Decline in drugged foster children
State cracks down on the rampant use of psychiatric medication
After years of efforts to crack down on the rampant use of psychiatric drugs in California’s foster care system, the number of youth prescribed the potent medications is plummeting — a major turnaround in how the state cares for some of its most vulnerable children.
The Bay Area News Group began examining the state’s use of the powerful medications in its series “Drugging Our Kids,” in 2014. Since then, the number of foster youth prescribed antipsychotic drugs has fallen by almost half, from 5,076 during the 12-month period that ended in June 2014 to 2,778 during the same period that ended in June 2017.
The number of foster children prescribed multiple antipsychotics dropped from 264 in that same 2014 period to 70 in 2017 — a 73 percent drop.
“You’re starting to see our state pay attention to the riskier practices and act as a parent would,”
said Anna Johnson, senior policy associate for the National Center for Youth Law, which helped push the reforms. Trends nationwide show increasing use of the drugs, she added.
This news organization's series found that, with alarming frequency, California's foster and health care providers were turning to psychiatric drugs as a convenient but risky remedy to control thousands of troubled kids. Nearly one out of every four adolescents in California's foster care system was receiving these drugs — 3½ times the rate for all adolescents nationwide.
The series helped spur California to enact a series of laws to monitor use of psychotropic drugs on foster youth. But while those laws appear to have led to a decline in use of the drugs, the new awareness still hasn't stopped the physicians behind the riskiest prescribing: Not one doctor has been investigated for controversial subscribing patterns that can leave troubled children in a stupor and suffering serious side effects.
In 2016 — after this news organization's extensive review of doctors in the foster care system found a small group of physicians were fueling most of the medicating — lawmakers gave the state Medical Board power
to monitor and punish doctors who violate standards of care.
But the board's investigators have been so slowed by bureaucracy that they have only been authorized to review detailed medical records for three of 86 foster youth whose prescriptions raised concern.
That did not sit well with state Sen. Mike McGuire, D-Healdsburg, who authored the 2016 law, SB 1174, allowing the Medical Board to monitor foster youth prescriptions. He said he plans to “sit down with the medical board staff to start developing solutions to this current challenge.”
“Getting stuck is not an option,” McGuire said. “We all worked overtime to get this bill passed with significant opposition, all in the name of the health and well-being of California's foster youth. We need to see this through to the finish line.”
The Medical Board, which licenses and regulates physicians, said in a statement through spokesman Carlos Villatoro that it is “working diligently” with other state agencies to identify patients who may have been inappropriately prescribed and to investigate further.
But the board added that SB 1174 “did not change the requirements for the agencies to protect the confidentiality of the parties involved.” As a result, the board stated, the state's healthcare services and social services departments “are not authorized to inform the board of the names and contact information for the foster youth or their guardians without their signed consent.”
An August 2016 article by this news organization based on analysis of MediCal pharmacy data obtained through a public records request found that 10 percent of the state's highest prescribing doctors were responsible for about half the cases where a foster child received an antipsychotic, and often used unproven and possibly dangerous combinations of the drugs.
Among those medications are those sold under the brand names Abilify, Geodon, Risperdal, Seroquel and Zyprexa. Though they can be effective in calming patients, they can have serious side effects, from weight gain to tremors, and for some, confusion or hallucinations.
Tisha Ortiz, a former foster child, testified before the state Legislature during debate over McGuire's bill that combinations of drugs left her “zoned out.”
But doctors who have prescribed multiple drugs continue to question the new rules.
Dr. Michael Barnett, a psychiatrist who has treated foster youth at group homes, said he used to treat 30 to 40 foster kids a month but now sees barely half a dozen. He says recent changes in the law, though well-intended, are harmful because they make it too hard to help kids whose problems make them a danger to themselves and others. He said the paperwork now required for prescribing antipsychotics to foster youth is “as stupid and ridiculous as any I've filled out.”
“I think their intentions were in the right place,” Barnett said. “The lawmakers have decided what's good treatment, that having kids not on an antipsychotic is better than having them on it, which I'd agree with, unless they need to be on them. If you have a kid in danger hurting himself, hurting other people, running away into traffic, smearing feces on the sofa, you have to do something to get them under control. The system has now been set up to interfere with that. Laws like that are a slam against my integrity as a practitioner — the law's saying ‘I don't trust you as a physician.'”