What is the name of your state (only U.S. law)? CO
I'll try to be brief, but this gets very complicated. It's a long one no matter how I slice it though. My elderly mother had been in an assisted living community for years, and aside from getting out to shop could take care of herself with few issues.
On July 11, 2010, my mother went to the hospital complaining of weakness. She was 75 at the time with Parkinson's disease, so her ability to move varies from day to day. In nearly all other aspects she is physically and mentally fit.
Her hospital stay lasted about 3 days. Tests did not show anything wrong, and the hospital decided to send her to short term rehabilitative care for physical therapy; 2-3 weeks tops.
Now for the complicated part. While at the hospital, she was catheterized. Within a day of arriving at Rehab Facility #1, she had called me saying that they were "chaining her down to the bed and torturing her", and that I had to come get her right away. Very unlike my mother!
Two days later, I received a call from Facility #2 asking me to come fill out intake documents - I had no idea she was even being transferred. They told me that my mother was ranting and violent, and they did not feel she was capable of understanding what was going on. So I came in and signed the admissions papers for her, wondering what the hell was going on.
Shortly afterward, I was called by Facility #2 and they told me that my mother was trying to hit people, so they gave her "something to calm her down." I was not told what it was, but I felt that mom could probably use a good night's sleep. Her recent behavior was completely foreign to me, like she was off on another planet!
Over the next couple weeks, mother would call me at random times with wild stories that did not make any sense at all. Hallucinations, paranoia, slurred speech, inability to move, dry mouth, muscle pain, and her Parkinson's tremors were out of control. I finally asked a nurse to tell me all the medications they were giving mom, and the answer I got was, "Well, you know, just the usual ones."
When I pressed, the nurse listed all of them in rapid succession by name. I then asked her to list them one by one and tell me what they are for, and after hesitating she did so. There were two Parkinson's meds (Requip, Sinemet) and three for hypertension (the ones I knew about). Also added were an OTC laxative, a heartburn medicine, a multivitamin, Vicodin(!), and one called Seroquel.
"What is Seroquel?" I wondered, so I did some research. It is an antipsychotic drug made by AstraZeneca meant to treat dementia in adults, but IS NOT recommended to treat elderly patients as there are too many harmful side effects, including death. It has known contraindications with Parkinson's meds, effectively neutralizing them. It is a central nervous system depressant, and can amplify the effects of other CNSDs such as hypertension meds and Vicodin.
In essence, if you could choose a patient that should NEVER receive Seroquel for any reason, it would be my mother; and this was the medicine they used to "calm her down." A layman can figure this out in 10 minutes with Google; I expect a PhD to know better!
So how did this happen? When my mother came in to Facility #2, she was still agitated and acting inappropriately. Remember the catheter? As it turns out (which was new to me at the time), when elderly people get urinary tract infections (UTIs), it often makes them bat-$#!t crazy. So when a catheterized patient comes in acting nutty with no history of dementia, nearly every nurse, doctor, director, intern, and even janitor I spoke with knew that the first thing to do is test for UTIs. Instead, the first step the doctor decided on was to administer Seroquel to my mother, making her barely able to move and think. The second thing he did was to give her "cognitive tests" while on Seroquel and suffering from the UTI. He then used the test results to "self-justify" continuing Seroquel. Only AFTER all of this did they check for a UTI (and found it, of course) and gave her antibiotics. When I questioned the doctor, he told me he was "not interested in my opinion." The people at Facility #2 stated that Seroquel use in elderly patients is "standard practice." When I presented evidence that it should not be given to my mother and asked why they chose to ignore all the warnings from NIH, the FDA, and AstraZeneca, I was told that "everybody does it." Many heated arguments ensued.
Over the next few months, my mother went in and out of lucidity, could not complete physical therapy, and went in and out of the hospital with other complications. I fought tooth & nail to have the Seroquel permanently discontinued, but each time she went to the hospital or another Facility they put her right back on it based on the first doctor's "diagnosis" of dementia!
By September 2010, my mother was transferred to Facility #4, which is a secured facility specializing in dementia and Alzheimer's patients. Mom could barely move, could not sit up, transfer, go to the bathroom, or eat without constant assistance. This once proud, self-sufficient, mentally capable woman had been reduced to nearly an empty shell, and said over and over that she wished she could just die. We were told that due to my mother's condition that she would not improve, and we should prepare to live with her like that for the rest of her life.
I know my mother, and I know she's not demented. I believe that she had been inappropriately given a medicine that started a chain reaction of botched healthcare, and that the end result of the first doctor's decision to ignore the multiple, documented warnings and push Seroquel was mom's near comatose nightmare of existence behind four locked doors in a dementia asylum.
A month before, I had contacted a lawyer to draft permanent POA and Living Will documents, but it kept being delayed due to mom's multiple trips. On Sept 21, 2010 I was officially granted durable medical and financial POA for my mother. Within the next two weeks, we arranged for her to be moved to Facility #5, which is her current place of residence. Unfortunately, it is private pay only and costs quite a lot per month, but their level of care is far superior to the previous Kaiser facilities.
In a short time, following my directions as POA, we had readjusted mom's medications and allowed her to "get back to normal." She can sit up, transfer back & forth from the bed to her wheelchair, and can even walk across the room by herself. Her mental ability has returned, with a few "holes" in her memory from the previous months. Essentially, by simply doing what I asked from the very beginning, my mother has improved dramatically and is about 90% of where she was prior to July 2010. At least that's the good news!
She doesn't have much memory of what had happened, so to her it's as if she went to the hospital in July, had months of nightmares, and woke up in her current place. When we describe what happened, she gets very angry and wants her life back. She was never told about the Seroquel and not given an opportunity to refuse it.
Further research has shown that inappropriate Seroquel (quetiapine) use on elderly patients is a common complaint, and that AstraZeneca has already settled multiple lawsuits related to it; there are even rumors of "kickbacks" from A-Z for prescribing it. There was no medical reason to give Seroquel to my mother, and I believe that many facilities like to use it because it makes "difficult" patients easy to deal with. This is a blatant violation of 42 CFR § 483.13: “(a) Restraints. The resident has the right to be free from any physical or chemical restraints imposed for purposes of discipline or convenience, and not required to treat the resident’s medical symptoms.”
I have been stretched very thin with all the additional drama that has ensued, and I am low on energy at this point. But I feel that the doctor who "shoehorned" my mother into an incorrect dementia diagnosis should be held responsible for what he caused!
Does my family have a leg to stand on in regards to the inappropriate use of Seroquel, or can physicians hide behind their ability to prescribe anything off-label and the general acceptance of ignoring all Seroquel warnings? If it was the doctor who chose to give the Seroquel despite the warnings (i.e. we did not know or approve of this), is he liable for what the drug causes?
Sorry this is so long, but it really is the shortened version of the last 9 months. I know the statute of limitations is 1 year, so I need some advice on how to proceed.
ThanksWhat is the name of your state (only U.S. law)?What is the name of your state (only U.S. law)?What is the name of your state (only U.S. law)?
I'll try to be brief, but this gets very complicated. It's a long one no matter how I slice it though. My elderly mother had been in an assisted living community for years, and aside from getting out to shop could take care of herself with few issues.
On July 11, 2010, my mother went to the hospital complaining of weakness. She was 75 at the time with Parkinson's disease, so her ability to move varies from day to day. In nearly all other aspects she is physically and mentally fit.
Her hospital stay lasted about 3 days. Tests did not show anything wrong, and the hospital decided to send her to short term rehabilitative care for physical therapy; 2-3 weeks tops.
Now for the complicated part. While at the hospital, she was catheterized. Within a day of arriving at Rehab Facility #1, she had called me saying that they were "chaining her down to the bed and torturing her", and that I had to come get her right away. Very unlike my mother!
Two days later, I received a call from Facility #2 asking me to come fill out intake documents - I had no idea she was even being transferred. They told me that my mother was ranting and violent, and they did not feel she was capable of understanding what was going on. So I came in and signed the admissions papers for her, wondering what the hell was going on.
Shortly afterward, I was called by Facility #2 and they told me that my mother was trying to hit people, so they gave her "something to calm her down." I was not told what it was, but I felt that mom could probably use a good night's sleep. Her recent behavior was completely foreign to me, like she was off on another planet!
Over the next couple weeks, mother would call me at random times with wild stories that did not make any sense at all. Hallucinations, paranoia, slurred speech, inability to move, dry mouth, muscle pain, and her Parkinson's tremors were out of control. I finally asked a nurse to tell me all the medications they were giving mom, and the answer I got was, "Well, you know, just the usual ones."
When I pressed, the nurse listed all of them in rapid succession by name. I then asked her to list them one by one and tell me what they are for, and after hesitating she did so. There were two Parkinson's meds (Requip, Sinemet) and three for hypertension (the ones I knew about). Also added were an OTC laxative, a heartburn medicine, a multivitamin, Vicodin(!), and one called Seroquel.
"What is Seroquel?" I wondered, so I did some research. It is an antipsychotic drug made by AstraZeneca meant to treat dementia in adults, but IS NOT recommended to treat elderly patients as there are too many harmful side effects, including death. It has known contraindications with Parkinson's meds, effectively neutralizing them. It is a central nervous system depressant, and can amplify the effects of other CNSDs such as hypertension meds and Vicodin.
In essence, if you could choose a patient that should NEVER receive Seroquel for any reason, it would be my mother; and this was the medicine they used to "calm her down." A layman can figure this out in 10 minutes with Google; I expect a PhD to know better!
So how did this happen? When my mother came in to Facility #2, she was still agitated and acting inappropriately. Remember the catheter? As it turns out (which was new to me at the time), when elderly people get urinary tract infections (UTIs), it often makes them bat-$#!t crazy. So when a catheterized patient comes in acting nutty with no history of dementia, nearly every nurse, doctor, director, intern, and even janitor I spoke with knew that the first thing to do is test for UTIs. Instead, the first step the doctor decided on was to administer Seroquel to my mother, making her barely able to move and think. The second thing he did was to give her "cognitive tests" while on Seroquel and suffering from the UTI. He then used the test results to "self-justify" continuing Seroquel. Only AFTER all of this did they check for a UTI (and found it, of course) and gave her antibiotics. When I questioned the doctor, he told me he was "not interested in my opinion." The people at Facility #2 stated that Seroquel use in elderly patients is "standard practice." When I presented evidence that it should not be given to my mother and asked why they chose to ignore all the warnings from NIH, the FDA, and AstraZeneca, I was told that "everybody does it." Many heated arguments ensued.
Over the next few months, my mother went in and out of lucidity, could not complete physical therapy, and went in and out of the hospital with other complications. I fought tooth & nail to have the Seroquel permanently discontinued, but each time she went to the hospital or another Facility they put her right back on it based on the first doctor's "diagnosis" of dementia!
By September 2010, my mother was transferred to Facility #4, which is a secured facility specializing in dementia and Alzheimer's patients. Mom could barely move, could not sit up, transfer, go to the bathroom, or eat without constant assistance. This once proud, self-sufficient, mentally capable woman had been reduced to nearly an empty shell, and said over and over that she wished she could just die. We were told that due to my mother's condition that she would not improve, and we should prepare to live with her like that for the rest of her life.
I know my mother, and I know she's not demented. I believe that she had been inappropriately given a medicine that started a chain reaction of botched healthcare, and that the end result of the first doctor's decision to ignore the multiple, documented warnings and push Seroquel was mom's near comatose nightmare of existence behind four locked doors in a dementia asylum.
A month before, I had contacted a lawyer to draft permanent POA and Living Will documents, but it kept being delayed due to mom's multiple trips. On Sept 21, 2010 I was officially granted durable medical and financial POA for my mother. Within the next two weeks, we arranged for her to be moved to Facility #5, which is her current place of residence. Unfortunately, it is private pay only and costs quite a lot per month, but their level of care is far superior to the previous Kaiser facilities.
In a short time, following my directions as POA, we had readjusted mom's medications and allowed her to "get back to normal." She can sit up, transfer back & forth from the bed to her wheelchair, and can even walk across the room by herself. Her mental ability has returned, with a few "holes" in her memory from the previous months. Essentially, by simply doing what I asked from the very beginning, my mother has improved dramatically and is about 90% of where she was prior to July 2010. At least that's the good news!
She doesn't have much memory of what had happened, so to her it's as if she went to the hospital in July, had months of nightmares, and woke up in her current place. When we describe what happened, she gets very angry and wants her life back. She was never told about the Seroquel and not given an opportunity to refuse it.
Further research has shown that inappropriate Seroquel (quetiapine) use on elderly patients is a common complaint, and that AstraZeneca has already settled multiple lawsuits related to it; there are even rumors of "kickbacks" from A-Z for prescribing it. There was no medical reason to give Seroquel to my mother, and I believe that many facilities like to use it because it makes "difficult" patients easy to deal with. This is a blatant violation of 42 CFR § 483.13: “(a) Restraints. The resident has the right to be free from any physical or chemical restraints imposed for purposes of discipline or convenience, and not required to treat the resident’s medical symptoms.”
I have been stretched very thin with all the additional drama that has ensued, and I am low on energy at this point. But I feel that the doctor who "shoehorned" my mother into an incorrect dementia diagnosis should be held responsible for what he caused!
Does my family have a leg to stand on in regards to the inappropriate use of Seroquel, or can physicians hide behind their ability to prescribe anything off-label and the general acceptance of ignoring all Seroquel warnings? If it was the doctor who chose to give the Seroquel despite the warnings (i.e. we did not know or approve of this), is he liable for what the drug causes? Sorry this is so long, but it really is the shortened version of the last 9 months. I know the statute of limitations is 1 year, so I need some advice on how to proceed.
ThanksWhat is the name of your state (only U.S. law)?What is the name of your state (only U.S. law)?What is the name of your state (only U.S. law)?