Thursday, February 26, 2009

Tuesday, February 24, 2009

3 Skilled Nursing Facility staff arrested for drugging deaths of patients

Report from thje Kern Valley Sun

Attorney General Jerry Brown today announced the arrests of a nurse, physician, and a pharmacist of the Kern Valley Healthcare District's Skilled Nursing Facility for “forcibly administering psychotropic medications for their own convenience, rather than for their patients’ therapeutic interests.” The Attorney General said these actions are alleged to have resulted in the deaths of three residents.

Taken into custody earlier today, Feb. 18, by California Department of Justice special agents were Gwen Hughes, the former Director of Nursing at the Skilled Nursing Facility of the Kern Valley Healthcare District in Lake Isabella, on charges of elder abuse and assault with a deadly weapon; Debbi Hayes, the former pharmacist at KVHD, on charges of elder abuse and assault with a deadly weapon; and Dr. Hoshang Pormir, a staff physician at Kern Valley Hospital, who was serving as the medical director of the Skilled Nursing Facility, on charges of elder abuse.

“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,” Attorney General Brown said. “This is appalling behavior, which amounts to assault with a deadly weapon.”

According to the statement issued by the Attorney General's office, Hughes, upon taking over as Director of Nursing in September 2006, ordered that Alzheimer’s and other dementia patients be given high doses of psychotropic medications to make them more tranquil and easy to control. It goes on to say, “She ordered the administration of these medications to patients who argued with her, were noisy, or who were otherwise disruptive.” Two patients who resisted were held down and forcibly given injections.

The complaint also alleges that Hughes directed Debbi Hayes, the hospital pharmacist, to fill prescriptions for these psychotropic medications. Hayes wrote and filled these prescriptions without first obtaining a doctor’s approval, the complain said.

According to complaint, Pormir approved these psychotropic medications only some time after they had been administered and without examining the patients first and determining whether these psychotropic medications were medically necessary.

Investigators allege that several of these patients had medical complications as a result of being given these psychotropic medications, including lethargy and the inability to eat or drink properly. It is believed that that three patients died and one patient suffered great bodily injury as a result.

The case came to the attention of authorities in January 2007, when an ombudsman reported to the Bakersfield office of the California Department of Public Health that a patient in the Skilled Nursing Facility had been held down and given an injection of psychotropic medication by force.

The Department of Public Health immediately sent an investigative team with a doctor, a nurse, and a doctor of pharmacology. They determined that 22 patients, including some who were suffering from Alzheimer’s at the Skilled Nursing Facility, were being given high doses of psychotropic medication not for therapeutic reasons, but to simply control and quiet them for the convenience of the staff.

The Department of Public Health issued a Certificate of Immediate Jeopardy which resulted in the immediate dismissal of the Ms. Hughes. The matter was then turned over to the California Department of Justice, Bureau of Medi-Cal Fraud and Elder Abuse.

Special Agents from the Bureau of Medi-Cal Fraud and Elder Abuse began a year-long investigation, with the co-operation and assistance of the Department of Public Health and the administration of the Kern Valley Healthcare District.

Pamela Ott, CEO at the time, left the district in May 2007. Current KVHD Board of Directors Chair Kay Knight said, “A lot of people don't understand that this happened more than two years ago and is not going on now.”

Chet Beedle, Chief Financial Officer, reported that CEO Rick Carter and Board of Directors spokesperson Victoria Alwin were unavailable. He added that he was prohibited from commenting on the arrests and that a formal statement was coming.

A search warrant was served on the facility in August 2008, resulting in the seizure of 36 patients' medical files and records.

Criminal charges were filed in Kern County Superior Court and the defendants are being held in Kern County Jail in Bakersfield. Pormir is charged with one felony count of causing harm/death of an elder of dependent adult. He is being held on $400,000 bail. Hughes and Hayes are each charged with two felony counts, one count of causing harm/death of an elder of dependent adult and another felony count of assault with a deadly weapon other than a firearm of great bodily force. The trio will be arraigned in Superior Court in Bakersfield Friday morning. If convicted, the defendants could face up to 11 years in prison.

The case is being prosecuted by the Attorney General’s Bureau of Medi-Cal Fraud and Elder Abuse, with the co-operation and assistance of the Kern County District Attorney’s Office.

More than half of all foster children in Texas above 6 are drugged, 41,3% of those who receive medication receive 3+ different classes of medicines

Who are the real child abusers here? More than half of all foster children in Texas above 6 receive psychotropic medication, 41,3% of those who receive medication receive 3+ different classes of medicines. A study published in Pediatrics, the Official Journal of the American Academy of Pediatrics

Psychotropic Medication Patterns Among Youth in Foster Care

Julie M. Zito, PhD a,b,
Daniel J. Safer, MD c,
Devadatta Sai, MS a,
James F. Gardner, ScM a,
Diane Thomas, BA d,
Phyllis Coombes, MA d,
Melissa Dubowski, BS d and
Maria Mendez-Lewis, MPA d

Departments of

a Pharmaceutical Health Services Research
b Psychiatry, University of Maryland, Baltimore, Maryland
c Department of Psychiatry and Pediatrics, Johns Hopkins Medical Institutions, Baltimore, Maryland
d Office of the Texas Comptroller of Public Accounts, Austin, Texas


CONTEXT. Studies have revealed that youth in foster care covered by Medicaid insurance receive psychotropic medication at a rate >3 times that of Medicaid-insured youth who qualify by low family income. Systematic data on patterns of medication treatment, particularly concomitant drugs, for youth in foster care are limited.

OBJECTIVE. The purpose of this work was to describe and quantify patterns of psychotropic monotherapy and concomitant therapy prescribed to a randomly selected, 1-month sample of youth in foster care who had been receiving psychotropic medication.

METHODS. Medicaid data were accessed for a July 2004 random sample of 472 medicated youth in foster care aged 0 through 19 years from a southwestern US state. Psychotropic medication treatment data were identified by concomitant pattern, frequency, medication class, subclass, and drug entity and were analyzed in relation to age group; gender; race or ethnicity; International Classification of Diseases, Ninth Revision, psychiatric diagnosis; and physician specialty.

RESULTS. Of the foster children who had been dispensed psychotropic medication, 41.3% received ≥3 different classes of these drugs during July 2004, and 15.9% received ≥4 different classes.

The most frequently used medications were antidepressants (56.8%), attention-deficit/hyperactivity disorder drugs (55.9%), and antipsychotic agents (53.2%).

The use of specific psychotropic medication classes varied little by diagnostic grouping.

Psychiatrists prescribed 93% of the psychotropic medication dispensed to youth in foster care. The use of ≥2 drugs within the same psychotropic medication class was noted in 22.2% of those who were given prescribed drugs concomitantly.

CONCLUSIONS. Concomitant psychotropic medication treatment is frequent for youth in foster care and lacks substantive evidence as to its effectiveness and safety.

Full Study at the Link

Thursday, February 19, 2009

Fourteen psychiatric patients have been sterilised in the Perm region of Russia against their will and without an appropriate court ruling.

As reported in Russia Today

This was the striking discovery made by the region’s human rights committee over the course of a two-year investigation, revealing numerous grave offences.

After receiving more than 50 complaints from patients of the 15 psychiatric asylums in the Perm region, an investigation was launched to analyse living conditions in these institutions. After two years of detailed study, a series of shocking discoveries was made.

Read more

Fourteen young women, born in the 1970s and 1980s were sterilised against their will, without the signed permission of their families or any appropriate court ruling. As the report states, the most poignant justification of these actions came from an unnamed asylum staff member. They did it so that the women “would not give birth to lunatics”.

In the Russian legislation, sterilisation of legally capable women is only permissible with their accord and when they’re aged over 35, or already have two children. When the woman is not legally capable, the signed permission of two gynaecologists and a court ruling are required.

There exists, however, an appendix to the law, which states that sterilisation can be carried out based purely on medical reasons if there exists “a threat to the woman’s life or health”. Staff have tended to interpret this appendix at will, using it to cover many sterilisations.

According to the human rights commission, the staff at the institutions were not even aware that a court decision was required to conduct the procedure. They based their decision simply on the advice of the institution’s administration.

Other infringements

It was discovered that the shocking cases of unlawful sterilisation were not the only cases of severe breaches of human rights in these psychiatric institutions. The official report drafted by Tatyana Margolina outlined three main areas of severe infringements of human rights in these institutions: medical care, the right to housing and the right to fair employment.

Perhaps the most fundamental malpractice in the institutions is the lack of adequate healthcare provision. According to the report some psychiatric institutions do not even have an appropriate medical licence.

Despite being state organisations, the institutions need to renew their medical licence every few years. Of those whose license had expired, the most recent renewal was in 2001. Since then, no new medical or diagnostic supplies were provided and no new medical personnel had been taken on.

“In several institutions medical attention was not provided and people simply died,” Margolina pointed out in the report. “Their death was a result of appropriate measures not being taken in due course.”

The lack of a medical licence resulted in the absence of basic medicines and diagnostic equipment. This has resulted in several deaths due to negligence in the last two years alone. The report refers to a number of unnamed cases. The causes of death named by coronary analysis include untreated and misdiagnosed pneumonia, a stomach ulcer and meningitis.

The last case is given specific attention. The patient was admitted to an institution and passed away only days later. The orderly simply gave the patient medicines against flu-like symptoms and proceeded to ignore the case for the next two days, during which the patient’s condition steadily worsened. Renewed medical attention was only given when the patient was on his deathbed, but it was too late. Even then, an appropriate diagnosis was not made.

Staff members point out that they don’t even call ambulances for the patients since the medics simply refuse to drive out to the institutions. In most places, no individual rehabilitation programmes were developed for patients. Some do not even have a stock of the required anti-psychotic drugs.

As a result, the patients’ abilities are not developed to their fullest potential. According to the report, some of the patients would have had the chance to do basic manual work and provide for themselves if given the appropriate training. Nevertheless, such fundamentals as sports equipment, professional and educational training and development programmes simply do not exist in Perm region institutions.

The living space provided for the patient is often far less than the basic minimum required by the Russian state. Some patients live in as few as three square metres of individual space with no access to privacy – nurses often break through locked doors and into restrooms as well as shower facilities.

The report points out that the conditions in the institutions breach several clauses of the UN charter and the human rights declaration: the patients do not have access to medical care, individual space, basic dignity, employment and personal development. Nevertheless, the report only goes as far as “advising” the local administration and the relevant institution to take these facts into account.

Regional problem?

Despite the gravity of the problem and its deep-rooted nature, the local administration appears to be inert in dealing with it. RT tried to get information of what the regional government is planning to do in order to resolve this shocking breach of basic human rights.

“Tatiana Margolina is refusing to give any comments on the situation, referring to the fact that it is a regional problem and the report was released regionally,” the human rights commissioner’s press office told RT.

When the local administration’s press office was contacted directly, RT was told that the general office does not have the competence to comment on such issues, and the human rights commission should be contacted.

As a result, no official comment was given on how the living conditions of the psychiatric patients will be ameliorated. So, despite the severe cases of human rights breaches and even abuse from state care providers being brought to public light, it remains unclear what will be done.

Wednesday, February 11, 2009

Pennsylvania judges accused of jailing kids for cash

As seen in this report

For years, the juvenile court system in Wilkes-Barre operated like a conveyor belt: Youngsters were brought before judges without a lawyer, given hearings that lasted only a minute or two, and then sent off to juvenile prison for months for minor offenses.

The explanation, prosecutors say, was corruption on the bench.

In one of the most shocking cases of courtroom graft on record, two Pennsylvania judges have been charged with taking millions of dollars in kickbacks to send teenagers to two privately run youth detention centers.

"I've never encountered, and I don't think that we will in our lifetimes, a case where literally thousands of kids' lives were just tossed aside in order for a couple of judges to make some money," said Marsha Levick, an attorney with the Philadelphia-based Juvenile Law Center, which is representing hundreds of youths sentenced in Wilkes-Barre.

Prosecutors say Luzerne County Judges Mark Ciavarella and Michael Conahan took $2.6 million in payoffs to put juvenile offenders in lockups run by PA Child Care LLC and a sister company, Western PA Child Care LLC. The judges were charged on Jan. 26 and removed from the bench by the Pennsylvania Supreme Court shortly afterward.

No company officials have been charged, but the investigation is still going on.
This fits into a larger pattern nation wide of sending kids away for "treatment" whenit is really for profit.