Category Archives: Miami Herald

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.

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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.

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Senator: drug companies “can lobby all they want. They can’t stop this.”


Miami Herald

Foster kids, prescriptions — finally alarm
By FRED GRIMM

Gabriel Myers finally matters.

Too late for him — the foster kid we addled with anti-depressants and anti-psychotics without quite knowing the effects drug cocktails might have on a 7-year-old.

One potential side effect of feeding Lexapro, Zyprexa and Symbyax to a 67-pound child became grotesquely obvious. Young Gabriel coiled a shower hose around his neck and hanged himself in the bathroom of his Miramar foster home.

Gabriel’s death on April 15 roiled child advocates, critics of the pharmaceutical industry, the media. But this week, a child’s suicide finally elicited a reaction where it matters.

“I tell you, we’re going to do something. We’re going to do a full-court press,” said State Sen. Tony Hill, a Jacksonville Democrat, still shocked after members of the Senate Children, Families and Elder Affairs Committee were briefed Wednesday by the Gabriel Myers Task Force.

UNACCEPTABLE

Committee Chair Rhonda Storms, a Valrico Republican, told reporters, “I cannot accept or believe that a little child cannot be reached except by drugging him and drugging him and drugging him.”

The task force catalogued drug regimens for foster children that the FDA never approved for children. It described a system blighted by haphazard oversight. No one within the child-care bureaucracy took direct responsibility for the child’s complex psychological needs. No one was looking out for a profoundly troubled child’s best interest.

Hill railed that Gabriel’s foster parents, schools, case workers and doctors hardly spoke to one another as his problems escalated. “No communication,” he said, his voice rising in anger.

No one acted as a parent. A vigilant, caring parent would have questioned a pharmaceutical solution to the little boy’s behavior. Child advocate Andrea Moore read the task force report and worried that the doctors had responded more to bureaucratic needs of the system than the therapeutic needs of children. About 22 percent of the foster children aged 6 to 12, and a third of foster kids 13 to 17, are on psychiatric drugs. Such numbers, utterly out of whack with the general population, defy any explanation other than foster kids were to be transformed into compliant little zombies.

“We’re going to find out,” Hill promised, describing a bipartisan fury.

“We’re going to find out why doctors are writing these prescriptions, and we’re going to find out about the relationship between the doctors and drug companies.”

`MAJOR CHANGE’

Advocates like Moore have long complained that state foster care facilities administered psychotropics in lieu of providing real therapy. Five years ago, the Legislature passed supposed safeguards to rein in the pill madness. Obviously, they didn’t work.

Meanwhile, pharmaceutical companies have been encouraging doctors to prescribe unapproved, off-label uses for their expensive, profitable drugs.

DCF has promised to revisit psychotropics regulations. Hill promised tough legislation. “Major, major change is coming. The whole committee is behind this.” He said drug companies “can lobby all they want. They can’t stop this.”

It took the death of a child to arouse the legislators. “I admit, I didn’t know this was going on before Gabriel,” Hill said, using the boy’s name to describe a tragic event. “That should never have happened to a child.”

But now, hopefully, it matters.

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DCF fires veteran spokeswoman in Broward

Miami Herald
BY CAROL MARBIN MILLER

The last several months have not been kind to the Department of Children & Families’ Broward County outpost.

In April, a 7-year-old boy, Gabriel Myers, hanged himself in the shower stall of a Margate foster home, causing a firestorm of bad press. This summer, two other Broward children died after calls to the state’s abuse hot line went unheeded.

Then, earlier this month, the agency was blasted when Anthony Caravella, who was freed by a judge after a DNA analysis cleared him of a rape and murder that sent him to prison for 26 years, spent an extra night in jail when DCF failed to evaluate him promptly.

The response from the agency’s new district administrator: Fire the messenger.

On Tuesday afternoon, with no warning, the spokeswoman for DCF in Broward, Leslie Mann, was fired and escorted from the building.

“You could have knocked me over with a feather,” Mann said late Tuesday. “I did not see this coming.”

“I’m someone who loved my job. I loved every minute I worked for the people of this community, serving clients and making Broward a better place. I feel I was lucky to have the opportunity to serve.”

DCF’s top administrator in Palm Beach and Broward counties, Perry Borman, at first declined to specify why Mann was terminated. Later, he said Mann was not fired for cause, but was let go so that both he and Broward’s new district administrator, Nancy L. Merolla, could develop a new leadership team with which they were comfortable.

“We are aligning our regional structure so that it is more like what our counterparts in the rest of the state are doing,” Borman said. “What Nancy was trying to do, with my support, is to get the appropriate leadership team in place for the next chapter of DCF in Broward County.”

“We’re really thankful for the work and experience Leslie Mann provided to DCF in Broward County,” Borman added.

For the last eight years, Mann was DCF’s public face in Broward.

She provided public statements on behalf of DCF during some of the more tumultuous periods in the agency’s history. She was the United Way’s coordinator both for DCF and Broward County as a whole. She served on the Child Abuse Coordinating Committee, the Drowning Prevention Committee and was chairwoman of the Prevent Child Abuse Month Winds of Change Committee.

Jack Moss, who was Mann’s boss her entire tenure and retired last summer, said Mann “cared deeply about the mission of the department and our clients. She had outstanding skills and was relied upon by her counterparts around the state, as well as those at state headquarters.”

“It doesn’t make sense to get rid of people who are well respected in the community,” Moss added. “She gave eight years of very loyal service to the agency. This is not the way to treat people. This is a people organization, and if the administrators acted without a heart in dealing with her, you have to wonder how the clients are going to be treated.”

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Foster care task force created after 7-year-old Margate boy killed himself wants changes

Miami Herald

A work group assigned to study the death of a Broward youngster released its final report. But advocates ask: Who will pay for the reforms the group recommends
By CAROL MARBIN MILLER

More lawyers and court-appointed guardians, more therapy, second medical opinions, and the security of long-term foster homes where caregivers treat kids “as we would our own children.”

Those are some of the wish-list items of a state task force that studied the April death of a Broward foster child and recommended a host of reforms for Florida’s chronically troubled foster-care system.

But will they work? Not, children’s advocates say, if state child welfare administrators can’t fix the one thing that has hampered the work of perhaps a dozen previous child-welfare task forces: a perennial lack of money.

Thursday, the Gabriel Myers Work Group released its final, 26-page report on failures of the state’s child-welfare system that were linked to the April 16 death of 7-year-old Gabriel, who hanged himself with a detachable shower cord in the bathroom of his Margate foster home.

Some of the recommendations require little more than tweaking internal rules and policies or having better compliance with existing rules — such as following state laws requiring informed consent from a parent or judge before giving a child powerful psychiatric drugs.

But a host of other recommendations will require millions of taxpayer dollars — at a time of shrinking state revenues and contracting budgets.

“This won’t be the first report or plan — and certainly won’t be the last — that runs into the reality of how much and where’s the money,” said Jack Levine, a longtime children’s and family advocate in Tallahassee.

Added state Sen. Nan Rich, a Weston Democrat who is vice chair of the Senate’s Children & Families Committee: “You can’t fix this problem without more financial resources. … We still have a long way to go to protect children.”

Department of Children & Families Secretary George Sheldon commended the work group, saying members “held nothing back” in issuing a blueprint for reform.

“Now,” he said, “it’s incumbent on me to carry the torch both from an internal standpoint, in terms of changing our culture, and from the external standpoint of getting the resources necessary to do it.”

`LEGACY’

Gabriel’s death — and the attention it received nationwide — will help provide lawmakers with the sense of urgency needed to resolve issues that long have plagued the agency, Sheldon said. “If any good comes out of this — if there will be a legacy for Gabriel — it will be a legislative initiative, both substantively and dollar-wise,” he said.

Gabriel, who was born in Ohio, was taken in by the Department of Children & Families on June 29, 2008, after his mother was found slumped in her car surrounded by narcotics. In the next 10 months, Gabriel was moved four times between a relative and foster parents.

In the weeks following the youngster’s death, authorities acknowledged Gabriel had been given several mental-health drugs — some linked to dangerous side effects in children — without the required parental or judicial consent. Though Gabriel had been seen by therapists and a psychiatrist, DCF admitted the agency missed key “red flags” that his condition was becoming critical.

KEY FINDINGS

Sheldon appointed five members to the work group, which held six meetings throughout the state in an effort to identify measures that could improve the care of children like Gabriel.

Among the work group’s key findings:

• DCF expects the work load to more than double — from 761 calls in budget year 2008 to 2,000 in 2009 — for a University of Florida program, called the Behavioral Health Network, that provides information on psychiatric drugs to parents, foster parents, court-appointed guardians and caseworkers for foster kids.

• Children with mental illnesses fare better when they receive psychological or behavioral therapy in addition to medication. Therapeutic services for foster children have remained stagnant in recent years along with state dollars for mental-health care.

• Court-appointed guardians ad litem should be reporting children’s wishes regarding medication to judges who oversee their time in foster care, the report said. But only about 6 out of 10 foster kids have access to a guardian, advocates say.

ATTORNEY FEES

• “Any child who objects to the administration of medication, at any point in time, should be appointed counsel to directly represent his or her position,” the group wrote. Some advocates, the report added, insist that every child in foster care — especially those taking psychotropic drugs — should have a lawyer.

The state now pays $1,000 in attorney’s fees for lawyers who represent parents accused of abusing or neglecting their children, said Judi Spann, DCF’s deputy chief of staff. The state pays another $1,000 in cases where parents might lose their rights permanently, and $1,000 more if there is an appeal.

`PRIORITIES’

And Florida law already requires that children in state care be appointed a guardian ad litem, said state Sen. Rich. Nevertheless, cuts in spending in the current state budget eliminated court-appointed guardians for 2,000 Florida children.

“It’s about priorities,” said Rich, a longtime children’s advocate. “There could have been funding for the Guardian ad Litem Program, but the Legislature did not determine it to be one of its top priorities. I disagree with that.”

`ACCOUNTABILITY’

Task force members acknowledged the difficulty in implementing the group’s proposals, though Thursday’s report suggests the greatest challenges lie in “accountability” and “responsibility” — not funding.

The last sentence of the report says concerns over “management and funding for the recommendations emerging from these findings remain, and must be addressed by appropriate executive and legislative branch agencies.”

FAMILIAR FINDINGS

Some of the work group’s recommendations have been around the block a few times.

Last April, for example, a Florida Bar committee on the legal needs of children recommended both lay guardians and attorneys for foster kids at key moments in their care — including when mental-health drugs are to be used. Legislation proposed by the Bar committee could cost as much as $15 million, said lawyer and children’s advocate Howard Talenfeld, who chairs the committee.

And in 2003, a task force studying the disappearance of then-5-year-old Rilya Wilson, a Miami foster child, said the judge overseeing Rilya’s case might have been alerted sooner that Rilya was missing if the child had been given a lay guardian.

A CHALLENGE

Sheldon acknowledged the concerns of some advocates that the Gabriel Myers report will end up on an agency bookshelf gathering dust along with prior studies.

“That’s a legacy I want to leave behind,” Sheldon said.

“I want to prove the cynics wrong.”

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Panel: Foster Kids Are Often Treated With Meds

CBS4

MIAMI — Four months after a Broward child in foster carem, who had been prescribed psychotropic medication, hanged himself from a shower hose, a panel’s report says children in state custody are often given mind-altering drugs instead of treating the reasons behind their emotional outbreaks.

Florida has approximately 19,000 children in state care and of those about 3,200 are in Miami-Dade County, according to DCF spokeswoman Flora Beal.

A state appointed panel recently reviewed all cases and released a report that found that the policies requiring parental consent or a second opinion were not uniformly followed.

Gabriel Myers, the 7-year-old who hanged himself on April 16th using a detachable shower head at his foster parent’s Margate home, was on psychotropic medications without the required consent. And his case isn’t an isolated incident, according to the panel’s report.

“Psychotherapeutic medications are often being used to help parents, teachers and other child workers quiet and manage, rather than treat, children,” the report says. “We have not clearly articulated the standard of psychiatric care expected for children in state foster care.”

DCF Secretary George Sheldon had appointed a panel to review the Myers case and how often the state relies on psychotropic drugs.

“There was a lot of evidence presented to the work group — from kids and from folks in the system — raising a lot of concern over the purpose of these drugs,” Sheldon told The Herald.

He warned that the report is not final and may be subject to change after another group reviews it.

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Drugging kids is the easy way out

Miami Herald
By DANIEL SHOER ROTH

Kids in foster care carry profound pain. It’s the pain that stems from the abuse, abandonment and trauma they have experienced during their character-forming years.

This pain often is revealed in various ways: anger, depression, rebelliousness and violence. For the state, it’s easier and less expensive to sedate them with medication than to help them heal.

Officials from the Florida’s Department of Children & Families have finally admitted that they too often use drugs to manage troubled children rather than to treat them.

It’s a practice that shows how little understanding the state has for its foster children and the bleak situations in which they have been left by their birth parents.

And it highlights the question of just what responsibilities doctors have toward these children. They have the last word. Some of them prescribe powerful psychotropic drugs, most of which are not authorized for children by the U.S. Food and Drug Administration.

UNETHICAL PRACTICE

The drugs keep the kids under control, but they don’t necessarily help them get better. When doctors prescribe these drugs, they fail the test of professional ethics.

The prescribing physicians often lack information about the children, including their medical histories. This was the conclusion of a report released by a panel of child-welfare experts and DCF administrators that examined the case of 7-year-old Gabriel Myers, a Broward foster child who hanged himself in the bathroom of his foster home. At the time, he was being given a risky regimen of psychiatric medications.

Basic information such as height and weight is often overlooked; some doctors even prescribe such drugs without a physical exam.

Others are simply not familiar with the emotional problems the young patient is suffering.

“The prescriber has a legal and ethical duty to obtain informed consent before psychotherapeutic medication is administered,” the report states.

SECOND-CLASS PATIENTS

At a time when healthcare reform is debated around the country, the panel’s findings underscore the adverse effects of government-sponsored medicine on the quality of care for vulnerable groups. Psychiatrists hired by the DCF are paid by Medicare, which reimburses them at a very low rate. This makes these children second-class patients.

Another problem is that the current system generally undervalues psychiatrists, and that insurance companies do not compensate them as specialists. Psychotherapy takes time, and if doctors are not able to give patients that time, they simply become pill-dispensers.

Doctors don’t mean to do harm. On the contrary, they believe they are freeing the child from suffering.

But in many cases neither medication nor psychotherapy is the only solution.

People involved in the lives of these children — foster parents, social workers, therapists, doctors — need the required motivation, knowledge, training and sensitivity to work with young people who have been so seriously affected by the rejection of their birth parents and the neglect of society.

Drugging foster kids is creating a generation of chronic patients who will depend on social services for the rest of their lives. They will end up in hospitals and prisons — all at the expense of taxpayers.

Doctors should put away their prescription pads unless a case is well documented and has proper consent.

Likewise, everyone in Florida’s child welfare system should look at these children as his or her own. Every parent in Florida should feel that minors under state custody are also their own children. Only then will the kids have a chance to rejoin society as equals.

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