St. Petersburg Times
By Kris Hundley
Saturday, May 30, 2009
The agency in charge of Florida's foster kids thinks it has finally gotten a handle on how many of its charges are on powerful psychiatric drugs.
But a closer look raises serious questions about the validity of the recently updated database.
While Florida's Department of Children and Families said Thursday that a review of case files found 2,669 children on psychotropic medications, the supporting data are shaky.
DCF's records include such unlikely scenarios as an eight-year delay between the time a court approved a drug and the date it was actually prescribed.
In another case, a child started taking a drug for attention deficit hyperactivity disorder nine years before the judge gave consent.
About 100 court approvals were signed on weekends.
And of more than 5,000 prescriptions, only one child was reportedly taking Symbyax, a combination antipsychotic and antidepressant that has been on the market since 2004. Symbyax was one of the psychotropic drugs being taken by a 7-year-old foster child who committed suicide in South Florida last month.
DCF is required by law to track foster children on psychiatric drugs because of potentially dangerous side effects. Previously, the department had reported that fewer than 2,000 kids were on such prescriptions.
In this week's review, DCF also admitted that one in six of those children did not have legally required approval by either a parent or a judge to have such a prescription.
But in hundreds of cases in which a judge's consent reportedly was obtained, the date of that order came either long before - or long after - the prescription started.
For instance:
· In 10 cases around the state, DCF's records show judges signing consent orders for a variety of drugs in January 2001, but the children's prescriptions did not start until 2009.
· A 16-year-old in Marion County was approved for the antipsychotic Risperdal in August 2005, but the prescription didn't begin until May 2009.
· A 15-year-old in Duval County had a judge sign off on another antipsychotic, Abilify, in January 2007; state records show the prescription began in May 2009.
John Cooper, DCF's acting assistant director of operations, acknowledged shortcomings in the state's database but said the medication start date could simply reflect the most recent prescription for a long-standing medication.
Andrea Moore, a longtime advocate for foster children, said that's no excuse. State law requires judges to regularly review the appropriateness of psychotropic prescriptions, she said, especially if the medication is changed.
"A consent signed two years earlier is not a valid consent,'' said Moore, former executive director of Florida's Children First. "That's particularly important when you're talking about atypical antipsychotics where serious questions have been raised about their long-term side effects."
Conversely, in more than 100 cases, there was an unusually long delay between the medication start and the court order.
· A 14-year-old in Brevard County reportedly on the ADHD drug Adderall since 1999 received court approval in November 2008.
· A 16-year-old in Hillsborough County began taking Seroquel, an antipsychotic, in October 2005, with a judge's consent receivedthis January.
DCF Secretary George Sheldon ordered a thorough review of all kids on psychotropic drugs last month after the suicide of Gabriel Myers. Myers, who had been in state custody for 10 months, was on Symbyax, as well as Vyvanse, for ADHD.
The state's database shows only one other foster child, a 14-year-old in Marion County, currently taking Symbyax. DCF's Cooper declined to comment on why the drug did not appear more frequently.
Symbyax has not been approved for children, although the practice that employs Gabriel Myers' psychiatrist is currently recruiting adolescents for a clinical trial of Symbyax for bipolar depression.
The most popular medicine on the state's database is Adderall. The next three most prescribed drugs, Risperdal, Seroquel and Abilify, are all antipsychotics
DCF's data show the sense of urgency among caseworkers as they scrambled through files in the aftermath of Gabriel Myers' suicide. Of the 2,433 court orders in the report, 187 of them are dated after April 16, the day the boy took his life. That includes the record of a 7-year-old in Palm Beach County who had been taking Adderall since November 2005.
The agency's database showed that 1,653 of the 2,669 foster children taking psychotropic drugs have multiple prescriptions. However, the state's tracking system is unable to easily identify kids on several different drugs at one time rather than multiple prescriptions for the same drug.
"We've noticed there are system limitations," said DCF's Cooper, who added that the system requires users to work through 12 screens to enter data. "As part of the Q.A. (quality assurance) process, we're trying to get a better idea of what's going on."
Moore, the foster child advocate, wonders why DCF released the data before checking it against Medicaid's records of the same children, a step DCF promises to take.
"When we've compared those two databases in the past, we've found significant under-reporting by DCF," she said. "At least Secretary Sheldon is trying to put pressure on them to get it right. But there's no reason, in my opinion, to trust the data they currently have."
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Blog on Gabriel Myers: http://gabrielmyers.wordpress.com/
