Orangewood Auditors Call for Tighter Drug Scrutiny : Health: County is advised to develop a handbook covering prescriptions of psychiatric drugs at home for children.

Outside auditors hired to review medication practices at Orangewood Children’s Home have recommended that the county develop a handbook for prescribing psychiatric drugs to children and tighten scrutiny of drug use, according to a summary of their findings.

The auditors called for simple standards regulating use of unusual medications, better monitoring of possible side effects and improved training for staff members about medication issues.

But the circumstances that led to the recommendations remain a mystery because the county refuses to release the full report, citing confidentiality restrictions.

And after a yearlong ordeal, nearly $10,000 spent and considerable controversy, it appears the impact of the findings will be limited.

Three of the auditors were hired late last year after Orangewood staff members complained that a psychiatrist at the county-run home for abused or neglected children was giving patients improper combinations of psychiatric drugs, over-medicating them and giving some of them adult dosages. A fourth auditor, a state official, reviewed quality assurance throughout the county’s mental health system.

County officials say the auditors uncovered no activity requiring reports to criminal or licensing authorities.

In addition, although the county mental health director, Timothy P. Mullins, has agreed to follow most of the auditors’ recommendations, he said they will produce marginal improvements, not momentous reforms, in services to children and adults. In many cases, county officials said in written responses to the recommendations, existing guidelines merely need to be “reviewed,” “updated” or “reemphasized.”

Most significant, Mullins said, is the development within the next eight to 12 weeks of a new handbook outlining psychiatric medication procedures for children. The county already has such a handbook for adults, but developing one for youngsters is not easy, because many psychiatric drugs have not been specifically tested in children.

The five-page summary of auditors’ recommendations and the county’s responses follows months of speculation--and frustration--over the Orangewood review.

The audit took a year to finish. It was delayed first by the turmoil of the county’s bankruptcy, then by the refusal of the chief auditor to turn over her portion of the findings because, according to county officials, she feared being sued for defamation. When the report was finally complete last month, the county counsel’s office ruled that most of it could not be released because of rules protecting patient confidentiality and quality assurance proceedings.

The recommendations suggest that the auditors were concerned about the use of psychiatric medications on young patients. They urge the county, for example, to watch children’s thyroid function more closely when they are taking the mood stabilizer lithium, and to have doctors monitor youngsters’ heart function when they are on clonidine, a drug used to treat attention-deficit disorder.

They also recommended that laboratory testing procedures--such as blood tests--be set up to guard against the possibility of untoward side effects. And they urged regular training for staff members on psychiatric drug use. The county agreed to abide by the suggestions.

Mullins described the audit as generally worthwhile.

“I work from the premise that nothing I do can’t be done better. I learned some stuff and we’ll do some things differently. . . . I don’t think the time was misspent.”

The Orangewood auditors included a Torrance child psychiatrist, a psychiatrist who works for Los Angeles County and a Camarillo pharmacologist.