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?”

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.