You can now read 10 articles a month for free. Read as much as you want anywhere and anytime for just 99¢.
  

Speakers clash over need for written consent for antipsychotic drugs

Physicians and consumer advocates clashed over regulations on prescribing psychoactive drugs to nursing home residents during a legislative committee meeting Tuesday at the State House.

Three bills — two in the Senate, one in the House — would require that doctors obtain written consent from patients or their legal representatives before prescribing antipsychotics and other powerful mind-altering drugs in nursing homes or hospitals.

Continue reading below

The patient advocates, professional caregivers, and legal specialists supporting the bills said they were a start, but did not go far enough to curb the rampant use of these drugs. The bills’ opponents, represented by three doctors from the Massachusetts Psychiatric Society, warned against adding legal hurdles to doctors’ ability to prescribe medicine that might be necessary to treat the mentally ill elderly.

A Globe series last year recounted overuse of antipsychotics in nursing homes, especially to sedate older residents suffering dementia.

On being admitted to a nursing home or hospital, patients typically are asked to give broad consent to whatever treatment doctors believe is needed, and physicians will usually discuss their treatment plans with patients or their families, especially when they propose to use nonstandard options.

But speakers recounted for the Joint Committee on Elder Affairs a litany of examples of patients who were treated with psychoactive drugs, even though they were not psychotic and had not agreed to the medications.

The pending bills would replace the standard informal conversation between patient and doctor with a uniform set of rules: Doctors would have to provide written information about side effects and the necessity of a drug, giving patients the opportunity to review it, before receiving their consent in writing.

Sharlene Hemp, 62, of North Andover testified Tuesday about her father’s death in 2001, which she said was caused by side effects of psychotropic drugs only 34 days after being admitted to a nursing home.

Hemp’s father had dementia, but was not declared incompetent to make medical decisions, so his wife and daughter were not legally declared his proxies. When caretakers in his facility found him wandering down the hall and entering the wrong room, they did not legally need to obtain his consent or anyone else’s. Seeing his late-night walk as a dangerous emergency, they gave him an antipsychotic.

“He was pacing the floor. How is that an emergency?” she asked. “And how long does an emergency last? He was still being prescribed [the drugs] . . . even when he was comatose and he couldn’t even speak.”

Emotional anecdotes stood alongside doctors’ testimony. Though Dr. David Harnett, a geriatric psychiatrist in Medford, said he did not think “the picture was rosy,” he and other mental health professionals said they worried about the many nursing home residents who are mentally ill and do need psychoactive drugs, such as antipsychotics, antidepressants, antianxiety drugs, and sleep aids.

Harnett and Dr. Jim Ellison, clinical director of McLean Hospital in Belmont, both said they believed the current system for obtaining informed consent protects residents.

“No one would roadblock medications by oncologists or cardiologists, even though they can be more dangerous,” said Harnett. He cited an example from his practice of a patient’s daughter who said low doses of antipsychotics for her mother were “a miracle.”

Sanjena Sathian can be reached at sanjena.sathian@globe.com.
Loading comments...

You have reached the limit of 10 free articles in a month

Stay informed with unlimited access to Boston’s trusted news source.

  • High-quality journalism from the region’s largest newsroom
  • Convenient access across all of your devices
  • Today’s Headlines daily newsletter
  • Subscriber-only access to exclusive offers, events, contests, eBooks, and more
  • Less than 25¢ a week