"Here was a brand-new population of people, and nobody had any earthly idea how to take care of them," he recalls. "Back then you’d see Mellaril [a powerful antipsychotic drug] brought in by the truckload. They used it as a chemical restraint. Nursing homes back then didn’t have a lot of help, so the best help they had was to drug the patients. I knew it wasn’t humane, and I fought it from day one."
On Wednesday night Neel is driving to a mom-and-pop motel in rural Georgia that he has stayed in many times. It’s not far from a county-owned nursing home Neel counts among his institutional clients.
The next morning at 9, Neel is stationed at a small desk near the nursing director’s office. He has brought along a notebook computer, portable printer and a supply of blank forms and printed materials. He knows just about everyone, it seems, by name.
An Epidemic of Overmedication
The doctor who serves as the nursing home’s medical director doesn’t seem to care for Neel’s approach to medication reviews — a task mandated by federal law that’s often seen as rubber-stamp work. The doctor doesn’t talk to Neel, choosing to deal with him mostly through the nursing staff.
Throughout the day Neel will type his medication-related suggestions on a form of his own design (printed on a pink paper so as to stand out in the patient’s medical records) that directs the patient’s physician to check a box that says "Accept" or "Reject" before signing and dating it.
The medical director rejects, almost without exception, Neel’s suggestions. He evidently takes umbrage at being second-guessed by a pharmacist — something, Neel says, that’s not at all unusual. Neel finds the lack of engagement troubling.
"He’s here once a month," Neel says. "Maybe five minutes per patient. That’s all a medical director is required to do."
Neel begins working his way through a tall stack of blue loose-leaf binders that contain patient charts and other medical records. Today he’s reviewing the charts of residents who are taking nine or more prescription medications simultaneously.