Advocates Criticize Medicating Foster Kids
Treatment raises claims of misuse
By Carol Marbin Miller
Originally published in The Miami Herald, April 12, 2001
Hard-to-manage children in Florida's troubled foster care system routinely are being prescribed powerful psychiatric drugs as "chemical restraints,"children's advocates say.
One of the most commonly prescribed drugs, Risperdal, is marketed as a treatment for schizophrenia and other psychotic disorders in adults. But the drug has been linked to serious side effects, particularly among young girls.
Officials with the Department of Children and Families, which administers the state's child protection and foster care efforts, strenuously deny allowing the use of antipsychotics to control unruly children.
In February, Coral Springs attorney Andrea L. Moore, who represents many Broward County children in foster care, wrote a letter to the state Department of Children and Families saying Risperdal was being prescribed to children whose diagnosis didn't warrant taking the drug.
"When I questioned the need for antipsychotic drugs in at least two cases, the doctors responded by changing the diagnosis to include either a psychosis or modified an existing diagnosis to include psychotic features, thereby 'justifying' administration of the drug," Moore wrote in a Feb. 8 letter to Phyllis F. Scott, DCF's Broward district administrator.
SIDE EFFECTS
In her letter, Moore complained that two of her clients may have developed severe side effects as a result of using the drug. One girl began lactating, though she wasn't pregnant.
Cecka Green, a spokeswoman in Tallahassee for the Department of Children and Families, denied that agency officials allow children in state custody to be drugged for behavior management.
Foster children generally receive care through psychiatrists in private practice, and caseworkers would have no input into the doctors' decisions, Green said.
"It is not the policy of this department to use psychotropic medications as chemical restraints," Green said.
Still, officials are taking steps to prevent such practices. In a March 1 response to Moore, Scott said she had a "mutual concern" about the issue.
She said the department would develop, within 90 days, a training program and hoped to hire a consulting psychiatrist in Broward.
"The overall process and training will ensure the development of a [system] for monitoring the appropriate use" of psychiatric drugs, Scott said.
Others in South Florida who are familiar with the state's foster care system confirm Moore's observations.
"Many of our foster children are medicated," said Joni Goodman, director of the Guardian ad Litem program in Miami-Dade County. "Risperdal is commonly prescribed."
Another source, who works with foster children in Broward but asked not to be named, said "a lot" of kids in foster care were being prescribed the drug. "I am concerned that, many times, they're prescribing the drug just to make the kids compliant," the source said.
TELLING SIGNS
Some of the kids, the source said, display signs they are overmedicated, such as lethargy, slurred speech and shakiness.
One Florida child advocate said he was "disgusted" by widespread use of Risperdal in the state's foster care system.
"There's a tremendous difference to me between claiming to be caring for children and chemically abusing them," said Jack Levine, president of the Tallahassee-based Center for Florida's Children. Said Richard Wexler, executive director of the Virginia-based National Coalition for Children Protection Reform: "This is a classic example of destroying children in order to save them."
COMMON FOR KIDS
In Florida, Risperdal is the most commonly prescribed antipsychotic drug among children whose health care is paid for by Medicaid, which insures the needy.
Risperdal, first marketed in 1994, is the largest-selling drug in its class. Officials at Janssen Pharmaceutica, which markets the drug, did not return calls for comment.
Though the drug, like most antipsychotics, is not specifically approved by the FDA for use with children, the state spent $4.8 million on Risperdal prescriptions for Floridians under age 18 last year, said Jerry Wells, pharmacy program manager for the state Agency for Health Care Administration.
For antipsychotic drugs generally, the bill was about $9 million for children on Medicaid, which includes thousands of children in state care.
The agency does not track whether the drugs are being prescribed to children in state care or those living at home.
Among 5- to 10-year-olds, 5,172 Floridians were prescribed an antipsychotic drug in 2000, Wells said; 7,329 children aged 11-15 were prescribed the drugs, as were 3,765 children aged 16-18.
"The 5-10 group shocks me," Wells said.
The agency reports showed some of the children were on the drug for a short time—though schizophrenia cannot be cured.
"If they're not psychotic, they shouldn't have been on the drugs," Wells said.
OLD LAWSUIT
Chris Zawisza, a law professor who heads the Children First Project at Nova Southeastern University, said she fears state officials may be encouraging the use of psychiatric drugs on foster children as an unintended consequence of her decade-old lawsuit, which charges the state underfunds mental health care for children.
Charges that child welfare authorities have "chemically restrained" foster children have been raised occasionally in other states. The drug has been linked to serious side effects.
The San Francisco-based Youth Law Center accused Orange County, Calif., officials of the practice in 1998 as part of a lawsuit over conditions in foster care.
"There is no good testing for these medications, even for children in preadolescence—let alone very young children," said Carole Shauffer, the center's executive director. "It's basically human experimentation to use these medications on children."
