Monday, March 2, 2015

Dumping and Doping the Elderly

Elderly individuals living with dementia or Alzheimer's, undoubtedly, may have need for some professional assistance when it comes to mental health issues. But, the medical interventions they are currently receiving, and have received in the past, address their needs in often dangerous or unethical ways. Now the U.S. Government is getting into the discussion with its most recent report by the Government Accountability Office. And the report can be pretty jarring for anyone with a loved one receiving this type of care.

Cost may be at the root of the problem for the GAO, but there is also an indication that the Department of Health & Human Services may have been less than vigilant when it came to antipsychotic meds being prescribed for these individuals and paid for by Medicare and Medicaid. The crux of the problem, for those who have more than dollar signs in their eyes or less-than-stellar education on psych meds, is that the drugs are dangerous and can cause death. Would you agree that a loved one shouldn't be treated with a med that has been shown to have a higher degree of mortality when used for treating these patients? It's not just a simple side effect, it's death.

For me, this doesn't come as a surprise since I've seen nursing homes where the medical directors were cognitively absent because of impairment due to age or substance abuse. Some, I had been told, failed multiple times to pass qualifying exams for certification as psychiatrists and this was true in psychiatric hospitals, nursing homes and community mental health centers. The day-to-day work was left to residents-in-training with minimal oversight. The primary sketchy oversight would be a nursing supervisor. Not always, but too often to be of concern.

Dumping residents, too, isn't such an uncommon practice. Once an elderly person is quieted with psychotropic drugs, they can be quickly stopped and the aggression returns. Then the person can be transported to an ER/ED and left with no intention of readmitting them to the facility once they are admitted to the hospital. In some places, they've even rolled patients up to a bus station or a hospital door and left them. Dump'em and leave'em and you're done. Such charitable work, isn't it?

Slashing staff levels and recruiting personnel with only the slightest understanding of geriatric personality, medical and psychiatric conditions only magnifies the problems providers must tackle. How much time and energy is devoted to on-site training? Off-site usually isn't an option because the staff don't get paid for time off to attend these trainings, unless they work for state, municipal or military facilities. Even there cuts are creating educational inroads that don't bode well for the care of patients or residents in assisted-care facilities.

What does a staff member who is overworked and underinformed do when a patient suddenly starts lashing out at them? If it happens once, they may try to calm the person down by using some things they've seen work in the past such as coaxing, music, an activity or an item they enjoy. Even food can be used as an inducement to calm down. If it happens repeatedly, the usual response may be for a script for a tranquilizer or even an antipsychotic. Either of these may result in poor ambulation, falls or stupor.  The frustration is understandable, but the solutions are unacceptable.

Aside from the inadequate preparation of staff to work with patients who have dementia or Alzheimer's or some other neurologic conditions, there is the growing concern that funds are being drained off by greed. The case of one psychiatrist, working at more than 30 different facilities, stands out as a particularly egregious one.

The physician was found to have submitted somewhere in the neighborhood of 140K false claims and was a kingpin of prescribers when it came to antipsychotic medications for patients. Found guilty of fraud, he has to repay almost $4M to the Government but one has to wonder just how much he actually pocketed through these machinations and other, less obvious, forms of compensation for handing over his ethics and his prescription pad in the service of his benefactors. Medications like these don't come cheap.

The scheme, it would appear, was further enabled through the Government's actions whereby these medications were designated as a "protected class" which mandated payments for patients who had them prescribed. Sounds like they laid a carpet out for the fox into the hen house, doesn't it? Does to me.

Bells go off when we read about these present-day versions of highway robbers and it may signal that it's not safe to begin to defraud insurance companies or the Government, but that's not quite true. It's tantamount to the sudden media reports that we read about income tax fraud around tax time. The fear tactics are supposed to get everyone in line but the truly bloated fraudsters know that they will only have to pay a small portion of the lucre they reaped.

Ask yourself why the computer programs that process all these claims aren't kicking out one where a physician, a facility or a pharmacy is filling an inordinate number of these scripts. Where are the programs that would quickly shortcuit this fraud? How arcane is the computer equipment, the servers, or the programs? Are we operating with something from the last decade and has no one updated the systems to be more sophisticated in their sniffing out of these frauds?

It would seem to me that 140K claims from one guy isn't something that should have passed muster at the Government Account Office or Medicare or Medicaid offices. How did it happen and how many more of these guys/gals are slipping in under the radar? Do we need to depend on whistle blowers to signal that we are being robbed big time?

The question of money is one thing, but the larger question of an immoral, unethical system that permits our elderly to receive not just inferior treatment but injurious and deadly treatment should mean more than fines. It should mean jail time because such actions are close to manslaughter and not just of the accidental or truly unintentional kind. These are people who are so cavalier with people's lives that they seem to not even give it a second thought while they're robo-signing these scripts and refilling them at a frenetic pace.

What elder person, right now, is being drugged and put into danger by the actions of those who prefer to adapt the "it's not my job" attitude? Do we care? Should we care?

http://www.drfarrell.net