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Bill would require consent to use antipsychotics

Concern about overuse of anti­psychotic medications and similar drugs in nursing homes, hospitals, and other health care facilities has prompted a sweeping proposal that would require Massachusetts facilities to inform patients, or their legal representatives, in writing of the medications’ risks, benefits, and alternatives.

This informed consent process would need to be repeated every three months if patients were taking these drugs long term, under a bill filed Friday by Representative Shaunna O’Connell, a Taunton Republican, and Senator Patricia Jehlen, a Somerville Democrat who has cochaired the Joint Committee on Elder Affairs.

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O’Connell said their proposal targets the wide spectrum of medications known as psychoactives — including antipsychotics, antidepressants, antianxiety drugs, and sleep aids — because research has shown that when regulators crack down on one type of psychoactive drug, such as antipsychotics, facilities sometimes get around the rules by switching to another psychoactive drug.

A Boston Globe series last year found that nursing homes in Massachusetts and nationwide often prescribed antipsychotics to control difficult behavior in residents with dementia, though they can leave residents in a stupor.

The federal government has also warned that the drugs can have potentially fatal side effects in such people.

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“We want to encourage these facilities to really concentrate on alternative treatment and therapy and finding out what the root of a problem might be, rather than too quickly prescribing these very powerful drugs,” O’Connell said.

“I hope all of the health facilities come with an open mind, and work with us to come up with the right bill that protects [patients] and is something health care facilities can comply with,” she said.

Jehlen said the legislation “isn’t perfect,” because it is more tailored to patients with families that are paying attention to their care, as opposed to the many who lack close relatives and instead have court-appointed guardians.

“There needs to be a bunch of prongs to the solution and one of them is family awareness and consent,” Jehlen said.

O’Connell said the harrowing experiences of one of her constituents, Nancy Sylvester, a Taunton first-grade teacher, inspired her to pursue the proposal.

A close friend of Sylvester’s was hospitalized with a blood infection in 2011 and was prescribed a sleep aid that, she said, led to swallowing problems and lethargy.

The 89-year-old was soon transferred to a rehabilitation hospital and prescribed an antidepressant and then an antipsychotic, without his family’s knowledge, Sylvester said.

“All of this happened within two weeks,” she said.

“They said he has dementia. He didn’t have dementia,” Sylvester said. “Up until this time he was walking to his own [kidney] dialysis” treatment.

The man developed a severe bed sore in the rehab hospital and died a few months later, she said.

The proposed legislation allows facilities to prescribe psychoactive medication without written consent if a patient “is at imminent and serious risk of physical or emotional harm,” or puts others at risk.

But in these cases, it requires written consent to be obtained after two days.

Scott Plumb, senior vice president of Massachusetts Senior Care, said the nursing home trade group was still analyzing the proposal and declined to comment.

The Massachusetts Hospital Association said in a statement that while the issue is “a very important topic,” the association also had not had a chance to thoroughly review it.

Paul Raia, vice president of professional clinical services at the Alzheimer’s Association of Massachusetts and New Hampshire, said the bill, if approved, would give consumers a lot more information than they typically receive.

“I see this as a good thing for those with dementia and others,” he said.

Kay Lazar can be reached at klazar@globe.com. Follow her on Twitter @GlobeKayLazar.
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