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Administration of medication to mental health patient (09HDC01408)

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(09HDC01408, 15 June 2011)

Mental health acute care unit ~ Public hospital ~ District health board ~ Mental health ~ Dementia ~ Medication ~ Quantity ~ Deterioration ~ Neglect ~ Recordkeeping ~ Rights 4(1), 4(2)

The family of a 64-year-old man complained about the care he received in a district health board's mental health acute care unit. The man was admitted under the Mental Health (Compulsory Assessment and Treatment) Act 1992. He was floridly psychotic and considered a risk to himself and others.

Various types of medication were trialed but were unsuccessful in controlling his delusions. The man began refusing all oral medication so it was decided to give him the drug fluphenazine deconoate (fluphenazine) by injection.

The records were unclear but the man was administered at least 162.5mg of fluphenazine over a period of up to 40 days. The manufacturer's recommended dose for people aged over 60 years is 6.25mg for a test dose and subsequently ¼-⅓ of the normal dose which equates to 22-75mg every three weeks.

After an initial improvement, the man's physical and mental functioning suddenly deteriorated. He had increasing body stiffness, stooping posture and a Parkinsonian gait, decreased mobility, a mask-like face, slow thinking and speech and a lack of attention to physical cleanliness. He never again was able to recognise his family. He was often left un-showered and wearing dirty clothes. He continued to deteriorate and, sadly, died.

It was held that the district health board gave the man more than the recommended quantity of medication for a man of his age with dementia and, as it had failed to provide fluphenazine with reasonable care and skill, it breached Right 4(1) of the Code.

It was also held that the district health board breached Right 4(2) for failing to clearly record the administration of fluphenazine and breached Right 4(1) for failing to have a clearly defined plan and strategy to manage the man's behaviour and hygiene needs.