Part 4 (See Parts 1, 2, 3, 5, 6 and 7 of our continuing investigation of nursing home abuse and neglect.)

DALLAS -- An ongoing WFAA investigation into Texas nursing homes has already revealed questionable practices in the hiring of criminal caregivers - and now WFAA has uncovered inappropriate and unnecessary drugging of residents.

In our latest report, called “Drugged and Dying,” News 8 investigative reporter Charlotte Huffman found that 96 percent of Texas nursing homes admit they’re giving drugs to residents who don’t need them.

According to the FDA, unnecessary use of antipsychotic medication kills 15,000 nursing home patients every year. Of all the drugs used as chemical restraints, antipsychotics are the most widespread and may be the most dangerous.

The federal government has previously caught drug manufacturers improperly promoting their antipsychotic drugs for use in nursing homes. (See here and here.)

As a result, nursing homes pledged to reduce the improper use of these drugs on their residents.

But our reporting shows that many facilities may have found a way to give the drugs to residents anyway.

Before nursing homes can give residents antipsychotics, new federal guidelines require doctors to diagnose them with at least one of three mental illnesses, the most common being schizophrenia.

A WFAA analysis of nursing home data shows that, after this new rule, the number of residents diagnosed with schizophrenia has skyrocketed 26 percent.

Typically, schizophrenia develops in a patient’s early 20s, not later in life, experts say.

Various healthcare officials and advocates, when reached for comment, have found WFAA's findings troubling.

“There's no doubt that it raises a big red flag,” said Amanda Fredriksen, AARP Texas director of advocacy and outreach. “It’s pretty disturbing when people are that motivated to drive their numbers down to falsify medical records or to make up diagnoses. But to the extent that that's happening, that's a real serious issue.”

Others such as Dr. Daniel Pearson, head of psychiatry at Methodist Hospital, questions a first-time schizophrenia diagnosis of an elderly nursing home resident. He said such a diagnosis, especially to sedate, may be inappropriate, and possibly dangerous.

“Does that surprise me? No. Are those diagnoses legitimate? Probably not,” Dr. Daniel Pearson told WFAA.

“If you are using it just to keep people quiet, there are significant risks that are associated with that…increased risk of cardiac death, increased risk of falling, breaking a hip,” added Dr. Pearson, who spent a decade as a psychiatrist in nursing homes.

The practice of drugging patients may be due to low staffing levels, experts told WFAA. Texas, unlike most other states, lacks minimum nursing home staffing requirements.

“About 70 percent of a nursing home’s expenses are staffing,” said attorney Ernest Tosh, who handles nursing home lawsuits. “So, if they can cut back on staffing, they can directly increase their profitability.”

In effort to cut costs, troubled nursing homes may drug the elderly rather than hire needed staff. The practice has been dubbed “chemical restraints.” It’s a practice of using powerful drugs to sedate or quell agitated, disruptive or violent patients.

But if used unnecessarily and inappropriately, advocates say the medications – particularly antipsychotics -- are another form of abuse, and may be potentially fatal to residents.

The WFAA investigation found one Dallas-area nursing home that medicated residents to sedate. Staff at the nursing home had a term for its practice.

“They said: ‘Take this lady to China,’” a nursing home worker told WFAA.

What does that mean?

“It just can be any medication that will put a person to sleep,” the worker said.

The worker told WFAA what happened next with this particular patient.

“They took that lady to China, and she went to the hospital,” the worker said. “The lady never did come back from the hospital.”

Our informant works directly with nursing home residents. She says she’s seen the drugging firsthand. She says she fears retaliation, so we are not revealing her identity.

WFAA also found other examples of patients who were medicated without their knowledge. That’s despite an “informed consent” law in Texas that requires caregivers to explain what they give to patients, and explain a drug’s possible side-effects.

One patient, Mae Vahl, had drugs crushed and hidden in her foods and drink. Her nursing home stay highlights concerns that nursing homes may go to extreme and questionable measures to hide the drugging of residents.

Mae, 68, was placed in the facilities because she was too weak to get herself out of bed. And she needed diapers, and someone to clean her regularly.

She began complaining about the care at one nursing home, and soon “blue and white pills” began showing up.

Later, she was admitted to another nursing facility, and diagnosed for the first time with schizophrenia. The staff tried to give her antipsychotics but she refused.

“Would you want to be drugged and knocked out?” Vahl told WFAA. “Would you want your mind destroyed? I don’t.”

Jerry Tindel knows the dangers of using antipsychotics without a correct corresponding medical diagnosis. He says his mother-in-law was in good physical and mental health when she went to live in an Austin nursing home.

Staff gave her Risperdal, even though she did not have a mental illness that required an antipsychotic.

“It changed her drastically. She wasn’t the same person,” Tindel told WFAA. “She was pretty much out of it … It really immobilized her. She couldn't walk without someone holding her because she had lost her coordination. (Risperdal) shouldn’t have been given to her.”

One night, Tindel’s mother-in-law tried getting out of bed to use the restroom and in a drugged-out state. She fell and broke her hip.

“That was the beginning of the end,” Tindel said. His mother-in-law died two weeks later.

Email investigates@wfaa.com

More information

Last year, the state of Texas warned nursing home administrators about inappropriately drugging residents.

That same watchdog created this brochure to inform nursing home residents about the dangers of them being inappropriately drugged.

Here is a link to federal government regulations dealing with medication administration and monitoring - see p. 505.

Watch a 2011 U.S. Senate hearing on antipsychotic drug use in nursing homes.

By the numbers

Which nursing homes are giving residents antipsychotic drugs without the correct diagnosis?

Below is a spreadsheet of Texas nursing homes from the federal Centers for Medicare & Medicaid Services (CMS).

The fourth column shows the percentage of long-stay residents who are receiving an antipsychotic drug without being diagnosed with one of the three eligible illnesses (schizophrenia, Tourette’s syndrome or Huntington’s disease) that CMS says warrants an antipsychotic drug. (Note: The national average is 15.5 percent. The lower the percentage, the better.)

The column on the far right shows whether state regulators cited the facility for an inappropriate drugging violation from the 3rd quarter of 2016 through the 2nd quarter of 2017.

Nursing Homes by wfaachannel8 on Scribd