The Chicago Tribune ran an article in today’s newspaper about a Chicago area psychiatrist who is noted for his frequent use of clozapine, a powerful antipsychotic medication. The medication carries 5 black box warnings about its side effects, marking it as one of the most risky medications approved for use in the United States. According to the news story, this psychiatrist prescribes clozapine at a rate higher than all of the psychiatrist combined in some other states.While he is hailed as a smart caring physician by some who work with him, this doctor is described as managing a practice where he just spends minutes with each patient, putting them on ever-higher doses of medications. According to the news story, he gives the patients the package inserts containing the five black box warnings and allows the patient to make the decision about whether to take the medication or not. Not only is this an unwise approach given that many of these patients are mentally ill, determining whether the medication is appropriate for the patient is a responsibility that the law places on the prescribing doctors. Not surprisingly, his approach to patient care has been blamed for the wrongful death of nursing home residents and he has been named as a defendant in a number of Illinois medical malpractice suits.While the newspaper article focused on the obvious features: that there is a doctor who is prescribing scandalously large quantities of medications to mentally ill residents of nursing homes with sometimes fatal results, it misses the larger story about the real consequences of this approach to patient care. Medicating nursing home residents to make them more compliant with nursing home staff is known as employing chemical restraints. This is because giving someone such powerful medications at such high dosage that they are incapable of their normal daily activities restrains them just as much as tying them to a chair. Employing chemical restraints is a form of nursing home abuse and neglect. Federal regulations prohibit the use of chemical restraints and encourage minimizing the use of medications such as clozapine.One reason that the use of these medication is discouraged is because of the adverse health effects they have on the overall well-being of the nursing home residents. For example, they may alter the residents desire for food or liquid refreshment, leading to malnutrition and dehydration. Decreased physical activity may contribute to the development of bed sores or pressure ulcers. It can also lead to the the loss of muscle tone, which increases the risk of a nursing home fall, and if it progresses far enough, to the development of contractures. Fall risk may also be increased due to diminished alertness and loss of coordination. There is also an increased risk of medication error due to drug interactions when residents are placed on a combination of medications, especially as potent and dangerous as clozapine. Taken together, these other side effects have doubtless taken a terrible toll on Illinois nursing home residents, especially in the Chicago area nursing homes where this physician practices.