She was just admitted to an assisted care facility. She has vascular dementia and is incontinent. The psychiatric nurse practitioner saw her once and has prescribed Abilify, a drug that is contraindicated by the FDA. This practitioner thinks he is right to prescribe this drug, but my sister has quickly (within five weeks) declined in her mental capacity and has started hallucinating much more. We questioned him about the drug and he got very angry with family questioning his treatment plan and even threatened us. What recourse do we have other than remove her to another facility?
I am also wondering did your sister exhibit reasons to prescribe an antipsychotic? You mention that she has anxiety. I think it is a giant leap from anxiety to psychosis.
Each facility should have posted the number for the State Ombudsman. I think a call to that office might help.
If you do not want to change facilities maybe a change her doctor. Does she have to be seen by the one that saw her initially?
Sorry, I know that a NP can prescribe meds, but I would go over this persons head. There has to be a doctor who oversees a NP. The NP either works for a doctor or if allowed to have a private practise in ur state have a doctor they answer to. Find out who this NP answers to and talk to them.
If this doctor is a staff doctor at the facility where she is presently, report your experience and questions to the facility administrator or whoever the " top dog/ buck stops with me" person in charge is.
If this is a personal physician who is not a part of the facility treating her , still report your concerns to the facility and, arrange for a new physician to assess her. There could be any number of issues contributing to her decline and behaviors.
Or, insist that she be transported to a hospital ER for symptoms observed and, have her assessed by staff at ER, possibly admitted for more observation, assessment and, share your concerns with the hospital staff. Then go from there regarding placement when she is ready to be discharged.
Of course you have the right to ask questions & report differences - you know your sister best!
I am wondering if there can be a 'family meeting' set up? Kind of like they do in rehab, where OT, PT & Doctor give their opinions for a more wholistic approach to the care plan.
This could involve the Facility Manager or Nurse in Charge, that Doctor & yourself & sister. Discuss how she is settling in, what is going right, what is not going so right. A wider view. I dunno... maybe this could help get everyone (inc Dr Ego) onto the same page??
It can be a balancing act... reducing hallucinations is a good aim but if the meds cause more or cause falls ir other negative effects, then another approach is required.
* Do no harm *
That's the aim afterall: a care plan that is best for your sister.
Wishing you success.
As someone else has said, you should have the right to take your sister for appointments outside of the facility. This may depend on her insurance program.
FYI, in our state a DPOA (Durable Power of Attorney) is only for financial issues. A Health Care Power of Attorney is required to make health care decisions.
Go over his head, make it real clear to the supervising doctor and the administrator in charge that the NP has a people problem and request that he not see your sister any longer.
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