State Moves to Monitor Foster Kids’ Drug Doses

Judges, psychiatrists and government officials are developing an unprecedented plan to protect abused children in the state’s care from receiving improper and unmonitored doses of potent psychiatric medications.

The effort, which is intended to lead to reforming legislation, comes in response to a Times investigation last May that found that thousands of children in California’s group and foster homes are routinely given psychiatric drugs, at times simply to keep them docile for their overburdened caretakers.

“Right now there are no standards,” said Dr. Penny Knapp, medical director for the state Department of Mental Health. “This is going to set the standard for how these children should be worked up and what the criteria should be for assessing whether they need medication.

“The key phrase is: raise the bar,” said Knapp, a child psychiatrist who is heading the effort. “Everybody knows this is a problem and the meds are just the tip of the iceberg.”

Knapp said the task force, formed as a result of a Senate bill passed in August, must report back to state lawmakers with a plan by July 1.

The revelations about the use of the mood- or behavior-altering medications on vulnerable children came as part of a series of stories earlier this year looking at the plight of children taken from abusive parents and placed under the state’s protection.

Foster youth are being given drugs in combinations and dosages that experts in psychiatric medicine say are risky and could cause irreversible harm. The drug use was revealed in a review of hundreds of confidential court files and prescription records, observations at group homes, as well as interviews with judges, attorneys, doctors and child welfare workers statewide.

The Times found children who had been prescribed several types of psychiatric drugs at the same time, even though most of the drugs have never been tested for use in children, and foster children as young as 3 taking potentially dangerous psychiatric drugs to control their “depression” and “rage.”

Officials responsible for these children’s welfare often did not know who put the children on the medications or why, and sometimes were not even aware the children were drugged. In numerous incidents, children seemed to be misdiagnosed, given the wrong medication or given too much medication.

Experts Agree Monitoring Is Needed

While many psychiatrists defend the use of psychotropic medications on children in foster and group homes--arguing that the benefits of using them on children who are often very troubled outweigh future risk of harm--most agreed the lack of consistent monitoring is disturbing.

In many instances, the doctors who prescribed what their colleagues call “chemical straitjackets” aren’t psychiatrists and have little training in the highly specialized field of psychiatric medicine. Some of these doctors and psychiatrists, according to group home directors and child care workers, examine a child for minutes before prescribing powerful medications.

The task force, set to meet for the second time Jan. 4, hopes to enact statewide standards that would prevent knee-jerk drugging of children who often are expressing normal despair and anger in response to abuse and abandonment, Knapp said.

“One thing we can do is make sure any child on medication has a thorough exam,” she said, to prevent a doctor from simply looking at “a rap sheet of a child’s bad behavior and giving him what I call a ‘bad boy cocktail’ of Ritalin, Depakote and clonidine.

“Right away there would have to be a certain amount of time spent with a child before he could receive medication and a standard for reporting it,” Knapp said. Currently, she said, some group homes hire on a doctor for, say, four hours a week and expect the physician to examine more than 20 children.

Social workers also would have to spend more time with children who are being given psychiatric medications, she said. And doctors would be required to monitor a child’s progress.

In response to the stories, The Times received more than 600 phone calls, e-mails and letters. Doctors, judges, attorneys and child welfare workers across California, as well as in 13 states and Canada, said such drugging occurs in other areas of the country as well.

Pat Leary, a former consultant to the Senate Budget and Fiscal Review Committee, said the children’s plight was so disturbing that lawmakers ordered a solution to be found as part of a massive foster care bill passed in August.

Los Angeles Superior Court Judge Terry Friedman, who supervises the courts that oversee the cases of foster children in Los Angeles, said the stories forced the state to face a troubling problem that had long been festering out of public view.

“Once brought out of the darkness, it’s much more likely that reforms will be enacted that protect children,” said Friedman, who imposed a system designed to regulate the use of psychiatric drugs in foster youth in Los Angeles last spring.

Health Passports Backed for Foster Kids

In Orange County, the focus of much of the series, Judge Ronald Owen, presiding judge of Orange County Juvenile Court, now must sign off on requests to medicate a child, though he admitted that he does not know much about the medications or the doctors prescribing them. Owen said he must trust that the requests are appropriate and safe. “Obviously I’m not a psychiatrist,” he said.

Harold LaFlamme, whose law firm has represented children in Orange County Juvenile Court for more than 20 years, said, “It’s not a very satisfactory solution. The most satisfactory solution would be to have a panel of independent psychiatrists review them and say yea or nay.”

But Owen said the court lacks the money to have an independent psychiatrist review the requests for medication. “We don’t even have enough staff to do what we need to do,” he said.

Friedman, who will serve on the state task force, said that has to change.

“There’s got to be a mandated second opinion on drug requests or some way to qualify the physicians,” he said. “These principles are necessary to protect children from harm.”

Knapp agreed. “What we’re trying to do is construct a system where each county will have a plan for following these children and monitoring them and the plan would be the same in all counties.”

Knapp, head of the child psychiatry unit at UC Davis, said the task force also hopes to enforce the use of health passports, detailing a child’s medical and medication history, that would accompany children as they move among group homes and physicians. An 8-year-old state law requiring such passports has been routinely ignored as too burdensome and foster children’s medical records are often incomplete.

Knapp said the state would have to “come up with the resources” to make such changes. “It’s not going to be a cheap and easy fix.”

In the meantime, state lawmakers have ordered other state workers to beef up their oversight of foster kids. Licensing officials now are responsible for checking not just that the group homes are safe, but that the children in them are properly cared for and the staff is trained.

“We’re not just looking at health and safety. We’re interviewing the children to see if their needs are being met and asking the staff what training they’ve received,” said Patrick T. Smith, a state licensing official who oversees Orange County homes.

In addition to problems with medication, in many group homes food is scarce, the surroundings are filthy, schooling is poor and the surrogate parents are $7-an-hour employees who often quit after a month. Abused children as young as 18 months old who sometimes have no mental problems are mixed together in homes designed for some of the system’s most disturbed children.

Last August’s $160-million foster care Senate bill also provided $40 million for more social workers so that every child receives at least one face-to-face monthly visit and $500,000 for a fraud unit to check that group home operators aren’t misusing funds.

Since the stories ran, the Orange County Department of Children’s Services has more than doubled the number of workers monitoring the county’s group homes.

Knapp, who had long seen problems with medications and foster youth, is optimistic. “It’s almost like you’re grateful to be told you have to do something you needed to do,” she said.