DSHS LOBBYING FOR FUNDING TO IMPROVE SAFEGUARDS FOR CHILDREN

LYLE QUASIM

Seattle Post-Intelligencer

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 Post-Intelligencer should be commended for raising the issue that all parents, including foster parents, routinely should ask questions regarding treatments and maintain contact with the physician regarding any observed reactions to the treatment. That was done by the foster parent in the Domico Presnell case, and is regularly done by our other foster parents.

Another missing piece of information important for readers to know is that three of the four foster children mentioned in the March 31 article, including Domico, were patients of Dr. Daniel Stowens.

Stowens has had his medical license summarily suspended. The state's Medical Quality Assurance Commission determined there was a reasonable basis to believe that ``there is imminent danger to public health and welfare'' of those he treated. Medical providers we consulted agree that the summary suspension of a doctor's license is a very serious matter.

Reviews of Stowens' medical records show that he failed to monitor his tricyclic medications in the usual and accepted manner - such as determining dosage based on a child's weight, monitoring vital signs and documenting the amount of medication found in patients' blood levels.

After meeting with the Department of Health on this case regarding Stowens' practice procedures, DSHS took the following actions:

Had doctors across the state evaluate all children under 12 in foster care who were on amitriptyline. Baseline evaluations, including EKGs, were done.

Drafted tricyclic medical protocols and sent them to medical providers for review and recommendations.

Sent letters to primary care providers and parents of Stowens' patients offering aid in identifying other doctors to treat the patients.

DSHS strives to improve services for children in our care. As part of that effort, we have a procedure for public review of our high-risk cases that result in death.

As noted in the series, the governor's budget proposal includes funding for several critical program improvements:

Additional front-line staff to ensure that children and families do not fall through the cracks.

Statewide implementation of the Passport Program for children entering foster care. The Passport Program will provide a concise record of a foster child's current medical, dental, behavioral, psychological and education status along with a record of vaccinations, allergies and medications. The program will be monitored by a public health nurse and will give doctors an important tool for treating children.

Funds for intensive foster care assessments for children who are expected to remain in care for more than 90 days. Assessment will identify service and treatment needs.

With ongoing commitment from the executive and legislative branches of government and the public at large, we can continue to improve the services we offer children and families in Washington.

The death of Domico Presnell was tragic for all of us who loved and cared for him. We hope the Post-Intelligencer will use its news coverage to bring all parties involved together to address the needs of foster children.