An obituary in The Boston Globe (below) reports that Ruby Rogers, the lead plaintiff in a landmark case in Massachusetts, Rogers v. Orkin, died on Jan. 12 at the age of 71. The case prohibited medical staff–psychiatrists and others–from forcing mental patients to take mind-altering psychotropic drugs against their will.

In October 1979, Judge Joseph L. Tauro issued a stern ruling in the case: 

"Whatever powers the Constitution has granted our government, involuntary mind control is not one of them, absent extraordinary circumstances," Tauro wrote. "The fact that mind control takes place in a mental institution in the form of medically sound treatment of mental disease is not, itself, an extraordinary circumstance warranting an unsanctioned intrusion on the integrity of a human being."

In a nod toward Ms. Rogers, he ruled that voluntary patients had the same right to refuse treatment as those committed involuntarily. And addressing issues she and others raised in testimony, Tauro wrote that "it is an unreasonable invasion of privacy, and an affront to basic concepts of human dignity, to permit forced injection of a mind-altering drug into the buttocks of a competent patient unwilling to give informed consent."

Then and now, many psychiatrists disagreed with the ruling.

Underscoring the current abusive use of psychotropic drugs in nursing homes, The Los Angeles Times reports (below) that three elderly residents in a California nursing home were allegedly killed by the antipsychotic drugs they were forced to take.

Arraignment is scheduled this morning for the center's one-time medical director, Dr. Hoshang M. Pormir, former nursing director Gwen D. Hughes and former chief pharmacist Debbi C. Hayes. They were jailed in Bakersfield on Wednesday.

"These people maliciously violated the trust of their patients by holding them down and forcibly administering psychotropic medications if they dared to question their care," state Atty. Gen. Jerry Brown said.

The psychopharmacological abuse of elderly patients is a national scandal facilitated by the absence of restrictive standards of reimbursement by Medicaid / Medicare. Congress needs to use its power of the purse to rein in abusive use of toxic drugs–in particular antipsychotics and anticonvulsants–as chemical restraints.

Vera Hassner Sharav
 
http://www.boston.com/bostonglobe/obituaries/articles/2009/0220 ruby_rogers_helped_win_key_rights_for_mentally_ill
THE BOSTON GLOBE
Ruby Rogers; helped win key rights for mentally ill
By Bryan Marquard February 20, 2009

In Turners Falls, nearly 100 miles west of where she spent decades confined in Boston psychiatric facilities, Ruby Rogers died quietly in a nursing home, a relatively anonymous end for a woman whose name is routinely invoked during Massachusetts court hearings involving the mentally ill.
"They said she just lay down and went to sleep," said her sister, Claudette Smith of Dorchester.

Ms. Rogers, who spent her last years at the Farren Care Center, left a sweeping legacy that established key rights for the mentally ill in the Commonwealth. With Rogers v. Okin, the landmark case that bore her name, she also helped determine the course other states took to help certain psychiatric patients participate in decisions about their treatment. Courts and lawmakers elsewhere examined the precedent that Ms. Rogers and six others set with the lawsuit they filed in 1975.

As a result of that case, the mentally ill in Massachusetts must give informed consent before doctors and nurses administer medication. A doctor who believes a patient isn't competent to grant permission must schedule what is known as a "Rogers hearing." If the patient is found to be legally incompetent, a judge – through what is called "substituted judgment" – decides whether the patient would want to accept the prescribed treatment.

The state Department of Mental Health plans to honor Ms. Rogers, who was 71 when she died Jan. 12, during a legislative breakfast March 2 at the State House.

The case began when Richard W. Cole, only months out of law school and working for Greater Boston Legal Services, went to Boston State Hospital as an advocate for the patients and listened to their complaints. At the time, mentally ill patients could not refuse treatment in Massachusetts once they were committed to a facility such as Boston State. Among the seven patients who took part in the court fight, he said, Ms. Rogers was notable, in part because she had voluntarily entered the hospital seeking help.
"Ruby became the lead plaintiff," Cole said. "We decided that based on Ruby's personality, her strength, how vibrant she was as a woman, and also because of her story, that she made the most sense to be the first name in the litigation."

Taking the stand in US District Court in 1978, Ms. Rogers told harrowing tales. Even though her concerns about her mental stability prompted her to seek treatment, she ended up setting her hair on fire in an attempt to get transferred out of Boston State Hospital after she was repeatedly forced to take antipsychotic medications with devastating side effects.

"It felt like something was crawling on my feet and biting them," she testified. "I didn't sleep. . . my arms and legs were jerking, twitching uncontrollably . . . my whole body quivered. When I would put on my clothes, it would take about an hour to put my slacks on. I couldn't put my hands up to comb my hair."

Ms. Rogers testified that if she refused to take her medicine, "I was just seized by six or seven men and rushed into seclusion and given the needle."
Locked in the seclusion room with no toilet, she "had to go on the floor,"
which was cleaned only when a nurse came by to hand out medication.

"You always felt you were smothering or dying," she said of being confined in the room. "It felt like it was 475 degrees in there. I couldn't breathe.
Most of the time I couldn't get water. I used to holler to get out."

In October 1979, Judge Joseph L. Tauro issued a stern ruling in the case, which was appealed to the US Supreme Court before being sent back to state courts for adjudication.

"Whatever powers the Constitution has granted our government, involuntary mind control is not one of them, absent extraordinary circumstances," Tauro wrote. "The fact that mind control takes place in a mental institution in the form of medically sound treatment of mental disease is not, itself, an extraordinary circumstance warranting an unsanctioned intrusion on the integrity of a human being."

In a nod toward Ms. Rogers, he ruled that voluntary patients had the same right to refuse treatment as those committed involuntarily. And addressing issues she and others raised in testimony, Tauro wrote that "it is an unreasonable invasion of privacy, and an affront to basic concepts of human dignity, to permit forced injection of a mind-altering drug into the buttocks of a competent patient unwilling to give informed consent."

Then and now, many psychiatrists disagreed with the ruling.

"I think it built into the law that families cannot be trusted to make decisions for their children or parents or spouses," said Alan A. Stone, the Touroff-Glueck professor of law and psychiatry at Harvard University. "In my view, judges have no basis to make these decisions. They don't know the patients, they don't know the illnesses, and they don't know the families.
So we go through long, complicated hearings about whether patients should receive medications for their psychoses."

Born in Clinchco, a tiny rural town in western Virginia, Ruby Rogers moved to Boston after high school and encouraged her younger siblings to follow.

"There was no work in Virginia for young girls or people of color, and she came here to better herself," her sister said.

Ms. Rogers worked as a nurse's aide at Boston City Hospital before deciding she needed help for mental illness. By then, she had six children, who went into foster care when Ms. Rogers was hospitalized, her sister said. Smith said the family has not been able to locate them.

"She loved her children dearly," Smith said. "Before she died, that's all she talked about."

In addition to Smith, Ms. Rogers leaves two brothers, Robert of Hyde Park and Jessie Anderson of Mattapan; and three other sisters, Kay Tyree of Sharon, Nancy Blackley of Walpole, and Brenda Ellis of Norton, Va.

"Ruby was a beautiful person, and I miss her," Smith said. "I'm going to take her remains to Virginia and bury her next to our mother, sometime in the spring."

Ms. Rogers remains a presence in Massachusetts courts and in Somerville, where the Ruby Rogers Center assists those who have been patients in the mental health system.

"She was willing to put herself on the line and fight for her rights and fight for the rights of other people who were in her situation," said Judi Chamberlain of Arlington, an advocate who formerly was program coordinator at the center.

"For all those years, Ruby hung in there, never wavered, and was a great spokesperson for what was really the core issue of the case," said Cole, her attorney. "This really helped her as she struggled with her problems over the years, the knowledge that she had accomplished something real and important."

<http://cache.boston.com/bonzai-fba/File-Based_Image_Resource/dingbat_story_end_icon.gif>

C Copyright 2009 Globe Newspaper

     
http://www.latimes.com/news/local/la-me-nursing-home-deaths20-2009feb20,0,30
95223.story
THE LOS ANGELES TIMES
3 arrested in nursing home deaths in Lake Isabella Psychotropic drugs were used to control residents who didn't need them at a Kern Valley Healthcare District center, complaint alleges. Three people died.
By Steve Chawkins

February 20, 2009

In an elder abuse case described by one investigator as the most outrageous he has ever seen, three former top managers at a Kern County nursing home have been arrested in the deaths of three residents who allegedly were given needless doses of psychotropic medications.

The state attorney general's office contended in a criminal complaint that more than 20 residents at a skilled nursing center run by the Kern Valley Healthcare District were drugged "for staff convenience." Many of them experienced side effects that included dramatic weight loss, slurred speech, tremors, loss of cognition and even psychosis, according to the complaint.

Arraignment is scheduled this morning for the center's one-time medical director, Dr. Hoshang M. Pormir, former nursing director Gwen D. Hughes and former chief pharmacist Debbi C. Hayes. They were jailed in Bakersfield on Wednesday.

"These people maliciously violated the trust of their patients by holding them down and forcibly administering psychotropic medications if they dared to question their care," state Atty. Gen. Jerry Brown said.

All three have been charged with elder abuse. Hughes and Hayes, who are accused of administering shots by force and without consent, also face charges of assault with a deadly weapon.

The complaint paints a bleak picture of a facility dominated by nursing director Hughes, 55, who is accused of seeking to drug all but the most docile residents. Medical director Pormir, 48, allegedly rubber-stamped Hughes' orders for medication, failed to examine patients and was "either willfully or naively ignorant" of his proper role, according to the complaint. Pharmacist Hayes, 51, told investigators that she went along because Hughes had wide experience in psychiatric hospitals, the complaint says.

Hughes had been fired from a convalescent home in Fresno in 1999 for allegedly overmedicating patients there, according to state officials.

At the Kern Valley facility in Lake Isabella, she ordered medications when the elderly residents — most of whom had dementia or Alzheimer's — glared at her or spoke disrespectfully, according to Samuel Obair, a pharmacist who helped in the state's investigation.

"It is beyond appalling to me," he told state officials. "I have never gone into a facility and seen psychotropic medications and mood stabilizers . . .
being used on so many patients, and so blatantly" without a legitimate diagnosis or careful documentation.

Among the drugs used for "chemical restraint" were Zyprexa, Depakote and Risperdal, according to the complaint. All may have benefits for certain elderly patients but carry a higher risk of damaging side effects for the frail than for the population as a whole.

Fannie May Brinkley, a woman in her 90s, might have lived another year or two had she not been given the anti-seizure drug Depakote, according to Kathryn Locatell, a physician who consulted for the state. But the drug "triggered a series of events, compounded by nursing neglect" that led to her death on Dec. 23, 2006, according to Locatell's account.

An attorney for Brinkley's family said the family didn't know how she died until a nurse who used to work at the care center tipped them off.

Phyllis Peters, Brinkley's daughter, ran into the nurse at a grocery store about a year after her mother died, said Daniel Rodriguez, an attorney representing the family in a lawsuit. The drug was allegedly administered because Brinkley wanted to go to the dining room when she wasn't supposed to be there, he said.

"The way they put a stop to that was to dope her up," he said. "She became dehydrated and lethargic and didn't want to eat. That's what did her in."

After being given Depakote and two other drugs, Joseph Shepter lost 20% of his weight in three months, became severely dehydrated, developed an infected heel ulcer and came down with pneumonia, the complaint says. The drugs "played a major role in this downhill course," Locatell said.

Shepter died Jan. 4, 2007, at 76 — only hours after the staff realized how ill he was, according to the complaint.

Alexander Zaiko, 85, arrived at the care center Sept. 12, 2006, and died eight days later. His dosage of Zyprexa had been increased and he was given Depakote for his dementia, the complaint says.

Other residents were placed on medication for behavior Hughes deemed inappropriate, according to the complaint. It says that one woman's food was sprinkled with Depakote because she refused to eat outside her bedroom, and that another was injected with Zyprexa after throwing her milk in the dining room.

In giving such medications, nursing homes are governed by strict Medicare guidelines and protocols from professional organizations, said Freddi Segal-Gidan, a gerontologist who teaches at USC.

"You have to have a targeted symptom," she said. "You have to document what the behavior is and that you've tried alternatives to medication."

Dr. Martin Schwartz, president of the American Geriatrics Society's California chapter, said "there's been a great movement afoot to get away"
from psychotropic drugs

"For people trained in geriatrics, medicine like that is a last resort, generally speaking," he said.

The charges came after an investigation that started in January 2007, when an ombudsman complained to the state Department of Public Health. The district fired Hughes after a tenure of only five months. Hayes later left, but Pormir still works as a district physician.

The district would not comment on specific allegations but issued a statement indicating that it "will not tolerate any behavior by employees that jeopardizes the safety of our patients." It said that state inspections since January 2007 have found no major problems.

steve.chawkins@latimes.com

Times staff writer Catherine Saillant and researcher Vicki Gallay contributed to this report.