Drug limits skirted for foster kids

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Date: 2009-05-08

In the aftermath of a little boy's death, child welfare chiefs acknowledge they can do better at complying with a law aimed at curbing psychiatric-drug use.

CAROL MARBIN MILLER

Declaring that mental-health drugs have uses other than the treatment of psychiatric problems, Florida child welfare administrators have sometimes ignored a 2005 law that requires the agency to obtain the consent of a parent or judge before giving mind-altering medications to foster children.

The head of the state Department of Children & Families acknowledged Friday that an agency administrator has allowed caseworkers to bypass the requirement when a foster child's doctor insists such drugs are not being used for psychiatric purposes.

''He did take that position,'' DCF Secretary George Sheldon said of Frank Platt, a DCF policy analyst who oversees medication of foster children. ``He won't take that position tomorrow.''

''That is not our policy, and I intend to make that clear,'' Sheldon added, saying he does not know exactly how many children were medicated without a parent or judge's consent as a result of the directive. He has asked a work group to pull the files of every child in state care to ensure state law is being followed, he said.

Sheldon's comments Friday, in an interview with The Miami Herald, come amid a far-reaching department inquiry into the use of sometimes powerful psychotropic drugs among the 35,000 children in DCF's care. The investigation was prompted by the death last month of Gabriel Myers, a 7-year-old Broward boy who hanged himself in a foster home.

Though Gabriel had been prescribed several psychotropic drugs in his last months, DCF administrators acknowledge he started taking the drugs before a judge was asked for consent, and DCF's computerized record system did not accurately reflect the medications he was prescribed.

DEEPER ISSUE

Some Florida lawmakers, who ended their annual session Friday, are suggesting Gabriel's death may be a symptom of deeper problems. The 2005 law was passed after lawmakers became concerned that kids in foster care were being needlessly medicated to control difficult behavior.

''This case raises serious concerns which demand attention and answers,'' Sen. Ronda Storms, a Brandon Republican who chairs the Children, Families and Elder Affairs Committee, wrote in an April 27 letter to Sheldon.

Among the questions, she said: ``To what degree, if any, has the [department] ignored or circumvented . . . the 2005 law which curbed the use of psychotropic drugs in the treatment of our children in department care?''

A former lawmaker who authored the 2005 legislation, Walter G. ''Skip'' Campbell, a Democrat who also chaired the children's committee, accused the department Friday of ''cooking the numbers'' in an effort to make it appear DCF had curbed the use of mental health drugs to manage the behavior of unruly children.

In a report last September to the Florida Senate, DCF said less than 7 percent, or 2,307 foster kids, were on such drugs, and in almost all cases the agency had received proper consent. But the report to lawmakers relied on DCF's internal database, called Florida Safe Families Network, or FSFN, which administrators long have acknowledged is unreliable.

In a September 2006 memo, DCF's then-director of family safety, Patricia Badland, said DCF's computer system recorded that only 4 percent of children in the state's care were being given psychotropic drugs -- but a separate system kept by Medicaid said nearly 12 percent of such children were on psychotropic medications.

''This discrepancy would . . . indicate there is under-reporting of children being prescribed psychotherapeutic medications,'' Badland wrote. ``It is critical that the . . . database be accurate and up-to-date to assure that we are able to monitor all children taking these medications.''

Eight months later, DCF reported to the Senate that, among all age groups, 11.3 percent of children in DCF's care from September through November 2006 had been prescribed mind-altering drugs.

DCF RESPONSE

Sheldon bristled at the suggestion his department intended to mislead lawmakers.

''I don't think there was an overt effort to misrepresent or cook the numbers,'' he said. ''But I do think there was an over-reliance on our database. I think we should have put more time and energy'' into preparing the Senate report.

Beginning in 2001, The Miami Herald reported that child welfare administrators were relying on powerful mind-altering drugs to manage the behavior of unruly foster kids, who sometimes developed dangerous side-effects. Advocates accused the department as using such drugs as ''chemical restraints,'' eventually leading to the 2005 law.

Dr. Ewald Horwath, interim chairman of the University of Miami Medical School's psychiatry and behavioral sciences department, said that although some mental health drugs can have different uses, they are still psychiatric drugs.

''What use can one have for an anti-psychotic drug, other than a psychiatric one?'' said Horwatch, who has no connection to either the agency or its critics.

He said the requirement for informed consent is important so that parents or other caregivers can make well-reasoned decisions on children's behalf.

''It seems to me you would want parental consent before prescribing,'' he said. ``You would want someone exercising judgment in place of the child, who cannot make decisions on whether benefits outweigh risks.''

Referring to the consent issue, Sen. Rudy Garcia, a Hialeah Republican who is a member of the Senate Children, Families and Elder Affairs Committee, said Friday: ``These are the types of things that we've been worried about that fall through the cracks. These are the things that I believe keep the secretary [of DCF] awake at night.''

Miami Herald staff writer Breanne Gilpatrick contributed to this report.

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