Prescription for disaster: Lax oversight puts children in danger
While most states have taken steps to track and reduce psychotropic drug use by youth, New Mexico has not
In 2015, Jane Barnes, a research scientist in her early 60s — “a tired old woman,” in her words — was desperate to rescue her grandsons.
Their mother — Barnes’ daughter — was a meth addict; their father was a violent felon who knocked out the boys’ teeth and sent them to the hospital in need of stitches. By the time New Mexico’s Children, Youth and Families Department took custody, the children had been traumatized by years of domestic violence, abuse and neglect. The agency placed them in foster care, where they were abused and neglected all over again.
The older boys screamed in their sleep. The baby banged his head in the crib. All four urgently needed therapy. What they got instead were monthly visits to a “high-risk prescriber” — Albuquerque psychiatrist Edwin B. Hall, who would soon be under criminal investigation in the overdose deaths of 36 patients and accused of overprescribing to hundreds of foster children. For the boys, Hall wrote dozens of prescriptions: antipsychotics, mood stabilizers, anticonvulsants and sedatives.
The medications filled a shopping bag.
“The boys had morning meds, and at lunch, they got meds at school,” Barnes ticks down the list. “At around 3:30 or 4, they got meds. And before they went to bed, they got meds. The only one who wasn’t on six or seven meds a day was the baby.”
For nearly 20 years, the world’s leading psychiatrists and researchers have condemned this practice, which is so notorious it has its own catchphrase: “Too much, too high, too young.” The Centers for Disease Control and Prevention, the U.S. Department of Health and Human Services, the National Institutes for Mental Health and the General Accounting Office all warn against giving antipsychotics or multiple psychiatric medications to children. Hundreds of medical studies confirm these drugs can cause extreme obesity, diabetes, heart disorders, high blood pressure and irreversible tremors in children. They are also believed to harm the developing brain.
At least 44 states have introduced formal protocols or programs to boost oversight and monitoring of
psychotropic drug use by children. Federal law requires such oversight. The risk of overdrugging children — particularly those in foster care and on Medicaid — is so widely recognized that most states took steps to track and reduce the problem by 2012. Not New Mexico. “It’s the negligence of inattention,” says George Davis, former director of psychiatry for CYFD. “It takes monitoring, expertise and regulatory teeth to solve this problem. The state lacks all three.”
A threemonth investigation by Searchlight New Mexico has found the state lacks the most basic safeguards to protect children on Medicaid and in foster care. An analysis of Medicaid pharmacy claims for children 18 and under, in fiscal year 2016 (the most recent data available), revealed:
Doctors in New Mexico wrote 136,000 psychiatric drug prescriptions for nearly 30,000 New Mexican children, an average of 4.5 prescriptions per child. Of the 305,000 kids on Medicaid in 2016, more than 10 percent of them take psychiatric drugs.
The most dangerous of these were antipsychotic drugs; New Mexico physicians wrote 19,300 prescriptions for Risperdal, Zyprexa and Abilify and others, including some for children under age 5.
At least 335 children worldwide have died while taking these “second-generation” antipsychotics, according to the Food and Drug Administration’s Adverse Events Reporting System. The drugs bring in billions of dollars in annual sales, a popularity largely attributed to their growing use in children.
Doctors wrote 70,000 prescriptions for stimulant medications to treat attention deficit disorder in 13,000 children. Medical experts say their jittery behavior is almost certainly traced to trauma; instead of masking the behavior with drugs, they need therapy.
Searchlight made at least six requests over a three-month period to interview the CYFD and Human Services Department secretaries; none was answered. Four public records requests yielded scant or no useful information. The state refused to provide data from Medicaid pharmacy receipts that would reveal ages of patients and the precise medications they received. In doing so, Human Services cited privacy laws, though Searchlight specified it was not seeking personal information.
CYFD says it lacks the power to enact effective guidelines.
“We can advocate,” says Bryce Pittenger, director of behavioral health at CYFD. “We can submit proposals, but that final say is not ours. And that actual obligation is not ours.”
‘Killing them slowly’
“The leadership completely lacks the courage to take action for the protection of children,” says psychiatrist Davis, who, until his retirement in 2017, spent more than 10 years trying to implement medication guidelines to safeguard children in state custody. There are about 2,500 youths in foster care annually, with some 200 more in juvenile justice lockups.
Some of the youths had psychosis — they benefited from being on an antipsychotic, Davis says. But he also saw 8-year-olds who gained 40 pounds in a single year on drugs that they didn’t need. “We’re killing them slowly,” he says.
Davis says he first started working on “best practice” guidelines for youth in 2006, but “I couldn’t get CYFD or HSD to publish them.” Between 2013 and 2017, he met with a task force to hammer out a comprehensive set of guidelines intended to “red flag” doctors who prescribed excessive amounts of psychiatric drugs to children. That, too, disappeared down a bureaucratic hole.
“Is it just incompetence or is it obstruction?” wonders Davis, a child and adolescent psychiatrist now in private practice.
Pittenger says CYFD did take action by publishing an internal document in 2016 that, she says, “raised consciousness” within the agency.
A child’s medical cocktail
Barnes was determined to do “whatever it took” to bring her grandsons home. What it took was endurance — first, to cope with a devastating string of family tragedies, and then to cope with the child welfare system. “The stupidity and the neglect and the jaded employees at CYFD that are wanting to do a good job but can’t because of the limitations set by upper-level people? Oh, it’s just unbelievable,” she says.
Between 2014 and 2016, psychiatrist Hall — now under state investigation, according to a spokesman from the New Mexico Attorney General’s Office — started one of Barnes’ grandsons on Risperdal, an antipsychotic medication associated with lifethreatening health problems. One of its side effects is gynecomastia, a condition that can cause boys to develop breasts as large as DD-size. A double mastectomy is the only treatment option.
In October 2017, after a 17-month investigation, the New Mexico Medical Board found Hall had overprescribed medications that led to the overdose deaths of six adult patients; his license was suspended. A year later, the Attorney General’s Office alleged that 30 additional patients in Hall’s care had died of overdoses. He also is being investigated for child abuse and Medicaid fraud, law enforcement sources say.
Big problems, small bodies
Parents who show up in a doctor’s office with an out-of-control child are desperate for help. The child may be in danger of being suspended from school or about to kicked out of a foster home.
Psychotropic drugs can be lifesavers, says Mark Olfson, a Columbia University psychiatry professor and leading researcher in the field. They can reduce suffering and dramatically turn a child’s life around.
This off-label application is legal, but it means the medication is used in ways that aren’t FDA-approved, on populations for whom there is no proof of effectiveness or safety. As the saying goes, “children are not small adults.” The doses that help a middle-aged patient with schizophrenia might spark terribly different outcomes in a child.
In a 2010 study, researchers at Tufts University studied psychotropic medication use in children and teens in 47 states over a 10-year period. They found that its rate of use in the general population hovered at 4 percent, while in the foster system it was high as 52 percent. In some states, more than 40 percent of foster children took three or more of the drugs.
That is the case in New Mexico, which has one of the highest “polypharmacy” rates in the nation.
Child poverty, excessive trauma, scant oversight and a severe shortage of mental health professionals have created the perfect storm in New Mexico, leaving thousands of children needing services they don’t receive, and thousands of others receiving services they shouldn’t get. Only 12 percent of the state’s psychiatric needs are met, according to the Kaiser Family Foundation.