Child’s suicide raises medication questions

Daytona Beach News Journal
By DEBORAH CIRCELLI

DAYTONA BEACH — Little bodies sink into adult-sized conference chairs.

With crayons between their fingers, they color on a sheet of paper after writing promises to their parents — “to control my anger,” “to make good grades” and “to go to the good side” when deciding what path to take in life.

In a room at Halifax Health Behavioral Services on Jimmy Ann Drive, 10- and 11-year-olds are dealing with adult issues — depression and mood swings.

For Walter Grimes, 11, his quiet demeanor is a sharp contrast from court documents describing a child in a school summer program who bit a teacher on both of her arms and punched and kicked her in the face. Walter, who was 10 at the time, was taken to Halifax Health Behavioral Services under the state’s Baker Act as a threat to himself and others and charged with battery on a school official, records show.

Therapy and psychotropic medication — medicine used for psychiatric reasons such as mood stabilizers, stimulants and drugs for attention deficit hyperactivity disorder — are helping him stay calm and concentrate, his therapist and great aunt said.

The question of how much is too much and how young is too young when it comes to prescribing psychotropic medications — some that are not approved for children by the Food and Drug Administration — is a statewide and national debate.

In Florida, 81,961 children covered by Medicaid were on psychotropic medications from January to June 2009, compared to 76,358 from January to June 2008, according to the state Agency for Healthcare Administration. Numbers for private health insurance companies are not public.

Local agencies are seeing a rise in the number of children with psychiatric problems, from severe anxiety to depression. They’re also seeing more young children who are 5 or 6 years old. The concern is especially high in foster care, where a higher percentage of children are given psychotropic drugs than in the general population.

The April 2009 death of a South Florida 7-year-old foster child, Gabriel Myers — who was prescribed several mind-altering drugs and hanged himself in his foster home — sparked a statewide review and recommendations in November that will result in new rules and legislation in the coming months for children under foster care.

“We must do better for our children,” said Alan Abramowitz, former local DCF administrator and state director of the DCF Family Safety Program Office. “Medication is not the cure-all.”

Adderall is the psychotropic medication prescribed statewide in foster care to the largest number of children for attention deficit hyperactivity disorder, DCF records show. Locally in foster care, the main psychotropic drug being prescribed is Seroquel for mental/mood conditions.

Some child advocates question whether medications — some of which have serious side effects such as suicidal thoughts — are being used as a quick fix to behavioral problems that children will grow out of because their brains are still growing.

“It shouldn’t take mind-altering medications to help children grow up,” said Karen A. Gievers, a child advocate and an attorney in Tallahassee. “It takes good parents to help children grow up.”

Others say some children need medications to help them concentrate and succeed in life. Some are being exposed to more violence at home and dealing with issues not seen a decade ago.

“We get children who haven’t giggled or laughed or smiled in years,” said Shirley Holland, department manager at Halifax Health Behavioral Services, the local community mental health provider for children. “Once we add medication, it’s like the light goes on. They experience life in a completely different way. It doesn’t mean the burdens go away, but life is not so heavy.”

MORE CHILDREN BAKER-ACTED

Halifax Health Behavioral Services has seen the number of children admitted under the Baker Act as a danger to themselves or others almost triple in Volusia and Flagler in a three-year period. The agency treats about 3,000 children in all its programs — more than half are on psychotropic medications.

The reasons behind the rise are unclear, but some point to children being subjected to more stress at home.

Holland said it would be unusual about 20 years ago to see a 12-year-old who was psychotic, hearing voices and hallucinating, but “they are younger than that now.”

She recalled a 5-year-old in 2009 who broke glass and swallowed it after stating he wanted to kill himself.

With a child or adolescent attempting suicide every 90 seconds in this country, Holland asked how can her staff not treat and help children have a better quality of life.

For Walter Grimes, he and his four siblings were adopted by their great aunt in 2008 after being removed from their parents by DCF. Carrie Hill, his great aunt, said the children dealt with issues of abuse and neglect, including sometimes sleeping on the floor when their cots broke. When he first came to live with her three years ago before he was adopted, Hill was often called to the school by police and administrators.

There were times he would “curse at me, hit me and spit on me,” she said.

Now, after being on medication for mood swings, Walter is making good grades and has certificates for scoring high on the FCAT in reading, but Hill said he still has more work to do.

“I was worried to put him on medicine, but I asked a lot of questions and talked to doctors and they helped me,” Hill said. “He has come a long way. He’s a sweet child and he’s very lovable and he has a beautiful smile. It’s just these issues he’s dealing with.”

At his Daytona Beach house recently, Walter was quiet and shy as he read his favorite book, “The Lion King,” to Hill, whom he calls “Auntie.” He said he loves to read because “it’s fun.”

The fourth-grader said he’s learned in therapy how to control his behavior by taking time to think about the situation, breathe or walk away if he is angry. He said the medicine “helps me stay calm. I don’t mind (taking it).”

Vanessa Harvey-Lents, program therapist at Halifax Health Behavioral Services, told children in the group recently they always have a choice to do the right thing. She told them that while the medicine they take calms them to think and make the right decision, they have to control their behavior.

“There is no cure to bad behavior,” she said.

UNKNOWN DRUG SIDE EFFECTS

Others worry children are being overmedicated and, in some cases, put on medications not approved for children, with unknown long-term side effects.

Dr. Christopher Bellonci, , a psychiatrist in Massachusetts and national expert who has testified before Congress and Florida child-welfare officials, said some psychotropic medications used for aggression in children can have serious side effects, from weight gain to diabetes and heart disease. He thinks there is “over-prescribing.”

He points to the diagnosis of bipolar disorder increasing 40-fold in the last decade. Part of the problem, he said, is the “societal viewpoint” that medications are the answer and will be easier than doing therapy and behavioral work.

“I don’t know that kids are any more ill than they were a decade ago,” Bellonci said. “But if you look at the diagnostic percentages, you are seeing huge increases in the way people are diagnosing these kids.”

Maryann Barry, CEO of the Children’s Advocacy Center in Daytona Beach, which provides therapy services to abused children, is concerned some children are being treated for mental illness when in truth “the problems are environmental or behavioral.” If there is a child in a violent, disruptive home, she said, the child will have violent or withdrawn behavior.

“Their body and mind is responding to that environment,” Barry said.

But Dr. Hilda Vega, a child and adolescent psychiatrist at Halifax Health Behavioral Services, said she looks at a variety of factors before deciding whether to place a child on medication, including the child’s pathology and his environment at home and school.

The youngest child she put on medication was 3 1/2 and was aggressive at home and in day care. But the family also saw a behavioral analyst.

In “an ideal world,” where there are no problems or illnesses, she said, she would not put any child on medicine. But she said, “we do not live in an ideal world.”

The brain is an organ, Vega said, and it also gets sick, which affects behavior and mood. Medicine, Vega said, helps regulate and stabilize. Many times children don’t have to stay on the medication into adulthood because, she said, they learn coping and organizational skills.

VIOLENCE AT HOME

“Our” Children First in Daytona Beach, which provides counseling and services to children and families, is seeing an increase in children who are depressed and making suicidal statements or threatening violent acts. In some cases, agency officials said, those children also have ADHD and their academics are impeded. Young children are being put on sleeping medication because of severe anxiety and post-traumatic stress, said Fran Moccia, the agency’s CEO.

“Children are seeing their mother shot and killed on the front lawn,” Moccia said, referring to a local Daytona Beach case and similar cases in West Volusia and Palm Coast where children were present when their mothers were shot. “There is so much violence every time you turn around..”

Crystal Knight, the agency’s clinical director, said while coping skills are taught in therapy, some children are not developmentally able to learn those skills and need medicine in conjunction with therapy.

“Sometimes counseling is just not enough,” Knight said.

Dr. Michael Bell, a DeLand pediatrician, said he’s shied away from prescribing psychotropic medication since the federal government issued warnings that some medications could cause suicidal thoughts in children. Instead, he refers children to a psychiatrist.

But Bell, who is also medical director of the child protection team at the Children’s Advocacy Center, also worries regulations and paperwork requirements are too strict for doctors and there is a risk more children will commit suicide if they are not treated with medication.

Still another concern is the use of off-label medications, which haven’t been properly tested for children, said Howard Talenfeld, president of Florida’s Children First, a statewide nonprofit children’s advocacy group, and chairman of a Florida Bar committee looking at children’s legal needs.

Ken Kramer, researcher for the Citizens Commission on Human Rights of Florida in Clearwater, which is associated with the Church of Scientology, agrees. He wants to see parents of all children fully informed about alternatives and risk and legislation requiring annual disclosures of gifts/payments by drug companies to physicians.

Walter Grimes’ aunt did her homework, and even though psychotropic medication is helping Walter and one of his brothers, she hopes they won’t have to take the medicine for very long.

“That is my prayer,” she said. “They said they can wean them away from it if they get better. I look forward to the day they can be off the medicine.”

State revamping children’s medication rules

Christina Pooley was used to the morning, noon and night ritual.

She’d open her mouth and move her tongue around so workers could see that the psychotropic medication she picked up in a little cup with her name on it was gone.

She tried “cheeking” her meds by hiding them in her cheek or partly swallowing them and coughing them up in her room at therapeutic foster homes throughout the state. When staff caught on and she refused to take the medicine, she said they’d give it to her through a shot or crush it up in apple sauce and watch her eat it.

The now 21-year-old Holly Hill woman said throughout almost her entire stay in foster care, from age 13 to 18, she was prescribed several medications at a time for mental health diagnoses, including depression, bipolar disorder, borderline personality disorder and oppositional defiant disorder.

Pooley’s story of being on psychotropic medications is not uncommon in foster care, state and national child welfare experts say. Nationally about 5 percent of all children are treated with psychotropic medications, but in foster care it ranges from 13 to 53 percent in states nationwide, experts say.

In Florida’s foster care system on Jan. 4, for example, about 14.5 percent of children — or 2,745 children — received one or more medications. The numbers locally were 13.5 percent or 112 children.

The April 2009 death of a South Florida 7-year-old foster child, Gabriel Myers, who was prescribed several mind-altering drugs and hanged himself in his foster home, sparked a statewide review and new rules, and legislation is being developed.

Pooley admits she hit walls, threw things, cut herself on her inner arms and legs and ran from group and foster homes, spending days on the Boardwalk. But she also thinks she was overmedicated. She now receives individual therapy at Halifax Health Behavioral Services and said she’s only on two medications to help her sleep.

Officials with the state Department of Children & Families would not comment on Pooley’s time spent in foster care and her records are not public. But a work group has been studying the broader issue after the South Florida child’s death last year .

The group made 90 recommendations in November, including hiring a chief medical officer to monitor prescribing such medications and appointing attorneys for children. Some changes have already been made, such as obtaining proper court and parental consent. DCF is continuing to develop new rules.

DCF Secretary George Sheldon said the state needs to ensure it’s dealing with children’s behavioral needs appropriately and realize just the act of removing children from their home is traumatic.

“I’m not anti-medication, but I think it is a last resort,” Sheldon said.

Locally, child-welfare officials have trained caseworkers on new requirements, including ensuring parents understand the forms they sign, consenting to their children being placed on psychotropic medication.

Robin Rosenberg, who serves on a statewide DCF work group and is deputy director of Florida’s Children First, a child advocacy agency, said the issue is whether the “right kids are getting the right medications.”

“Before you say we are going to cure that problem with medicine, you need to address what is happening in that child’s life,” Rosenberg said.

Pooley said she was removed from her home and placed in the state’s care because of issues at home. She also said each time she moved from one group home to the next, new doctors would put her on different psychotropic medications, which child-welfare officials and Halifax Health Behavioral Services representatives said is not unusual when children move around and see new doctors.

But Pooley said sometimes the amount of medication she was on made her feel “like I wanted to die.” She said when she was 16, she tried overdosing on one of the medications — Seroquel, which DCF officials say is the most common psychotropic drug used on local foster children.

When she ran from foster care and was on the Boardwalk, she said, she felt better being off medication.

She said that at Halifax Health Behavioral Services — where she was taken by police under the state’s Baker Act as being a danger to herself or others — doctors took her off all her medications, evaluated her and put her on fewer medications. She believes the people there saved her life and are continuing to help her now with therapy since finding out two years ago she’s going blind from a brain malformation that also causes headaches and insomnia.

“It’s more depressing than being in foster care, but I don’t act out or cut myself and I’m able to deal with it,” Pooley said.

She’s planning to start back this month at Daytona State College after various surgeries. She wants to get a degree in psychology and work with children at Halifax Health Behavioral Services.

“A lot of (other) people gave up and said I wasn’t going to amount to anything,” Pooley said. “But people at (Halifax Health Behavioral Services) said, ‘We know you have it in you. This is what you have to work on and get it done.’ They kind of held me to it.”

BY THE NUMBERS

Here are the number of children prescribed psychotropic medications to deal with the top four diagnoses at Halifax Health Behavioral Services:*

1,350 Children who are prescribed drugs, such as Concerta or Adderall, for attention-deficit hyperactivity disorder/attention-deficit disorder. Possible side effects are: anxiety, nervousness, chest pain, high blood pressure, headache and mood changes.

471 Children who are prescribed drugs, such as Prozac or Lexapro, for major depression/depressive disorder. Possible side effects are: nervousness; loss of appetite; anxiety or trouble sleeping; and feelings of irritability. May increase risk of suicidal thoughts in children, teens and young adults.

241 Children who are prescribed drugs, such as Depakote/Depakene, for bipolar disorder. Possible side effects are: dizziness; increased or decreased appetite; trouble sleeping; fast or irregular heartbeat; and hallucinations. Severe and sometimes fatal liver problems have occurred.

159 Children who are prescribed drugs, such as Seroquel, for oppositional defiant disorder. Possible side effects are: fast or irregular heartbeat; increased hunger; seizures; and suicidal thoughts or mood changes.

NOTE: *Number of children as of Dec. 11, 2009

SOURCE: Halifax Health Behavioral Services and News-Journal research

BAKER ACT & CHILDREN

The number of children in Volusia and Flagler counties admitted to Halifax Behavioral Services involuntarily under the state’s Baker Act as a danger to themselves or others is on the rise:

2005/2006: 289

2006/2007: 662

2007/2008: 784

2008/2009: 845

SOURCE: Halifax Behavioral Services.

Fiscal year starts Oct. 1 and ends Sept. 30.

PSYCHOTROPIC MEDICATION IN FOSTER CARE

The number of children from birth to age 17 in foster care who are on one or more psychotropic medications:

• Florida: 2,745 children or 14.55 percent of all children in foster care.

• Volusia/Flagler/Putnam: 112 children or 13.58 percent of all children in foster care

SOURCE: Florida Department of Children & Families as of Jan. 4, 2010

Task Force to Stop Child on Child Sexual Abuse

WCTV

Child on child sexual abuse touches and troubles the lives of thousands of children each year and the state of Florida is launching a new effort to stop it.
Reporter: Tara Herrschaft

New research by the Justice Department shows more than a third of sex crimes against children are committed by other children.

The Florida Department of Children and Families identified more than 8300 children as either alleged perpetrators or victims of child on child abuse from 2008 to 2009.

And officials say it’s critical to respond immediately. “Because many of the children that are abused at some point could later become abusers,” said Alan Abramowitz, the State Director of the Family Safety Office for DCF.

The death of 7 year-old Broward County boy Gabriel Myers has sparked the DCF Secretary to form a task force. Myers was sexually abused by a 12 year-old boy and killed himself back in April. He was also on psychotropic drugs, which officials believe may have been another contributing factor. Now the group is holding hearings around Florida, gathering feedback to prevent future crimes.

“A lot of times we don’t know particularly how to react to it. Either in the law enforcement side, the parental side, or the social worker side. So we’ve got to do a better job of preparing parents and in our case, foster parents with dealing with these issues. We’ve also got to do a better job of making sure the support systems are in place. Because it takes specialized psychological and emotional services to be able to deal with the child who’s been victimized and equally important to deal with a child who’s the victimizer,” said Jim Sewell, the Special Assistant to the DCF Secretary.

The first hearing was a couple weeks ago, and there will be about five more. The Tallahassee meeting is scheduled for March 11th. Organizers are planning on submitting a report of their findings and recommendations to the DCF Secretary and then the legislature.

Feds investigating high prescribing Fla. docs

Associated Press

By KELLI KENNEDY
Associated Press Writer
MIAMI (AP) — The federal government has stopped reimbursing a Miami doctor who wrote nearly 97,000 prescriptions for mental health drugs to Medicaid patients over 18 months, in a case that prompted a key Senator to call for a nationwide investigation.

U.S. Sen. Sen. Charles Grassley of Iowa said Dr. Fernando Mendez Villamil wrote an average of 153 prescriptions a day for 18 months ending in March 2009. That’s nearly twice the number of the second highest prescriber in Florida, who wrote a little more than 53,000 prescriptions, according to a list compiled by state officials.

Grassley, an Iowa Republican and ranking member of the Senate Finance Committee, which oversees Medicare and Medicaid, called the figures alarming and sent a letter Wednesday to the Department of Health and Human Services asking the agency to investigate top prescribers across the country. His inquiry comes as the government targets waste and fraud in the taxpayer funded programs.

HHS officials said they were aware of Florida’s list of high prescribing doctors and were working closely with the state and federal agencies that investigate Medicaid fraud, according to a statement from Sec. Kathleen Sebelius’ office.

Dr. Villamil hasn’t been reimbursed by Medicare since May when HHS started investigating him.

An employee at Villamil’s office declined to comment and a voicemail left at his office Thursday was not immediately returned.

“It’s hard to believe that this dramatic level of activity could go unnoticed,” Grassley told The Associated Press.

“It’s a matter of program integrity, taxpayer protection and patient safety,” added Grassley, who asked HHS officials to explain whether and how the agency tracks high-prescribing doctors.

The vast majority of the doctors near the top of Florida’s list are in the Miami area, where Medicare fraud totals over $3 billion a year, higher than any place else in the country.

“The highest prescribers are always in Miami,” said Karen Koch, vice president of the Florida Council for Community Mental Health. “They tend to use medication more maybe than in some others areas and then sometimes it’s an anomaly in the data.”

Koch said that some doctors on the list have multiple practices with other prescribers using their license, which is legal. The state also has a shortage of psychiatrists, meaning a smaller number of doctors are serving more patients each.

And sometimes patients doctor shop with the intention of selling the drugs, which also drives up prescription numbers.

The drugs that Villamil, a psychiatrist, prescribed most commonly included Seroquel, Zyprexia and Abilify.

Seroquel is the only drug that has street value in the United States. “When snorted, it acts like cocaine,” said Koch. The other drugs “have high street value in South American countries because it is not available there so families in the U.S. are always trying to get it for their relatives there,” she said.

The state’s top prescriber list is part of the Medicaid Drug Therapy Management Program, which began monitoring mental and behavioral health medications when the program was created in 2006.

“The number of prescriptions recorded for Dr. Fernando Mendez-Villamil is high when compared to other Medicaid prescribers,” state Agency for Health Care Administration spokesman Sue Conte said in an e-mail to The Associated Press.

However, she said “it does not indicate that there is anything improper regarding his prescribing,” saying patients seeing a specialist like Villamil would need daily medications plus medications for acute episodes. Villamil’s prescriptions also included refills, she said.

If a concern arises, AHCA’s Office of Inspector General will more thoroughly investigate billing practices and prescribing patterns. If fraud is suspected, the case is sent to the Florida’s Attorney General. About 123 cases were referred to the Medicaid Fraud unit in the past fiscal year, according to AHCA.

A spokesman for Florida’s Attorney General said the office has a pending investigation into Villamil, stemming from a 2007 request from a private citizen. She declined to comment further.

A Florida doctor who prescribed several mental health medications to a 7-year-old foster care boy who killed himself in April is also on the list. The drugs carried a special FDA black box warning indicating they can cause suicidal thoughts and are not approved for young children, though some doctors still prescribe them to treat children.

Dr. Sohail Punjwani wrote 10,150 prescriptions during the same two year period, according to the report.

Dr. Punjwani, who has appeared on the high-prescriber list multiple times but has never been sanctioned, did not immediately return a phone call left by The Associated Press on Thursday.

Grassley’s letter comes months after Gabriel Myers hung himself with a shower cord at his foster parents’ home while under Punjwani’s care. 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.

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.