In 2007, the Ontario Auditor General directed the Ontario Ministry of Health and Long-Term Care to improve its oversight of medication management in nursing homes. It was also told to ensure informed consent and monitor high-risk residents regarding prescriptions. The Ministry’s response was to enact legislation in 2010 meant to facilitate better care for nursing home residents and increase training and resources for health care providers so it could achieve that.
Less than six months after the new Long-Term Care Homes Act, 2007 had come into force, the Toronto Star broke a story about widespread negligence and abuse of residents in Ontario nursing homes. Once again, the government responded, this time by spending $59 million dollars to hire and train more health care providers.
Apparently, $59 million doesn’t buy what it used to. According to 2013 provincial data shared by Liberal Etobicoke Centre MPP Donna Cansfield’s office, long-term care facilities continue to be plagued by nursing shortages and personnel lacking specialised training to deal with complex conditions like dementia, which 63% of residents suffer from. This has led to an alarming reliance on “off-label” [i.e. using a drug to treat a condition or age group in a manner which is not approved by Health Canada] use of antipsychotic drugs to manage agitated or aggressive residents. Powerful antipsychotics like risperidone, olanzapine or clozapine, are routinely used to control the behaviour of dementia suffers, despite the serious risk atypical usage poses to long-term health and its horrible side effects .
According to 2013 data released by MPP Canfield’s office , an average of 33% of residents in 631 long-term care homes are prescribed antipsychotics. That’s over twice the rate found among the U.S.’s own 1.5 million residents in 2012; a rate troubling enough for the Obama administration to launch an enquiry and a new federal database that compares homes and their antipsychotic usage rate.
Antipsychotics are not approved by Health Canada for treatment of elderly patients suffering from dementia. Pharmaceutical companies are clear on this and have issued the strongest form of caution known as a “black-box warning” on their labels. The warning states “elderly patients with dementia treated with atypical antipsychotic drugs are at an increased risk of death compared to placebo. Patients face a 60% increased risk of death compared with similar patients who are not on these drugs”.
It follows that the “off- label” use of antipsychotics are known to have devastating effects on seniors with dementia, including causing the aggression and confusion they are meant to treat. They can also produce movement disorders that lead to injuries or turn a slip and fall into a fatality, like it did to a 85- year -old Ontario woman with dementia on risperidone . Factor in the risk of heart attack, stroke, and early onset of Parkinson’s disease and it’s hard to buy why “off-label” usage remains legal in Canada.
Although, treating psychotic disorders or severely aggressive forms of dementia may warrant antipsychotics, using them to “chemically restrain” or “calm” average dementia patients is unfair and negligent
Under the Long-Term Care Homes Act, medical practitioners, facility operators and their staff owe a duty of care to residents and must do their due diligence regarding the clarity of the informed consent of patients treated with high-risk antipsychotics.
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Stephan Intraligi, Hon.B.A., J.D., Esq.
Mr. Intraligi is a personal injury lawyer and the founder of www.intraligilaw.ca offering free consultations for all victims of car accidents, slip and falls and all other type of personal injury related matters.