State Reprimands Psychiatrist Thomas Opechowski Over Treatment of Elderly Patient

January 24, 2019

On December 5, 2018, the Arizona Medical Board reprimanded psychiatrist Thomas A. Opechowski following an investigation of a complaint about his care and treatment of an elderly patient with a special form of dementia.

In 2017, the Board received a complaint regarding Opechowski's treatment of a 72-year-old patient. The complaint alleged that Opechowski failed to treat the patient in a timely manner, improperly prescribed the antipsychotic Risperdal to the patient despite the patient having Lewy Body Dementia, and inadequate follow-up communication with the patient's family. 

(Lewy Body Dementia is named after researcher Frederic Lewy [1885-1950] who discovered a particular type of abnormal protein deposits ["Lewy bodies"] in the brains of individuals with dementia who exhibited a certain set of symptoms, caused by the deposits, in addition to the usual symptoms of the disease.)

The Board's document states that the patient was admitted to a geriatric inpatient facility on May 2, 2017 due to an overall decline in functioning following the diagnosis of Lewy Body Dementia. During a phone conversation the following day, the patient's wife advised Opechowski that her husband could not be placed on certain medications due to his diagnosis.

One of the drugs that Opechowski prescribed to the patient was the antipsychotic Risperdal. In 2005, the U.S. Food and Drug Administration issued a warning about the use of antipsychotics in elderly patients with dementia, citing statistics which showed that the chances of death in elderly treated with this class of drugs is as much as 1.7 times greater compared to patients treated with placebo.  

Further, Risperdal's label (package insert) states about Lewy Body Dementia that, "Patients with Parkinson's Disease or Dementia with Lewy Bodies who receive antipsychotics, including RISPERDAL®, are reported to have an increased sensitivity to antipsychotic medications. Manifestations of this increased sensitivity have been reported to include confusion, obtundation [dulling of awareness], postural instability with frequent falls, extrapyramidal symptoms [includes involuntary muscle movements, tremors, muscle rigidity, etc.], and clinical features consistent with the neuroleptic malignant syndrome [a life-threatening reaction to antipsychotics which can include high fever, variable heart rate, confusion, etc.]."

Five days after admission, the patient was admitted to a medical hospital after being found slumped over in bed in an altered state of consciousness. He was diagnosed with brain damage and stroke and was discharged to hospice services, where subsequently passed away. 

The Board found that Opechowski deviated from the standard of care by prescribing a drug which which carried clear warnings against use in elderly patients with dementia, and particularly with Lewy Body Dementia. The standard of care further requires a doctor to document that informed consent was obtained regarding the risks and benefitis of a drug, which Opechowski did not do. 

"Actual harm was identified in that [the patient] had a stroke while taking risperidone [Risperdal] and suffered a serious decline in mental status and functioning that was exacerbated by use of risperidone," the Board's document states. 

The Board also noted that Opechowski had advised the patient's wife to not visit her husband after his admission and to stay away for the first few days. Opechowski's communicated with the wife only three times: upon admission, the day after admission and the day the patient was transferred to a medical hospital. Board members expressed concern over the limited nature of Opechowski's communication with the patient's family.

The Board concluded that Opechowski's conduct constituted "failing or refusing to maintain adequate records on a patient" and "any conduct or practice that is or might be harmful or dangerous to the health of the patient or the public." 

Source: Findings of Fact, Conclusions of Law and Order for Letter of Reprimand and Probation in the Matter of Thomas A. Opechowski, M.D., license no. 22676, Arizona Medical Board, December 5, 2018 

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