Maryland Nursing Home Lawyer Blog

Antipsychotic medications are typically used to treat patients with schizophrenia or bipolar disorder, helping reduce and control delusional thinking and hallucinations. In nursing homes around the United States, staff also use antipsychotics for patients suffering from dementia as a way of controlling paranoia and aggression. These medications can be useful for the small percentage of dementia patients who actually demonstrate psychotic behavior and constitute a risk to other nursing home residents and themselves. For most dementia patients, antipsychotics may only further isolate them and make them even less communicative. This is of particular concern to families and loved ones of dementia patients, who wish to ensure that they are receiving the best possible care.

An FDA warning from 2005 gives notice to doctors of an increased risk of death from pneumonia or heart attacks among dementia patients prescribed atypical antipsychotics. This class of drug includes Abilify, Geodon, Invega, Risperdal, Seroquel, and Zyprexa. The agency added the older class of drugs known as typical antipsychotics to that warning in 2008. Typical antipsychotics include drugs like Thorazine and Haldol. Despite the warnings, off-label use of antipsychotic medications in dementia patients continues.

The Associated Press reports that nursing homes are beginning to take notice of the risks inherent in using antipsychotics for dementia and are gradually decreasing their rate of use. One nursing home in Florida has seen a reduction in the rate from twenty-five percent of all patients to a current rate of fourteen percent. A Brooklyn, New York nursing home went from thirty to fifteen percent without much trouble. Most patients taken off the antipsychotic regimen reportedly displayed significant improvements in both mood and behavior.

Among nursing home staff, the concern is that, without the antipsychotic medications, they will be unable to control aggressive or violent dementia patients. Some patients may truly need such medication, especially since there are no FDA-approved drugs specifically treating behavioral aspects of dementia. Patient advocates cited by the Associated Press argue that the use of such medications has more to do with keeping patients sedated for staff convenience. In situations where use of antipsychotics may be endangering a patient’s life, all other concerns should be secondary to protecting the patient.

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The use of surveillance cameras to monitor treatment of elderly patients by nursing home staff, sometimes known as “granny cams,” is becoming more and more common in Maryland and around the country. While granny cams raise some concerns about the privacy rights of the patients, they have proven to be effective at exposing abuse that might have otherwise gone undiscovered, and state legislatures and agencies are taking notice.

This Maryland Nursing Home Lawyer Blog has previously reported on incidents when granny cams provided evidence of abuse, including a New Jersey case in which the family of a nursing home patient have sued for wrongful death after finding footage of an employee removing the patient’s oxygen mask and hitting her, which they claim led to her death. An Ohio man captured evidence of nursing home staff slapping his Alzheimer’s-stricken mother, shoving her into bed and into her wheelchair, and slamming her against walls. Three nursing home workers in Pennsylvania were arrested when hidden camera footage showed them mocking a patient while forcing her to stand topless.

The nursing home industry has vigorously fought legislative efforts to compel nursing homes to allow placement of cameras in patients’ rooms. Privacy advocates, as well as doctors, have also opposed such legislation at times, arguing that placement of cameras could be used to violate patients’ privacy, considering that nursing home patients requiring assistance in performing daily routines may often appear undressed on camera. Nursing homes further argue that the use of cameras may erode the trust between patients and staff and act as an invitation to lawsuits without good cause. Nursing home reform advocates, however, increasingly favor legal requirements that nursing homes allow cameras.

Some states have passed legislation preventing nursing homes from blocking the use of cameras, although Maryland is not yet one of them. Former Maryland Delegate Sue Hecht introduced such legislation several times beginning in 2001, after she witnessed her mother, Vera, suffering abuse at the hands of nursing home staff. Several bills titled “Vera’s Law” did not make it out of their committees, but a bill passed in 2003, also titled “Vera’s Law,” that required the Maryland Department of Health and Mental Hygiene to develop guidelines that do opt to allow use of electronic monitoring devices with the consent of the patient or the patient’s guardian. The Department issued its guidelines on December 1, 2003, and those guidelines remain in effect today.

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A study has identified a link between increasing rates of influenza vaccination among nursing home staff and decreasing rate of flu infection among patients. The study, which looked at 75 New Mexico nursing homes, found an 87% decrease in the likelihood of a flu outbreak in facilities where 51% to 75% of direct care workers received vaccinations. This supports earlier findings from the Centers for Disease Control and Prevention, which has encouraged healthcare workers to get vaccinated against the flu.

Interestingly, the study also found that high rates of vaccinations among nursing home patients led to higher odds of a flu outbreak in that home. Researchers suggest that this is due to lower rates of vaccination among staff in nursing homes with high rates of patient vaccinations. This finding would further support the conclusion that high rates of staff vaccination keeps outbreak rates low.

The Centers for Disease Control and Prevention (the “CDC”) currently recommends that healthcare workers obtain annual vaccinations against the flu. Their research found that only 13% of healthcare workers reported a requirement of vaccination from their employers. At the same time, a substantial majority of healthcare workers reported vaccinations being available at work, often at no charge.

Outbreaks of disease in the nursing home environment are a persistent concern. Officials at a nursing home in Turtle Creek, Pennsylvania are currently fighting an outbreak of Legionnaire’s disease that has sickened eight people so far. A 2009 study in Ontario, Canada found that, of the 83 disease outbreaks reviewed, 91% of them occurred in long-term care facilities. A 2003 study published in the journal Clinical Infectious Diseases found that one-third of the reports of infectious diseases from nursing homes involved sudden disease outbreaks. The study examined reports of respiratory infections, including influenza, tuberculosis, and pneumonia; gastrointestinal illnesses such as E. coli, salmonella and viral agents; skin infections; and antibiotic-resistant bacteria. The study concluded that the environment of nursing homes allows easy transmission of disease outbreaks, largely due to close living conditions, lack of proper diagnostic equipment, and the already-diminished health condition of many nursing home residents. Recommendations included greater management plans and surveillance of symptoms in patients to try to recognize diseases before they reach outbreak status.

Vaccinating nursing home staff against known contagions is an important step in this process. Nursing homes must also commit to maintaining a clean environment for its residents. Many infectious diseases can reach outbreak status in a nursing home simply due to a lapse in cleaning. Respiratory illnesses such as influenza are commonly transmitted directly from one person to another, but germs can also persist on various surfaces. An elderly individual, practically one with an already-suppressed immune system, who comes into contact with a contaminated surface risks infection.

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A nursing director at a Maryland nursing home faces charges of forging signatures on prescription slips and attempting to obtain oxycodone at an area pharmacy. On August 24, 2011, Maryland State Police arrested Pamela Brittingham Quillen, nursing director of Manokin Manor Nursing & Rehabilitation Center in Princess Anne, and charged her with prescription forgery. She was released that day on a $5,000 bond.

Quillen is accused of forging the signatures of two individuals: Vincent Lewis, a physician's assistant at Manokin Manor, and Dr. Vel Natesan, an internist in nearby Salisbury, Maryland. She then allegedly took the forged prescription to Karemore Pharmacy in Princess Anne. A pharmacist contacted Dr. Natesan’s office to verify the prescription. Dr. Natesan received a faxed copy of the prescription, confirmed with Lewis that it was a forgery, and contacted state police. Video surveillance footage also places Quillen at the pharmacy at the time the prescription was presented. Quillen now faces a trial date on October 14.

Coverage of this story offers no indication of any history of drug use or abuse by Quillen, nor does it address her employment at a nursing home. She is charged with five separate offenses:

• obtaining a prescription by fraud under Maryland Criminal Code section 5-701(d)(4)(i);
  
• obtaining a prescription by counterfeit or alteration under Maryland Criminal Code section 5-701(d)(4)(ii);
  
• obtaining a prescription by concealment under Maryland Criminal Code section 5-701(d)(4)(iii);
  
• personal identity information theft under Maryland Criminal Code section 8-301(c)(2)(i); and
  
• theft of less than $100.00 under Maryland Criminal Code section 7-104.

Each of these offenses is a misdemeanor under Maryland law, carrying maximum jail terms from 90 days up to 2 years and fines up to $5,000.00. She will get her day in court, but her case demonstrates the importance of professionalism and care in nursing homes, particularly in positions of leadership.

To operate a Maryland nursing home, one must be licensed as a nursing home administrator by the Board of Examiners of Nursing Home Administrators. Nursing home administrators must adhere to a high standard of care in carrying out their professional duties. A nursing home can be a large and complex organization, requiring management of doctors, nurses, medical technicians, and other employees, not to mention the care of sick and elderly patients with a vast range of needs.

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