Use of meds by L.A. County foster, delinquent kids prompts reform

Los Angeles County officials are preparing to crack down on doctors who inappropriately prescribe powerful psychiatric drugs to foster youth and children in the juvenile delinquency system, according to a copy of the plans obtained by The Times.

Social workers and child welfare advocates have long alleged that the widespread use of the drugs is fueled in part by some caretakers’ desire to make the children in their care more docile. On May 1, the county Department of Mental Health is scheduled to launch a program to use computer programs to identify doctors who have a pattern of overprescribing the medications or prescribing unsafe combinations of the drugs.

Once problematic doctors are identified, the department will recommend that judges no longer approve their prescriptions for youth under court supervision.

Additionally, Los Angeles County mental health workers will fan out across the county to randomly interview children, caregivers and doctors about the reasons behind the prescriptions and how they are working.

The hope is that the in-person reviews will allow the county to go beyond the information doctors submit in their paperwork, offering a more complete picture of the youth’s mental health and whether less-intrusive interventions were used before turning to drugs.

“We know there is really a need to do this,” said Fesia Davenport who was recently named interim director of the county Office of Child Protection, a new agency charged with coordinating services across county departments for abused and neglected children. “Once we start to look at the data I think we’ll identify patterns and really understand why the use of the drugs seems to be high.”

The Times reported in February that 51% of California’s foster youth who are prescribed mental health-related drugs took the most powerful class of the medications — antipsychotics.

Antipsychotics are only approved by the U.S. Food and Drug Administration to treat schizophrenia, bipolar disorder and certain other forms of serious mental illness, but only 25% of the foster youth on the drugs have been diagnosed with those disorders, according to a 2009 national study by Stephen Crystal, a professor of health-services research at Rutgers University.

Studies show that 40% to 60% of mistreated children have mental health problems, and many do not have effective treatment. Children in foster care are at the highest risk of receiving high-cost medications in combinations that have not been well-tested, the studies show.

Kesha Price, a former Los Angeles County foster youth, said, “I was on 14 pills a day when I was 13 years old, and let’s just say I was not able to function in school.”

Lawmakers have introduced four bills in Sacramento in recent weeks that also aim to curb the use of the drugs through a series of new restrictions, including requirements for a second doctor’s opinion in some cases, computer alerts for social workers when unusual prescribing practices are detected and thorough medical examinations before and after the medications are provided.

Additionally, the Legislature is considering whether Medi-Cal claims data should be checked by county child welfare workers to ensure that every child on the drugs has obtained the required court authorization for the medication.

Michael Nash, who recently stepped down as the presiding judge of Juvenile Court, said that he was “deeply concerned” about the high level of prescriptions — whether the youth received a judicial order or not--and he urged state lawmakers to force the county to do more.

Nash said he was proud of the procedures he had helped to design to protect youth from misuse of the drugs, but he worried about the county’s adherence to the safeguards. “If they become legislative mandates, it would actually get done,” he said.

Others, however, argue that the root of the problem runs deeper than any court approval process can hope to achieve.

“When children are continually abused or they do not get their psychological, physical, spiritual, education and spiritual needs met, they develop disruptive behaviors,” said Dr. Gayani DeSilva, a psychiatrist who treats many foster youth. “The foster care system’s inability to meet the core needs of these traumatized children begins the vicious cycle of overuse of medications.”

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