Monthly Archives: October 2009

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.

Leave a comment

Filed under St. Petersburg Times

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.

Leave a comment

Filed under Miami Herald

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.

Leave a comment

Filed under Palm Beach Post - Post on Politics

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.

Leave a comment

Filed under Sun Sentinel

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.

Leave a comment

Filed under Miami Herald

DCF doesn’t get autopsy report of 7-year-old who died in state custody


Palm Beach Post – Post on Politics

by Dara Kam

Department of Children and Families Secretary George Sheldon made the apparent suicide of a 7-year-old Broward County boy in foster care one of his top priorities in April.

Sheldon created a working group to get to the bottom of Gabriel Myers’ death and examine why the child was on a psychotropic drug cocktail without the consent of his guardians.

Despite Sheldon’s attention to the boy’s case, his office was unable to get its hands on a copy of the autopsy released to the public by the Broward County Medical Examiner early Thursday afternoon.

About an hour after the autopsy was made public around 11 a.m., Sheldon’s press secretary Joe Follick said he did not have a copy of it. He suggested getting a copy from the medical examiner.

Broward County Medical Examiner Joshua Perper quickly replied to a public records request and e-mailed a copy of the 28-page report.

Hours later, Follick still did not have a copy of it.

“By reviewing the facts of this case carefully, we can work to continue to improve the child welfare system in Florida. While much progress has been made, Gabriel’s death starkly reminds us that when it comes to a child’s life, we cannot relax. Every decision we make profoundly affects the life of that child,” Sheldon said in a press release when the Myers work group was created in April.

Leave a comment

Filed under Palm Beach Post - Post on Politics

Florida foster kids slower to get medications now


Florida Times Union

Florida foster kids slower to get medications now
The new rules come after a 7-year-old boy hanged himself in April.
By Brandon Larrabee

TALLAHASSEE – New practices after the death of a 7-year-old foster child who took psychiatric medications have slowed the flow of the drugs to children in state care, local health-care providers say. Whether those changes are for the better is a contentious question.
The renewed attention to so-called psychotropic drugs comes in the wake of the hanging death of Gabriel Myers of Fort Lauderdale, whose apparent suicide in April led to an ongoing examination by the Department of Children & Families. His death sparked promises by lawmakers to strengthen laws aimed at preventing the overuse of the medications by foster children.

It is the latest chapter in an international battle over how and whether the drugs should be used, with medical professionals stressing they are largely safe for older patients but advocacy groups pointing to suicides, particularly among children, as a reason use of the medications should be curtailed. Those fears have prompted the FDA to put a “black box” warning on the drugs.

The task force investigating Myers’ death found hundreds of children were on psychiatric medication without a paper trail showing consent. DCF has in recent months put a renewed emphasis on ensuring that it has the required parental consent or court order for children taking the drugs.

“It has slowed down in some cases the child physically taking the medicine,” said Denise Marzullo, clinical director for Northwest Behavioral Health Services in Jacksonville.

Marzullo said more paperwork has been required recently, perhaps in the last year or so, but that some DCF caseworkers are also ready with the required consent as soon as the child is prescribed the medication, cutting back on delays in those cases. And she said the often tumultuous life of children in state care doesn’t mean that taking time to get the drugs correct, and make sure other drugs might not cause a negative reaction, is a bad thing.

“Who knows what they’re taking from foster home to foster home?” she said.

But Joe Zichi, clinical director at Psi Family Services in Jacksonville, said the problems can actually be interrelated; children who aren’t on the proper medication can actually be shifted from foster parent to foster parent because of adults who don’t know how to care for them.

“Further damage has been done, because he’s been rejected three more times by adults in his life,” Zichi said, using a hypothetical example.

Policies that delayed getting drugs to children picked up steam after Myers’ death, Zichi said, and Psi has dealt with requests from the state for documents like proof a child was tested for sickle-cell anemia or a patient’s dental records before approving prescriptions.

“We’re seeing more and more stuff come down from Tallahassee,” he said. “We don’t need to be going through all these steps when the child needs help yesterday.”

Alan Abramowitz, director of DCF’s Family Safety Program Office, said the agency is working to more clearly spell out what paperwork doctors and the agency need to have a good grasp on a child’s medical history before writing a prescription. Physicians with a question about an unusual state request should contact the agency, he said.

But Abramowitz also said the state is simply following the law and trying to ensure that the drugs are necessary before a prescription is written.

“We want those obstacles,” he said. “Those obstacles are good. Those things are going to make sure a child is not being put on medication as an easy fix. … The purpose of the medicine can’t be just so you don’t act out.”

Leave a comment

Filed under Florida Times Union