Doctor gives risky drugs at high rate
Complaints, suits follow psychiatrist to thousands with serious mental illness
Shirley Palmer's brother Alvin Essary died at a nursing home on the North Side in 1999 of clozapine intoxication. Palmer, of Bloomington, Ill., said she can't believe the doctor who prescribed the drug to Essary is still practicing. (Tribune photo by Antonio Perez / July 20, 2009)
Staffers told state investigators that so many patients were clamoring to complain to Reinstein about their medications that a security guard was assigned to accompany him on his visits. In addition, staffers said Reinstein had induced patients to take powerful antipsychotic drugs with the promise of passes to leave the home.
Though state officials shut that facility in 2000 for inadequate care and wretched conditions, Reinstein, the home's lead psychiatrist, continued to practice. Today he is one of the most prolific providers of psychiatric care in Chicago-area nursing homes and mental health facilities, even as he is trailed by lawsuits and complaints like the ones at Maxwell Manor.
Neither state nor federal officials appear to have ever assembled a complete picture of Reinstein's thriving practice, built in part within Illinois' poorly regulated system of nursing homes serving the mentally ill. But an investigation by ProPublica and the Tribune found that Reinstein has compiled a worrisome record, providing assembly-line care with a highly risky drug.
Searching publicly available documents, reporters discovered that Reinstein, 66, has been accused of overmedicating his mentally ill patients. His unusually heavy reliance on the drug clozapine -- a potent psychotropic medication that carries five "black box" warnings -- has been linked to at least three deaths.
In 2007 he prescribed various medications to 4,141 Medicaid patients, including more prescriptions for clozapine than were written by all the doctors in Texas put together, Medicaid records show.
Records also show he is getting government reimbursement for seeing an improbably large number of patients. Documents filled out by Reinstein suggest that if each of his patient visits lasts 10 minutes, he would have to work 21 hours a day, seven days a week. Reinstein sees 60 patients each day, he wrote in an audit report in 2007.
Illinois provides powerful incentives for cut-rate, high-volume care in nursing homes for the mentally ill, where Reinstein sees most of his patients.
The state Medicaid program pays psychiatrists as little as $22 per patient for some services, a rate drastically less than customary fees. State lawmakers recently did not act on a bill that would have given psychiatrists the first Medicaid fee increase in years.
Working from a strip-mall office in Uptown, Reinstein says he is psychiatric medical director at 13 nursing facilities, seeing patients with chronic mental illness whom few doctors will accept. Those include people with schizophrenia, who make up the bulk of his practice. His supporters say they admire the hardworking doctor, who makes daily rounds in a car with 140,000 miles on the odometer. And Reinstein maintains that clozapine was not to blame for the patient deaths.
In written statements to ProPublica and the Tribune, Reinstein said he works long hours seven days a week, as do his four partners, who separately also prescribe clozapine. State records overstate his workload, he said, because of a computer system that forces him to submit claims several times. He said he is trying to recruit more doctors to his practice, but it has been difficult because of low pay, high malpractice insurance rates and a perception that the work is dangerous.
He also strongly defended his reliance on clozapine, saying the medication is underprescribed and is the most effective in its class for schizophrenic patients. That view is supported by a prominent study that found clozapine helped patients more than similar, newer drugs. Clozapine can control psychotic episodes, reduce suicide risk and help patients live independently outside of institutions, Reinstein said.
"The most gratifying part of my day," he wrote, "(is) when patients reach this level and come to the office!!!"
Autopsy and court records show that three patients under Reinstein's care died of clozapine intoxication. Alvin Essary died at age 50 at the Somerset Place nursing home on the North Side in 1999. Medical records show that when he died his blood contained five times the toxic level of clozapine.
The plaintiff's expert in his family's medical malpractice lawsuit contended that Reinstein was grossly negligent to give multiple medications to a man with only one kidney. Reinstein settled the claims against him for $85,000, but Essary's sister, Shirley Palmer, said she can't believe he is still practicing.
"There's nothing that's been done to this doctor who's caused all these problems," Palmer said. "It makes me mad that this keeps going on."
Reinstein has a far different view of his career.
"I am grateful for the opportunity to be of service to the patients I treat and have treated for over 37 years," he wrote. "I take pride in the many people I have been able to help and feel badly about those patients who have not seen the benefits of treatment."
Drug with many warningsUse of any medication carries risks, but clozapine stands out. It ranks just behind the more widely used painkiller oxycodone as the medication suspected in the most patient deaths, according to a study that examined reports to the Food and Drug Administration.