Mind drugs given to hundreds in Fla. foster care

By Kathleen Chapman, Palm Beach Post Staff Writer
Friday, September 12, 2003

An alarming number of Florida's foster children -- including more than a dozen younger than 6 and even a baby -- are being given drugs for depression, schizophrenia and other mental disorders.

A Florida Statewide Advocacy Council report released Thursday said doctors prescribe the medications with poor documentation or with little state oversight. Some of the children on the drugs were not diagnosed with any psychiatric problem.

Though commonly prescribed, most psychotropic drugs are not approved by the federal government for use in children.

In a review of the files of 1,180 children, most in therapeutic foster homes, the advocacy council found 652 were on at least one psychotropic medication. About 44 percent of those receiving medications had no record of a medical examination in the file. In many cases, there was no evidence that doctors had the consent of a parent or guardian to prescribe the drugs. Many of the drugs were prescribed by primary care physicians, not psychiatrists who specialize in emotional and mental disorders.

And in two-thirds of the cases, there was no evidence anybody checked for the side effects that can range from irregular heartbeats, permanent shakes and tics and worsening of the very symptoms the same drugs are supposed to improve.

The discovery of preschoolers on psychotropic drugs was especially disturbing to the researchers, who included doctors, mental health experts and social workers.

"Diagnosing mental illness in children at such a young age is extremely difficult as these children are unable to describe their symptoms adequately, if at all," the authors wrote.

DCF officials questioned the study during a telephone conference Thursday, saying it was flawed. The 1,180 children represent a small sample compared to the 15,000 in foster homes. The children selected weren't random, but mostly those in therapeutic programs with a history of emotional and behavior problems.

"Why aren't they outraged? DCF should be leading the charge," said Andrea Moore, a Broward County attorney and child advocate who has long questioned the oversight of medications.

Last month, The Palm Beach Post told the story of Isaiah White, a Palm Beach County foster child injected at age 6 with the powerful drug Haldol at Sandy Pines in Tequesta. A psychiatrist prescribed the first-grader at least three other kinds of psychotropic drugs -- medicines that have an altering effect on the mind -- saying his behavior was dangerous to himself and others.

Isaiah remains in a state psychiatric program, a year after his mother relinquished him to state foster care. DCF Secretary Jerry Regier said this week he is still looking into Isaiah's case.

DCF officials conducted an internal investigation several years ago and found "that the use of psychotropic drugs in children in their care was not a problem," according to the report. But after a series of news articles in 2001, DCF appointed a panel to study the issue and suggest changes. If those recommendations had been applied, Moore said, "Isaiah and many other children like him would have been helped in a different way."

DCF officials said Thursday they have never done their own comprehensive study, but began compiling a database six months ago that will track the prescriptions of all children in care.

Celeste Putnam, DCF's acting deputy secretary for programs, said her agency would immediately look into the cases of the children under 6.

Putnam said in many cases of very young children, the drugs likely were prescribed for medical reasons, not mental disorders.

"How they picked up a 1 or a 2-year-old in that sample, I can't tell you," Putnam said. "That's pretty shocking."

Putnam said state foster children never receive a prescription without a physician's evaluation. If caseworkers can't find the parent to get consent, they go to court to get an order. DCF gives foster parents guides about psychotropic drugs to help them understand proper administration and side effects of the medicine.

And while the drugs aren't typically tested in or approved by the Food and Drug Administration for use in children, many doctors believe there is enough anecdotal evidence to prescribe them safely.

Critics claim the state overmedicates foster children as a way to keep difficult children quiet and compliant. In psychiatric programs and crisis units, they say officials are tempted to medicate the children instead of trying to find out why they are acting out.

One foster teen in a psychiatric ward was so drugged that she acted more like a passive Alzheimer's patient, said John Walsh, who represents foster children in Palm Beach County through the Legal Aid Society. Walsh said he has been increasingly concerned about the number of young children on antipsychotic medication in the past three or four years.

Some children don't need it, he said, but Legal Aid can't usually afford to go to a second physician for another opinion.

Other times the children have experienced so many traumas that they do need treatment with medication, Walsh said. Often a foster child has "been moved from foster home to foster home, to hotel, to crisis unit to foster home."

"After that, I would need medication, too," Walsh said.

The solution, he said, is both the simplest, and the hardest.

"The real way to control his behavior was to put him in a stable, loving home six months ago," Walsh said.

kathleen_chapman@pbpost.com