Hospital Suicide Sparks a Rule

UCI Medical Center has told state health regulators it will require pharmacists to review and approve physicians’ unconventional use of drugs to treat patients, as part of a plan to correct deficiencies discovered in the wake of a patient suicide in December.

Last month, the state Department of Health Services found that the Orange hospital treated a psychiatric patient with drugs not approved for his condition and that there was no record of a pharmacist signing off on the therapy plan, as required by law. The drugs are known to increase the risk of suicidal thoughts.

Doctors regularly prescribe medications for uses other than those approved by the U.S. Food and Drug Administration. But in this case, state officials questioned whether this “off-label” usage of one of the drugs had merit.

Under a correction plan the state approved Thursday, pharmacists will make computerized entries in patients’ medical records showing they have signed off on the drug therapy.

The patient, an 18-year-old man from Fountain Valley, was admitted to the psychiatric ward in October after being admitted twice previously. He had a history of wrist-cutting and pill overdoses.

The man was diagnosed with schizophrenia and depression. He was treated with Zoloft, an antidepressant, and Strattera, a drug used to treat attention deficit disorder. A state report issued in March said the doctor, who has not been identified, prescribed Strattera because of “cost for the family.” Both drugs carry warning labels citing a possible increase in suicidal behavior by adolescents who take them.

UCI disputed the state’s findings that the drugs may have been inappropriate for the patient. Warning labels say the greatest risk of suicide occurs when the patient begins taking the drugs. The hospital said the warning label was irrelevant in this case because he already was using the drug when he was admitted. It also defended the use of Strattera, saying there was no other approved medication to treat the patient’s symptoms.

The hospital said doctors and family members thought the patient was improving and that he told hospital staff he had no desire to kill himself, even making the statement an hour before the suicide.

The medical center also said it will make other changes, including removing handrails, shower heads and door locks from bathrooms. The patient hanged himself from a bathroom handrail with a bed sheet.

UCI will also tell staffers more explicitly that they must actually see patients during safety check rounds.

A hospital aide knocked on the patient’s bathroom door and heard noises suggesting that the patient was “on the toilet,” according to the state report, but then left and returned five minutes later.

The aide got no response after knocking again. No key to the bathroom was immediately available, and hospital staff could not open the door until 10 minutes later.