Lawmakers, docs debate oversight for kids’ meds
By JIM WALLS
Feb. 10, 2012 — Georgia’s foster children are being over-medicated, often to sedate them or control their behavior rather than treat a medical condition, a new study confirms.
The question is: What should Georgia do about it?
One solution being considered by state legislators calls for oversight of medications given to adjust the mood or behavior of thousands of foster children in Georgia. The bill would require written standards for dosages of psychotropic drugs given to those children, as well as an independent clinical review of prescriptions for those medications and related treatments twice a year.
But some child psychiatrists, worried about second-guessing and potentially lengthy delays in treatment, object to a provision for pre-authorization of certain medications or unusual doses. They also cautioned state lawmakers last week about the consequences of language that would require the informed consent of children 14 and older before they took a new psychotropic drug.
“These medications can be very problematic if stopped abruptly,” said Dr. Peter Ash, chairman of child psychology at Emory University School of Medicine. “What happens if an adolescent refuses? … The reality is we have to care for them nevertheless.”
Georgia’s Medicaid program recently launched a pre-authorization process for prescribing the latest generation of anti-psychotic drugs to children. Officials say there’s not enough data yet to determine whether there have been inappropriate delays in treatment.
Rep. Ben Watson (R-Savannah), a physician, and other lawmakers worried that state monitoring of prescriptions might discourage psychiatrists from treating foster children. “Is this going to reassure [doctors] in their treatment or be more cumbersome?” Watson asked.
Two witnesses testified last week about their own experiences in Georgia’s foster care system and the dangers of inadequate medical oversight.
Giovan Bazan, now 21, said he almost died at 16 when a combination of medications caused him to convulse and vomit. A sedative made it difficult for him to sit up in bed, Bazan said, and he would have suffocated if the staff at his group home hadn’t recognized the danger and come to his aid.
Bazan told the House Health and Human Services Committee that his foster parents had used more medications and stronger doses to control his behavior. He said juvenile justice officials also warned that they would not end his probation unless he kept taking his medication.
“Obviously as a youth we have a bit of a rebellious spirit,” he said, “but that doesn’t mean that we are mentally ill.”
Mason McFalls, 24, said nearly every child he met in 14 years in foster care was taking psychotropic medications.
“I’ve seen kids literally shaking from being so wound up on the medication,” McFalls said.
Frequently, foster children are treated by a different doctor every time they’re moved to a new foster home, authorities say. Those doctors generally do not have access to a foster child’s medical history, so they may diagnose different disorders and prescribe different drugs and treatment.
At Department of Juvenile Justice facilities, Bazan said, “they would prescribe me a different medication even if I was only staying there a week.”
Over-medication was the common thread in a new study of 93 so-called “cold cases” — children who’ve spent years shuttling between foster placements without finding a permanent home.
A draft report on the study found high rates of children taking multiple behavioral medications, which were frequently prescribed for the convenience of caregivers.
“Those expedient solutions … tend to be the most popular,” said Melissa Carter, executive director of Emory’s Barton Child Law and Policy Center, which conducted the study.
Many foster children were given multiple medications at the maximum recommended dosage for adults, the study found. Most psychotropic drugs, because of the costs involved, are not tested for effectiveness or for the optimal dose for children.
Sometimes, there was no evidence in the case files to justify the prescriptions, said Dr. Brent Wilson, a child psychiatrist who studied the cold case files for the project.
Some children in the study were taking as many as eight different psychotropic medications, Wilson said. Use of multiple prescriptions can make it difficult to determine which drug is causing an unwanted side-effect, he said, and the lack of reliable medical histories makes it tough for doctors to know whether a drug is still necessary.
Thirty-two percent of Georgia foster kids were taking psychotropic medications in 2010. Of those, one in three was also prescribed at least one anti-psychotic drug, and nearly 5 percent received at least four psychotropic medications.
Those prescriptions cost Georgia’s Medicaid program $7.8 million in 2010, said Rep. Mary Margaret Oliver (D-Decatur), sponsor of the proposed Foster Children’s Psychotropic Medication Monitoring Act.
Oliver’s bill addresses a2011 federal mandate for states to monitor the use of psychotropic medications among foster children. Her bill does not address standards for Georgia’s juvenile justice system, which is not part of the federal mandate, although many children move back and forth between that system and foster care.