In its seemingly endless series of well-done articles regarding the ‘state of nursing homes’ in Illinois and throughout the country, the Chicago Tribune, recently highlighted a well traveled Chicago psychiatrist– Michael Reinstein.
Putting it mildly, Dr. Reinstein has a very unique style of practicing medicine– one that commonly entails use of the powerful psychotropic medicine, clozapine. Among Reinstein’s unusual practice ‘accomplishments’:
- In 2007, he prescribed medication to 4,141 Medicaid patients
- According to an audit report, Reinstein sees 60 patients per day, 365 days per year
- He is a the psychiatric medical director at 13 nursing homes in the Chicagoland-area
- Reinstein personally write more prescriptions for clozapine than all the physicians in the state of Texas combined write for their patients.
The dangers of clozapine
Clozapine (the generic medication for Clozaril) is an anti-psychotic medication approved for use in schizophrenia and for reducing the risk of suicidal behavior in patients with schizophrenia or schizoaffective disorder.
Clozaril carries five black box warnings– the FDA’s strongest warning. Consequently, Clozaril is only approved for use in limited circumstances and the FDA requires ongoing monitoring of the patients to minimize the risk of complications.
1) Agranulocytosis– An abnormally low white blood cell count. Since white blood cells are necessary to fight diseases, this is a potentially fatal side effect. Patients being treated with Clozapine must have a baseline white blood cell (WBC) count and absolute neutrophil count (ANC) before initiation of treatment as well as regular WBC counts and ANCs during treatment.
2) Seizures- Seizures have been associated with the use of Clozapine. Studies have conclusively demonstrated that the the incidence of seizures increases as the dosage increases. Additionally, patients taking Clozapine, should be advised not to engage in any activity where sudden loss of consciousness could cause serious risk to themselves or others.
3) Myocarditis- Inflammation of heart muscle. The incidence of myocarditis has been demonstrated to substantially particularly in the first month of use.
4) Orthostatic hypotension- A large, sudden decrease in blood pressure upon standing that can result in fall.
5) Increased Mortality in Elderly Patients With Dementia- Elderly patients with dementia-related psychosis treated with atypical anti-psychotic drugs, such as Clozapine, are at an increased risk of death compared to placebo.
Not surprisingly– especially when medicating such a large group, many with high clozapine dosages– some of Dr. Reinstein’s patients have suffered adverse effects and even death related to clozapine intoxication. Who is responsible, the drug itself or the man responsible for prescribing it? Would his patients be better served with another type of treatment?
Related Nursing Homes Abuse Blog Entries