Los Angeles County officials are allowing the use of powerful psychiatric drugs on far more children in the juvenile delinquency and foster care systems than they had previously acknowledged, according to data obtained by The Times through a Public Records Act request.
The newly unearthed figures show that Los Angeles County's 2013 accounting failed to report almost one in three cases of children on the drugs while in foster care or the custody of the delinquency system.
The data show that along with the 2,300 previously acknowledged cases, an additional 540 foster children and 516 children in the delinquency system were given the drugs. There are 18,000 foster children and 1,000 youth in the juvenile delinquency system altogether.
State data analysts discovered the additional cases of medicated children by comparing case notes of social workers and probation officers with billing records for the state's Medi-Cal system. The billing records for those additional children did not appear to have corresponding case notes, leaving child advocates concerned that the drugs may have been prescribed without appropriate approval.
The previously published figures, posted on a UC Berkeley website by the state Department of Social Services, helped to guide efforts to improve oversight and curb the use of the medications but obscured their widespread use in the delinquency system.
State law requires a judge's approval before the medication can be administered to children under the custody of the courts, but a preliminary review showed no such approval in the newly discovered cases.
Child advocates and state lawmakers have long argued that such medications are routinely overprescribed, often because caretakers are eager to make children more docile and easy to manage — even when there's no medical need.
The information about the additional cases of prescribed drugs was received by the county's Department of Children and Family Services last year, but county staffers resisted reviewing and releasing the data until The Times' public records request.
The information about delinquent youth was shared with the county's Probation Department by DCFS this week, after authorities learned that The Times had obtained it.
"We were just made aware that there may be a problem," said Reaver Bingham, deputy chief of the Los Angeles County Probation Department. "We are researching whether the approval process for the medications was fully executed."
DCFS Medical Director Charles Sophy, who is in charge of oversight for foster youth on the medications, said he was not aware of the information until this month.
DCFS Director Philip Browning said that he had also been unaware, but that he learned recently that staffers delayed work on the issue because they hoped for an agreement with state officials that might allow them access to current Medi-Cal billing records on an ongoing basis. He noted that Sacramento lawmakers are in the early stages of drafting legislation that may order counties to review the Medi-Cal billing records to ensure that all children receiving the drugs are properly approved.
Leslie Starr Heimov, who leads the court-appointed law firm representing foster youth, said she was frustrated that the county was not treating the information in hand with greater urgency.
"If there are group homes prescribing these medications without proper approval, we need to know that right now," she said. "We shouldn't wait for the Legislature to tell us that we need to take care of these kids."
No one questions that many children involved in the foster care and delinquency systems benefit from the medications. Both populations have experienced a high level of trauma, and mental health issues are diagnosed at a more frequent rate. The drugs help many to emerge from depression and other disorders. Sophy said that medications often allow children to return to family settings after stays in group homes and multiple failed efforts to stabilize the children's lives.
But many experts say there is ample evidence that the drugs are overprescribed, and Congress has ordered states to improve oversight to prevent overuse.
In California, 51% of children on psychiatric medications are taking the most powerful class of the drugs — antipsychotics — which have experienced explosive growth in foster care over the last 15 years, according to data obtained by the National Youth Law Center through a Public Records Act request.
"To me, this rate for antipsychotics is extraordinarily disturbing," said Bill Grimm, a senior attorney with the law center.
Most scrutiny centers on a new class of antipsychotics sold under such brand names as Abilify, Seroquel, Risperdal and Zyprexa. These drugs, which have strong sedative powers, have been linked by researchers to sudden and severe weight gain, increased risk for diabetes and movement disorders.
In a study of 2009 national Medicaid claims data, researchers found that the listed diagnosis supporting the use of 49% of antipsychotics for foster youth was hyperactivity or disruptive behavior. The drugs are approved by the
The second-highest prescribed class, antidepressants, were given to 48% of foster children on psychiatric medications in California, according to the information obtained by the National Youth Law Center.
The FDA has issued a "black box" warning — its most serious drug labeling — that antidepressants may increase the risk of suicidal thinking and behavior in some children and adolescents.
A district covering Los Angeles County and three coastal counties to its north had the state's highest rate of foster youth being treated with multiple psychiatric medications simultaneously: 41%, according to the law center's information.
Leslie Gilbert-Lurie, who co-chaired a blue ribbon commission appointed by the L.A. County Board of Supervisors to make recommendations on how to improve the safety net for abused children, said medications were a constant concern as her team surveyed foster youth and professionals across the county
"We heard over and over that children were being so overly medicated in the classroom that they were not in a position to learn," she said. "There is a great need for children to be assessed properly and to have access to talk therapy in addition to any medication they might need."
Foster youth repeatedly reported, she said, that medications put them in a foggy state of mind.
"Medication," Heimov said, "is often the first line of attack and not the last. We should be starting with less intrusive behavioral interventions, and that is rarely the case."
"Every one of my lawyers could name five children who did better once they were off the meds," she said.