3 arrested in nursing home deaths in Lake Isabella, CA

In an elder abuse case described by one investigator as the most outrageous he has ever seen, three former top managers at a Kern County nursing home have been arrested in the deaths of three residents who allegedly were given needless doses of psychotropic medications.

The state attorney general's office contended in a criminal complaint that more than 20 residents at a skilled nursing center run by the Kern Valley Healthcare District were drugged "for staff convenience." Many of them experienced side effects that included dramatic weight loss, slurred speech, tremors, loss of cognition and even psychosis, according to the complaint.
Arraignment is scheduled this morning for the center's one-time medical director, Dr. Hoshang M. Pormir, former nursing director Gwen D. Hughes and former chief pharmacist Debbi C. Hayes. They were jailed in Bakersfield on Wednesday.

"These people maliciously violated the trust of their patients by holding them down and forcibly administering psychotropic medications if they dared to question their care," state Atty. Gen. Jerry Brown said.

All three have been charged with elder abuse. Hughes and Hayes, who are accused of administering shots by force and without consent, also face charges of assault with a deadly weapon.

The complaint paints a bleak picture of a facility dominated by nursing director Hughes, 55, who is accused of seeking to drug all but the most docile residents. Medical director Pormir, 48, allegedly rubber-stamped Hughes' orders for medication, failed to examine patients and was "either willfully or naively ignorant" of his proper role, according to the complaint. Pharmacist Hayes, 51, told investigators that she went along because Hughes had wide experience in psychiatric hospitals, the complaint says.

Hughes had been fired from a convalescent home in Fresno in 1999 for allegedly overmedicating patients there, according to state officials.

At the Kern Valley facility in Lake Isabella, she ordered medications when the elderly residents -- most of whom had dementia or Alzheimer's -- glared at her or spoke disrespectfully, according to Samuel Obair, a pharmacist who helped in the state's investigation.

"It is beyond appalling to me," he told state officials. "I have never gone into a facility and seen psychotropic medications and mood stabilizers . . . being used on so many patients, and so blatantly" without a legitimate diagnosis or careful documentation.

Among the drugs used for "chemical restraint" were Zyprexa, Depakote and Risperdal, according to the complaint. All may have benefits for certain elderly patients but carry a higher risk of damaging side effects for the frail than for the population as a whole.

Fannie May Brinkley, a woman in her 90s, might have lived another year or two had she not been given the anti-seizure drug Depakote, according to Kathryn Locatell, a physician who consulted for the state. But the drug "triggered a series of events, compounded by nursing neglect" that led to her death on Dec. 23, 2006, according to Locatell's account.
An attorney for Brinkley's family said the family didn't know how she died until a nurse who used to work at the care center tipped them off.

Phyllis Peters, Brinkley's daughter, ran into the nurse at a grocery store about a year after her mother died, said Daniel Rodriguez, an attorney representing the family in a lawsuit. The drug was allegedly administered because Brinkley wanted to go to the dining room when she wasn't supposed to be there, he said.

"The way they put a stop to that was to dope her up," he said. "She became dehydrated and lethargic and didn't want to eat. That's what did her in."

After being given Depakote and two other drugs, Joseph Shepter lost 20% of his weight in three months, became severely dehydrated, developed an infected heel ulcer and came down with pneumonia, the complaint says. The drugs "played a major role in this downhill course," Locatell said.

Shepter died Jan. 4, 2007, at 76 -- only hours after the staff realized how ill he was, according to the complaint.

Alexander Zaiko, 85, arrived at the care center Sept. 12, 2006, and died eight days later. His dosage of Zyprexa had been increased and he was given Depakote for his dementia, the complaint says.

Other residents were placed on medication for behavior Hughes deemed inappropriate, according to the complaint. It says that one woman's food was sprinkled with Depakote because she refused to eat outside her bedroom, and that another was injected with Zyprexa after throwing her milk in the dining room.

In giving such medications, nursing homes are governed by strict Medicare guidelines and protocols from professional organizations, said Freddi Segal-Gidan, a gerontologist who teaches at USC.

"You have to have a targeted symptom," she said. "You have to document what the behavior is, and that you've tried alternatives to medication."

Dr. Martin Schwartz, president of the American Geriatrics Society's California chapter, said "there's been a great movement afoot to get away" from psychotropic drugs
"For people trained in geriatrics, medicine like that is a last resort, generally speaking," he said.
The charges came after an investigation that started in January 2007, when an ombudsman complained to the state Department of Public Health. The district fired Hughes after a tenure of only five months. Hayes later left, but Pormir still works as a district physician.

The district would not comment on specific allegations, but issued a statement indicating that it "will not tolerate any behavior by employees that jeopardizes the safety of our patients." It said that state inspections since January 2007 have found no major problems.

This article was written by Steve Chawkins of The Los Angeles Times
http://articles.latimes.com/2009/feb/20/local/me-nursing-home-deaths20

The Journal of the American Medical Association (JAMA) reports that around 225,000 Americans die from medical errors per year. An individual may have a medical malpractice action if the doctor or other healthcare provider gave the patient the wrong medicine or the wrong dosage, failed to diagnose a medical condition, made the wrong diagnosis, failed to get informed consent, made errors during surgery, left items inside the patient after surgery, or committed nursing home abuse.

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