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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.

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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.”

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Lawmakers pledge action on psychiatric drugs in foster care


Florida Times Union

By Brandon Larrabee

TALLAHASSEE — Alarmed lawmakers said Wednesday they plan to push through legislation next year to try to prevent overuse of mind-altering drugs by foster children after the apparent suicide of a 7-year-old boy last April.
Members of the Senate Children, Families and Elder Affairs Committee from both parties said the state needed to toughen laws and rules for prescribing psychiatric drugs to children in the wake of the hanging death of Gabriel Myers and an ongoing examination by a Department of Children and Families task force.

Jim Sewell, a former assistant commissioner of the Florida Department of Law Enforcement and chair of the group, presented some of the task force’s findings to the committee at a meeting Wednesday.

But even as they pledged action, committee members and officials with DCF acknowledged that the state has tried before to get handle on the number of children taking psychiatric drugs and how the state goes about getting approval for those children to use the medications.

“It’s the same problem over and over and over again,” said Sen. Ronda Storms, R-Valrico.

Storms said legislators would need to follow up on any laws it passes to ensure that the initiative would be more successful than past changes to the law.

It’s not entirely clear what measures might be included in the bill planned by the committee. Lawmakers will wait to hear recommendations expected to be released by Sewell’s task force in November.

One problem the legislation could address is the working group’s discovery that hundreds of foster children were taking psychiatric drugs, even though the department lacked proof that a parent or judge had approved the medications.

State officials have since whittled down that list, largely by gaining judicial approval for the drugs. Lawmakers and officials with the state agency seemed to agree that parental consent could be problematic because parents could feel compelled to accept the medicines so that the state will return their children.

DCF Secretary George Sheldon, who took over the agency late last year, said the death of Gabriel showed glaring weaknesses in the system.

“This little boy was flooded with services,” he said, “but nobody was acting as the child’s parent.”

Sen. Steve Wise, R-Jacksonville, said that’s one problem lawmakers should look to fix.

“Some place along the line, somebody’s got to be advocating for the children’s medical care,” he said.

Some lawmakers were also interested in tracking any agreements or incentives physicians might get from pharmaceutical companies for prescribing certain drugs. Sen. Tony Hill, D-Jacksonville, compared it to schools that get incentives from soda or junk-food makers for allowing vending machines in schools.

“If it’s not the schools making a profit off it, is it the doctors making a profit off it?” he asked.

Sen. Nancy Detert, R-Sarasota, also said the state should make sure foster parents know their responsibilities when caring for children in state care.

“Let’s be brutally honest: Foster-care parents get paid to do this,” she said. “I think the target audience here should be foster parents, too.”

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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.”

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Many foster kids being medicated in Florida

Florida Times Union
By Brandon Larrabee Story updated at 4:45 AM on Friday, May. 29, 2009

TALLAHASSEE – Almost 2,700 foster children are on psychiatric medicines, including hundreds in Northeast Florida, even though the Department of Children and Families has no authority to give the drugs to more than 16 percent of those children, according to a state report issued Thursday.

The report follows an ongoing review by DCF after the assumed suicide this year of 7-year-old Gabriel Myers in Fort Lauderdale.

Gabriel was taking psychiatric, or psychotropic, medications. But DCF later found that those caring for the boy hadn’t obtained the parental consent or court order required by state law.

According to the report, 2,669 children being cared for outside of their home – or almost 13.2 percent of foster children – are taking some form of psychotropic drugs. The agency couldn’t find evidence of parental consent or a court order in 16.2 percent of those cases.

“It is inconceivable to me … that the system doesn’t have this right yet,” said DCF Secretary George Sheldon, speaking to reporters after the agency released the information, a picture of Gabriel projected on the wall behind him.

Sheldon, who took over at DCF late last year, said there was no excuse for the agency to wait until the boy’s death to make sure the law was being followed.

“In my opinion, there’s absolutely no rational basis, no argument that can be made,” he said. “We’ve got to get it right. We will get it right.”

Sheldon also said he has rescinded a memo saying case managers didn’t need to get parental consent or a court order if the drug was prescribed for a non-psychiatric purpose.

“That is not the statute,” he said. “That is not the law.”

Psychotropic drugs, particularly anti-depressants, 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.

Across Northeast Florida

In the Fourth Circuit, which is Duval, Clay and Nassau counties, 205 children in foster care are taking at least one psychotropic drug. That number is 136 for the Seventh Circuit, comprised of St. Johns, Putnam, Flagler and Volusia counties, and 76 in the Eighth Circuit of Baker, Union, Bradford, Gilchrist, Alachua and Levy counties.

The agency found no authorization for 22 children, or about 5 percent, in the agency’s 19-county Northeast Region – comprised of the Fourth, Seventh and Eighth circuits, along with the Third Circuit.

The agency will try to obtain parental consent for children taking the drugs by June 5, or it will take the cases to court.

Lawmakers said the report raised troubling questions about how well the agency has kept tabs on children taking the mind-altering drugs.

“Some place along the line, I think they’ve got to get control of that,” said Sen. Steve Wise, a Jacksonville Republican who sits on the committee overseeing DCF.

Rep. Lake Ray, a member of the House committee responsible for the agency, said the breakdown also stretched beyond DCF.

“I’m really amazed,” said Ray, R-Jacksonville. “I’m amazed that the doctors don’t have a policy in place.”

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Hundreds of Northeast Florida foster kids on psychotropic drugs

Florida Times Union
Brandon Larrabee

TALLAHASSEE — Almost 2,700 foster children in state care are on pyschiatric medicines, including hundreds in Northeast Florida, even though the agency has no authority to give the drugs to more than 16 percent of those children, according to a state report issued Thursday.

The report follows an ongoing review by the Department of Children and Families after the assumed suicide earlier this year of 7-year-old Gabriel Myers in Fort Lauderdale.

Gabriel was taking psychiatric, or psychotropic, medications. But DCF later found that those caring for the boy hadn’t gotten the parental consent or court order required by state law.

According to the report Thursday, 2,669 children being cared for outside of their home are taking some form of psychotropic drugs. The agency couldn’t find evidence of parental consent or a court order in 16.2 percent of those cases.

“It is inconceivable to me … that the system doesn’t have this right yet,” said DCF Secretary George Sheldon.

In the Fourth Circuit, which includes Duval, Clay and Nassau counties, 205 children in foster care are taking at least one psychotropic drug. That number is 136 for the Seventh Circuit, which includes St. Johns, Putnam, Flagler and Volusia counties, and 76 in the Eighth Circuit, which includes Baker, Union, Bradford, Gilchrist, Alachua and Levy counties.

The agency found no authorization for 22 children, or almost 5 percent, in the agency’s 19-county Northeast Region, which includes the Fourth, Seventh and Eight circuits, along with the Third Circuit.

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