Monthly Archives: March 2010

In wake of child’s suicide, Legislature moves to limit foster care’s reliance on psychiatric drugs

St. Petersburg Times
By Cristina Silva, Times Staff Writer

TALLAHASSEE — A year after a 7-year-old boy heavily medicated on powerful psychiatric drugs hanged himself in his Margate foster home, lawmakers are pushing to reform state medical requirements for foster children.

The Senate’s Children, Families, and Elder Affairs Committee unanimously approved a measure Thursday designed to curb the prescription of mental-health drugs to children in state care.

The proposed law would require the state Department of Children and Families to assign volunteer guardians to oversee each child’s mental health care. It prohibits foster children from being the subject of clinical drug trials and raises the age at which children are allowed to take these drugs from 6 to 11 in many cases.

The measure (SB2718 and HB1567) would also give children some say in the drugs they take.

“We are not just going to medicate them until they turn 18 and then dump them into adulthood,” said sponsor Sen. Ronda Storms, R-Brandon, chairwoman of the Children, Families, and Elder Affairs Committee.

The state’s growing use of adult medication on emotionally and mentally troubled children has sparked debate for years.

Multiple state studies show child-welfare doctors and case managers routinely failed to follow legally required treatment plans or properly document when and why drugs were given to foster children, creating a network of youth sedated by “chemical straitjackets,” Storms said.

The death of Gabriel Myers in April further revealed the shortcomings of 2005 legislation that required more information sharing, parental involvement and second-party review of doctors’ prescriptions for the youngest children.

Because foster children are often cared for by multiple service contractors, communication lapses and fragmented mental health care are still rampant, a recent state report on Myers’ death determined.
“Our response to him was to medicate him, and medicate him, and medicate him,” Storms said.

Under the bill, proposed medical treatment plans must be explained to a child and the child must consent to the treatment in many cases before taking the drugs.

“What this means is less medication and more behavior analysis so that they are not just sedated little zombies,” said Jan Montgomery, president of the Florida Association for Behavior Analysis, which would train legal guardians to observe and treat behavioral problems.

Still, Montgomery said she did not expect a sudden culture shift, given failed past efforts to track foster children’s medical records.

“It’s going to be a slow slide toward what we are hoping is the right way,” Montgomery said.

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Bills worry child advocates


Daytona Beach News Journal

By DEBORAH CIRCELLI

DAYTONA BEACH — While social service agencies brace for more cuts this legislative session, many are following dozens of bills dealing with everything from giving foster children psychotropic medications to better screening of employees who work with vulnerable children and adults.

Improvements in background screenings for state-regulated jobs passed the Florida House on Thursday, but will still need approval in the Senate and by the governor. Owning a gun also won’t prevent someone from adopting a child, based on a bill approved in both chambers Thursday.

Local child-welfare officials are also watching what new guidelines will be passed dealing with prescribing psychotropic medications to foster children after the April 2009 death of a South Florida 7-year-old foster child, Gabriel Myers. Gabriel was prescribed several mind-altering drugs and hanged himself in his foster home. Locally, about 120 or 14.4 percent of foster children in out-of-home care such as foster homes, group homes or living with relatives are on psychotropic medications.

Former foster youth receiving a monthly stipend by the state for living expenses while they continue their education could also see their money cut in half.

A House bill (HB 5305) would place a cap of $675 on how much former foster youth could receive each month for living expenses while continuing their education. About 70 youth locally are receiving about $1,200 a month. Another committee bill (SB7066) would require an audit of the program to track how youth are doing and spending the funds.

State and local advocates fear cutting funds will lead to youth dropping out of high school or college and becoming homeless.

“I think it would be extremely difficult for them to make it,” said Bill Babiez, CEO of Community Partnership for Children, the local foster care agency for the state.

Some other bills being followed by social service agencies include:

• BACKGROUND SCREENINGS (SB1520/HB7069): Enhances screenings for groups working with vulnerable adults and children. Some areas would include Guardian Ad Litem, nursing homes, foster homes, mental health personnel, home health agency personnel and people working with the developmentally disabled. The bill passed unanimously in the House. Fingerprints for various groups would be submitted electronically and retained by the state Department of Law Enforcement.

• FIREARMS/ADOPTIONS (SB530/HB0315): Prohibits an agency from denying a person the ability to adopt because they lawfully possess a firearm. The Legislature adopted the bill Thursday — including a 112-0 vote in the House and 38-2 in the Senate — and Gov. Charlie Crist said he supports it.

• ADOPTION (SB102/HB0003): Repeals law that currently prohibits someone who is homosexual from adopting.

• ATTORNEY REPRESENTATION FOR FOSTER CHILDREN (SB1860/HB7075): Appoints attorneys for foster children in certain cases such as if they’ve been in care for 18 months and their parents’ rights have not been terminated, or if a child asks for an attorney and the court agrees. Also, in cases where psychotropic medications are prescribed and the child objects or the court is concerned.

• INCREASED SERVER PENALTIES/OPEN HOUSE PARTIES (SB1068/SB1066/HB0033): Enhances penalties for people serving alcohol to someone under 21, including someone hosting an open house party where drugs or alcohol are possessed or consumed by minors. As opposed to 60 days in jail and a fine not to exceed $500, a person could get a one-year sentence and $1,000 fine, which is a first-degree misdemeanor, for selling or delivering alcohol to a minor within one year of a prior conviction.

• MENTAL HEALTH, CRIME REDUCTION AND TREATMENT ACT (SB1140/HB 1189): Provides more substance abuse and mental health services in the community such as crisis intervention teams and mental health courts. The legislation would reduce the number of people with mental illnesses or substance abuse disorders from being in the criminal justice system. Chet Bell, CEO of Stewart-Marchman-Act Behavioral Healthcare, said, “We want mental illness among nonviolent offenders to be treated as a health issue, not a criminal justice issue,”

• INTELLECTUAL DISABILITIES (SB1388): Would replace the word “mental retardation” in current legislation to “intellectual disability.” Barry Pollack, president & CEO of United Cerebral Palsy of East Central Florida in Daytona Beach, said, “Our society has turned the word ‘retardation’ and variations of the word into a socially unacceptable label with very negative characterizations.” Other bills dealing with rights of people with disabilities include increased training requirements for people teaching children with disabilities.

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FDA warns psychiatrist who treated dead foster child

Miami Herald
BY CAROL MARBIN MILLER

MENTAL HEALTH
FDA warns psychiatrist who treated dead foster child
The psychiatrist who treated the Broward foster child who killed himself last year is now in hot water with the FDA.

A South Florida psychiatrist who was treating a 7-year-old foster child before the boy committed suicide last year has received a warning from federal drug regulators who say he failed “to protect the rights, safety and welfare” of children enrolled in clinical drug trials.

In a strongly worded letter dated Feb. 4, regulators at the U.S. Food and Drug Administration said Dr. Sohail Punjwani over-medicated children who were enrolled in clinical trials for undisclosed drugs. One girl, the letter said, slashed her wrists while hallucinating.

Another, a 13-year-old, “experienced sedation and dizziness during the study,” the letter said.

The warning letter, a harsh and rare form of discipline by the agency, says Punjwani failed to “adhere to the applicable statutory requirements and FDA regulations governing the conduct of clinical investigations.”

“Your failure to conduct the requisite safety measures contributed to the unnecessary exposure of pediatric subjects to significant overdoses, which jeopardized the subjects’ rights, safety and welfare,” the letter says.

Punjwani did not return calls from The Miami Herald seeking comment.

Punjwani, who practices in Tamarac and has offices elsewhere in South Florida, was treating 7-year-old Gabriel Myers when the boy hanged himself with a shower cord in a Margate foster home. The boy’s death prompted a yearlong probe by a Department of Children & Families task force, as well as proposed legislation before the Florida Senate.

Before Gabriel’s death, Punjwani had prescribed several powerful mental health drugs — some of which had not been approved by the FDA for use on children and had been linked to dangerous side effects, including an increased risk of suicide among children.

Punjwani also was sued last summer by a Tamarac mother who claims her son, 16-year-old Emilio Villamar, died after being over-medicated with a group of mental health drugs at a Fort Lauderdale psychiatric hospital.

The letter mailed to Punjwani does not specify the names or types of drugs the doctor was testing, and a spokeswoman for the FDA, Sandy Walsh, said such details are kept confidential to protect drug companies.

Walsh said the FDA does not send out such warning letters often, and the agency considers breaches of its regulations to be “very serious.” The letter was signed by Leslie K. Ball, a doctor who heads the compliance office of the Division of Scientific Investigations, and Constance Cullity, a doctor who is also a compliance officer.

For years, drug makers did not study most medications on children, largely due to ethical concerns over using kids as test subjects. More recently, however, Congress passed laws to encourage pharmaceutical companies to test their drugs for safety and efficacy with children by extending patents on drugs approved for adults.

In a trial for one drug that was not identified, Punjwani gave one child dosages “in excess of… specified limits,” the letter says.

The child was discontinued from the trial before it was completed, the letter says, “due to worsening auditory hallucinations that apparently caused the subject to lacerate her wrists.” The girl was “overdosed” on the drug for more than two weeks.

The letter says Punjwani submitted a corrective action plan to the FDA and revised his procedures to better protect his research subjects from dosing missteps. “However,” the letter says, “we are concerned that the response is not adequate to prevent future recurrence of the violation.”

The clinical trials for a different drug were to adhere to a series of protocols that specified what dosage of the drug was to be used, depending on the child’s weight, the letter states. But for six of seven children — chosen at random — who received one of the tested drugs in Punjwani’s study, the dosage exceeded what was spelled out in the protocol.

One child who weighed 103 pounds, for example, “was overdosed on study medication for 20 consecutive days while participating in the study,” the letter states. The child is identified only as “Subject 1001.”

A child identified as “Subject 1003,” who was 15 at the time of the trials, “was overdosed on study medication for 21 consecutive days while participating in the study,” the letter says. “Subject 1004,” a 16-year-old, “received doses in excess of the maximum target dose for 3 consecutive days while participating,” the letter says.

A 10-year-old, identified as “Subject 1007,” was “overdosed” for nearly two weeks while on the study, the letter states.

Department of Children & Families Secretary George Sheldon, who appointed a task force last year to study Gabriel’s death, said Monday he is asking the FDA to compare a list of Florida foster children with lists ofchildren enrolled in Punjwani’s clinical trials. Sheldon said he was acting on concerns that children in state care may have been involved in clinical trials, which is against state law.

The FDA letter, Sheldon said, “raises clear ethical issues and judgment issues that we need to clearly understand.” If foster kids were enrolled in clinical trials, he said, “we will need to take it to another level.”

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Regulations sought for foster kids prescribed psychiatric drugs

Miami Herald
FLORIDA LEGISLATURE

In the wake of a Broward child’s death, state lawmakers will consider a bill designed to make it harder for child welfare workers to use mental health drugs to control foster kids.
BY CAROL MARBIN MILLER

Florida lawmakers will once again consider a measure to rein in the use of psychiatric drugs among foster children in the wake of last year’s death of a 7-year-old Broward boy who was on a cocktail of mood-altering drugs.

A new bill, filed Friday by state Sen. Ronda Storms, a Brandon Republican, would, among other things, require that foster children assent to the use of psychiatric drugs. The proposed law would require caseworkers to explain to children, in a manner they can understand, why the drugs are necessary and what risks they carry.

“It’s a huge step forward for the children of Florida,” Robin Rosenberg, deputy director of Florida’s Children First, said of the provision. “It’s integral to effective treatment for children to be involved at a developmentally appropriate level.”

The requirement that foster kids be involved in their own treatment was one of scores of recommendations made by a child welfare work group of administrators from the Department of Children & Families, doctors and children’s advocates who studied the death of Gabriel Myers last April.

Gabriel, originally from Ohio, entered state care in June 2008 when his mother was found slumped in her car in a restaurant parking lot — with a narcotic pill bottles surrounding her. Gabriel hanged himself on April 16, using a retractable shower cord as a noose.

In the aftermath, The Miami Herald reported that the boy had been prescribed several anti-psychotic and anti-depressant drugs in the months before his death. Most of the drugs have not been approved for use with children, and some have been linked to serious side effects, including an increased risk of suicide.

While Storm’s bill tracks most of the work group’s findings, it differs in some respects. One major difference: The work group wanted each child being administered psychotropic drugs to have the benefit of a lawyer at all court appearances.

Storms’ bill requires the state to appoint guardians ad litem, or volunteer lay guardians. Storms said the guardians are qualified for the role because they already are involved in the children’s lives.

Rosenberg, who was a member of the Gabriel Myers Work Group, said “the work group concluded that attorneys are best suited to protect children’s interests when prescribing medication,” she said.

The bill would also:

• Prohibit children in state care from being involved in clinical trials designed to determine the safety or efficacy of drugs that have not yet been approved by the FDA.

• Require an independent medication review before psychiatric drugs can be administered to children 10 or younger.

• Require mental-health professionals to prepare an overall treatment plan, including the use of counseling and therapy, when children are prescribed psychiatric drugs.

“We want to give a preference to behavioral therapy,” said Storms, the bill’s sponsor. “We’re not going to just drug them through their childhood and adolescence.”

Storms said she thought the prescribing of such drugs has become a crutch for therapists, who are eschewing traditional couch chats with children. Research shows, she said, that some doctors are writing one prescription for a child every three minutes.

DCF administrators have supported the legislation, which marks the second time this decade that lawmakers have sought to crack down on mental-health drug use among kids in state care.

“With young kids, we really need to err on the side of caution,” said DCF Secretary George Sheldon, who has supported both the work group and the legislation.

State Sen. Nan Rich, a Sunrise Democrat who is vice chair of the children’s committee, said the bill will fail if lawmakers decline to set aside enough money to pay for it — especially the provision that requires guardians for foster kids who are prescribed drugs.

Miami Herald staff writer Robert Samuels contributed to this report from Tallahassee.

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Bill tightens rules for foster kids’ prescriptions

Associated Press

By KELLI KENNEDY

FORT LAUDERDALE, Fla. – Powerful mental health drugs dispensed to Florida foster care children would be more closely monitored under a bill introduced in the Florida legislature that comes after the death of a 7-year-old boy who was taking several psychiatric medications.

Sen. Ronda Storms, who filed the bill (SB 2718), said the drugs have replaced talk therapy and are over-prescribed to subdue unruly children. The measure requires an independent review before psychiatric drugs can be administered to children 10 or younger.

The bill, filed late last week, also expands the role of court-appointed guardians in overseeing children on mental health drugs and requires caseworkers to explain the possible side effects of such drugs to children in an age appropriate manner.

Mez Pierre, who entered the foster system at age 5, said he was given various medications, including one that caused diabetes, and said it’s crucial that children be involved in their own treatment.

“Its fair to know what it is you’re putting in your body,” said Pierre, 22.
The proposal is largely based on the findings of a task force formed after Gabriel Myers, who was on several psychotropic drugs, locked himself in a bathroom and hanged himself with a shower cord last April.

Gabriel was on Seroquel and other psychiatric drugs linked by federal regulators to potentially dangerous side effects, including suicide, but the risks may not have been adequately communicated to his foster parents. They are not approved for use with young children. But doctors often prescribe them ‘off-label,’ for purposes for which the drugs have not been approved.

“All you do is mask the behavioral problems by treating him psychotropically. All you’re doing is putting him in a chemical straight jacket so that he can’t act out so you can get him to 18 and dump him into adulthood and that’s not acceptable,” said Storms, R-Valrico.
A similar bill was filed in the House on Tuesday.

Gabriel’s death prompted a statewide investigation that found 13 percent, or 2,699, of all foster children are on such drugs, according to a Department of Children and Families study. That compares with only an estimated 4 percent to 5 percent of children in the general population.

“I think it’s an extremely important step forward,” DCF Secretary George Sheldon said Tuesday. “The key is going to be the ability of the department to implement and hold people’s feet to the fire. You can have the best statutes but if we don’t do our job it’s not going to make a difference.”

Child advocates say prescribing doctors often lack pertinent information on the child, including medical history and behavioral background. The bill requires caregivers and doctors to report any adverse side effects, which DCF must document.

“There was no record when a child had a bad reaction of any kind to the medication. There was no way to keep that information,” said child advocate and Broward County attorney Andrea Moore.

The bill also requires children to have a mental health treatment plan that includes counseling for children prescribed such drugs. Sheldon said he’s heard from too many foster children who were kept on mental health drugs until they turned 18. Treatment plans must include a time frame for discontinuing medications, he said.

Basic analysis of all medications for children in state care — such as what medication they were taking, why and when it was prescribed, and whether it worked — was supposed to be collected beginning in 2005, but that never happened.

A DCF review shows caseworkers failed to complete treatment plans, didn’t consult psychiatrists and failed to obtain consent for the drugs in many cases. The bill addresses each of those issues.

The bill says foster children often receive “fragmented medical and mental health care” and requires a court-appointed guardian to oversee mental health treatment plans for all foster children prescribed such medications. The Gabriel Myers’ work group recommended a lawyer instead for each child.

“We very often are the ones in the courtroom standing up expressing concern or disagreement when it comes to pyschotropic medications,” said Marcia Hilty, spokeswoman for the Florida statewide guardian ad litem office.

The increased role of the court-appointed guardian could require more funding for additional training as medications are constantly changing, she said.

Pierre said his court-appointed guardian was a wonderful mentor, but Pierre thinks it’s “ludicrous” for them to play such a large role in medical treatment plans. He said an attorney is better equipped to navigate those matters.

“Why would we ask people who are just volunteers to go through the court system and be a liason on the way medications are distributed to children?”

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Drugs for foster children

The Tampa Tribune
By CATHERINE WHITTENBURG

Drugs for foster children: GOP Sen. Ronda Storms of Valrico, who is chairwoman of a human services policy committee, has made restricting the use of psychotropic drugs to treat the state’s foster children a priority this session. The issue came to light last year after a 7-year-old foster child who was prescribed such medication hanged himself in Broward County.

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