Report: Medication System Failing Foster Kids

CBS-4

TALLAHASSEE (CBS4) ― The system meant to protect children in foster care failed because doctors and case managers routinely failed to complete treatment plans, failed to share information, or properly document the usage of powerful psychiatric drugs, according to the Department of Children and Families. One of the children that it failed was 7-year-old Gabriel Myers, who hanged himself in April.

However, the study also said it would be a mistake to blame Gabriel’s death solely on the drug Symbyax. The drug is an antipsychotic used to treat bipolar disorder, also known as manic depression. It can also be used as a treatment for clinical depression if two other drugs have failed to treat the depression.

The study from DCF said that numerous rule and laws on meds for children in foster care weren’t followed for all 6 and 7 year olds, according to CBS4 news partner the Miami Herald. Among the other findings reported:

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 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 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 study comes one year after a similar review that examined the drugging of children in state care under the age of 6. The committee probing the child-welfare system plans to issue a report by Aug. 20.

Florida’s psych drug rules for foster kids ignored

Miami Herald

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
Herald/Times Tallahassee Bureau

TALLAHASSEE — 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.”

DCF’s child-drugging problems

St. Petersburg Times

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.”

More here

— Marc Caputo

System faulted in Margate boy’s suicide while in foster care

Sun Sentinel

By Marc Caputo The Miami Herald

MIAMI – 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 children 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 investigating 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 — may 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.”

DCF says its rules on children’s drugs are often ignored

St. Petersburg Times
In Print: Tuesday, July 7, 2009

TALLAHASSEE — 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 such children was Gabriel Myers. The troubled 7-year-old, medicated with an adult antidepressant 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 caseworkers, legal guardians, judges and other physicians determine a child’s mental well-being.

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

• In 76 percent of the cases, the caseworker didn’t provide parents with information about the psychotropic drugs their kids were being prescribed. Nor did the caseworker 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 before seeking a court order to medicate the child.

The committee 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 caseworkers — all of whom work for privatized agencies under contract with the state — might face sanctions, pending the report.

Marc Caputo can be reached at mcaputo@MiamiHerald.com

Consent for foster kids’ psychiatric drugs on rise

Florida Times Union
More parents, courts approve medication; some fear they aren’t informed decisions.
By Brandon Larrabee

TALLAHASSEE – As a task force examining the use of psychiatric drugs by foster children draws nearer to issuing its report, caseworkers across the state are working to get parents or courts to approve the use of the medications to treat hundreds of children.

And while the number of foster children reported to be taking the medicines has risen from 2,669 in early June to 3,100 in numbers released Thursday, the proportion doing so without consent has dropped steeply, from 16.2 percent to 6.1 percent.

Even so, some advocates are worried that the rush to generate a paper trail for children already taking the medicines might mean some permission is being given without a full understanding of the drug’s purpose and possible side-effects.

“They’ve been working very hard to get paper files that reflect consent,” said Robin Rosenberg, interim director of Florida’s Children First and a member of the state’s Gabriel Myers Work Group. “But that is different than informed consent.”

The work group began its investigation in the wake of the death of 7-year-old Gabriel Myers, a foster child in South Florida who police say hanged himself April 16.

Myers was taking psychiatric medicines, and the Department of Children and Families later found that local caseworkers had not obtained proper consent for him to use the drugs.

Psychiatric drugs, particularly antidepressants, have become controversial because of worries that they might increase thoughts of suicide in children, prompting the FDA to put a “black box” warning on the medications.

State figures show 488 children in the agency’s 19-county Northeast Region – which includes Duval, Clay, Nassau, St. Johns, Flagler and Baker counties – are taking the medicines. In June, about 22 children – about 5 percent of those taking the drugs at the time – did not have consent; that number is now 18 children, about 3.7 percent.

Consent from courts

Much of the shift, though, has taken place by obtaining consent from courts. For example, 46 percent of children in the Northeast Region taking the drugs in June had consent from parents, with 44.8 percent taking the medicines under a court order.

According to Thursday’s figures, 42.3 percent of children using the drugs are now doing so with parental consent, with court orders now accounting for about 53.1 percent of children being treated.

Statewide, the proportion of children taking drugs under court order has risen from 43.4 percent in June to 51.1 percent now.

Jim Sewell, former assistant commissioner of the Florida Department of Law Enforcement and head of the work group, said caseworkers were probably headed to court more often because some parents are difficult to find or have had their rights terminated.

“My speculation is that it’s probably the safe way right now because there’s so much attention on it. … With the attention given this, there’s a whole lot of pressure on these local organizations to get the paperwork right,” he said.

Rosenberg pointed out that many foster children are in the system for a reason.

“The child was removed because of the parent’s conduct,” she said.

She also said that the child should also have an age-appropriate influence on treatment.

“They know what’s happening to their bodies,” she said.

Sewell said his group is closely monitoring even the cases where consent has already been obtained, to make sure that parents and courts are getting enough information to make the right decision. The panel is hoping to complete its report by Aug. 20 and present it to state officials six days later.

It’s also wrestling with the loaded question of how many drugs are being prescribed. Sewell said the focus isn’t on whether the department and physicians are underprescribing or overprescribing drugs.

“The issue really is, are we properly prescribing drugs,” he said.

Rosenberg said some children do need to take the medicines.

“But if they’re angry or depressed or misbehaving to get attention,” she said, “a lot of things could be going on that have nothing to do with a psychological diagnosis.”

System faulted in boy’s death in foster care

Miami Herald
BY MARC CAPUTO

TALLAHASSEE — 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.”

Florida Agency for Persons with Disabilities has its own psychotropic drug problem

Sun Sentinel
Posted by Doug Lyons
July 1, 2009
By: Howard M. Talenfeld and Maria E. Abate

The use of dangerous prescription medications for children and adults in residential and group home facilities licensed by the Florida Agency for Persons with Disabilities (APD) is an alarming situation.

Two years before the suicide of Gabriel Myers, a foster child who was prescribed a “cocktail” of powerful psychotropic drugs, 12-year-old group-home resident Denis Maltez succumbed to serotonin syndrome after being given similar drugs.

Gabriel’s death brought to light the near-rampant use of these drugs among Florida’s foster children – and resulted in a sweeping review of the practice by the Florida Department of Children and Family Services. The APD should conduct a similar review.

Such a survey would likely find what a review of Denis Maltez’s death confirmed; some group homes allow these drugs to be administered to adults who are not competent to provide informed consent and to children whose parents or guardians have not provided such consent. These drugs often are prescribed without a full physician review or medical history, without parent or guardian consent, and in an “off-label” fashion not intended by the manufacturer.

Rarely are behavioral interventions exhausted and investigations undertaken to ascertain how the different medications will react to one another – or how the individual will respond to the regimen. The drugs also are prescribed and administered without appropriate follow up monitoring and blood testing, as was the case with Denis Maltez.

The DCF review found that 2,669 of Florida’s 20,235 foster children under the age of 17 were given one or more psychotropic drugs – with one in six, or about 16 percent, lacking required permissions. These findings only scratch the surface the use of these drugs.

We call upon the Florida Agency for Persons with Disabilities to join DCF Secretary George Sheldon in a review and scrutiny of these practices. APD should survey all licensed group homes working with the Agency to determine how many are administering psychotropic medications without appropriate consent, and how many are using these medications as chemical restraints. We are also asking that the APD take necessary actions to ensure appropriate procedures are in place to ensure the use of these medications is appropriate and only as a last resort after all behavioral interventions have failed. The APD must join in DCF’S effort to protect vulnerable persons like Denis Maltez.

Howard M. Talenfeld and Maria E. Abate are South Florida trial attorneys who are involved with child welfare issues. Talenfeld is also president of Florida’s Children First.