Orangewood Care Report Sparks Calls for Reform

County leaders and advocates for abused children called Monday for immediate action--including a possible management shake-up within the county’s health-care agency--in response to an official report that blasted the way youngsters are medicated by doctors at the Orangewood Children’s Home.

“The allegations are horrendous, and in my eyes it’s not something the Board [of Supervisors] should put on the shelf along with the report,” remarked Supervisor Todd Spitzer, referring to a newly released report by the Juvenile Justice Commission.

“The board has to demand that we clean up this situation . . . and make sure it never happens again,” Spitzer added.

The report focused new scrutiny on the department in the county’s massive Health Care Agency that is responsible for providing mental health services to disadvantaged and abused children.

Some officials said the county should now take a hard look at the department and its longtime manager, Dr. Bernard Rappaport, who has oversight responsibility for the psychiatrists who over-medicated some children at Orangewood.

“I hope the Health Care Agency could use this as a wake-up call to review management and determine whether they want to look at some changes,” said Gene Howard, head of the Orangewood Children’s Foundation, which raises private money for the county-run children’s home.

The commission report found that Health Care Agency psychiatrists jeopardized the health of young patients by prescribing powerful drugs without first recording diagnoses, by failing to keep accurate charts for some patients and by changing their medications with great frequency.

The report--compiled over a two-year period and released on the eve of the long Independence Day weekend--concluded that doctors prescribed powerful mood-altering or anti-psychotic drugs with little oversight or consultation with colleagues, and that the Health Care Agency failed to adequately investigate the allegations when they first were made in 1994.

The findings were based in part on several confidential audits and reports that the commission subpoenaed from Children and Youth Mental Health Services, the department within the Health Care Agency. Attorneys for the agency unsuccessfully fought the subpoena in court, arguing that the documents should remain confidential.

Rappaport and Health Care Agency Director Tom Uram did not return phone calls Monday. In an interview last week, Timothy P. Mullins, Mental Health and Drug Abuse Services director, acknowledged the validity of some of the report’s criticism, but said the agency has significantly improved services at Orangewood, an emergency shelter that houses more than 300 abused and neglected children.

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County Chief Executive Officer Jan Mittermeier said Monday that health-care officials will prepare an “action plan that ensures prompt attention to each of the Commission’s recommendations. They’ll keep me updated on their progress.”

But Spitzer said the Board of Supervisors should demand a presentation from the Health Care Agency on the issue to make sure the commission’s concerns are addressed.

And “if it [the presentation] involves personnel issues, let’s do it in closed session,” Spitzer said.

Hans Askensky, a Laguna Beach psychologist and longtime critic of Rappaport, said the commission’s findings underscore the need for new leadership at Children and Youth Mental Health Services. “Rappaport is ultimately the one responsible for all this,” Askensky said.

But others defended the manager, who they describe as talented and committed to children. “He has dedicated his whole career to helping children, even where there is not a lot of money to go around,” said Felix Schwartz, executive director of the Health Care Council of Orange County.

Advocates for better children’s services hoped the commission’s findings will result in improvements at Orangewood and increased funding for children’s mental health programs.

Howard, the Orangewood Children’s Foundation head, stressed that many of the questionable record-keeping practices described in the report have already been corrected by the Health Care Agency. “Those problems existed, but have been corrected,” he said.

Barbara Oliver, head of the Child Abuse Prevention Council, added: “We are watching this very closely. We want to make sure all the agencies are open with each other and that the problems are all fixed.”