I was honored to be asked to start writing periodic blog posts for Long Term Living Magazine (LTLM). LTLM is read by many professionals in the nursing home and long-term living industry. I hope my blog posts provide a unique perspective to the issues repeatedly encountered by the hardworking men and women who are entrusted with caring for our elders. Feel free to contact me if you have an idea for a post.
Have you heard about the nursing home employees charged with the intentional drugging of residents at Kern Valley Nursing Home, in California? That’s right—three nursing home employees including the director of nursing, the pharmacist, and staff physician are all facing criminal charges related to the inappropriate use of sedatives and psychotropic medications to control the behavior of residents they were responsible for caring for.
A nursing home ombudsman first reported the situation to authorities when she witnessed the staff at Kern Valley forcibly restraining a resident as sedatives were injected against the person’s will. The ombudsman documented how nursing home staff administered narcotics without a physician’s order or supervision.
Use of chemical-restraints in nursing homes is not only dehumanizing but also against the law. The OBRA (Omnibus Budget Reconciliation Act of 1987), which provides Federal regulation of the nursing home industry specifically, states that: (1) residents are to be free from unnecessary drugs of all types, and (2) free from chemical restraints commonly thought of as psychotropic drugs, including antipsychotics, antidepressants, and hypnotic medications.
In this situation, the druggings resulted in severe physical deterioration of many residents because they were unable to eat and drink in their diminished capacity. An investigation into the matter by the California Attorney General concluded the deaths of three residents were directly related to the inappropriate use of medication.
While the alleged criminal behavior of the nursing home employees definitely deserves attention, perhaps the most startling part of this news story revolves around the Director of Nursing at Kern Valley. During her tenure at Kern Valley, the nursing director, Gwen Hughes, was allegedly able to employ an abusive agenda of forcibly medicating elderly nursing home residents who were deemed ‘disruptive’ by her. Hughes apparently instructed the entire staff at Kern Valley on what residents should be medicated and with what drugs. No one on the entire staff voiced any opposition to the unnecessary and harmful orders.
Prior to working at Kern Valley, Hughes worked at another California nursing home where she was fired for behavior similar to that which she stands accused of. After a state investigation, it was confirmed Hughes acted inappropriately when dispensing high dosages of psychotropic medication to residents. “We were so cowed and threatened with losing our jobs and our licenses that after a while we just shut our mouths and did what we had to do,” according to Trish Orr, a registered nurse for 25 years who worked with Hughes.
How can one woman bully the workers at two nursing homes into carrying out her cruel medical orders without any questioning on the part of the staff? Is Hughes so persuasive that nurses would blindly follow orders that pose a significant health risk to residents?
In this case there is obviously plenty of responsibility to go around with respect to the acts allegedly committed by the three employees at Kern Valley. At this point, there are no other criminal charges or civil fines pending against any of the co-workers or supervisors of the three indicted.
With the public outrage over situations like this reaching a boiling point, it is important for administrators and employees to use this incident as a learning tool and implement preventative measures at their facilities to assure situations like this don’t occur in the future. A healthy dose of common sense can prevent situations like this from occurring in the first place and decrease the likelihood of an accompanying lawsuit.
How to protect your facility
Conduct a thorough screening of all applicants. In this day and age you can never assume any of the information you receive from an applicant is correct. References must be contacted and, if possible, interviewed in person. You can learn quite a bit about your potential job candidate by the body language and tone of the person you are interviewing.
Contact an agency that does thorough background checks. Relatively inexpensively ($100 – $200) you can learn quite a bit about a perspective employee. Information contained in background searches can provide equally valuable insight in making an evaluation as to a candidate’s ‘fit’ with a facility as an interview.
Keep an open door policy. Encourage employees, in all positions and all levels of seniority, to mingle with administrators and facility executives. Encouraging employees to interact not only increases the likelihood they will speak up when they see potentially suspicious behavior, but will also provide valuable insight as to how patient care can be improved. Employees who feel like their input matters are more likely to be effective and have decreased incentive to look for other jobs.
We will never know if implementation of similar procedures could have prevented the tragedy at Kern Valley from occurring. The reality is that all the procedures in the world can’t take the place of common sense and good judgment on behalf of all employees. Don’t let the rotten apples taint the staff at your facility.
Jonathan Rosenfeld is a lawyer who represents people injured in nursing homes and long-term care facilities. Visit his personal blog at https://www.nursinghomelawcenter.org.