Judge mulls sanctions in foster system
Teen testifies on her trauma in state custody as lawyers challenge adequacy of CPS care
Jackie Juarez was 11 when state officials took custody of her. She came out of the foster care system more traumatized than when she entered it.
Juarez, now 18, testified in federal court Monday that a staff member at one group home she stayed at sent her inappropriate texts. She slept in Child Protective Services offices, a church and a hotel when she didn’t have a placement. Children there beat her so badly she needed medical attention, she said.
Her voice broke as she recounted CPS workers telling her she was in state custody “because my parents didn’t want me.” She said she ran away to escape the chaos.
“Things need to change for everyone,” Juarez said. “We need a change, because everybody tells you, ‘Oh, CPS is going to take care of you,’ but just like they let me down, they let other kids down.”
Juarez’s testimony was part of a three-day hearing in Texas’ 12year-old federal lawsuit over unsafe conditions for foster children. Lawyers for the thousands of children in the state’s custody are asking U.S. Judge Janis Jack to hold the state in contempt for failing to adequately comply with six court-mandated reforms, including improving the quality of abuse investigations, training staff to identify signs of sexual abuse and properly administering medication to foster children.
The plaintiffs’ witnesses — including Juarez, former state employees and national experts — described a “broken” foster care system that regularly leaves children in danger. Juarez’s testimony marked the first time the court has heard directly from a child in foster care since the case went to trial in 2014.
Lawyers for the state presented just one witness, the head of Texas’ Medicaid program, before resting their case. They have argued that while there is always room for improvement, state officials have sufficiently complied with the court’s remedial orders and should not be punished.
(The state has not commented on the case outside of court, citing pending litigation.)
On Wednesday, Jack said she would not put the state into receivership — the most extreme remedy the plaintiffs requested that would have allowed Jack to appoint new leadership in struggling areas —
but will issue a “very narrow order” down the road.
“I’m just sorry we’re at this point,” she said.
Paul Yetter, the lead attorney for the plaintiffs, issued a statement Wednesday night blasting the state’s “indifference” at the hearing and accusing Texas officials of “box checking” instead of making meaningful changes to improve child safety.
“While thousands of children face needless turmoil and danger every day, the state wants to claim success at achieving its own skewed view of compliance,” Yetter said. “It misses the letter and violates the spirit of the remedial orders. Texas has stopped trying to fix its system, so it can spend more taxpayer funds for more lawyers and more litigation.”
Jack previously has held the state in contempt twice over similar concerns. Texas paid $150,000 in fines in 2019 after Jack accused child welfare officials of lying about the supervision of foster kids.
Last week, much of the testimony focused on the administration of psychotropic drugs to foster children. The medication is intended to improve people’s mood and behavior, but the plaintiffs’ lawyers have accused the state of failing to review whether children are being wrongly or overly prescribed those pills.
Court-appointed monitors looked at case files for more than 150 foster children last year and found that almost half of them were taking four or more psychotropic drugs. State officials had gone through the proper medication review process for just 21 of those children, monitors reported.
At one point, Juarez was taking eight pills a day, including at least five psychotropic medications, lawyers said. They made her so sleepy she couldn’t go to school.
The prescriptions included an asthma drug she was allegedly given for panic attacks, though Juarez said she didn’t have them, and an anti-seizure medication.
“I would feel always tired,” she said. “When I went to school, I always stay focused. But then my whole mood would drop, and I would feel so tired that I couldn’t stay awake.”
Juarez, who aged out of foster care two months ago and recently earned her GED, said she told her caregivers that the medications didn’t make her feel well, but they told her she was prescribed them so she had to take them. Now, Juarez no longer takes any drugs for her mental health, and “I feel happy.”
“I do a lot of things,” she testified. “I’m not tired. I’m able to focus more on sports, art, reading and school.”
The state’s witness was Dr. Ryan Van Ramshorst, the chief medical director for Medicaid and CHIP Services at the Texas Health and Human Services Commission. He said Texas has made improvements in its administration of psychotropic drugs, roughly halving the percentage of children who are taking four or more of them from 2004 to 2021.
That still means there are hundreds of current and former foster kids who are heavily medicated, the plaintiffs’ attorneys said.
Yetter and Jack berated Van Ramshorst during most of his time on the stand, taking issue with his questioning of terms like “significant” and his refusal to answer some questions with a “yes” or “no” response.
“Is it not a parent’s responsibility to get medical care for their child?” Jack asked at one point.
“I would say that is part of their responsibility,” Van Ramshorst replied.
“Well, then it becomes the state’s responsibility when they take over the parent’s responsibility,” she said. “Does it not?”
Van Ramshorst did not reply immediately. “This is not hard,” Jack said, and the doctor briefly started to speak before the judge cut him off.
“You can’t just take over custody of a child and not provide them with decent medical care,” she said. “I guess that’s where we have a breakdown in the system is that the state does not know that that’s a responsibility and does not accept that as a fact and doesn’t understand it, and I’ll make that finding.”
Dr. Christopher Bellonci, a child psychiatrist at Harvard University, testified on Wednesday that Texas was putting its foster children in danger by declining to regularly review the use of psychotropic medications.
“A parameter is only as good as you use it,” he said.
Foster children often come into the system with traumatic experiences, and trauma can often manifest in those cases like a mental illness, Bellonci testified. But psychotropic medications won’t help if the root of the issue is actually trauma — and, in some cases, it can make things worse, he said.
“We don’t have medication for trauma,” he said. “We have to get through that through therapeutic supports and ensuring that we’ve removed the sources of the trauma from the child’s life.”
The court also is reviewing whether the state is notifying children of their rights and telling them how to report abuse; whether caregivers are properly informed about children who have histories of sexual abuse or aggression; and whether caseworkers have adequate caseloads.