IN COLO., AN ADOPTION GOES AWRY
By PETER S. CANELLOS=
c.1997 The Boston Globe
GREELEY, Colo.—Motherhood was a dream that Renee Polreis nurtured through years of fertility treatments, her desire for children growing more palpable with each failure to conceive.
On the other side of the world, a blond 2-year-old boy grew out of infancy without a mother's love, spending his early months in a Russian orphanage.
The two seemed perfectly matched to fill each other's needs. But six months after Polreis and her husband, David, adopted the child and named him David Jr., the little boy was dead, and Renee Polreis, 43, stood accused of killing him.
Rescue workers took him from his parents' bathroom on Feb. 11, 1996, nearly brain dead and with bruises coating his body like a rash. He had been alone with Polreis all night. Doctors called it one of the worst child abuse cases they'd ever seen. Police found a broken wooden spoon wrapped in a bloody diaper in a trash can.
The death shocked people in placid, family-oriented Greeley, many of whose residents described Polreis as the model of a caring mother.
OLYMPIA - New restrictions on using psychotropic drugs to control foster children will have to wait until next year.
Key lawmakers say they are concerned about what the mood-altering drugs do to children under the state's watch. But even with the report of one death connected to the medication, legislators say they do not want to make hasty changes before the Legislature adjourns April 27.
"We need to do something, but we want to do it right," said Rep. Bill Backlund, R-Redmond. Backlund is a physician and vice chairman of the House Health Care Committee.
Republican budget writers have agreed to fund programs Gov. Gary Locke says would help the state monitor foster children.
A budget agreement unveiled yesterday includes $8.2 million for three foster-care programs. The House and Senate earlier had rejected Locke's proposals.
The budget now includes money for Locke's priority: a program to track foster children's medical records when they move to a new home.
Regarding your series on foster care needs, Steven Goldsmith and the Post-Intelligencer editorial writer are articulate advocates for bettering foster care for children; however, in their collective enthusiasm, they succeeded in nailing several innocent scapegoats to the cross. As a physician member of the "independent group" that the Department of Social and Health Services asked to investigate Domico Presnell's death, I rapidly concluded that it represented only the very tip of the iceberg of the whole "attention deficit disorder" controversy - as well as the plight of DSHS.
Let's clarify one point: The unfortunate child died, not from cumulative amitriptyline, but from a one-time excessive ingestion. Moreover, amitriptyline is but one member of a class of drugs, any one of which in overdose can prove fatal. Most are not FDA-approved for children under 6, but a number are widely used without problems, even for bed-wetting. Your readers don't realize that it costs a bundle to get FDA approval for use in children - and that it is not needed once a drug is released.
Helping children and families is central to the mission of the state Department of Social and Health Services. The Post-Intelligencer's series on behavioral medications and foster children sought to raise important issues. As the first article in the series points out, the use of psychotropic medication for children with severe behavioral problems is a complicated issue.
Children enter the foster care system because they have been or are at risk of being abused or neglected. The abuse and neglect issues often are compounded by the effects of drugs and alcohol used by the parents of the children before they are born. Many of the children are at a higher risk of needing behavioral management.
While medical experts disagree on the use of psychotropic drugs with children, we cannot expect social workers or foster parents to second-guess doctors regarding medical diagnoses and treatment. They are not medically trained and they must rely, as do all parents, on the expertise of medical professionals to prescribe and oversee the patient's care.
The state's top social services administrator yesterday pledged to intensify training of foster parents and social workers, to rewrite key policies and to seek an outside review of a child's death in connection with the use of mood-altering drugs to treat foster children.
The reform also includes trying to assign a primary care doctor to each of the state's 10,000-plus foster children by the end of next year.
Department of Social and Health Services Secretary Lyle Quasim outlined the seven-point plan for the use of psychotropic medication after a Post-Intelligencer series last week described occasional damage caused by medicating children in the state's care.
"We run a forward-thinking administration and we know there are problems, but I think the newspaper articles will help raise the awareness around issues of drugs and children," Quasim said. "A lot of children are in foster care because they have behavioral problems, so they have a higher incidence of medication management, and this is something we need to know."
Washington state should notify the biological parents of children in foster care when the children are prescribed powerful psychotropic drugs, a key House committee chairwoman said yesterday.
"These drugs just have a tremendous impact on these kids," said Rep. Suzette Cooke, a Republican from Kent who heads the Children and Family Services Committee.
Rep. Mary Lou Dickerson, D-Seattle and vice chairwoman of the minority caucus, said it is urgent the state beef up safeguards governing prescription drug use by wards of the state.
"It shows that huge caseloads and poor medical monitoring are literally threatening the lives of foster children entrusted to state care," she said. "Let's save kids' lives."
The legislators made their remarks in response to a four-day series in the Seattle Post-Intelligencer that showed that children in state foster care have experienced serious medical problems, and even death, from behavior-altering medications that flow from doctors to children with virtually no state oversight.
Dan and Kathy Blackburn are back in court, this time to answer a welfare petition that claims several of the couple's Haitian children need state services.
Office of Family and Children officials will not comment on the Blackburn case. But they say such petitions are filed to administer and coordinate services for children.
The petition was filed March 21 by caseworker Ellen Matheney. She alleged that filthy conditions and a serious gas leak meant that at least some of ``the children's physical or mental condition (was) seriously impaired or seriously endangered as a result of the inability, refusal or neglect of the children's parent.''
June Sanders, director of the Shelby County Office of Family and Children, has said such petitions do not necessarily seek to remove children from the home and that state law encourages families to remain intact.
Court hearings in such matters are not open to the public.
PEOPLE IN CHILD'S CIRCLE OF CARE MUST BE TOLD ABOUT DRUGS
April 3, 1997
When God speaks to Mary Jackson, she hears the voice of her son Bobby.
It's a voice frozen in a 7-year-old's chirp, the voice of Bobby four years ago, when he died.
Bobby had been in a foster home with seven other children for nearly a year. The longer he was there, the worse he behaved. A psychiatrist came every six weeks and gave Bobby stronger and stronger doses of the anti-depressant imipramine.
Lethal doses, the coroner said, which made Bobby collapse and stop breathing after running three blocks home from school.
Six months later, Jackson, a woman of limited education and years lost to heroin, entered the state Capitol in Salem. Her shaky voice persuaded Oregon lawmakers to pass the Bobby Jackson Law, which requires government workers to notify a foster child's parents, advocates and lawyers when the child is given psychotropic drugs.
Legislators passed it unanimously, despite resistance from the Children's Services brass and the Oregon Psychiatric Association.
The Post-Intelligencer's six-month investigation of the way foster children are prescribed powerful psychotropic drugs found that Washington's lack of safeguards put youngsters at risk.
Child welfare experts said that inappropriate medicating also can be a symptom that public officials are failing to perform the task taxpayers hired them for: watching after kids.
Foster children, they said, did not ask for the childhoods they are having - did not ask the people who brought them into the world to beat them up, check out on drugs or liquor, molest them, fall ill or maybe just fall apart.
Government cannot save every child whose family hurts or fails him. But here are four suggestions for reducing foster children's medication risks gleaned from more than 120 interviews with foster families, social service experts and health professionals.
Dan Blackburn says public agencies haven't given him any real help caring for the 19 adopted Haitian children he's raising.
``They just want to be in control,'' he says.
Now the county welfare office says Blackburn is failing to provide a clean, safe home for the children. An adopted teen-age daughter of Blackburn's is pregnant, welfare workers say.
The Shelby County Office of Family and Children says in a court document that Dan Blackburn's house was filthy and unsafe on at least three occasions when inspectors came to visit.
The Indianapolis Star and The Indianapolis News obtained a copy of the neglect petition, which is not a public document.
Despite the allegations, the welfare office isn't seeking the removal of the 19 children still living with Blackburn.
Blackburn was granted custody of the children following an acrimonious divorce from his former wife, Kathy. Last month, Shelby Circuit Judge Charles O'Connor ordered Blackburn to quit his two jobs and go on welfare.
Lawrence coos and gurgles, patiently trying to coax his foster mother's yellow-headed parrot to let down its guard.
Many people are trying to get Lawrence, a 9-year-old cast aside by an abusive father and drug-addicted mother, to do the same.
But intensive therapy for Lawrence and children like him has gotten scarcer, while money for behavioral drugs continues to flow, infuriating health professionals who believe drugs alone aren't the answer.
"This kid's life is not going to get fixed up by medications," said Barbara Kleine, supervisor of a program at Children's Hospital that for a time provided Lawrence with daily counseling. "It's just a long haul of people being there."
Providing the people and programs to help troubled children is getting harder. In the past two years, King County has chopped in half the money available for mental health services for severely disturbed children, many of whom are in foster care.
More than a third of the alleged victims of Wenatchee's child sex ring were placed on psychotropic drugs paid for by the state once they entered foster care.
Use of the drugs may have affected the children's testimony in the highly charged sex cases. At the very least, it created the appearance of a conflict of interest for the state that continues today, a Post-Intelligencer investigation found.
Exonerated defendants claim memories of sexual abuse were planted by investigators after the children became wards of the state.
Psychotropic drugs were part of the "recovered memory" techniques used to convince children they had been victims of sex crimes, said Kathryn Lyon, an Olympia attorney whose upcoming book dissects the Wenatchee investigations.
The little boy was so out of control with manic depression and attention disorders that he had been through three hospital programs by the age of 12.
The day his parents brought him to a child neurologist named Dr. Daniel Stowens, he hid under a table in the waiting room.
Anti-depressant drugs prescribed by Stowens have helped reunite the family from Kent.
"Dr. Stowens provided light when there was no light," said the boy's father. "He's getting better."
Similar medicine, prescribed by the same doctor, killed Domico Presnell.
Domico was a foster child. Youngsters like him are wards of the state - in a sense, everybody's children.
Everybody, that is, but the people who know them best. Washington doesn't give biological parents or grandparents a formal voice in decisions on medicating children in foster care. As a result, knowledge of a child's medical background gets lost, and dangerous side effects can be overlooked.
PRESCRIPTIONS GIVEN TO CHILDREN ARE SOARING OUT OF STATE CONTROL
March 31, 1997
One out of every five children in Washington state's foster care system is on potent mood-altering medications. Yet the state has no safeguards to protect the children who swallow these sometimes toxic pills.
As a result, foster children have suffered hallucinations, loss of bowel control, abnormal heartbeats - even death.
The state does not chronicle the problems children experience with these drugs. Officials aren't even sure how many of their troubled wards take behavioral medications, a six-month investigation by the Seattle Post-Intelligencer found.
Foster parents are given virtually no special training for handling the drugs. And there is no requirement that a child's biological parents or family members be told about the medications.