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CANHR Launches New Website to Help Fight Drugging of Nursing Home Residents

California Advocates for Nursing Home Reform (CANHR) is pleased to announce the launch of a new website dedicated to stopping the drugging epidemic in California nursing homes: http://www.canhr.org/stop-drugging/

The first-of-its kind website is the next step in CANHR’s Campaign to Stop Chemical Restraints in Nursing Homes. The website is full of valuable information to help consumers and advocates fight the widespread use of antipsychotic drugs and other psychoactive medications that are used to drug residents into submission. Its features include:

• A petition urging the Governor to crack down on nursing home misuse of psychoactive drugs;
• A 3-part CANHR video series on how to prevent drugging of nursing home residents;
• The Stop Drugging Our Elders Blog, featuring regular commentary by CANHR staff and special guests;
• Toxic Medicine, CANHR’s free consumer guide on how to fight nursing home misuse of psychoactive drugs;
• Information on use of psychoactive drugs by each Medicare and Medi-Cal certified nursing facility in California (this data is located in the News & Resources Section under Advocacy Actions);
• An extensive News & Resources section that contains information on legal options for victims, pertinent laws & regulations, media articles, alternatives to drugs, studies and reports, the latest advocacy actions, government investigations & prosecutions, and more.

On Tuesday the Assembly Committee on Aging and Long Term Care held an oversight hearing on the long term care Ombudsman Program in CA.  The Ombudsman Programs were represented by Joe Rodrigues, State Long Term Care Ombudsman and three local ombudsman coordinators. Creating an independent State Ombudsman Office – moving the Ombudsman office out of state govt. – was added as the last item on the agenda.

I was unable to attend due to prior scheduling issues, but  I did send a letter on behalf of the Committee for an Independent State Office (CISO) and we were represented admirably by a member of our committee, Linda Robinson, Santa Cruz County Ombudsman Coordinator.  Below is a link to California Watch which picked up on the hearing, interviewed Linda, and attached a copy of our letter to their article.

We are committed to continue working toward a truly independent state office that can speak up and for residents in long term care.

http://californiawatch.org/watchblog/local-987-elder-care-ombudsmen-revolt-call-4-independent-leader

Sylvia Taylor-Stein

Executive Director

Long Term Care Services of Ventura County, Inc.,

If you are an elderly person living in a nursing home it is quite possible you are one of the 60 percent who have outlived their family and friends or have no family or friends who ever visit. You most likely have no one who will speak up for you, check on you, and look out for you. You need a watchdog.

The organization that serves as the watchdog for almost 8,500 seniors in 234 nursing homes and assisted living facilities in Ventura County is the Long Term Care Services of Ventura County, Inc., Ombudsman Program.

For almost 30 years, this program made up of a small staff and volunteers, has continually worked on behalf of elderly residents in long-term care to help ensure their care and quality of life.

Since 2008, when Gov. Arnold Schwarzenegger vetoed $3.8 million in funding for the local ombudsman programs throughout California, services to residents have been in jeopardy.

Last year, a portion of the lost funding was restored by using existing penalties paid by nursing homes cited for providing deficient care. A recent audit of that account, however, reveals funds were overstated and the account is almost insolvent. In the current budget crisis, there are no general funds that can be tapped.

The lifeline that could rescue this vitally important program is 6-year-old legislation, Assembly Bill 1629, which is currently undergoing much- needed reform.

In 2004, the Legislature passed AB1629 to increase MediCal rates paid to nursing homes, with the intent the extra funding would improve quality of care through increased staffing and wages. Many advocates objected to this bill because there was no accountability to ensure the funds would be used as intended.

Six years later, three significant studies show that despite receiving almost $1 billion in additional funding, nursing home residents are worse off than ever.

California legislators are now enacting reforms to AB1629 as part of the state budget process. Under consideration are changes that would create accountability measures, cut out wasteful and inappropriate expenses and generate savings.

Advocates are urging legislators to utilize a portion of the savings from these reforms — $3.8 million — to fund local long-term care ombudsman programs statewide.

“Annual MediCal spending on nursing homes is about $4 billion. Out of a $4 billion budget, California should be able to find at least $4 million to get the ombudsman program back on its feet,” said Michael Connors of California Advocates for Nursing Home Reform.

A nursing home resident said it best, “All my family is gone. My only visitor is my ombudsman. He helps me so much; he speaks up for me. I don’t know what I would do without him.”

We urge California legislators to “speak up” for nursing home residents as well. A very small investment in the local ombudsman programs in California can help ensure that the state’s colossal investment in nursing-home care will result in better care and quality of life for all residents in all nursing homes.

Make permanent funding of the local ombudsman programs an essential reform of AB1629.

Go to link below if you would like to comment to the Ventura County Star article.

http://www.vcstar.com/news/2010/jul/06/funds-sought-for-local-ombudsman-programs/

Link to “Complaints Up Against County Care Facilities”

http://www.vcstar.com/news/2010/jul/03/complaints-up-against-county-care-facilities-law/?print=1
………………………………………………….

Sylvia Taylor-Stein

Executive Director

Long Term Care Services of Ventura County, Inc.,

www.ombudsmanventura.org

a 501 (c) 3 non profit organization

This means that U.S. DOJ has found that all three of the most commonly used antipsychotics used to drug elders with dementia — Seroquel, Risperdal and Zyprexa — are being illegally marketed for this purpose. Eli Lilly agreed to pay $1.4 billion last year to settle such charges involving Zyprexa. The U.S. DOJ filed a lawsuit against Johnson & Johnson earlier this year for illegally peddling Risperdal to nursing home doctors.

Here is the DOJ press release:

Attorney General Eric Holder spoke at the press conference.

Here is his statement:

Here is a New York Times article. I’m sure there will be more news tomorrow.

The New York Times

April 26, 2010

For $520 Million, AstraZeneca Will Settle Case Over Marketing of a Drug

By DUFF WILSON

AstraZeneca has completed a deal to pay $520 million to settle federal investigations into marketing practices for its blockbuster schizophrenia drug, Seroquel. The Justice Department plans a news conference on Wednesday to disclose details of the case, according to two people close to the negotiations who were not authorized to discuss it publicly.
AstraZeneca becomes the fourth pharmaceutical giant in the last three years to admit to federal charges of illegal marketing of antipsychotic drugs, a lucrative category of medications that have quickly risen to the top of United States sales charts. Aggressive sales and promotional practices have helped expand the use of powerful new antipsychotic drugs for children and the elderly.
AstraZeneca will sign a corporate integrity agreement with the federal government over its marketing of Seroquel for unapproved uses, but will not face criminal charges, the people close to the negotiations said.

The company, based in London, has been accused of misleading doctors and patients by playing up favorable research and not adequately disclosing studies that show Seroquel increases the risk of diabetes.

AstraZeneca still faces more than 25,000 civil lawsuits filed on behalf of patients contending that the company did not disclose the drug’s risks.
The deal would make formal an agreement in principle the company reached last October with the United States attorney in Philadelphia. At that time, AstraZeneca said in a filing with the Securities and Exchange Commission that it had set aside $520 million in respect to the investigation.
The company was facing two federal investigations and two whistle-blower lawsuits involving Seroquel sales and marketing practices. One of the investigations related to physicians who had participated in clinical trials. The other inquiry involved sales staff. Details are expected to be announced Wednesday.
As a result of aggressive marketing, Seroquel has been increasingly used for children and elderly people for indications not approved by the Food and Drug Administration. The drugs have caused rapid weight gain in children, and side effects including deaths have prompted warnings against giving the drugs to elderly patients for dementia.
Although doctors are permitted to prescribe any approved drug for off-label uses, it is illegal for drug makers to promote medications for any purpose not specifically approved by the F.D.A.
Tony Jewell, a company spokesman, declined to comment on Monday. Patricia Hartman, a spokeswoman for Michael L. Levy, the United States attorney in Philadelphia, said she would neither confirm nor deny the report. “We don’t have anything public on AstraZeneca,” Ms. Hartman said.
AstraZeneca, which reported $4.9 billion in Seroquel sales in 2009, plans to report its first-quarter financial results on Thursday.
The company will join a series of American pharmaceutical companies that have admitted to illegal marketing after federal investigations and whistle-blower filings and have signed agreements with the government to monitor and avoid such activity in the future.
In the largest such case, Pfizer paid $2.3 billion last September, including $1.3 billion in the biggest criminal fine of any type in United States history, for off-label marketing of the painkiller Bextra and other drugs. Bextra was withdrawn from the market in 2005. The Pfizer fine included $301 million for off-label marketing of its antipsychotic drug Geodon.
Eli Lilly paid $1.4 billion in January 2009 to settle investigations into illegal marketing of its antipsychotic drug Zyprexa. Lilly’s settlement included a $515 million criminal fine, which until the Pfizer case was the largest such fine ever imposed on a corporation.
In 2007, Bristol-Myers Squibb and a subsidiary paid $515 million to settle federal and state investigations into marketing of its antipsychotic drug Abilify.
The newer generation of antipsychotics has surpassed cholesterol-lowering drugs to become the nation’s top-selling category of medications, accounting for $14.6 billion of the nation’s $300 billion in drug spending last year, according to the research firm IMS Health.
Seroquel, a pill usually taken once or twice a day that sells for more than $4 each, was the fifth-best-selling drug in the United States last year, IMS said. As with other antipsychotics, much of that spending is by the federal government, through the Medicaid and Medicare programs.
AstraZeneca, with American headquarters in Wilmington, Del., has previously denied wrongdoing in the Seroquel investigations. It has paid $656 million to defend itself in court against more than 25,000 civil lawsuits, the company said in an S.E.C. filing in January. Those cases are only recently beginning to reach trial.
The company has argued that people who were found to have diabetes after taking Seroquel already had diabetes or had existing conditions that made them at high risk of the disease.
According to company e-mail unsealed in civil lawsuits, AstraZeneca “buried” – a manager’s term – a 1997 study that showed Seroquel users gained 11 pounds a year, while publicizing a study that claimed users lost weight. Company e-mail messages also refer to doing a “great smoke-and-mirrors job” on unfavorable studies.

Gardiner Harris contributed reporting.

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Michael Connors
Advocate
California Advocates for Nursing Home Reform (CANHR)
Tel:  415/974-5171
Fax: 626/796-6256
Email: michael@canhr.org

Visit our web site at http://www.canhr.org

To help support our efforts, please visit:
http://www.canhr.org/help.html

The email below is from our funding team leader. Not really encouraging news from our hearing yesterday on  AB2555, but we have a lot of support and hope that we can continue to move this forward.

Thank you all so much for your many support letters.  They do make such a difference in these tight situations.

We are deeply appreciative.
Sylvia

Ombudsman Funding Committee

……………………………………………………………………………..

Hello All,

AB 2555 hit a speed bump at today’s Assembly Appropriations Committee hearing, where it was sent to the Suspense file. Nonetheless, we are very hopeful that it will move forward in a timely fashion due to the tremendous support for the bill.

Mike Feuer made a strong, passionate presentation, stressing that the ombudsman program helps save lives but cannot do so without funding. He advised the committee of the dire consequences if the funding is allowed to run out at the end of June and called for timely action on the bill. Although AB 2555 was sent to the Suspense file, the committee chair, Felipe Fuentes, seemed open to the possibility of taking action before May 27 when bills on the Suspense file are scheduled to be taken up.

Tippy Irwin did a great job as lead witness and was joined by about a dozen supporters and co-sponsors. Co-author Jim Nielsen and Assembly Member Calderon made strong statements in support of the bill and the urgency of its passage. The Department of Finance didn’t have any comments or concerns about the bill and the opponents didn’t speak at the hearing.

We are consulting with Arianna Smith of Mike Feuer’s office about the best way to keep the bill moving forward as quickly as possible and will keep you posted on how you can help.

In the meantime, please continue to urge legislators to support the bill. Please inform legislators in your area about the value of the ombudsman program and the urgency of passing AB 2555 in a timely manner. Please encourage legislators to sign on as co-authors of AB 2555 if they haven’t already done so and express thanks to those who are supporting the bill. Favorable media attention would also be very helpful.

Many thanks to all of you for the great support. Special thanks to the Alzheimer’s Association for making AB 2555 one of its top priorities for its advocacy day today. We are thrilled that 130 of its wonderful advocates worked the Capitol today to promote the bill.

A related item of interest: California Watch published an interesting article today on the pending audit and DPH’s failure to collect nursing home fines. See below. Additional information is posted on the California Watch website.

http://californiawatch.org/watchblog/why-state-only-collecting-one-third-nursing-home-fines

Why is state only collecting one-third of nursing home fines?

April 21, 2010 | Christina Jewett

California lawmakers have called for an audit exploring why state regulators are collecting only about one-third of the fines they have levied against nursing homes in recent years.

A legislative committee unanimously approved the audit in February. It is expected to look at how the funds that were collected have been spent in light of laws that say the money should be used to protect the health of residents in nursing homes.

“The whole point of having citation accounts and the penalty system is to deter nursing homes from doing anything but provide the highest quality care to residents,” said Mike Feuer, D-Los Angeles, one of 10 lawmakers who signed a letter calling for the audit. “If the fines coming in are less than a third of (those) issued, it leaves one to wonder if the state is being as effective as it could be in protecting nursing home residents.”

The Department of Public Health has levied fines in recent years after workers hit patients, stole from them or left them languishing in dirty diapers.

Records released to California Watch under the Public Records Act show that the state’s fine collections are falling behind. In 2005, authorities had collected 60 percent of the fines they levied, about $1.8 of $3 million.

However, by 2008, authorities collected a smaller portion of the fines, about $1.5 million of $5 million that had been assessed, or less than 30 percent.

In contrast, the same state department, the Department of Public Health, has collected nearly 80 percent of the fines it levies against hospitals that fail to report preventable errors, records show.

Kathleen Billingsley, deputy director of the Department of Public Health Center for Healthcare Quality, said in an interview that her office has hired 95 inspectors since 2006 who complete the inspections and have issued a rising number of citations.

Billingsley said nursing homes have the right to appeal fines and do not have to pay until the process is completed in administrative and state courts. When nursing homes are faced with a final fine amount, the department is equipped to force many nursing homes to pay, she said.

The department can garnish a nursing home’s Medi-Cal payments to collect unpaid fines, leverage it holds over 75 percent of the state’s nursing homes that accept low-income patients.

The state, however, writes off unpaid fines if a facility goes bankrupt, changes ownership or does not accept patients through the Medi-Cal program, a spokesman said.

While the appeal process delays fine collections, there are other reasons nursing homes don’t pay the full amount. In 2007, records show, half of the $4 million in nursing home fines issued were categorized as “allowable adjustments.” That means homes may have qualified for a 35 percent discount allowed under law for homes that pay promptly.

In other cases, an administrative law judge or mediator pares down a fine, a scenario that is becoming increasingly common. Since 2005, the number of cases that nursing homes appeal has doubled, from 110 to more than 220 in 2008, Department of Public Health records show.

Critics of the waning fine fund point to a 2004 law that gave nursing homes a powerful incentive to fight the penalties. That law, AB 1629, overhauled nursing home funding and allows nursing homes to bill the state for legal fees spent fighting citations.

It’s a scenario that Sen. Elaine Alquist, D-Santa Clara, calls a “perverse incentive.” Other advocates call it outrageous and scandalous. “It undermines everything,” Alquist said. “We know that enforcement really needs to improve.”

And even as more nursing home owners are appealing more cases, they are seeing settlement proceedings end with deeper and deeper discounts. Authorities knocked $320,000 in fines down to $20,000 for one Los Angeles County nursing home, according to Department of Public Health data and citation-review-conference records.

Those fines were accumulated after workers turned off an alarm to a ventilator, an action that prevented workers from immediately realizing that a 90-year-old patient was disconnected from her breathing tube and was slipping away, records show.

Workers at the same home were cited 11 more times for continuing to dismiss the ventilator alerts, records show. Those citations each carried a $20,000 fine, but each was dismissed in an appeal hearing.

Lydia Sainz, administrator of Casa Bonita Convalescent Hospital, said the eventual dismissal of the bulk of the fines was the appropriate outcome. She said she felt the state reacted harshly under pressure from the outspoken family of the 90-year-old who died after her ventilator alarm was turned off. And she said the nurses who later dismissed other alarms did so when patients were in no distress.

Sainz said the state’s efforts to penalize the facility were a poor use of public funds. “It’s really sad because it’s hard to work in places like nursing homes and then you get a bad (reputation),” Sainz said. “It’s really hard for the nurses.”

Other observers, commenting generally on the state’s waning rate of fine collections, see the trend as evidence that nursing homes face little accountability if their actions or inactions harm patients.
“As long as facilities know there’s no punitive damage, nothing will change,” said Joan Parks, manager of the nonprofit Ombudsman Services of Northern California.

The Bureau of State Audits report on the nursing home fine fund is expected to evaluate the laws and rules governing the state’s collection of the fines and recommend better ways to go forward.

--

Michael Connors
Advocate
California Advocates for Nursing Home Reform (CANHR)
Tel:  415/974-5171
Fax: 626/796-6256
Email: michael@canhr.org

Visit our web site at http://www.canhr.org

To help support our efforts, please visit:
http://www.canhr.org/help.html

———

Joan S. Parks,
AdministratorOmbudsman & HICAP Services of Northern California
3950 Industrial Blvd. Suite 500
West Sacramento, CA 95691
916/375-3307Fax 916/376-8914
jparks@osnc.net

It shows that hundreds of California nursing homes used increased Medi-Cal funding to pad profits by cutting staffing and wages. It ran in many California papers:

The Press Democrat – Santa Rosa  (PDF)
The Orange County Register (PDF)
Contra Costa Times (PDF)
Oakland Tribune  (PDF)
San Jose Mercury News (PDF)
Press Telegram Long Beach (PDF)
The Press-Enterprise – Inland Southern California’s Newspaper (PDF)

Many newspapers gave the story front page treatment and gave local examples of abuse and neglect.

The findings of this detailed investigation help demonstrate the dire conditions in many California nursing homes and the great need for a fully functioning ombudsman program.

Mike
–

Michael Connors
Advocate
California Advocates for Nursing Home Reform (CANHR)
Tel:  415/974-5171
Fax: 626/796-6256
Email: michael@canhr.org

Visit our web site at http://www.canhr.org

To help support our efforts, please visit:
http://www.canhr.org/help.html

Here is a link to the online Los Angeles Times story of the same name taken from testimony.

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This came to me this morning from one of our volunteers.  We have been aware of this case in LA County since it occurred, but the Los Angeles Times article brings out the horrendous details.  More than ever we need strong advocacy for our seniors in long term care.

Sylvia

Sylvia Taylor-Stein

Executive Director

Long Term Care Services of Ventura County, Inc.,

A Novel Take on Assisted Living
By PAULA SPAN

“Breaking Out of Bedlam”

I can’t say with assurance that Leslie Larson’s “Breaking Out of Bedlam” is the first novel set in an assisted living facility, so I’ll just say it’s the first one I’ve read, and that it’s a kick.

The fun comes from meeting protagonist Cora Sledge, an 82-year-old in a perpetual rage because her children have moved her into a place called The Palisades. Ornery Cora hardly qualifies as a model resident: she smokes though she has emphysema; she purposely takes so many pills that her days pass in a haze; she’s a casual bigot; she’s rude. Overweight and underactive, barely able to walk down the hall without wheezing, Cora won’t be one of those elegant silverhairs shown strolling the grounds in an assisted living brochure.

But reading her “journals,” as she reawakens, finds a friend and a paramour, and plots her escape, is a hoot. (I’ll overlook the fact that The Palisades, drawn broadly for comic effect, sounds more like a nursing home than an assisted living residence.) I was less interested in Ms. Larson’s plot twists than in Cora’s scathing observations about aging, families, assisted living and more.

A sample (the italics are Cora’s own, and so is one four-letter word I’ve had to bleep): I am sick to death of pastels, elastic waists, and baggy knits. Why is it that, once you turn sixty, you’re supposed to wear the same colors as babies? Pale pink andpowder blue, dingy yellow and that pukey lavender that turns my stomach. You see it all over here: old ladies walking around like wedding mints or Jordan almonds, milquetoast pastels that drive you to the depths of depression.

I want some patterns. Flowers. Stripes or triangles or polka dots. Bold prints. And some bright colors. Scarlet, peacock blue, royal purple. Fuschia, poppy, watermelon, chartreuse! But oh no. When you’re fat, you’re supposed to wear dark colors. Flat black, navy blue, and [bleep] brown. That’s about it. Otherwise, somebody might notice you.

Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”

………………………….

I am definitely buying this book!!

Sylvia

Sylvia Taylor-Stein

Executive Director

Long Term Care Services of Ventura County, Inc.,

I am posting an email from our funding workgroup leader, and I am asking for your support.  You helped us so much last year to get legislation (AB392)  passed that provided funding for the local ombudsman programs statewide.  This funding made the difference for some of our local ombudsman programs to keep their doors open.

Her letter explains where we are today with our AB 392 funding.  Please see Joan’s letter below and support our efforts to have the source of our funding – the federal citations penalty account audited.

We thank you so much for standing with us,

Sylvia

Sylvia Taylor-Stein

Executive Director

Long Term Care Services of Ventura County, Inc.,

~~~~~~~~~~~ THE LETTER ~~~~~~~~~~~~~~~~~~~~

TO:

Ombudsman Funding Workgroup
Ombudsman Support Network – Co-Sponsors AB392
Ombudsman Coordinators

FROM: Joan Parks & Mike Connors
RE:       Status of Ombudsman Funding – FY2010-2011

DATE:  January 28, 2010

Dear Friends,

We need your immediate help to obtain an audit of the DPH citation penalty accounts in order to ensure that moneys in the accounts are available to help fund the local long term care ombudsman programs.

Before explaining how you can help, here is a very brief update on plans for ombudsman funding legislation this year.

Assembly Member Mike Feuer is considering our request to carry a bill that would replicate AB 392 by seeking a $1.6 million appropriation in FY 10/11 for local ombudsman programs from the citation penalty accounts. He is concerned about the availability of funds in the citation accounts and has been seeking updated information from DPH. We hope to learn his decision soon and to schedule a call with all of you to discuss plans for moving forward.

There are strong signs that the Administration and Department of Public Health will oppose continuation of the AB 392 funding. The money is not in the Governor’s budget. Additionally, DPH wrote key legislative budget officials earlier this month reporting that the federal citation penalty account is virtually bankrupt. The Department’s documentation shows a retroactive $2.6 million offset to this account but doesn’t explain the disappearing funds.

Thus the need for an audit. Fortunately, Mike Feuer and several other legislators wrote the attached letter to the Joint Legislative Audit Committee (JLAC) seeking an audit by the Bureau of State Audits. The Committee is scheduled to consider this request during its next hearing on Wednesday, February 17 at 9:30 am in Room 444 of the Capitol. See attached letter.

This is where we need your help. Before February 17th, please send letters of support for the audit to Assembly Member Alyson Huber, Chair of the Joint Legislative Audit Committee, and copy your letters to the other members of the JLAC, which includes 7 members from the Assembly and 7 members from the Senate. The Committee Roster is listed at: http://www.assembly.ca.gov/acs/newcomframeset.asp?committee=208

We are in competition for other audit requests and must take this opportunity to share our compelling reasons. The letter to Assembly Member Huber can serve as a guide for your letter.

If you have any questions, please do not hesitate to contact us. Many thanks for your continued support!

Joan S. Parks, Administrator

Ombudsman & HICAP Services of Northern California3950 Industrial Blvd. Suite 500West Sacramento, CA 95691916/375-3307
Fax 916/376-8914

jparks@osnc.net

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