Date: 2001-06-07

The Miami Herald

Leslie F. has two choices: She can agree to take powerful, mood-altering drugs she says make her sick and sleepy - or she can risk becoming homeless this afternoon.

Leslie turned 18 last October, is set to graduate from high school and wants to go to a vocational school to become a nurses' aide. She also has a newborn child. By state law, the Department of Children & Families can allow Leslie, who is in foster care, to remain in state care if she is in school.

But to do that, Leslie must sign an agreement, which says, in part, that she will consent to any medical treatments the DCF deems necessary - including the use of psychotropic drugs, which she was prescribed on and off during her years in foster care.

Earlier this year, she signed the contract, adding a clause that said she signed the agreement because she had "no choice." She hasn't been prescribed the medications since 1998.

Paul Hancock, an assistant attorney general who represents the DCF in the dispute, says the department has not asked Leslie, as she's identified in court records, to take any unwanted drugs. And the teenager's services contract specifically says she is not being required to waive any constitutional rights - including the right to refuse drugs.

"Just like any other child in care, she must abide by a doctor's recommendations," Hancock said. "So then she's being treated no different than any other child."

But Carolyn Salisbury, associate director of the University of Miami Law School's Children and Youth Law Clinic and an attorney for Leslie, said the agreement violates Leslie's most fundamental rights to consent or not consent to medical treatments.

"She does not have to take psychotropic drugs, but if she refuses to take psychotropic drugs, they can kick her out of foster care, and throw her onto the street," Salisbury said Wednesday.

Though the department faxed Salisbury a letter last week saying Leslie's services would "expire" at 5:30 p.m. today, Cecka Green, a DCF spokeswoman, said Leslie will continue in state care while her attorneys continue to negotiate some kind of settlement with the DCF.

"She's not going to get kicked out of the system," Green said.

Leslie has been in foster care since she was 5. Her parents abused her, leaving her with permanent brain damage and mild mental retardation. Her mother is dead; her father's parental rights were terminated.

Advocates say Leslie's dilemma highlights an issue that is central to the ongoing debate over the use of psychotropic drugs among children in state care: How are such children being protected against the unwanted use of drugs that have not been specifically approved by the FDA for use with kids?

Martha Lenderman, a Pinellas Park human services consultant who worked for the DCF for 30 years and now advises the state welfare agency on involuntary psychiatric commitment issues, said a person is not capable of providing "express and informed consent" to a medical procedure if he or she is being threatened with consequences for refusal.

Alan Lipton, a psychiatrist at Atlantic Shores Healthcare, which operates South Florida State Hospital in Pembroke Pines, agreed with Lenderman. "Informed consent" implies that the patient understands what he or she is consenting to, why the treatments are necessary, and what the consequences - good or bad - might be, Lipton said. "To tie that up with someone's living arrangements seems to me, right off the top of my head, to totally dilute the notion of free consent."


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