July 7, 2009
System faulted in boy's death in foster care
BY MARC CAPUTO
Herald/Times Tallahassee Bureau
Child-welfare doctors and case managers routinely failed to complete legally required treatment plans, share information or properly document the prescribing of powerful psychiatric drugs for children, according to a new state study of 6- and 7-year-olds medicated in state care.
One of the 268 children was Gabriel Myers. The troubled 7-year-old, medicated with an adult anti-depressant known to cause suicides in children, hanged himself in April in his Margate foster home.
But the state study, which documents how many times caseworkers and doctors followed child-welfare rules and laws, shows that it would be a mistake to blame Gabriel's death solely on the drug, Symbyax, said Florida's drug czar, William Janes.
"It wasn't just the medications,'' said Janes, who sits on a committee investigating ways to prevent cases like Gabriel's. ``It was the system and his world. His environment just collapsed on him. And there was no one there to really put their arms around him."
- In 86 percent of cases, the prescribing physician didn't complete what's known as a Psychotherapeutic Medication Treatment Plan, which helps case workers, legal guardians, judges and other physicians determine a child's mental well being.
- In 75 percent of the cases, the case workers did not provide physicians with pertinent medical information about the child.
- In 76 percent of the cases, the case worker didn't provide parents with information about the psychotropic drugs their kids were being prescribed. Nor did the case worker help arrange transportation or phone conversations between the doctor and the child's guardian.
- In 58 percent of the cases, the case manager didn't attempt to speak with or meet the parent or guardian prior to seeking a court order to medicate the child.
- In 89 percent of the cases where parental consent wasn't obtained to medicate children, case managers failed to inform state lawyers that they were seeking a court order to administer the medication.
The DCF study also found numerous record-keeping and data discrepancies in the state's child-tracking system, Florida Safe Families Network. The study follows a similar review last month concerning the drugging of children in state care under the age of 6. DCF is now studying other age groups.
Dr. R. Scott Benson, former head of the American Psychiatric Association, pointed out the difficulties physicians have in meeting all the state record-keeping requirements.
Benson, who doesn't treat children in state care, said he found it ''horribly troubling'' that physicians weren't given all the pertinent medical information about the children prior to making a prescription. But, he said, he wasn't surprised because of the complicated nature of child-welfare cases and clients.
The committee probing the child-welfare system plans to issue a report by Aug. 20.
It is only touching on Gabriel's case, which is the subject of a Margate police investigation. Some doctors and case workers -- all of whom work for privatized agencies under contract with the state -- might face sanctions, depending on what the report finds.
The DCF study, as well as Gabriel's case, show the troubles with 2005 legislation designed to curb the prescribing of mental-health drugs to kids in state care.
Among its requirements, the law mandates more information sharing, parental involvement and second-party review of doctors' prescriptions for the youngest children.
One committee member, Dr. Rajiv Tandon, pushed for a simple electronic record system that physicians and case workers can share.
He said the system also needs to be ''tweaked'' to clarify who's in charge and who needs to do what.
"There's only so much we can do. There's no substitute for common sense," Tandon said. "There's no substitute for people doing the right thing. Sadly, in this case, the right thing wasn't done by some people."