Restraint

All three were sitting in the nurses’ office, the two agency nurses and the outreach worker. The one nurse expressed frustration in response to the treatment she had been getting from her supervisor. There were chronic and on-going criticisms of her job performance, which were not warranted. This nurse had worked many years at the agency, with no problems, yet recently she could do nothing according to the supervisor. Conversation turned to the outreach worker’s concern about the agency psychiatrist’s practice of prescribing high dosages of psychotropic medications to clients. The dosages were much higher than recommended for their treatment effect. The nurse said that clients had died, implying under these psychotropic regimens. When asked, she willingly identified by name one of these clients, a developmentally disabled client. The worker found the file in the closed cases, and indeed she had been prescribed high dosages of several psychotropics by the agency psychiatrist and several medications by the group home’s physician for medical conditions, without any indication of coordinated treatment. He also found five more cases with the identical characteristics, high psychotropic medication dosages prescribed with no diagnoses to justify such medications at all. Clearly, this was appeasement of the care providers by chemically restraining residents. When looking more into the originally identified client’s case, the autopsy indicated that she had a collapsed lung; evidence of a seizure and cause of death was drowning. She was found in the bathtub. The emergency services technician who came to the scene expressed concern that a cold medication-dispensing cup was found in the bathroom at the time. She was told that she was not to worry because there was going to be an autopsy. The home’s staff declared that shampoo was put in this cup so that the resident wouldn’t use a whole bottle of shampoo while bathing alone. The resident had an early childhood history of a seizure disorder, but she had been taken off of these medications by this same agency psychiatrist years ago for no documented reason. It is important to note that the combination of cold relief medications an anti-depressant medications heighten a persons sensitivity to seizures. This was subsequently considered circumstantial and the resident’s death was deemed accidental and it all faded away. The resident’s family did contact an attorney, but nothing visible came of it. It later came out that the attorney, the psychiatrist and the agency director were friends, and after all it was a small community. Surprisingly, a home providers’ meeting minutes reported the psychiatrist indicating the state was changing its policy in using medication for behavior modification. He could no longer prescribe medication for specific behaviors, but only for diagnosed mental disorders, and could not use restraints. The home providers were incensed. They had come to expect lethargic, docile residents, presenting hardly any behavior at all. They protested that the residents needed the medication to protect the home care staff from injury.