ONCE CHILDREN ARE PLACED INTO FOSTER CARE, FAMILIES LOSE THEIR SAY ABOUT DRUGS
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.
This gap appeared to play a part in at least six documented illnesses, accidents and adverse reactions linked to psychotropic drug use by Washington's foster children.
Unlike nearly a score of other states, Washington does not require birth parents to consent to drugging a child in foster care and has no statewide guidelines on psychotropic medication of its wards.
That means key adults in a foster child's life - birth parents and grandparents, social workers and legal advocates - have no reliable way of knowing what drugs a child is on or whether they're doing him or her any good.
Ricky, for example, was reported by a caseworker to be exhibiting "zombie-like behaviors, sleep disturbances, bowel/bladder accidents" from high doses of dexedrine.
Yet his Seattle grandparents, who waged a five-year legal battle for custody in Oregon and Washington, said they learned only recently that the 10-year-old boy was still on the stimulant, coupled with the anti-depressant imipramine.
"My grandson hasn't even grown," said Loraine Mullins, his grandmother. "He's just real, real thin. They've had him on medications since he was 5."
Mullins said the boy was diagnosed with hyperactivity and learning problems. His southern Washington foster parents, who recently adopted Ricky and his sister, said he needs the medication to control outbursts of rage at school.
Ricky's new father, who asked not to be identified, says he closely tracks the dosages, and the boy is gradually "improving."
The American Academy of Pediatrics approves of the use of psychotropic drugs by children, but only after careful diagnosis and "a partnership that includes the child, family, school personnel, physician and other health professionals."
That partnership often crumbles for children in state care.
"What I worry about is that children aren't thoroughly assessed," said Dr. Carrie Freedheim, medical director at Seattle Children's Home.
Key information about kids gets lost, she said, as they are shuttled between their often-fragmented birth families and foster homes. Half of those who stay in the system in Washington state longer than a year move through a succession of three or more households, the non-profit Families for Kids program found.
Caseworkers who might be able to piece a child's story together transfer or leave. About 15 percent of foster children lose their first caseworker for one reason or another; another 10 percent get at least three primary social workers during their stay, according to a decadelong study by the state Department of Social and Health Services.
Against that background, doctors wind up diagnosing and medicating foster children with limited information and little backup from others.
Stowens, a child neurologist whose practice has been suspended by the state, said he assumed while he was treating Domico as a specialist that a primary care physician also was monitoring the boy's general health.
No doctor was.
Stowens, a 49-year-old father of three from Bellevue, was treating nearly 200 foster children when the state temporarily suspended his license Feb. 14.
The Medical Quality Assurance Commission will meet this spring to decide whether his treatment of the children violated medical standards.
Investigators reviewing Stowens' records alleged that he failed to reduce doses for many of his foster child patients, despite clear side effects. One foster child in his care made grunting noises, another alternated being "spaced out" and restless, and a third suffered from bouts of extreme fearfulness, according to an affidavit submitted by Dr. Christopher Varley, a University of Washington associate professor of child psychiatry.
"It is my opinion," Varley wrote, "that more probably than not the care rendered by Dr. Daniel Stowens to the patients in this chart review resulted in injury or created unreasonable risks to these patients."
The Ivy League-educated Stowens said it is standard for doctors to vary from published dosage guidelines and that he had drawn on his two decades of experience in prescribing amitriptyline and similar drugs. "I think it's safe," he said.
The medical establishment around the country has resisted outside oversight.
"It is not within the purview of the agency to dictate medical practice," Dr. Nancy Fisher, a DSHS medical adviser, wrote in response to a review panel's recommendations that the agency monitor psychotropic doses and side effects.
The panel, in a report released to the Post-Intelligencer late last week, found that foster care authorities kept poor records of Domico's care, never made sure he got a general health assessment and had given his foster mother only token training in handling potent prescription drugs.
To date, the state's main response to such criticisms has been to begin writing up new drug guidelines for DSHS staffers, which Children's Administration policy director Jennifer Strus said should be ready in about two months.
While state policies may be revised, Rosie Oreskovich, assistant secretary for children's services, said she is reluctant to recommend new laws as the answer for protecting foster children.
"We'll review the legislation that has occurred in other states," she said. "I haven't yet seen anything that can resolve a problem like this."
That attitude isn't good enough, said Marilyn Brown, an administrator of Los Angeles' massive foster care system of more than 50,000 youngsters.
"Any check and balance we can put into the system," she said, "is to the child's benefit."