ABSOLUTE FAILURE OF LICENSING TO UPHOLD RULES AND REGULATIONS TO PROTECT THE ELDERLY
...When we discovered that mother had been given drugs to chemically restrain her (the antipsycyhotics drug Loxapin - also, it was given without consent) we requested that it be stopped. The administrator of Cheam Village would not comply with that request, so we had mom's doctor rescind its use, and to ensure
everyone was aware of this we went to see the pharmacy. We discovered there was no accountability and when we realized how deceitful the "environment " at the home had become coupled with the fact that the pharmacy who dispensed the drugs in question lied about the return of the discontinued drugs, we turned to the government body that was suppose to make sure that the "rules and regulations" were followed and lodged a complaint:
July 10, 2009
Hi Jody,
We are VERY upset that my mom was given the drug, Loxopine. The resident Dr., (Macintosh), who was moms Dr. before she entered Cheam Village, knew our concerns about these sorts of drugs as did the owner/administrator/head nurse Anne-Marie Leyen. As well, the nurse that was there when my mom was admitted, Laurie, (don't have last name) said to me a few days ago that she remembered our concern about drugs and said SHE never gave the drug to my mom and also said that my mom wasn't a problem.
Loxapine along with other anti-psychotic drugs such as Risperidone, have a warning attached to to them that says, "This medication is not approved for the treatment of dementia-related behavior problems in the elderly and can cause death"
To compound this issue my mom has had a bad history with these sort of drugs from the time she had a stroke and was in MSA hospital. It almost ended up in a lawsuit when the hospital used the same sort of drugs on a second occasion with the same BAD results WITHOUT checking her records to see what drugs she shouldn't have! Dr. Macintosh knew about this. Anne-Marie knew about this issue also and they still went ahead and administered these drugs for what is behavior control' and the ease of staff. When I spoke to her about this on June 25th, she admitted that that's exactly what they use the drugs for. I consider this to be a violation of Residential Care Regulation Div.5- 73, 74, 75. My mother has vascular dementia, she can get very repetitive because of her memory impairment. They say that sometimes she hits people. I, nor any member of our family, have never seen my mom be violent in ANY way and we spend a lot of time with her. We have a real hard time believing this so we have asked them the circumstances involved and what may have led up to these instances What we get is she may grab someone's arm to get their attention if they're not listening. She has pushed people out of the way when they have her helping to clean up the kitchen. They have mom do things like help in the dining room, fold laundry etc.and we have no problem with this because she's always looking for "something to do" I can see her trying to get someone out of the way so that the work can be facilitated but there is no way she's LASHING out at people because of her mental impairment. Another nurse said that she gets into other peoples "space" because she too 'motherly'. The family thinks this is nothing but trumped up and exaggerated charges so that they can use the drugs when they don't have the patience to deal with her repetitiveness and re-direct the situation. Sometimes the drug was given late at night when everyone else would have been asleep so you can't tell me she was having some sort of altercation with someone! As the Dr. has admitted the nurses are not trained anymore for "care giving" and just drug giving. They don't give re-direction to residents but instead drug them up. This story could go on and I have much more to say on this subject but you will the drift from this. All is done for "ease of staff"
They also gave this drug without our knowledge from the 9th of April until the 26th of May when the 'cat was let out of the bag' so to speak. My sister was going to take mom out for a drive and a nurse asked her if she wanted to take some Loxapine with her. This totally baffled my sister as she didn't know they were giving her these drugs and she asked what for and how often it had been given. The nurse said that they'd "only used it a few times this month".
When we would see unusual things going on with mom and report them ie. dizziness, slurred speech, etc. we thought they were signs of side effects of some of her other drugs being too high or even her mental decline when in fact they had been drugging her all along with the Loxapine and they didn't tell us! The doctor ordered that the drug be discontinued on June 23rd but our lack of trust in the staff and their 'grab bag' of drugs has left us cynical especially since the pharmacy cannot account for the Loxapine that were to be returned. (15 missing from the initial 35/10mg prescribed, and 33 from the subsequent 35/5mg. refill).
Now we would like to have a copy of her medical chart/files held at Cheam Village and we have had nothing but a run around. Cheam telling us that the Dr. has to give it and the Dr. telling us that Fraser Health has to give it and Fraser Health telling us that Cheam has to give us the copy. Full circle. It seems they don't want us to have access to the information? When we wanted to know how often mom was given the drug the nurse in Charge Susan Grapuik (sp.?) wrote down on a piece of paper the dates and time for May and June but nothing for April and yet the perscription was filled on April 9th. Now I have to go back to what the nurse told my sister on the 26th of May - "Only a few times this month ", and wonder if that was referencing a "lot" of use in April. We had a meeting with Dr. Macintosh on Thurs. July 9th and when we asked how often mom had been given the drugs in April he said he couldn't find anything on April and said it must have been archived. He kept looking and finally found something but nothing on any drugs or related issues for April? This isn't making any sense to us. We have lost all trust in the staff at Cheam Village and want to know what else might be in her medical files that they aren't telling us or perhaps things reported that we should be aware of and the accuracy of the information. Have they switched, or taken pages out of the files. This would be against the law. We are very concerned.
We also have other concerns with the way the facility is run. The doors don't have locks on them and my mom is always thinking that her stuff is gong to be stolen. And in fact it has been by other residents and by nursing staff (the nursing staff have gone through her possessions and removed certain items and have been reading her personal journal.) I have personally witnessed another resident try and walk off with my moms telephone. Since our July 9th meeting with the doctor, he has instructed that a lock be put on her door for a trial period. But the facility administrator did not approve our initial request as of June 25, 2009.
There has never been a care plan implemented with the inclusion of the family and it's been 7 months that my mom has been there.
Many times I've been there for several hours and in that time have looked for a nurse and haven't been able to find anyone! I talked to cleaning staff and they said they couldn't find anyone half the time either! So lack of staff is another issue. Also, it appears that staff are not suited for, nor trained to deal with, the elderly and the many afflictions that befall them, but simply to drug them to keep them in line.
There are no checks and balances for drug discontinuation and returns. I found it impossible to find out if the right amount of Loxapine was returned to the pharmacy. There is no pharmacist that is looking at the drugs being given and if they are safe. If there was, this drug in question would not have been given out. When I asked the pharmacist about it he didn't seem to know until at my inquiry he looked it up!!!
As I go through the regulations for long-term care I see so many things that aren't happening that should be that I really fear for my mom being in this kind of facility.
~Doreen Bodnar
Being of a somewhat "naive" nature as to the role "government agencies" play, we thought that it would be the correct route to follow to make sure our mom was not subjected to any more "abuse", and her rights respected.
We continued to try and ensure that mom's rights would be respected, and that we would reach an understanding whereby care would be provided, and we would work on settling mom into the facility so she could become less anxious with her surroundings. This involved perusing her files to see if we could establish some time line patterns to help us determine when we could be of the most assistance in reaching this goal. What we discovered led us to forward a second e-mail expanding our initial complaint.
July 12, 2009
Hi Jody,
I just felt I needed to add what I have found out since the last e-mail I sent.
On Sunday July 12 before we took mom out for the day I asked the nurse on the second floor of Cheam Village (moms floor) if I could READ moms file. She gave it to me and I sat by the nurses desk and for about an hour read through the file. I noticed first off that the April page that the doctor couldn't seem to find seemed to be there and in the proper order (after March) but the page with the Loxapine was empty. There were three of us with the doctor at the meeting and we all watched as he paged back and forth through the file and couldn't find the page. Or was there something else suppose to be there or....?. On Friday July 10th Susan Greypuik (sp?) called me and said she had a meeting with Dr. Macintosh on Thurs. after we met with him. (Her call was about the door lock) I really have to wonder if or what was done to the files at this meeting. I also noticed that there was already a negative comment in the files made about her having difficulty with the key for her door, right off the bat! She hasn't had a door to lock for the last seven months! I can only think that this is the beginning of more negatives to discredit her so they can take the key away. This may sound nit-picky but in the big picture it has its relevance. I also noticed that there was another Dr. prescribed anti-psychotic drug on my moms file, closer in date to her admittance. It had been crossed out and I asked the nurse why and she told me that the Dr. must have written it for another resident and put it in my moms file by accident. Is this allowed? Would a Dr. actually be that careless or absent minded with someone's medical files!? Or was it just another lie to add to the heap? Resperidone is also in her file and crossed out. It's one of the drugs that mom has had a bad reaction to and was in the report from Fraser Health and in her files. Was it also given to her because no one bothered to check the files for adverse drug reactions.
I also noticed in the files that my mom was bitten by a dog that someone had brought into the facility. No one ever told me this. I do seem to remember her fingers had bandages on them and when I asked her what happened she couldn't remember. I just assumed that maybe she cut her fingernails too short or something. At that point I didn't know I couldn't trust the care that was suppose to be given to her! She was also sick and vomiting etc. and yet no one ever let me know! My mom is not a person that ever gets sick like this so I have to wonder why or what the circumstances were. Did they give her more drugs that she shouldn't have?
You may be getting the picture of just how much we distrust everyone concerned. We (the family) have so many questions and suspicions right now that we are starting to feel that this needs to be dealt with legally.
I also read other things in moms file that I felt were inaccurate and I feel they have to be corrected with someone that has the authority to correct them. This is another reason that the family needs to have a copy of moms medical files. There should be no inaccuracies in them.
Doreen Bodnar
We had no way of knowing at the time and only found out at a much later date through FOI documents that the "confidential" complaint and additional correspondence would be was forwarded to Gem Algie, (July 22, 2009) a manager at Fraser Health Residential Services and a long time friend and colleague of the Administrator of Cheam Village. This was after the "assurance" given several times by Jody Belous, Licensing Officer, that the complaint would be held in the strictest confidence. (This also appears in the rules governing complaints made to Licensing.)
According to the Licensing Officers word, they were supposed to investigate expiditiously and we were not to "tip them off". As we had not heard from the Licensing Officer for a few weeks, and other "things" appeared to be going on, I sent the following e-mail:
July 30, 2009
Hi Jody,
I haven't heard from you yet and I'm not sure what has transpired with your investigation at Cheam Village, however, I think Ann Marie Leyen is pretty mad at me for making a complaint. She says she's is angry because I'm harassing her nurses. When I asked her specifically what I did she wouldn't say but she had told my sister earlier that her nurse Judy was upset because I had asked her to sign a paper acknowledging that we told them what the surgeon had instructed about my moms pills (she has just had breast cancer surgery) They were reluctant to follow what Dr. Wiggens had told us to do with moms meds. In particular the aspirin and Vitamins. As these are blood thinners she was not to have them until Friday. This was very important and for some reason the nurse didn't want to take our word for it and we had forgotten to ask the surgeon for a "written" note. Sharon (my sister) decided to write out the instructions as the Dr. told us and have a signature to make sure that there was a record that we told them of the instructions (previous surgeon's instructions after her biopsy had not been followed .) It was done in a very courteous manner. I was watching as my sister asked if Judy would sign it. Ann Marie Leyen thinks that I was the one that asked for this when in fact I didn't, it was my sister that did, but my sister didn't tell her that. She wouldn't say if there was anything else specifically that we did. I would assume they don't like us asking so many questions all the time about moms meds , if there has been a change or whatever, but we are worried about her and fearful that they are not working in her best interest. Anne-Marie also still justifies the use of anti-psychotic drugs for restraint purposes even after all of this and stated as much today.
As you may recall from our conversation, I do get rather excited and exasperated when I have to talk about what is going on at Cheam Village, after all it does concern my mothers well being. I was speaking to Ann Marie Leyen no differently than I spoke to you and she told me she didn't like my personality and the way I presented myself (she then said to my sister that she was ok!) and she said there "would never be a way of pleasing me". She repeated this phrase several time. (Obviously she can't come out and say it, but it's left me wondering if it insinuates that in order to get rid of "me" ,mom should be moved?)
I'm not that hard to get along with and have a very good repoire with many of the care givers at Cheam and think they do a wonderful job. I cant' say the same for all the nurses however, although I always thank them after I've gotten the information that I'm seeking. They make us feel that we have no business asking any questions about my moms care. I have just wanted everyone to follow the rules and give good care that we could also be part of. To date they haven't included us in any care issues and there never has been any care plan nor did they even give the pharmacy a list of the drugs that my mom has adverse reactions to even though they are in her file. I have had to go to the pharmacy and make sure they had this list! They make us feel that we have no business asking any questions, or getting involved, but if we don't how do things like this get corrected?
Anne Marie wants us to talk to a person from Fraser Health Jem Allgie (sp?) from Abbotsford. I'm not sure what she is getting at or what this is suppose to accomplish other than perhaps the removal of my mom to another facility? I feel that this is just retaliation for my making the complaint and her way of trying to get rid of my mom (and me!). As I stated before my mom has just had breast cancer surgery I don't think any move would be in her best interests regardless as to whether we trust any one at Cheam or not.
I, or my sister, have spent a part of everyday for the last month and a half at Cheam Village and the more time I send there the more worried I get about what I witness going on there. Many things are totally unacceptable but you only see them if you spend some time there. That being said I am not under the illusion that other facilities are any better. I just think that the staff and owner of the facility need to be educated in and follow the rules set out by Fraser Health for 'Adult Care Regulation' and get to the business of care giving instead of serving their own interests .
PLEASE ADVISE,
Doreen Bodnar
Chilliwack Licensing totally failed in it's mandate to make sure that that Rules and Regulations were followed. They failed to understand how and why anti- psychotic medications are used within the system. They failed to understand the rights of residents, and the law concerning consent. They made excuses for medical charts that were inaccurate or had "gone missing" as well as excuses for "physician mistakes" OR did they just decide to ignore the obvious because of the "comradery" within the system and the systematic "condoning" the drugging of our seniors as a way to address the overall deficiencies of Residential Care
We were also to discover that there is a certain "comradery" between Licensing officers and Administrator as well. (Eventually the Administrator of Cheam Village, Ann Marie Leyen would be forwarded all "private and confidential" correspondence from family to Chilliwack Licensing and F. H. Residential Services.- these were sent to her long before Sept. 5, 2009, the day she responded to the report). There was never any chance that our complaint would be dealt with fairly or competently.
It should be noted that we were never given a copy of the Licensing report of findings even after a request for it was made to the Licensing Officer, Jody Belous, who was in charge.
Aug. 4, 2009
Hi Jody,
I do not agree with your definition of a restraint as set out by the Adult Care Regulations. There would not be any other reason to administer Loxapine, if they weren't trying to change my moms behavior for the convenience of staff. As it is meant for use in schizophrenia, and is not approved for ANY behavior problems in the elderly with dementia, I believe your findings, and the administration of the loxapine was wrong. I also respectfully disagree with some of your other findings. Please pass this on to your superior.
As I will be taking this to the next level I would request that you send me a copy of your findings as soon as they have been finalized.
Doreen Bodnar
We finally obtained a copy (at a much later time-May 13, 2010 to be exact) through a FOI request. It was then that we discovered that the Administrator of Cheam Village was privy to the report, had the opportunity to respond (which was also filled with fabrications, medical inaccuracies and never did address missing documents) and was sent a nice letter closing the complaint, but WE, as the ones who had made the complaint, were not.
In closing I would just like to point out that we have compiled all the documentation (i.e. e-mails, contradicting facts, audio tapes, and pictures) to substantiate and corroborate any and all allegations we present.
