DCF may hire medical officer to monitor kids’ meds

ABC 7 – WZVN-HD

TALLAHASSEE, Fla. (AP) – Florida’s welfare agency should hire a chief medical officer to monitor powerful medications prescribed to foster children.

That’s the recommendation of a task force formed after a 7-year-old foster child hanged himself in April.

Before his death, Gabriel Myers was on several powerful psychotropic medications that carried U.S. Food and Drug Administration “black box” label warnings for children and increased the risk of suicidal thinking.

Some of the medication is not approved for children.

Wednesday’s report says the Department of Children and Families should also contract out independent research studies to examine the effects of psychotropic medication on children. The agency should also frequently review data about how many children receive such drugs in the state.

In Florida, it’s Adoption Year

Palm Beach Post
Opinion

November is National Adoption Month, a fitting time to recognize the strides Florida has made in turning around its foster care system and putting more children into permanent homes.

The state’s child welfare system is still in need of major improvements as illustrated this spring when 7-year-old Gabriel Myers, who was taking an anti-psychotic drug that neither his mother nor a judge had approved, killed himself at his Broward County foster home. Gabriel’s is one of several horror stories starring the Florida Department of Children and Families since the state privatized foster care and adoptions.

Still, the number of children in foster care — which has steadily decreased — and the number being adopted — which has steadily risen, tell a different story — one of success and hope.

Florida set a record this fiscal year with 3,777 adoptions through June 30. Of those foster children, 162 were in Palm Beach County, 20 in Martin County and 44 in St. Lucie County.

There have been 600 finalized adoptions since July 1, and about 200 — including 50 in Miami on Friday — will become final this month, putting those children in permanent homes in time for Christmas.

Florida also has seen a drop in the number of children in foster care. As of July 1 of this year there were 19,797 in foster care, a decline of 9,483 since the beginning of 2007.

The federal government recognized the state’s efforts by awarding Florida $9.75 million in adoption incentives, nearly one-third of the $35 million given to 38 states and Puerto Rico. The bonus money rewards states for adoptions of older children in foster care and those with special needs. In December, DCF created the “Longest Waiting Teens” initiative to encourage adoption of teenagers. Of the 103 children seeking permanent families, 26 have found one.

“Nationally, we rank at the very top as far as adoptions. We’re very proud of that accomplishment,” Jim Kallinger, Florida’s chief child advocate said in an interview. “And communities are getting involved. People are answering the call and adopting these kids despite the economy, which is quite amazing.”

These accomplishments are certainly worth lauding. What also would be amazing is for Florida’s Supreme Court to repeal the state’s ban on gay adoption. Florida is the only state to ban adoptions by all homosexuals. A case to overturn the ban is pending before the 3rd District Court of Appeal. Any decision will likely be appealed again at the Supreme Court level.

The court can take Florida to an even higher level of adoptions by allowing all loving families willing and qualified to give abused and neglected children a permanent home the right to do just that.

Florida panel wants tougher rules on drugs for foster kids

Florida Times Union

Florida panel wants tougher rules on drugs for foster kids
Task force investigating boy’s suicide is making final recommendations.
By Brandon Larrabee

TALLAHASSEE — A task force investigating the apparent suicide of a 7-year-old foster child approved a list of nearly 100 recommendations concerning the use of psychiatric medications by foster children Thursday as the examination of the hanging death of Gabriel Myers continues.

The panel called for several measures to toughen accountability in the dispensing of psychotropic drugs and making sure the medications aren’t the only part of a child’s therapy.

Members of the working group also called for the Legislature to devote more resources, including the creation of a chief medical officer for the Department of Children & Families, to keep an eye on treatment for foster children.

“We need to have a better system of accountability over children who are being taken care of,” said Jim Sewell, former assistant commissioner of the Florida Department of Law Enforcement and head of the task force. “… If we’re serious about making sure we’re taking care of children, we’ve got to make sure that we’re devoting funding to it.”

The recommendations include calling for tighter oversight by local DCF workers of the nonprofit organizations that handle foster care services and increased scrutiny from the agency’s central office. The panel also suggests making sure that caseworkers and caregivers get second opinions for the use of certain types and frequencies of medications.

Sewell said the panel’s recommendations, which are being put into final form after an hours-long meeting Thursday to hammer out the details, focus less on whether the psychiatric medications are over-prescribed than whether they are “properly prescribed.”

“We don’t say the drugs are completely bad,” Sewell said. “Medications are useful … when they’re part of dealing with the child’s overall issues.”

But Sewell said part of the solution is making sure the department employees follow existing laws and rules.

“The framework’s in place,” he said.

The use of the drugs and whether the agency was obtaining proper consent from parents or courts entered the spotlight when, in the aftermath of Gabriel’s death, the department revealed that more than 3,000 foster kids were taking the medications without the legally required permission.

While the major recommendations for the Legislature involve what Sewell described as “tweaks” to the law and more resources for monitoring the use of the drugs, lawmakers are likely to more closely examine the use of psychiatric medications for foster children.

Members of the Senate Children, Families and Elder Affairs Committee from both parties pledged this month to toughen laws and rules for prescribing psychiatric drugs to children in the wake of Gabriel’s death.

“We’ve got a lot deeper issues than the medical director,” Sen. Tony Hill, D-Jacksonville and a member of the committee, said Thursday.

He said lawmakers could move around funding to provide the necessary money for things like the medical position, but also wanted assurances that there would be accountability for failures like Gabriel’s death.

“We need to find out what the department is going to do about this to makes sure there won’t be another Gabriel Myers situation down the line,” Hill said.

Gabriel Myers Work Group ready to review final report, recommendations

Fort Myers News Press

The Gabriel Myers Work Group will meet Thursday to review its final report and recommendations.

Department of Children and Families Secretary George Sheldon established the group to review the use of psychotropic medication to treat children in foster care.

It came after the April death of a 7-year-old Broward County foster child, Gabriel Myers, who hanged himself.

The department had not obtained valid consent for his medication.

A draft of the report released earlier found that medicating children in state care is often an unregulated, haphazard process in which drugs are prescribed to help caregivers calm difficult children instead of treating them.

Report Rules Myers Cause of Death ‘Undetermined’

The Jacksonville Observer

News Service of Florida

A 7-year-old Margate boy being treated with powerful psychotropic drugs may not have intentionally killed himself last spring when he hanged himself by a shower hose in his foster family’s home, a medical examiner concluded in a recently released report.

The report, released Thursday, states that though Gabriel Myers was responsible for the actions that led to his death, he never expressed any thoughts of suicide to psychiatrists who interviewed him several times.

“He has a history of self-inflicted injury for secondary gains,” wrote Dr. Stephen Cina, Broward County’s deputy chief medical examiner. “In fact, at one point he injured his own neck to mimic strangulation in order to get other children in trouble. An argument could be made that his hanging was accidental, an attention-getting act gone awry.”

Myers had been bounced from home to home, disciplined for behavioral problems and forbidden to see his mom.

The case drew outrage from child advocates last spring, when Department of Children and Families officials released the information about the case. Myers had been on heavy doses of psychotropic drugs, yet those medications were not accurately reflected in his case file.

Psychotropic medications include a wide range substances used to treat psychotic behavior, depression, anxiety, obsessive behavior and attention deficit disorder and include such brand name drugs as Haldol, Prozac, Valium and Ritalin.

DCF Secretary George Sheldon appointed a work group to investigate the case and the use of psychotropic drugs on foster children. The results were even startling to the department.

The group found that about 15 percent of foster children in Florida were being prescribed mood or mind-altering medications. However, only 5 percent of all children nationally are on such drugs. The research found that foster children as young as 2-years-old have been treated with psychotropic drugs.

And in many cases, the children had been put on the drugs without parental consent or judicial order.

Former Florida Department of Law Enforcement Commissioner Jim Sewell, who chaired the work group, told the News Service Friday that he has begun to review the medical examiner’s report, but he is also waiting for the police to release a final report on Myers’ death as well.

Regardless of whether Myers’ death was an intentional suicide or not, Sewell said it brought to light problems within the child welfare system that need to be addressed. The final report of the Gabriel Myers Work Group illustrated a complete breakdown between different services within the system.

Psychiatrists, school officials and foster care officials all noted behavioral problems in Myers and attempted to help. But none of the people communicated with each other, a repeated pattern, the group found.

“The greatest difference with Gabriel was that kid was crying for help in a lot of different ways,” Sewell said. “And you had a lot of people who wanted to give it to him, but they weren’t coordinating it well.”

The issue and work group report has received legislative attention as well. Lawmakers have held two committee meetings on the issue, one in Tallahassee and one in Tampa. Sen. Ronda Storms, R-Valrico, said last month the Senate committee on Children, Family and Elder Affairs will be introducing legislation related to the issue in the coming months.

The work group will release its recommendations on Nov. 19, Sewell said. He said the majority of them will likely focus on integrating services within the system so that, hopefully, no other children will be in the same position as Myers.

“You had a lot of good attempts by a lot of different agencies to help him and they weren’t successful,” Sewell said.

Role of drug questioned in boy’s suicide

St. Petersburg Times

FORT LAUDERDALE — It is unclear whether powerful psychotropic medications played a role in the death of a 7-year-old foster child, and the boy may have hanged himself for attention, according to a medical examiner’s report released Thursday.

Gabriel Myers locked himself in a bathroom and hanged himself with a shower cord in April, but the report classifies his death as undetermined. The report says it’s possible Gabriel did not intend to kill himself and did not fully understand the finality of his actions.

“His psychiatric history suggests that this fatality may represent a tragically flawed attempt of self-injury for secondary gain,” wrote Dr. Stephen Cina, Broward County’s deputy chief medical examiner.

Gabriel was on several powerful psychotropic medications, including Symbyax, before his death. That drug carries a U.S. Food and Drug Administration label warning for children’s safety and increased risk of suicidal thinking. It is not approved for use with young children, but doctors often prescribe them.

The boy’s death prompted debate at the state’s child welfare agency about stricter rules for prescribing powerful antidepressants and other drugs to foster children. The drugs affect the central nervous system and can change behavior or perception. They are prescribed for depression, anxiety, schizophrenia and other psychiatric conditions.

Critics say the drugs are overused for unruly children. A report by the Department of Children and Families released earlier this year indicates the 2,699 children taking psychotropic drugs account for 13 percent of all Florida children in out-of-home foster care. That compares with only an estimated 4 percent to 5 percent of children in the general population.

Autopsy proves foster child hanged himself; why is a mystery

Miami Herald

The autopsy on 7-year-old foster child concludes Gabriel Myers hanged himself, though his reasons will forever remain unknown.
BY CAROL MARBIN MILLER

Gabriel Myers, the 7-year-old foster child whose death sparked a statewide inquiry, died of asphyxiation after hanging himself, the Broward medical examiner’s office has ruled, though authorities say they will never know whether the youngster meant to kill himself.

Weeks before Gabriel roped a shower cord around his neck in the bathroom of his Margate foster home on April 16, the little boy choked himself at school, the report noted.

“Although the investigation suggests that he alone took the actions that resulted in his death, his psychiatric history suggests that this fatality may represent a tragically flawed attempt [at] self-injury for secondary gain,” states the ME’s report, written by Deputy Chief Medical Examiner Stephen J. Cina.

Gabriel entered state care in June 2008 after police found him in a parked car with his mother, who had passed out behind the wheel.

Police found an abundance of Xanax and other prescription drugs in the car. Authorities suspected Gabriel had been abused, as he had bruises, bites and other marks on his body.

One of the key issues prompting DCF’s detailed review of his death was the administration of several powerful mood-altering drugs on the boy, including two — an anti-psychotic and an anti-depressant — linked by the FDA to an increased risk of suicide among children.

In his report, Cina concludes there is no way to determine whether the medications were linked to Gabriel’s death.

“While several medications in [Gabriel's] blood have been associated with an increased risk of suicide in some cohorts, it cannot be proven that their presence played a role in this fatality,” Cina wrote.

Cina’s report states a “well-documented absence” of suicidal thinking on Gabriel’s part as evidence that the boy may have meant only to gain attention when he wrapped the shower cord around his neck. Cina cites a 29-page report on the boy’s death by a work group appointed by DCF Secretary George Sheldon.

But a timeline of the boy’s case — also prepared by the work group, though not attached to the final report — states that on March 31 Gabriel’s caseworker received a call from the boy’s school saying that “he was out of control and destroying school property and stating that he wanted to kill himself.”

That same day, progress notes say, Gabriel was taken to his psychiatrist, who said the boy did not have any thoughts of killing himself or others.

The autopsy report documents several bruises on the boy’s body, including “extensive” bruising along Gabriel’s legs.

A Margate police detective investigating the boy’s death said Thursday that an expert who consulted on the case attributed the bruises to the normal activities of an active boy.

Cause of death of 7-year-old in foster care who hanged himself: “undetermined”

Palm Beach Post – Post on Politics
by Dara Kam

A medical examiner found that that the cause of death of 7-year-old Gabriel Myers‘, the Broward County foster child in state custody who hanged himself, was “undetermined” and that he did not commit suicide.

Broward County Deputy Medical Examiner Stephen Cina’s report also said that the child had no history of suicidal thoughts.

That’s contradicted by the Department of Children and Families’ own investigation that found that “he was out of control and destroying school property and stating that he wanted to kill himself” shortly before his death.

DCF Secretary George Sheldon created a workgroup to look into the boy’s death after it was learned that he hanged himself and was on numerous psychotropic drugs that his guardians had not signed off on.

Medical examiner: Cause of 7-year-old Margate boy’s death is ‘undetermined’

South Florida Sun Sentinel
By Sofia Santana

FORT LAUDERDALE – Does a 7-year-old understand suicide?

Unable to answer that question scientifically, the Broward Medical Examiner’s Office has decided not to rule a Margate boy’s hanging death earlier this year a suicide. The manner of death has been listed as “undetermined,” Broward Chief Medical Examiner Dr. Joshua Perper said Thursday.

“The medical examiner who did the autopsy, [Dr. Stephen Cina], looked at the case very carefully,” Perper said. “Whether at age seven a child has the capability to appreciate the results of his actions, some people may say yes, some people would say no.”

Police and prosecutors, meanwhile, are still investigating the unusual death of Gabriel Myers, who was living in a foster home and had been given a prescription for Symbax, a powerful mind-altering drug not recommended for children.

At the time of his death on April 16, Gabriel was home with only the 19-year-old son of his foster father. Gabriel got upset with the young man during lunch, locked himself in the bathroom and said he was going to kill himself. The 19-year-old used a screwdriver to pick the lock and found Gabriel hanging from a shower hose, the state’s Department of Children & Families reported. Gabriel was pronounced dead one hour later at Northwest Medical Center in Margate.

The child did not have a history of suicidal thoughts or tendencies, which further encouraged medical examiners to be very cautious in their ruling on the death, Perper said.

Gabriel, whose mother was a drug addict and father is in prison, was placed in DCF custody in October 2008. He lived first with relatives before being placed with the Margate foster family, with whom he lived for only three weeks.

Report: Fla. boy may not have meant to kill self

Miami Herald

By KELLI KENNEDY
Associated Press Writer
FORT LAUDERDALE, Fla. — It is unclear whether powerful psychotropic medications played a role in the death of a 7-year-old foster child, and the boy may have hanged himself for attention, according to a medical examiner’s report released Thursday.

Gabriel Myers locked himself in a bathroom and hanged himself with a shower cord in April, but the report classifies his death as undetermined. The report says it’s possible Gabriel did not intend to kill himself and did not fully understand the finality of his actions.

“His psychiatric history suggests that this fatality may represent a tragically flawed attempt of self-injury for secondary gain,” Dr. Stephen Cina, Broward County’s deputy chief medical examiner, wrote in the report.

Gabriel was on several powerful psychotropic medications, including Symbyax, before his death. That drug carries a U.S. Food and Drug Administration “black box” label warning for children’s safety and increased risk of suicidal thinking. It is not approved for use with young children. But doctors often prescribe them off label.

The boy’s death prompted debate at the state’s child welfare agency about stricter rules for prescribing powerful antidepressants and other drugs to foster children. The drugs affect the central nervous system and can change behavior or perception. They are prescribed for depression, anxiety, schizophrenia and other psychiatric conditions. Some are used to alleviate pain.

Critics say the drugs are overused as a chemical restraint for unruly children. A report by the Department of Children and Families released earlier this year indicates the 2,699 children taking psychotropic drugs account for 13 percent of all Florida children in out-of-home foster care. That compares with only an estimated 4 percent to 5 percent of children in the general population.

A records check showed that 433 of those children, or 16 percent, had not had their drugs approved by parents or court orders.

“Psychotherapeutic medications are often being used to help parents, teachers and other child workers quiet and manage, rather than treat, children,” according to an August report released by a panel that studied the Gabriel’s death.

DCF Secretary George Sheldon has said he may recommend further review for all children in state custody on such medications and the appointment of a new in-house state medical director to keep tabs on cases.

The task force also said case workers, doctors and teachers failed Gabriel at several points along the way and ignored warning signs. He was in three different foster homes, switched therapists and medications, and touched classmates in a sexually inappropriate way. He also tried to strangle himself in December, leaving noticeable red marks and scratches on his neck.

Gabriel also had several blunt force injuries at the time of his death, including bruises on his knees, thighs and forehead, according to the report.