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The Scope of the Illinois Nursing Home Anti-Psychotic Drug Problem

Yesterday we discussed the “blockbuster” lawsuit alleging hundreds of thousands of instances of Medicare and Medicaid fraud by a Chicago doctor at nursing homes in the area. The case is a perfect testament to the real scope of the overmedication problem in nursing homes. A close look at the details of the case make clear how extensive the problem was–it is shocking that this sort of thing did not raise red flags sooner.

The full complaint in the case can be found here.

Universal Nursing Home Over-Medication
The main issue is that the doctor allegedly made decisions about prescriptions to patients based on money he received from the pharmaceutical company which made the drug. The Chicago Tribune summarized the situation by noting that the the doctor had a strong proclivity to prescribe the drug Clozaril. The drug was manufactured by Novartis. Not surprisingly, for a time Novartis actually paid the doctor to promote the drug. During that time the doctor had thousands of patients on Clozaril. In 1998 the pharmacetical company’s patent on the medication ran out, however, the doctor resisted efforts to switch patients to far cheaper generic versions of those drugs. Throughout this time he was the “largest prescriber of Clozaril to Medicaid recipeients in the United States.”

It seems that the doctor’s attachment to the drug was less due to its benefits to patients and more to the benefits to his own bottom line. When the company, Novartis, decided to stop promoting the drug and making payments to the doctor, the doctor decided to convince makers of the generic drug to provide him resources in exchange for switching patients over to the generic version.

According to the lawsuit, the manufacturer of the generic drug, Ivax Pharmaceuticals, agreed to meet the doctor’s conditions. That included a $50,000 a year “consulting agreement,” payment to his nurse to speak about the drug, and funding of a “research study” connected to the doctor at the Uptown Research Institute.

After the agreement was made, the doctor began switching his patients from Clozaril to the generics. Just like before, he began leading the nation in use of the drug. Subtlety was not in his protocol. Apparently, national averages suggest that about 4% of patients with schizophrenia were prescribed the drug–generic or otherwise. However, at times nearly half of the defendant-doctor’s patients, 50%, were on the drug. That means that his prescription rate was well over 12 times the national average.

Patient Needs Not Considered
So where did the patients fit into all of this? Who knows. It seems like that actual needs and best interests of the vulnerable patients–most of them Chicago nursing home residents with cognitive ailments–were of little importance. If the allegations made in the federal lawsuit are to be believed, then the residents were nothing more than pawns to be used by the doctor to benefit himself.

The distorted priorities highlighted by this high-profile case is indicative of the underlying problem with so much nursing home abuse and neglect. Patients needs are sacrificed to the profit-margins of higher up decision-makers. From the overmedication of residents to low staffing levels, maximizing profit for others is never an acceptable excuse for providing less than reaosonable care to each and every nursing home resident in a facility.

See Our Related Blog Posts:

Nursing Homes, Public Funds, and Overbilling

Nursing Home Medicaid Kickback Lawsuit