Noah Berger for The Bay Citizen

Martin Titcomb with his wife, Lydia, in a residential care home in San Bruno. He has Parkinson’s, and he now takes Seroquel safely.

A woman with a medical history of seizures was prescribed the antipsychotic drug Seroquel, despite research showing that elderly people who take antipsychotic drugs are more likely to experience seizures. She was also given the antidepressant Trazodone, which has been linked to an increase in seizures among older patients. And then, according to a recent investigation by the California Department of Public Health, the woman was given a second antipsychotic drug, Risperdal. The combination of the two antipsychotic medications, the investigators said, could cause “life-threatening arrhythmias (irregular heartbeats).”

Despite these potentially dangerous side effects, the pharmacist responsible for reviewing the prescriptions of the woman, a resident of the Greenhills Manor nursing home in Campbell, told state investigators that he had not noted these irregularities or addressed them in the patient’s chart.

Pharmacists responsible for reviewing the medication of patients in California nursing homes routinely allowed inappropriate and potentially lethal prescriptions of antipsychotic medications, and failed to correct other potentially dangerous drug irregularities, according to recent state investigations.

In reports obtained by The Bay Citizen, the department found that in 18 of the 32 investigations conducted in California nursing homes between May 2010 and June 2011 — 17 of the 32 were in the Bay Area — pharmacists failed to red-flag cases in which residents were inappropriately prescribed powerful antipsychotic medications like Seroquel, a drug used to treat schizophrenia. Pharmacists also overlooked or approved cases in which medications were prescribed at questionable levels or in unsafe combinations that could put patients at risk of seizures, accidents or even death, according to the public health department.

“The consultant pharmacists’ review, which is intended to identify unnecessary or potentially inappropriate drugs among nursing home residents, is defective in the state of California,” said Jonathan Evans, a geriatrician and the vice president of the American Medical Directors Association. He called the problem “widespread.”

The state investigations also suggested a “probable correlation” between the inadequate review of nursing home patients’ medications by pharmacists and the failure of those nursing homes to pay a fair market rate for the pharmacists’ services. A 1982 anti-kickback law requires nursing homes to pay a fair rate for pharmacy services to discourage consulting pharmacists from endorsing or extending the prescriptions of expensive, and potentially dangerous, drugs. A majority of the nursing homes where the state found patients who were inappropriately prescribed antipsychotic medications were paying below-average fees for pharmacy services.

Noah Berger for The Bay Citizen

A container of Seroquel, along with the seven pills Martin Titcomb takes during lunch

The California investigations come in the wake of a report last year by the United States Department of Health and Human Services. The report revealed that, in nursing homes nationwide, at least 40 percent of all Medicare claims for so-called atypical antipsychotics, like Risperdal, are inappropriate, given in excessive doses, given for too long, given without the need for use, without adequate monitoring or “in the presence of adverse consequences” and should be reduced or discontinued.

By California state law, consulting pharmacists who work for nursing homes are required to review residents’ charts monthly, and recommend to prescribing doctors that medications be stopped, reduced or changed if they pose potential dangers or are causing harmful side effects. The state health department found in its investigations that pharmacists failed to identify the misuse of antipsychotic medications in 90 percent of cases. In 59 percent of those cases, violations occurred in nursing facilities that were cited for accepting pharmacy services below cost.

The average pay rate for California pharmacists is $56.29 an hour, according to the Bureau of Labor Statistics. But a review of nursing home records indicated that some were billed much less, in some cases as low as $11 an hour. The state anti-kickback law bans nursing homes from accepting below-market rates “from any pharmacist or pharmacy as compensation or inducement for referral of business to any pharmacy.”