System faulted in boy's death in foster care

Relates to:
Date: 2009-07-07
A new state study found that child-welfare doctors and case workers aren't following the rules when it comes to the drugging of 6- and 7-year-olds in state care.

By Marc Caputo

Child-welfare doctors and case managers routinely failed to complete legally required treatment plans, share information or properly document the prescribing of powerful psychiatric drugs for children, according to a new state study of 6- and 7-year-olds medicated in state care.

One of the 268 children was Gabriel Myers. The troubled 7-year-old, medicated with an adult anti-depressant known to cause suicides in children, hanged himself in April in his Margate foster home.

But the state study, which documents how many times caseworkers and doctors followed child-welfare rules and laws, shows that it would be a mistake to blame Gabriel's death solely on the drug, Symbyax, said Florida's drug czar, William Janes.

''It wasn't just the medications,'' said Janes, who sits on a committee investigating ways to prevent cases like Gabriel's. ``It was the system and his world. His environment just collapsed on him. And there was no one there to really put their arms around him.''

The Department of Children and Families study, presented Monday to the committee, indicates that a number of rules and laws on medication for children in state care weren't followed for all 6- and 7-year-olds:

• In 86 percent of cases, the prescribing physician didn't complete what's known as a Psychotherapeutic Medication Treatment Plan, which helps case workers, legal guardians, judges and other physicians determine a child's mental well being.

• In 75 percent of the cases, the case workers did not provide physicians with pertinent medical information about the child.

• In 76 percent of the cases, the case worker didn't provide parents with information about the psychotropic drugs their kids were being prescribed. Nor did the case worker help arrange transportation or phone conversations between the doctor and the child's guardian.

• In 58 percent of the cases, the case manager didn't attempt to speak with or meet the parent or guardian prior to seeking a court order to medicate the child.

• In 89 percent of the cases where parental consent wasn't obtained to medicate children, case managers failed to inform state lawyers that they were seeking a court order to administer the medication.

The DCF study also found numerous record-keeping and data discrepancies in the state's child-tracking system, Florida Safe Families Network. The study follows a similar review last month concerning the drugging of children in state care under the age of 6. DCF is now studying other age groups.

Dr. R. Scott Benson, former head of the American Psychiatric Association, pointed out the difficulties physicians have in meeting all the state record-keeping requirements.

Benson, who doesn't treat children in state care, said he found it ''horribly troubling'' that physicians weren't given all the pertinent medical information about the children prior to making a prescription. But, he said, he wasn't surprised because of the complicated nature of child-welfare cases and clients.

The committee probing the child-welfare system plans to issue a report by Aug. 20.

It is only touching on Gabriel's case, which is the subject of a Margate police investigation. Some doctors and case workers -- all of whom work for privatized agencies under contract with the state -- might face sanctions, depending on what the report finds.

The DCF study, as well as Gabriel's case, show the troubles with 2005 legislation designed to curb the prescribing of mental-health drugs to kids in state care.

Among its requirements, the law mandates more information sharing, parental involvement and second-party review of doctors' prescriptions for the youngest children.

One committee member, Dr. Rajiv Tandon, pushed for a simple electronic record system that physicians and case workers can share.

He said the system also needs to be ''tweaked'' to clarify who's in charge and who needs to do what.

''There's only so much we can do. There's no substitute for common sense,'' Tandon said. ``There's no substitute for people doing the right thing. Sadly, in this case, the right thing wasn't done by some people.''

 

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A few words about "the system"

Benson, who doesn't treat children in state care, said he found it ''horribly troubling'' that physicians weren't given all the pertinent medical information about the children prior to making a prescription. But, he said, he wasn't surprised because of the complicated nature of child-welfare cases and clients.

The committee probing the child-welfare system plans to issue a report by Aug. 20.

It is only touching on Gabriel's case, which is the subject of a Margate police investigation. Some doctors and case workers -- all of whom work for privatized agencies under contract with the state -- might face sanctions, depending on what the report finds.

There are those who believe privatization in social service is not such a good or helpful thing for people, especially if financial gain (profit) -- not quality service -- is the main goal of a given private company.

For those who want to know why this next report ( due in August, with suggested recommendations?) is so important, I'd like to share some things I discovered, within the past couple of years.

In 2007, when PPL first started, a member posted the article, States wrestle with medicating foster kids. Within that article, several points were made:

  1. The child welfare system wasn’t prepared for the deluge of kids that have mental health problems.
  2. The issue, over-medicating foster children, is not being adequately addressed because basic data (the extent to which medication is being used to pacify problem behavior) is lacking.
  3. A nationwide shortage of child psychiatrists, and a shortage of funds is complicating the diagnosing and treatment process for children with mental disorders.

In 2008, another article, Greater Psychotropic Medication Use in Foster Care Raises Concerns, more points are made about the sort of "health care" given to foster children:

  1. Psychotropic drugs are frequently used to treat children in foster care, but according to one researcher, there is a lack of “substantive evidence of their effectiveness and safety".  [Behavior, as opposed to diagnosis, determines a drug-treatment plan.]
  2. In Texas, Medicaid records indicate children in foster care receive at least three times more psychotropic drugs than (comparable) children in poor families.
  3. More than 75 percent of the psychotropic medication prescribed for children is off-label.  [The drugs are given for a purpose other than the approved use on its label.]

Another article, Some Texas foster kids' doctors have drug firm ties, suggests how money is being made through foster children, at tax payer expense.

States that require doctors who write prescriptions to foster children to report their financial arrangements have found evidence that their work can be affected.

In Minnesota, more than a third of the state's psychiatrists were found to take money from drug companies. A review of that state's data by The New York Times last year found that psychiatrists who received at least $5,000 from drug companies that make new antipsychotic drugs wrote three times more prescriptions to children than doctors who didn't receive the funding.

In Vermont, drug companies gave more to psychiatrists in 2007 than to doctors in any other field. Eleven psychiatrists received an average $57,000 each. Other national studies have shown that researchers who are on pharmaceutical company payrolls are more likely to report positive findings when reviewing those drugs.

Although such entanglements are common in the medical industry, they are increasingly raising concerns about improper influence.

This summer, The New York Times reported that three prominent Harvard University researchers responsible for discovering bipolar disorder in children – and for treating it with psychiatric drugs – were found to have failed to report a combined $3.2 million in income from drug companies to their university. Between 1994 and 2003, the number of children diagnosed with bipolar depression increased 40-fold, and the sales of the drugs used to treat it doubled.

According to that same article, accepting grant money for research in not illegal. 

In fiscal year 2007, nearly 15,000 of the 40,000 Texas children in state custody were prescribed at least one behavioral drug, costing the state $37.9 million.

Furthermore, it seems in some emergency situations, consent isn't needed to conduct a medical study, either.

According to one committee member, (involved in the Florida investigation), the system [also] needs to be ''tweaked'' to clarify who's in charge and who needs to do what.

Indeed... who is in charge of children put-in-care, and who needs to do what so cases like Gabriel Meyers don't get repeated over and over again?

 

some historical perspective

The really sad thing is that this problem has been known for decades. Already in 1975 the Subcommittee to Investigate Juvenile Delinquency of the Committee on the Judiciary, United States Senate held hearings in July and August pertaining to the abuse and misuse of controlled drugs in institutions. These hearings didn't focus on foster care, but on all forms of institutionalization of children, so there was a strong focus on homes for mentally retarded children and juvenile dentention facilities.

The topics mentioned show an eery similarity to the issues at hand nowadays. The names of the meds have changed, but not the purpose for administering them, nor have the risks involved changed over the years. Already in 1971 various news paper articles appeared on the side effects of the use of Ritalin on hyper active children. Of course those who have watched One flew over the cuckoos nest, know the abuse of medication in institutional settings have been taking place at least since the 1950's.

The big difference between the 1970's and now seems to be that there is written less about the subject. Pharmaceutical companies have grown and so have the budgets for promotion. As a result mainstream media is less likely to report negatively about the effects of medication. The money used to lobby lawmakers has also significantly increased over the last 30 years, so it is less likely a congressional hearing like the one of 1975 will be held nowadays. Only when a child dies do lawmakers have an incentive to do something about it. The only question is, will the changes have a lasting impact or will practices resume the old patterns once the name of the dead child has disappeared from public memory.

Pound Pup Legacy