Audit of Orangewood Drug Prescribing Begins : Health care: Inquiry by three outside experts seeks to determine if adult medications have been given to children at county facility. Review stems from complaint about one psychiatrist, official says.

The county’s mental health director said Monday that he has ordered an outside audit of psychiatric medication practices at Orangewood Children’s Home in response to concerns from staff members that drugs may have been administered inappropriately.

Timothy Mullins said the staff members alleged that adult medications have been improperly given to children at the county-run home, and that drugs have been administered without the consent of social services workers, as required.

The audit also stemmed from complaints that medications have been changed too rapidly, making it too difficult to assess each drug’s effects, Mullins said.

County Supervisor William G. Steiner, former director of Orangewood, said he asked county health officials to arrange for the audit last November after an employee of the Health Care Agency complained about the prescribing practices of one psychiatrist.

“The concerns and the allegations are aimed at one particular physician,” Mullins said. “But when you do an audit, it’s only fair to look at all practices. You have to expand it beyond that one particular physician (to) . . . the practices of the program in general.”

Mullins declined to identify the physician, one of three full-time psychiatrists on staff at the 236-bed home for abused or neglected youngsters. Steiner said the psychiatrist has been removed from his assignment at Orangewood but still is working in the county’s Health Care Agency.

He said the audit team will consist of a pharmacologist from Camarillo State Hospital, a psychiatrist from a facility similar to Orangewood in Los Angeles County, and a UCLA children’s psychiatrist. He declined to identify the auditors by name.

Mullins said auditors have a broad mission and may “look at whatever they want” pertaining to medication practices at Orangewood, including patient charts. He said he expected them to look in particular at practices in the past year, but that they were free to expand on that time frame.

“It’s not designed to be a narrow audit,” Mullins said. “I do not want to constrain them.”

Mullins said he had ordered the audit last November, but it “fell to lower priority” after the county declared bankruptcy Dec. 6. “It should not have, but it did,” he said.

He said the first auditor started her review Friday and the other two are expected to begin work in April.

Mullins said the issue affects a minority of Orangewood’s residents. Less than 10% of the home’s population of about 250 take psychiatric medications, he said.

But Dr. Bernard Rappaport, who heads the county’s division for mental health services to children and youth, said the concerns expressed at Orangewood are part of a larger national issue: determining the appropriate use of adult drugs in children.

The problem, Rappaport said, is that few psychiatric drugs have been specifically approved for use in youngsters. Although administering adult drugs to children is legal, it can be a complicated decision, he said.

“Diagnoses tend to be more fluid (than in adults), and it is more difficult to state specifically what a child has,” he said.

Consequently, he said, “there will be larger differences of opinion among psychiatrists as to what should be used than in adults.”

Mullins said that at Orangewood, one of the drugs whose usage has been questioned is clonidine. This medication is approved by the Food and Drug Administration for treatment of high blood pressure in adults, but it is also prescribed to children as a treatment for attention deficit disorder.

“It’s a medical issue” to determine whether the drug is being used appropriately, Mullins said. “It’s not an issue of illegality.”