Category Archives: Sun Sentinel

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.

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DCF needs better tools to monitor psychotropic drug use

Sun Sentinel

Editorial Board

The working group brought together by the tragic death of Gabriel Myers has finished its work. Unfortunately, its final report comes as no surprise: Simply put, the 7-year-old foster child who committed suicide died at the hands of a neglectful bureaucracy.

Gabriel’s lifeless body was found hanging in his Margate foster home on April 16. The death shone a troubling spotlight on the boy’s medical history and — once again — resurrected the controversy over prescribing psychotropic medications to children. Nationally, about 5 percent of all children are treated with psychotropic drugs. In Florida’s foster care system, roughly 15 percent of its children receive at least one of these powerful drugs.

The working group’s findings are replete with all-too-familiar instances of red flags and missed opportunities. One finding, however, stands out and is a testimony to the failure of a major reform to the state’s child welfare system: “There was inadequate oversight of the involved agencies by the [Florida] Department of Children & Families.”

Community-based care was designed to take care of that. The initiative, dating back to the days of Gov. Jeb Bush, took the responsibility for operating foster care services away from what was then a dysfunctional state agency and turned those duties over to local, “community-based” organizations, such as Child-Net, the group responsible for Gabriel’s care. DCF, under this reform, would concentrate its bureaucratic resources on oversight.

At least that’s how it was supposed to work.

Instead, DCF has had a tough go of it. State lawmakers earlier this year considered a bill to limit the department and other health and human services agencies’ ability to monitor these contracts, despite a recommendation by OPPAGA, the Legislature’s watchdog agency, against such limits.

Fortunately, cooler heads prevailed, and the legislation failed to get real traction. Lawmakers should instead find ways to improve monitoring to ensure quality services without strangling contractors’ operations. As Gabriel’s case shows, it’s needed.

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DCF chief: Stricter rules needed in prescribing drugs for foster children

Sun Sentinel

By Kelli Kennedy The Associated Press

FORT LAUDERDALE – The head of the state’s child welfare agency is recommending stricter rules for prescribing powerful anti-depressants and other drugs to foster children after a 7-year-old in state care committed suicide.

George Sheldon, the secretary of the Department of Children and Families, said Thursday he might consider recommending additional 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 department released a 55-page preliminary finding in the case Thursday, four months after Gabriel Myers hung himself with a retractable showerhead at his foster home.

“If you [prescribe psychotropic meds] there’s got to be a treatment plan in place, there’s got to be an end date in place and there’s got to be ongoing dialogue,” Sheldon told The Associated Press.

The new report found a lack of accountability and inadequate supervision in every step of Gabriel’s case.

The state has been struggling to admit and fix such problems since 2002, when a 4-year-old girl went missing for a year before state officials realized it. She is presumed dead.

“If everybody is responsible for your children, then no one is responsible,” Jim Sewell, Former Assistant Commissioner of the Florida Department of Law Enforcement, said at one meeting of the task force that issued the report.

In Gabriel’s case and others like it, workers did not use procedures adopted years ago, such as keeping a form that included his diagnosis and medications. Gabriel was on several 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.

A records check after he died found nearly 2,700 children, 13 percent of all those in out-of-home foster care, taking psychotropic drugs, compared with an estimated 4 to 5 percent in the general population.

“Psychotherapeutic medications are often being used to help parents, teachers and other child workers quiet and manage, rather than treat, children,” the report says.

The records check showed that 433 of those children, or 16 percent, had not had their drugs approved by parents or court orders. Even if they had, people on the task force said, such approvals was often just a rubber stamp from judges with little understanding of such drugs and their side effects.

Sheldon also said cases need to be reviewed again after an initial diagnosis when a child enters foster care.

“When a child comes into care, that’s when they’re the most traumatized, probably sad, bordering on depression, should we be making a long-term assessment at that point that will follow them for the rest of their care?” he asked.

Those assessments need to be re-evaluted a month or 90 days later, Sheldon said.

In Gabriel’s case, Sheldon said, he was flooded with services, therapuetic sessions, medical evaluations and psychiatric appointments, “but nobody in the case was acting as a parent.”

The report found that caseworkers didn’t talk to doctors. Teachers didn’t talk to caseworkers. Caseworkers and the psychiatrist made the same cookie cutter notes in Gabriel’s file nearly every visit, despite his increasingly troubled behavior. Nearly every opportunity to help him instead became a symbol of the department’s inefficencies and blame shifting.

Red flags were repeatedly ignored, the panel found.

Myers choked himself so badly he once left red marks on his neck. He stole knives at his foster home, telling classmates he would kill them and repeatedly touching classmates’ private parts. He later told a therapist he had been sexually abused by a 12-year-old boy while living in Ohio with his grandparents.

A Florida therapist recommended the state place Myers in a residential program that deals with abused children, but that never happened.

Task force member Dr. Rajiv Tandon, a psychiatrist with the University of Florida, called Myers case a “10 in terms of a red flag for a child who is crying out … but this information was not all pulled together.”

Kimberly Foster, who was on psychotropic medications every day during a decade in foster care, hopes the department will make changes to help children like her. She told the panel that children in state care are overmedicated.

“They looked at me as a troublemaker instead of a child who is coming out of a troubled environment,” said Foster, now 25. “If you cry, you’re depressed. If you act out in school, you’re a behavior problem. We’re so quick to put these diagnoses on children.”

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System faulted in Margate boy’s suicide while in foster care

Sun Sentinel

By Marc Caputo The Miami Herald

MIAMI – Child-welfare doctors and case managers routinely failed to complete legally required treatment plans, share information or properly document the prescribing of powerful psychiatric drugs for children, according to a new state study of 6- and 7-year-olds medicated in state care.

One of the 268 children was Gabriel Myers. The troubled 7-year-old, medicated with an adult anti-depressant known to cause suicides in children, hanged himself in April in his Margate foster home.

But the state study, which documents how many times caseworkers and doctors followed child-welfare rules and laws, shows that it would be a mistake to blame Gabriel’s death solely on the drug, Symbyax, said Florida’s drug czar, William Janes.

”It wasn’t just the medications,” said Janes, who sits on a committee investigating ways to prevent cases like Gabriel’s. “It was the system and his world. His environment just collapsed on him. And there was no one there to really put their arms around him.”

The Department of Children and Families study, presented Monday to the committee, indicates that a number of rules and laws on medication for children in state care weren’t followed for all 6- and 7-year-olds:

• In 86 percent of cases, the prescribing physician didn’t complete what’s known as a Psychotherapeutic Medication Treatment Plan, which helps case workers, legal guardians, judges and other physicians determine a child’s mental well-being.

• In 75 percent of the cases, the case workers did not provide physicians with pertinent medical information about the child.

• In 76 percent of the cases, the case worker didn’t provide parents with information about the psychotropic drugs their children were being prescribed. Nor did the case worker help arrange transportation or phone conversations between the doctor and the child’s guardian.

• In 58 percent of the cases, the case manager didn’t attempt to speak with or meet the parent or guardian prior to seeking a court order to medicate the child.

• In 89 percent of the cases where parental consent wasn’t obtained to medicate children, case managers failed to inform state lawyers that they were seeking a court order to administer the medication.

The DCF study also found numerous record-keeping and data discrepancies in the state’s child-tracking system, Florida Safe Families Network. The study follows a similar review last month concerning the drugging of children in state care under the age of 6. DCF is now studying other age groups.

Dr. R. Scott Benson, former head of the American Psychiatric Association, pointed out the difficulties physicians have in meeting all the state record-keeping requirements.

Benson, who doesn’t treat children in state care, said he found it ”horribly troubling” that physicians weren’t given all the pertinent medical information about the children prior to making a prescription. But, he said, he wasn’t surprised because of the complicated nature of child-welfare cases and clients.

The committee investigating the child-welfare system plans to issue a report by Aug. 20.

It is only touching on Gabriel’s case, which is the subject of a Margate police investigation. Some doctors and case workers — all of whom work for privatized agencies under contract with the state — may face sanctions, depending on what the report finds.

The DCF study, as well as Gabriel’s case, show the troubles with 2005 legislation designed to curb the prescribing of mental-health drugs to kids in state care.

Among its requirements, the law mandates more information sharing, parental involvement and second-party review of doctors’ prescriptions for the youngest children.

One committee member, Dr. Rajiv Tandon, pushed for a simple electronic record system that physicians and case workers can share.

He said the system also needs to be ”tweaked” to clarify who’s in charge and who needs to do what.

”There’s only so much we can do. There’s no substitute for common sense,” Tandon said. “There’s no substitute for people doing the right thing. Sadly, in this case, the right thing wasn’t done by some people.”

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Florida Agency for Persons with Disabilities has its own psychotropic drug problem


Sun Sentinel

Posted by Doug Lyons
July 1, 2009
By: Howard M. Talenfeld and Maria E. Abate

The use of dangerous prescription medications for children and adults in residential and group home facilities licensed by the Florida Agency for Persons with Disabilities (APD) is an alarming situation.

Two years before the suicide of Gabriel Myers, a foster child who was prescribed a “cocktail” of powerful psychotropic drugs, 12-year-old group-home resident Denis Maltez succumbed to serotonin syndrome after being given similar drugs.

Gabriel’s death brought to light the near-rampant use of these drugs among Florida’s foster children – and resulted in a sweeping review of the practice by the Florida Department of Children and Family Services. The APD should conduct a similar review.

Such a survey would likely find what a review of Denis Maltez’s death confirmed; some group homes allow these drugs to be administered to adults who are not competent to provide informed consent and to children whose parents or guardians have not provided such consent. These drugs often are prescribed without a full physician review or medical history, without parent or guardian consent, and in an “off-label” fashion not intended by the manufacturer.

Rarely are behavioral interventions exhausted and investigations undertaken to ascertain how the different medications will react to one another – or how the individual will respond to the regimen. The drugs also are prescribed and administered without appropriate follow up monitoring and blood testing, as was the case with Denis Maltez.

The DCF review found that 2,669 of Florida’s 20,235 foster children under the age of 17 were given one or more psychotropic drugs – with one in six, or about 16 percent, lacking required permissions. These findings only scratch the surface the use of these drugs.

We call upon the Florida Agency for Persons with Disabilities to join DCF Secretary George Sheldon in a review and scrutiny of these practices. APD should survey all licensed group homes working with the Agency to determine how many are administering psychotropic medications without appropriate consent, and how many are using these medications as chemical restraints. We are also asking that the APD take necessary actions to ensure appropriate procedures are in place to ensure the use of these medications is appropriate and only as a last resort after all behavioral interventions have failed. The APD must join in DCF’S effort to protect vulnerable persons like Denis Maltez.

Howard M. Talenfeld and Maria E. Abate are South Florida trial attorneys who are involved with child welfare issues. Talenfeld is also president of Florida’s Children First.

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THE ISSUE: Child’s death exposes a big problem in foster-care reform

Sun Sentinel
Sun Sentinel Editorial Board

It wasn’t that long ago when the Florida Department of Children & Families was seen as a hapless bureaucracy. Whether it was their seeking to incarcerate an 8 year-old to ensure he received proper care, or simply losing youngsters supposedly under its care, it didn’t take much for DCF to make a mockery of its role in child welfare.

The good news is that DCF is no longer that troubled agency. Unfortunately, many of those problems that once bedeviled DCF now belong to those local nonprofits and government agencies that are under contract with the state to provide foster care and other child protective services. Thank community-based care for that.

Community-based care came about during the first term of then-Florida Gov. Jeb Bush, who combined his zeal for public private partnerships with the need to improve the state’s largest government agency to create a largely successful policy initiative. Today, more people are involved in the critically important care of Florida’s children.

Yet, cases like the death of 7-year-old Gabriel Myers continue to expose holes in what remains a major governmental reform. Myers’ body was found hanged in his Margate home. The youth’s suicide is problematic enough, but it is only compounded by the prescription of powerful anti-psychotic drugs that brought periods of calm into the child’s life but may have produced unwanted side effects. One of Myers’ drugs, Symbyax, contains a “black box” warning that it causes suicidal thoughts and behavior in children.

Worse, the medication was prescribed without a court order or parental consent, a clear violation of state law, and Myers wasn’t alone. According to a recent study released by DCF, the social agencies that are under contract with DCF aren’t complying with benchmarks governing the use of psychotropic medication among foster children. So what began as a horrific case in Broward County remains a statewide problem.

The task of caring for foster children remains difficult. The onus to make sure that the reform called “community-based care” succeeds now rests with groups like Broward County’s Child Net and Child and Family Connections in Palm Beach County, which must shoulder a greater responsibility of ensuring that wards of the state under their jurisdiction receive proper care.

BOTTOM LINE: The onus now is on local groups running foster care.

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DCF’s role ‘should’ be to protect foster kids

Sun Sentinel
By Brian J. Cabrey

The April 16 suicide death of 7-year-old Gabriel Myers, a foster child in the custody and care of the Florida Department of Children and Families, shocks the conscience. Gabriel apparently hung himself with the shower hose in the bathroom of his foster home in Margate.

The victim of sexual abuse, as well as other abuse and neglect that resulted in him being removed from his family and placed in foster care, Gabriel had been prescribed a variety of mind-altering psychotropic medications while in foster care to deal with the myriad behavioral problems he was experiencing, no doubt largely the result of the abuse he had suffered. Reports are that he was on three or four different drugs, or combinations thereof, at the time of his death. What is almost as shocking to the conscience as a 7-year-old wanting to, knowing how to and actually committing suicide, is that a 7-year-old would be on not just one, but multiple psychotropic medications. Most such drugs have never been tested for pediatric use, and have not been FDA-approved for such use. Their prescription and use with kids is generally “off label,” meaning there are no approved instructions or guidelines for such use.

Too often these drugs are used by DCF as chemical restraints to deal with difficult children who exhibit undesirable, inappropriate or dangerous behavior. Rather than deal with their underlying issues and problems, drugs are used to turn these children into non-disruptive zombies so that they can be safely placed in a foster home or institution. A 2005 study revealed that one out of every four foster children in Florida is on some sort of psychotropic medication, including multiple children less than 1 year of age. Never mind that no research has been done as to the long-term effects of such medications on a growing child’s brain. Such use of these medications is reprehensible and amounts to warehousing children.

The goal is and should be to protect and rehabilitate children who have been harmed and damaged by abuse, abandonment or neglect, not simply to store them away safely, only to be shown the door when they turn 18 and age out of the foster care system. In this case, little Gabriel didn’t even get that far. Instead, he ended up dead, at 7. Such a short, traumatic life abruptly and prematurely ended in an equally tragic manner. Godspeed, little Gabriel. We’re sorry.

Brian J. Cabrey is vice president of Florida’s Children First in Jacksonville.

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