human being stole their pills.  This absolutely calls into question the quality of employees nursing homes are employing and management’s supervision.  Even worse, this incident of pill philfering is just one among many as can been seen by the increase in the number of drug thefts in Minnesota. In hospitals and nursing homes across the state the number of reported cases has increased by twice the rate they were in 2005. “The trend reflects what experts say is a nationwide surge of prescription drug abuse — in many cases by the very people entrusted with caring for patients.”

BND.com reported the sentencing of Diana L. Van Etten to two years probation after making false claims for fraudulent prescriptions to be filed with Medicaid.  Van Etten was a licensed practical nurse employed at Caseyville Nursing Home.  While she worked at Caseyville Nursing Home, Van Etten would sign Hydrocodone out as if she were giving it to nursing home residents, but she would consume the Hydrocodone herself.   She would also fax false prescription requests for Hydrocodone to the pharmacy and would steal whole cards of Hydrocodone that were supposed to go to residents. Van Etten also diverted Hydrocodone for her personal use from numerous nursing home residents.

Van Etten caused 11 false claims to be submitted to the Illinois Medicaid Program for fraudulent prescriptions. She pleaded guilty to health care fraud in June 2012. The case was investigated by agents of the U.S. Department of Health and Human Services — Office of Inspector General, the Illinois State Police — Medicaid Fraud Control Bureau and the Caseyville Police Department.

 

The Blotter on Statesman.com reported on the arrest of Katrina Calvert-Hervey for taking prescription medicine from nursing home patients at New Hope Manor and giving it to her boyfriend to sell, according to the arrest warrant.  She had access and opportunity.  She worked as a state-certified medication aide at New Hope Manor nursing home.  She was charged with diversion of controlled substance by registrants, dispensers and other certain persons.

Police searched the house of Calvert-Hervey and her husband on April 23 and found 219 dosage units of controlled substances including alprazolam, lorazepam, methadone, morphine, methylphenidate and hydromorphone. Calvert-Hervey admitted that while working she stole controlled substances and non-controlled prescription medications from patients by documenting that the patients had received their medicine and then taking the medications home with her.

 

 

Newsday reported the below Opinion of Karen Angel about the misuse and overuse of anti-psychotics in nurisng homes.

A nurse from my mother’s nursing home calls to ask if it’s OK to put her on a new drug. Just a low dose to calm her, the nurse assures me.

I agree, thinking the nurse is an expert and probably knows best. And I’ve seen my mother’s mood change dramatically for the worse as the day wanes, a phenomenon in dementia patients called “sundowning.”

The drug the nurse administers is the antipsychotic Risperdal. I later find out that the FDA has issued its strongest safety caution — known as a “black box warning” — against using this drug and similar antipsychotics in elderly dementia patients because they pose an increased risk of death, stroke, seizures and diabetes.

“They’re not supposed to be used to control dementia-related so-called bad behavior,” Richard Mollot, executive director of the Manhattan-based Long Term Care Community Coalition, told me. “A lot of family members are being told ‘we need to calm down your loved one’ when in fact this is not appropriate care for people with dementia.”

A report this month by the inspector general of the Department of Health and Human Services found that 99 percent of nursing home records show a failure to follow federal safety and quality guidelines for the use of antipsychotics, suggesting drug misuse is widespread and enforcement lax.  But along with heightened scrutiny by HHS, a recent government crackdown against drug companies for illegally marketing antipsychotics is providing a ray of hope that this could change.

Introduced in the 1990s, these “second-generation” antipsychotics have largely replaced drugs created in the 1950s to treat schizophrenia, in part because the newer medicines have been considered safer, with fewer troubling side effects. Almost 40 percent of nursing-home residents with dementia received the drugs in 2010, according to the Center for Medicare and Medicaid Services. Partly as a result, antipsychotics are now the top-selling class of pharmaceuticals, with yearly revenue of about $14.6 billion — despite their approval for only about 1 percent of the population.

The federal Nursing Home Reform Act of 1987 established “the right to be free of unnecessary and inappropriate physical and chemical restraints” — but the government has failed to enforce this. In fact, as a campaign against physical restraints has all but eradicated them over the past two decades, chemical restraints have become more entrenched — even as the issue has been hotly debated in Congress.

“The way antipsychotic drugs are used in nursing homes is a form of elder abuse,” Patricia McGinnis, executive director of California Advocates for Nursing Home Reform, told the Senate Special Committee on Aging in 2010. “Instead of providing individualized care, many homes indiscriminately use these drugs to sedate and subdue residents.”

 

The largest study of the use of such antipsychotics, conducted by Harvard Medical School and published earlier this year, found that elderly dementia patients using them are almost twice as likely to die as those on a placebo. David Graham, associate director of the Food and Drug Administration’s Office of Drug Safety, has estimated that 15,000 elderly people die in nursing homes every year as a result of the off-label prescription of these antipsychotics.

Last year, a report by the inspector general found that 88 percent of successful Medicare payment claims for antipsychotics were for nursing-home residents with dementia, despite the documented risk of death, and 22 percent of patients were on the drugs for too long or at too high a dose, violating federal rules on unnecessary drug use. The report condemned nursing homes’ failure “to comply with federal regulations designed to prevent overmedication.”

Fifty-one percent of the claims in the study didn’t meet the government’s Medicare reimbursement rules — but were paid anyway. This means the Medicare system is shelling out hundreds of millions a year to pay for these drugs, with taxpayers footing the bill. If nothing changes, costs will explode over the next two decades as 10,000 baby boomers a day become eligible for Medicare.

No enforcement action was taken as a result of the report, the inspector general’s office said, because the data were drawn from a random nationwide sample and weren’t sufficient to establish patterns at particular nursing homes.

Beyond their physical risks, antipsychotics are problematic because they not only suppress dementia patients’ agitation, they wipe out pleasurable emotions, too. “They turn people into zombies,” Mollot says.

Patients on these drugs sleep a lot. Now it’s clear to me why my mother would be in bed by 6 p.m. at the nursing home, while since moving back home and stopping the drug, she often stays up watching classic movies past 9.

 

Though the government hasn’t gone after nursing homes, it has recently won four big settlements against drug giants for illegally marketing antipsychotics. Last year, Eli Lilly and Pfizer paid the largest criminal fines in U.S. history — $515 million and $1.3 billion, respectively — for deceptive promotion. In a case in Arkansas last April, Johnson & Johnson was fined $1.1 billion for misleading doctors about Risperdal’s risks.

Meanwhile, a federal case is pending against Johnson & Johnson for allegedly paying millions in kickbacks to Omnicare, the nation’s largest long-term-care pharmacy, to recommend Risperdal for nursing-home patients.

In another promising reform initiative, the Center for Medicare and Medicaid Services has launched a campaign against antipsychotic use in nursing homes, with the goal of reducing it by 15 percent by 2013 through alternatives such as increased staffing and better pain management.

Yet, though commendable, these efforts have done little so far to change practices on the ground level for a population that has no time to spare.

I recently asked my mother if she still gets pleasure out of life, even though in the past year, she has gone from being independent to relying on a full-time caretaker for all her basic needs. She replied, “Absolutely!”

All elderly deserve that chance. But until nursing homes face greater scrutiny and sanctions, our elderly will continue to languish in chemical restraints.

 

A nursing home in Oklahoma is at the center of a drug ring involving residents’ prescription medications.  Director of Nursing Jackie Allen Alexander and Melanie A. Kirby, the assistant director of nursing were arrested on charges for multiple counts of obtaining controlled substances by fraud or forgery, conspiracy to obtain and conspiracy to distribute.  Prosecutors have filed drug-related charges against six employees at Callaway Nursing Home. The Oklahoma Bureau of Narcotics says the employees are accused of calling in fraudulent prescriptions to pharmacies to obtain painkillers, including hydrocodone.  The drugs were later sold on the street.

An audit showed more than 9,000 dosage units of controlled substances had been diverted by employees, said Mark Woodward, Oklahoma Bureau of Narcotics spokesman. More than 8,400 of the dosage units involved the pain medication hydrocodone.

 

An interesting article reported on Minnesota Public Radio that two nurses, at separate facilities, have both been accused of stealing pills from their residents. A nurse in Fairbault facility stole Percocet, while another nurse in Inver Grove Heights stole Oxycodone.  In both cases the perpetrators were reported to the state nursing board by their facility managers. A new law in Minnesota requires all state health licensing boards to investigate ways to make background checks for applicants and licensees more thorough.

Incidents like these truly exemplify the need for more stringent background check procedures so family can be more confident in the quality of staff they are trusting their loved ones with.

 

Depakote, an anti-seizure and mood-stabilizing drug, is approved by the Food and Drug Administration to treat epilepsy, bipolar disorder and migraine prevention. However, nursing homes use it to sedate residents as a "chemical restraint".  Lawsuits filed by four groups of whistle-blowers alleged that Abbott marketed the drug for off-label uses, including for treatment of schizophrenia, dementia and autism. The Justice Department intervened in those suits to determine whether the company’s marketing of the drug violated civil and criminal laws, including fraudulently charging Medicare and Medicaid.  Abbott admitted that beginning in 1998 it trained a special sales force to promote Depakote to nursing-home employees as a way to control the agitation and aggression that can occur in elderly patients suffering from dementia.  In 1999, Abbott was forced to discontinue a clinical trial testing Depakote’s effectiveness against dementia when it became evident that the drug increased the incidence of drowsiness, dehydration and anorexia in elderly study participants. Yet the sales team continued to push the drug to nursing homes through 2006.

The L.A. Times and Washington Post each had articles reporting that Abbott Laboratories will pay $1.6 billion to settle federal and state claims that it improperly marketed the neurological medication Depakote for off-label uses.   Abbott encouraged and trained its salespeople to market Depakote off-label to nursing-home directors, geriatric doctors and other long-term-care providers. The company also gave doctors illegal kickbacks to talk about off-label uses of the drug to boost sales. 

Abbott will pay $800 million to resolve civil allegations split among federal and state governments, $700 million in criminal penalties and $100 million to states to resolve consumer protection matters.  Of course, Abbott made ten times that amount selling the drug for off-label use.

Abbott only had to plead guilty to one misdemeanor violation of the Food, Drug and Cosmetic Act for misbranding. The company also will be restricted from marketing the drug for off-label uses.

 

 

Numerous media outlets reported on the tragic fire caused by an operational meth lab at Ohio’s Park Haven Home.  One man died and several others were injured in the fire caused by a methamphetamine lab.  A medical examiner said the man who was burned on more than 90 percent of his body suffered an accidental death. 

Methamphetamine is a highly addictive stimulant. Mobile meth labs, also called one-pot or shakeand- bake labs, usually consist of a 2-liter bottle and the drug’s ingredients, said Bob Frey, the health department’s chief of health assessment.

How could this happen?  Where was the staff?  Where was the supervision?

The home was cited last year for inadequate care and numerous other violations, state records show.   Alleged violations found in a December survey included: inadequate care; failure to investigate how a resident was injured; and improperly responding to residents’ complaints about missing property. A federal rating system gives the nursing home one star out of five — the lowest possible on health inspections and quality measures.

 

The New York Times reported that the Obama Administration will require drug companies to disclose the payments they make to doctors for research, consulting, speaking, travel and entertainment.   Under the new standards, if a company has just one product covered by Medicare or Medicaid, it will have to disclose all its payments to doctors other than its own employees. The federal government will post the payment data on a Web site where it will be available to the public.   Companies will be subject to a penalty up to $10,000 for each payment they fail to report. A company that knowingly fails to report payments will be subject to a penalty up to $100,000 for each violation, up to a total of $1 million a year.

Critics and researchers have found evidence that such payments influence doctors’ treatment decisions and contribute to higher costs by encouraging the use of more expensive drugs and medical devices. Consumer advocates agree that disclosures increased the likelihood that doctors would make decisions in the best interests of patients, without regard to the doctors’ financial interests.

Large numbers of doctors receive payments from drug and device companies every year — sometimes into the hundreds of thousands or millions of dollars — in exchange for "providing advice and giving lectures".   The Times has found that doctors who take money from drug makers often practice medicine differently from those who do not and that they are more willing to prescribe drugs in risky and unapproved ways, such as prescribing powerful antipsychotic medicines for children.

Medicare and Medicaid, the programs for older Americans, the disabled and the poor, spend more than $100 billion a year on drugs and devices.