Report Decried Giving Drugs to Kids

Consultant studied Florida centers for foster care

By Carol Marbin Miller
Originally Published in The Miami Herald, May 11, 2001

A consultant hired by the state Department of Children & Families to study residential treatment centers for Florida foster kids reported in February his "critical" concern over the "widespread use" of psychiatric drugs on children in state care.

The report by child welfare consultant Paul DeMuro was released by the department Thursday only after The Herald had demanded access to the record for two weeks.

Revelations in the report, as well as several others obtained by The Herald on Thursday, shed light on a controversy that has raged for almost a month over allegations by child advocates that children in state care are routinely being given potentially harmful psychiatric drugs in order to control unruly behavior.

The department, which has expressed concern over the allegations, nonetheless insisted Thursday that the use of psychotropic drugs among foster children is neither widespread nor unusual when compared to children who are not in out-of-home care.

A separate internal department investigation into allegations that psychiatric drugs are being used as "chemical restraints" on children in state care found that slightly less than 5 percent of the state's foster children are being administered the drug Risperdal, one of several psychotropic medications that have serious side effects.

That investigation reported that 667 children in foster care were taking Risperdal, among 14,649 foster children statewide, said Cecka Green, a spokeswoman for the department in Tallahassee.

About 100 of the children are Miami-Dade foster kids, and another 70 or so live in Broward County, Miami-Dade District Administrator Charles Auslander told The Herald.

Some young children, male and female, have developed enlarged breasts and begun lactating as a result of being administered Risperdal, records and interviews show.

The state has yet to analyze use of several other antipsychotics, which advocates claim also are widely used.

Most of the drugs have been successful in combating fairly common disorders—such as attention deficit-hyperactivity disorder and at least one form of autism, but advocates assert they are widely used as "chemical restraints" for difficult-to-manage children.

DeMuro, whose team studied conditions at seven Florida treatment centers, reported Feb. 10 his concerns about the use of drugs on children in residential treatment centers.

"The widespread use of psychotropic medications is a systemwide issue," DeMuro stated in the report made public Thursday. "DCF needs to seek medical consultation and establish guidelines for the use of psychotropics in residential settings. This is a critical issue, particularly in light of the young ages of many of the children" in treatment centers.

One teenage boy interviewed by DeMuro's team "had difficulty staying awake," the consultant reported. "He appeared over-medicated."

The disclosures have fueled concerns by children's advocates.

"Six-hundred and sixty-seven is an awful lot of kids on powerful medication," said Pat Wear, deputy director of the Advocacy Center for Persons with Disabilities.

"Hasn't anybody told DCF to just say no to drugs?," said Richard Wexler, a persistent critic of the agency who is director of the Virginia-based National Coalition for Child Protection Reform.

"Here we are trying to send a message to young people about drug abuse, and it is possible that the biggest pusher in the state is the Department of Children & Families," Wexler added. "It is very hard to believe that one out of 20 Florida foster children really needs to be doped up on Risperdal."

Children & Families officials have insisted that they will not tolerate the use of drugs to restrain difficult children in their care.

"We do not dispense these drugs; we do not prescribe them," said Green, an agency spokeswoman in Tallahassee. "We do put the psychiatric care of children in the hands of professionals. We can only assume that they are using their medical knowledge when prescribing this drug, or any drug, to kids."

Earlier this week, Gov. Jeb Bush told The Herald his office was "looking into" the use of psychotropic drugs among children in state care.

But the governor's office also insisted officials do not believe the drugs are being misused.

Among the documents reviewed by The Herald:

A February 2000 report by the University of South Florida's Florida Mental Health Institute, a mental health research arm of the school, on 1,200 Broward foster children shows that 56 percent of the kids, or 675 children, had a mental health diagnosis. Among the adolescents, aged 9-15, 45 to 46 percent of the 675 were on some type of psychotropic medication, including such drugs as Risperdal, Ritalin, lithium and Prozac.
The most common diagnosis among the Broward foster kids was adjustment disorder, a diagnosis applied to 38 percent of the 675 children. The second most common diagnoses, at 19 percent, were attention deficit-hyperactivity disorder and/or "disruptive behavior disorder," the report states.
A consultant who studied a residential treatment program for foster kids at Fort Lauderdale Hospital that was operated until recently by Brown Schools of Florida said that "all" the children in the program were being given psychotropic drugs.
"Almost all" of the children at the Tampa Bay Academy, a Tampa treatment center, were being administered psychotropics, a consultant reported, adding, "many of [the children are] on multiple psychotropics. The medical director reported that the psychiatrists attempt to use psychotropic medication in as limited fashion as possible."
At Devereux Florida Treatment Network, another treatment center, the consultant said 80 percent of the residents were being medicated. And at The Caring Place, a Fort Lauderdale emergency shelter, the consultant said five of 17 teenage boys—or close to 30 percent—were on psychotropic medications.
"The use of this medication allows the individual a level of control of their behaviors and assists them in gaining insight to their problems and thus [to] take advantage of the program," the consultant quoted a Devereux doctor as saying.
A review by the Broward Regional Health Planning Council's Behavioral Health Review Team of one residential treatment center, Alternate Family Care, Inc., quoted staff there as saying that a "barrier" to the program's success was that "children [are] being given too many medications."

Said Howard Talenfeld, a Fort Lauderdale attorney who represents 1,430 Broward County foster children in a pending 1998 federal class-action lawsuit: "As a means of behavior control, we are institutionalizing kids and putting them on psychotropic medications."