March 2011 Archives

March 31, 2011

Study Finds Typical Antipsychotics No Safer for Elderly Patients Than Atypical Drugs

I've written here several times before, from my perspective as a Philadelphia medical malpractice lawyer, about the use and overuse of atypical antipsychotics in nursing home patients. Although antipsychotics are not approved for use in controlling dementia symptoms, nursing home staff members use them for this purpose anyway because they believe it helps control difficult or violent behavior. However, research over the past few years has found that atypical antipsychotics -- the drugs most often used for this purpose -- increase risk of death in elderly and demented patients, which has led to a dramatic drop in their use. Now, a new study published in the Canadian Medical Association Journal finds that typical antipsychotics, which may be used as an alternative, are no better.

The study was conducted using nursing home records for 10,900 patients in British Columbia. Scientists looked at all psychotropic drugs for patients 65 and older admitted to nursing homes between 1996 and 2006. That included roughly equal proportions of patients getting atypical and typical antipsychotics, as well as even more patients receiving antidepressants or benzodiazepines. After looking at outcomes for each class of patients, the researchers concluded that there was actually a lower risk of death for users of atypical antipsychotics than for patients in the other three categories. A geriatric psychiatrist from the University of Rochester, who was not connected to the study, said it was well designed, but more research was needed before doctors should change their prescribing practices.

As a Pennsylvania nursing home lawyer, I'm disturbed by these conclusions, because they suggest that no psychiatric drug is especially safe. Use of atypical antipsychotics has dropped since they got a black box warning about death, but it looks as if the clearest alternatives, older antipsychotics, carry at least an equal risk. That's unfortunate because nursing homes frequently use them -- in my opinion as a Pennsylvania injury lawyer, overuse them. Using drugs to control dementia patients' behavior may be tempting, especially for homes that have cut staff to save money and don't have the resources to handle difficult patients. However, these "chemical restraints" also leave them in a drugged state and puts them at risk of death and serious illness. I believe this is a form of Pennsylvania nursing home abuse, and families that have suffered an injury as result should hold them legally responsible.

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March 21, 2011

Western Pennsylvania Man Accused of Physical Abuse of Nursing Home Resident

One of the most high-profile and saddening things I do as a Pennsylvania nursing home lawyer is representing victims of physical abuse and their families. Pennsylvania nursing home abuse encompasses more than just hitting, but physical violence does happen, and it's completely inexcusable. Such an incident apparently occurred Feb. 7 in Washington County, Penn., outside Pittsburgh. According to a March 16 article in the Pittsburgh Post-Gazette, 34-year-old Michael Ashmore, an employee at the Washington County Health Center, is accused of snapping a towel in the face of a 93-year-old resident, and attempting to punch and choke the man.

Few details about the incident were available. According to the article, Ashmore is charged by Chartiers Township police with simple assault, neglecting to care for a dependent person and making terroristic threats. He has been fired from his job at the state-run home as well. Though the incident occurred in early February, reports of the arrest and charges began surfacing March 15. The Post-Gazette said officials at the home waited to report the incident until after they had finished an internal investigation. All three of the charges are misdemeanors, and Ashmore could face a wide range of penalties, including jail or prison time. However, the incident also likely means Ashmore will be ineligible to work with nursing home or dependent patients in the future.

As a Philadelphia medical malpractice lawyer, I hope that's the case. Pennsylvania nursing homes are supposed to do criminal background checks on all new employees, and decline to hire people with certain convictions in their past. However, as a recent federal study showed, nursing homes across the nation have still employed people with criminal convictions that should have disqualified them. There are many reasons for this: incomplete databases, no state law requiring a background check and allowing employees to start work before the background check comes through. Unfortunately, some homes even intentionally ignore or sidestep the background check requirements, irresponsibly letting inappropriate people loose to abuse or neglect vulnerable sick or elderly people. When homes hire people they knew or should have known were unqualified as caregivers, they leave themselves liable in lawsuits by injured patients and their families.

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March 14, 2011

Drug Maker Settles Charges It Promoted Antipsychotic for Dementia and Hid Dangers

As a Pennsylvania nursing home lawyer, I've followed the controversy over using antipsychotic drugs to control the behavior of patients with dementia in nursing homes. Much of the media coverage of this has focused on the use of Risperdal, but on March 10, 37 states announced that they've settled a lawsuit over another antipsychotic, Seroquel (quetiapine), with manufacturer AstraZeneca. The lawsuit accuses AstraZeneca of deceptive marketing, in part because Seroquel is not FDA-approved for treating any disorder other than schizophrenia, bipolar disorder and sometimes depression. Even more alarmingly, the manufacturer was accused of hiding negative results from studies on Seroquel's safety and effectiveness, and failing to disclose side effects. It will pay $68.5 million to 37 states; seven others are still pursuing separate lawsuits. The settlement is on top of a $520 million settlement AstraZeneca paid to the federal government last year in a similar lawsuit.

Doctors may prescribe medications off-label for any purpose they wish, but manufacturers are forbidden by law from promoting them for any unapproved purpose. The lawsuit against AstraZeneca alleged that it promoted Seroquel for Alzheimer's, dementia, anxiety and unapproved forms of depression. It also alleged that the company suppressed information about the potential for patients taking Seroquel to develop diabetes and high blood sugar. In the federal lawsuit, an email was made public in which one company official praised burying a negative scientific study as "a great smoke and mirrors job." In addition to paying the states, the company also agreed in the settlement to stop providing financial incentives for off-label marketing; ask salespeople not to promote it to doctors who are unlikely to prescribe it for an approved use; and publicize any payments to doctors on a website.

This settlement is good news for patients, families and Philadelphia medical malpractice lawyers like me. Misuse of antipsychotics in nursing homes is a serious and potentially widespread problem. Antipsychotics are powerful neurological drugs that carry significant side effects and interact with other drugs. In addition to diabetes and high blood sugar, Seroquel's concerning side effects include cardiovascular problems, increased appetite, increased risk of death, increased risk of seizures and pronounced sedation. In fact, critics call use of antipsychotic drugs in dementia patients "chemical restraint" because they can leave the patients incapacitated and uncommunicative. This takes away the need for understaffed nursing homes to control dementia patients' behavior -- but it also takes away their ability to fully experience life or communicate when something is wrong. In my opinion as a Philadelphia injury lawyer, this is a form of Pennsylvania nursing home abuse that patients should not have to endure.

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March 7, 2011

Federal Study Finds 92 Percent of Nursing Homes Have Hired a Convicted Criminal

As a Pennsylvania nursing home lawyer, I know criminal backgrounds are an ongoing problem in Pennsylvania and across the nation. Criminal background checks are required by state law in Pennsylvania and 42 other states, but the databases used can be incomplete and the employees sometimes start before the check is complete So I was extremely interested to see a report about a new federal study saying the vast majority of nursing homes have hired a convicted criminal in the past. As CBS reported March 2, the federal Department of Health and Human Services also found that about half of the homes had hired five or more people with criminal convictions.

The Inspector General of HHS conducted the study by checking names of about 35,000 employees at 260 facilities against the FBI's list of convicted criminals. The study found that five percent of all nursing home employees examined had at least one criminal conviction. The majority of the crimes, at 44 percent, were property crimes -- theft, shoplifting or bouncing checks. Another 12.5 percent were convicted of crimes against a person, such as assault and battery. Perhaps most disturbingly, seven of the 35,000 employees were registered sex offenders. And 16 percent of the convictions had come after the employee was already working in nursing homes. The inspector general recommended that nursing homes use a nationwide criminal background check program. In fact, such a program was passed along with the Obama administration's controversial health care bill, but each state's participation is voluntary.

As a Philadelphia injury lawyer, I believe it would best serve patients if participation were mandatory. I've written here several times about criminal convictions for nursing home employees, and one theme I've noticed is incomplete background checks. Convictions from Pennsylvania might show up in Pennsylvania's database, but convictions from New York or New Jersey might not. Some of this is simple bad record-keeping, but as CBS noted, only 10 of the states that require background checks require use of the FBI database. That means someone with a problematic history, including a history of nursing home abuse, sexual assault or opportunistic theft can slip under the radar simply by moving to a new state. In my opinion as a Philadelphia medical malpractice lawyer, this puts nursing home patients at an unnecessary risk. Nursing homes could be legally and financially liable for any Pennsylvania nursing home abuse that sloppy background checks fail to prevent, so careful background checks are also in their best interests.

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March 3, 2011

Judge Declines to Dismiss Johnson & Johnson Kickbacks Lawsuit as New Suit Filed

More than a year ago, I blogged about a major lawsuit against pharmaceutical company Johnson & Johnson. The issue is interesting to me as a Pennsylvania nursing home lawyer because J&J was accused of paying kickbacks to Omnicare, the nation's largest provider of drugs to nursing homes, for using its products. Among those products is Risperdal, an antipsychotic that was widely used to control dementia patients' behavior until scientists realized it actually hastens death in the elderly. Last week, a federal judge declined to dismiss the lawsuit, which is being pursued by the U.S. Justice Department because the fraud allegations affect Medicare. Also in late February, a former J&J employee filed a related whistleblower lawsuit alleging that the company also defrauded Medicaid by concealing discounts the government should have been entitled to receive.

The new lawsuit was filed by Scott Bartz, a former sales employee of the pharmaceutical company. Drug manufacturers are required to give Medicaid the same price as the lowest price given to private companies. Bartz alleges that J&J intentionally concealed discounts to others in order to inflate its prices to Medicaid for drugs including Risperdal and others given to nursing home patients. In this, he claims, J&J was aided by Omnicare and distributor McKesson. Meanwhile, the decision in the earlier whistleblower suit means J&J must defend itself in court against allegations that it paid Omnicare to increase the sales of antipsychotics in nursing homes. Omnicare has already paid $98 million to settle its portion of the Justice Department lawsuit.

As a Philadelphia injury lawyer, I'm pleased that so many of these allegations are getting their day in court. Science has shown that Risperdal and other atypical antipsychotics are dangerous for elderly people, yet those antipsychotics were prescribed heavily until the FDA took action. To make matters worse, all of those prescriptions were off-label, which means the drug was never approved to control dementia patients -- it was only ever approved for use in psychotic patients. That means safety studies focused on safety in those patients, not in the elderly or demented. Using drugs off-label in this manner as "chemical restraints" can be considered a form of Pennsylvania nursing home abuse. If you believe your loved one suffered or died because of this practice, don't hesitate to contact a Philadelphia medical malpractice lawyer to learn about your rights and legal options.

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