Review finds shortfalls in monitoring of foster children on psychiatric drugs

Kris Hundley

Spurred by the shocking suicide of a 7-year-old on psychiatric drugs, the agency in charge of Florida's foster children has discovered serious shortcomings in its monitoring of kids on such powerful prescriptions.

After reviewing its files, the Department of Children and Families determined it had undercounted the number of foster kids on such medications as Risperdal and Adderall, overlooking hundreds of cases.

It also has failed to meet its legal requirement that such prescriptions be given only after parental consent or court order.

On Thursday, DCF said a review of the files of more than 20,000 children currently in the state's foster care showed 2,669, or 13.19 percent, are taking one or more psychotropic medications.

That compares with about 4 or 5 percent of children in the general population who are on such prescriptions.

Of those foster children taking drugs, DCF discovered 16 percent had no proof either a parent or judge had signed off on the prescription, as required by a 2005 Florida law.

"That is unacceptable," said DCF Secretary George Sheldon. "We're going to bring every single case of a foster child on drugs into compliance with the law."

Concerns about pediatric use of antipsychotic and antidepressants such as Adderall and Risperdal have been growing along with increased warnings of such side effects as suicide, diabetes and weight gain. Few of the drugs have been tested or approved by the FDA for children, though physicians can prescribe them for this age group.

Robin Rosenberg, a Tampa lawyer and deputy director of Florida's Children First, said advocacy groups like hers have been fighting for oversight of psychotropic drugs for years. "We're not as far along as we should have been if the state had followed up on serious concerns starting in the late 1990s,'' she said. "It's a shame we're in this place today."

Sheldon, who was named to the top job at DCF in October, left no doubt that he had been deeply affected by Gabriel Myers, the 7-year-old who hanged himself on a shower hose in South Florida in mid April. The boy was in his third foster home and on Vyvanse, a medication for ADHD, as well as Symbyax, a combination antipsychotic and antidepressant.

Though his caseworker repeatedly said Gabriel's mother had agreed to the medications, that was not true. The boy's psychotropic medications also had not been entered in the state's tracking system.

To correct ongoing problems, Sheldon set a deadline of June 5 for action on cases without consent. This could include scheduling new doctors' appointments, gaining informed consent from parents or expediting a judge's review of the prescription.

Sheldon said he also was going to focus on the cases of 73 children under age 6 found to be on psychotropic drugs.

"I want a sense of urgency, but I also want to get it right,'' he said. "I want to move forward, but I think it's important for the agency to apologize for misinformation it may have put out in the past."

Flaws in DCF's record-keeping became clear in the immediate aftermath of Gabriel's death. An initial review of the state's database showed only 1,950 kids on psychotropic prescriptions. After a thorough review of individual records, however, that number grew by more than 700.

Preliminary data released in mid May also showed some questionable dates on judicial consent. Though it's not inconceivable a judge might sign an order on a Saturday or Sunday, early returns showed weekend consent orders on 129 occasions.

The final database, including information on types of drugs and diagnoses, was not available Thursday. Sheldon said a summary of the drug data would be posted on the DCF Web site and updated weekly.

"I've got a lot more confidence in these numbers than I had two weeks ago," he said. "But any database is only as good as the quality of the information being put into it."

One ongoing area of concern, Sheldon said, is the validity of any consent given by parents whose kids are in the state's custody.

"A parent whose child is taken into our care is going to sign virtually anything and that's not informed consent," he said. "My preference is that the biological parent have a dialogue with the psychiatrist."

Now that DCF has a handle on the number of foster children on psychotropic drugs, Sheldon said the department can begin to address the bigger issue of the efficacy of such drugs.

He has asked an independent panel investigating Gabriel Myers' death to make recommendations on improving DCF's oversight of these medications. Sheldon said a second-party review of all such prescriptions might be necessary; currently, only prescriptions for kids under age 6 require such review.

DCF has set up a page on its Web site that tracks the progress of the panel investigation into the boy's suicide. The page includes a photo of the smiling boy.

"We have his face on the screen watching us to see how well we learned from his life and death," Sheldon said. "We cannot let him down."

Kris Hundley can be reached at khundley@sptimes.com or (727)892-2996.