Advocates for nursing home patients charged Thursday that enforcement of a federal law calling for reductions in the use of powerful drugs and physical restraints on patients has been undercut by an agreement between California and the federal government.
"California's political leaders have jeopardized these long-awaited and carefully crafted reforms and, in doing so, have placed at risk the health and safety of nursing home residents across the nation," Patricia L. McGinnis of California Advocates for Nursing Home Reform said at a hearing of the Senate Labor Committee's subcommittee on aging.
A federal official insisted, however, that enforcement of the law has not been weakened, and that California is in compliance.
"There was no political arrangement or political deal with California," said Louis B. Hays, associate administrator of the Health Care Financing Administration. "We are proud we were able to get a recalcitrant state into compliance."
The dispute focuses on instructions given to state surveyors, or inspectors, who inspect nursing homes to see if they comply with a 1987 federal law aimed at expanding the rights of patients to have a voice in their treatment.
The law states that nursing homes should reduce the use of powerful drugs that keep patients in a docile, sometimes zombie-like condition, and they should avoid strapping patients or tying them to their beds.
McGinnis told the committee about a patient in a Napa nursing home "who was threatened with eviction until her daughter agreed to the prescription of Haldol--a mind-altering, psychotropic drug. Within three months she was unable to move, her tongue was hanging out, she contracted pneumonia and died."
With Gov. Pete Wilson leading the way, California mounted an aggressive campaign to modify the federal guidelines, arguing that the original instructions for surveyors would have cost the state an extra $30 million a year for unnecessary paperwork, while raising costs to the nursing home industry by more than $400 million.
For a brief period, the federal government carried out inspections of nursing homes in the state because California officials refused to train their personnel on the new rules.
The dispute ended when the federal government accepted California's demand for a new introduction to the guidelines. It provides widespread discretion, saying that the guidelines "do not require that surveyors make any particular finding . . . nor do they require that any particular enforcement action result from their findings."
This discretion means that surveyors will be reluctant to take aggressive action to enforce the law, according to critics. They complain that enforcement will vary dramatically from state to state.
California officials say the state is doing an effective job of inspecting the nursing homes and enforcing the law.
"Our surveyors go in and make sure patients are not being unnecessarily restrained," Kassy Perry, associate secretary of the California Health and Welfare Agency, said in Sacramento. "There is good cause for restraints for some patients who are psychotic or violent," she said. "But we're looking at very low numbers. Our surveyors are pretty aggressive in looking at the problem."