Drugged seniors were prescribed by doctors: Minister

Ontario Health Minister Deb Matthews acknowledged the drugging of seniors in provincially regulated nursing homes is a problem but suggested doctors are responsible.

“Let’s remember, it’s doctors who prescribe these drugs, not the government,” Matthews told reporters in a heated scrum at Queen’s Park.

The minister’s comments came after a Star investigation found provincially regulated nursing homes are drugging helpless seniors despite warnings that the powerful antipsychotics can kill elderly patients suffering from dementia.

“What we know is that there are a lot of people being prescribed drugs that raise questions and this work is well underway to make sure that doctors who are prescribing . . . are doing so appropriately,” Matthews told reporters at Queen’s Park. Matthews did not elaborate on what work is being done to ensure appropriate prescribing practices by doctors.

“This is a serious issue, make no mistake about it,” Matthews said. She pointed out that caregivers associated with Behavioural Supports Ontario are doing “fantastic work” controlling the behaviour of people with dementia in nursing homes without drugs. Last year, Ontario invested $43 million in this program.

“It is the way to go and we are going in that direction,” Matthews said.

The Star article, published Monday, revealed some long-term care homes, often struggling with staffing shortages, are routinely doling out these risky drugs to calm and “restrain” wandering, agitated and sometimes aggressive patients. At more than 40 homes across the province, roughly half the residents are on the drugs. At close to 300 homes, more than a third of the residents are on the drugs.

NDP Leader Andrea Horwath said Tuesday the Star’s findings were “horrifying.”

At one nursing home east of Ottawa, the Star found, 73 per cent of the residents are on the drugs. A leading drug safety expert on Tuesday called the high rate “madness.”

The head of the long-term care physicians association, Dr. Andrea Moser, did not take issue with the minister’s comments in an interview with the Star.

The use of antipsychotics is “a system issue. You can’t point a finger at one person,” said Moser.

“A lot of good work has been done over the last couple of years. We’re making progress. We still have a long way to go.”

Matthews’ suggestion that the government is not involved in prescribing decisions “outraged” the head of the registered nurses association, Doris Grinspun.

Grinspun said the province can do more to boost training and staffing levels at nursing homes so that caregivers rely less on antipsychotics to control agitation in those with dementia.

“I am, quite frankly, outraged at anyone, let alone the minister, who tries to divert responsibility. It’s all of our responsibility,” Grinspun said.

While doctors ultimately make the decision to prescribe, experts the Star spoke with said it is often done after consulting with long-term care home staff, including nurses and personal support workers, or PSWs.

The medications at issue, including olanzapine, quetiapine and at least 10 others, are not approved by Health Canada for elderly people with dementia. Pharmaceutical companies have issued the strongest possible caution, known as a black-box warning, on their labelling.

“Elderly patients with dementia treated with atypical antipsychotic drugs are at an increased risk of death compared to placebo,” a typical warning says, adding that these patients face a 60 per cent increased risk of death compared with similar patients who are not taking these drugs.

In one of the cases probed by the Star, antipsychotic medication was apparently given to a senior without consent.

Ethel Geraldine Anderson, known as Aunt Gerry to her loved ones, is among such cases reported in the Star investigation. Anderson’s niece said “they tried to quiet her down” with doses of olanzapine in the Wellesley St. nursing home where she was living. Four months later, she was dead.

In a heated scrum with reporters, Matthews said it is clear to her that “doctors cannot prescribe this kind of medication without the consent of the individual or their substitute decision maker.”

Matthews, who cautioned reporters that the information the Star has is “raw data,” added that her government is making investments in care plans that will provide “alternatives to that pharmaceutical solution.”

Nursing homes and the association representing them have also acknowledged the problem and called on the province to act. A fellow member of Matthews’ Liberal government, MPP Donna Cansfield, has said the province must act.

Family members, doctors and, in one case, the provincial coroner believe that prescriptions for these drugs have contributed to the deaths of Ontario seniors with dementia.

France Gelinas, the NDP health critic, said Tuesday the “deadly crisis” must be addressed. “The consequences of excessive prescribing of antipsychotic drugs can and has been deadly.”

The NDP said a 2007 auditor general report warned the government about the overuse of antipsychotic drugs.

“I am shocked that the government has not moved on this issue even though they’ve known about it for some time,” said Horwath.

Several homes with high rates told the Star they are trying to get their prescribing rates down. Where possible, they want to devote resources to “behavioural” therapies, whereby caregivers are trained to identify and neutralize what triggers agitation in residents with dementia. Triggers may include hunger or physical contact in common living areas.

Earlier this year, Health Minister Matthews announced funding to place nurse practitioners in 75 long-term care homes over a three-year period. Grinspun, of the nurses association, said the announcement is a start but more help is needed to address a provincewide problem.

Statistics obtained by the Star show rates of antipsychotic use at 631 nursing homes in the first half of 2013 averaged 33 per cent.