DCF's drug records suspect
EDITOR'S NOTE: A correction notice has been appended to this story.
By Kris Hundley and Connie Humburg, Times Staff Writers
Published Friday, May 29, 2009
The agency in charge of Florida's foster kids thinks it has finally gotten a handle on how many of its charges are on powerful psychiatric drugs.
But a closer look raises serious questions about the validity of the recently updated database.
While Florida's Department of Children and Families said Thursday that a review of case files found 2,669 children on psychotropic medications, the supporting data are shaky.
DCF's records include such unlikely scenarios as an eight-year delay between the time a court approved a drug and the date it was actually prescribed.
In another case, a child started taking a drug for attention deficit hyperactivity disorder nine years before the judge gave consent.
About 100 court approvals were signed on weekends.
And of more than 5,000 prescriptions, only one child was reportedly taking Symbyax, a combination antipsychotic and antidepressant that has been on the market since 2004. Symbyax was one of the psychotropic drugs being taken by a 7-year-old foster child who committed suicide in South Florida last month.
DCF is required by law to track foster children on psychiatric drugs because of potentially dangerous side effects. Previously, the department had reported that fewer than 2,000 kids were on such prescriptions.
In this week's review, DCF also admitted that one in six of those children did not have legally required approval by either a parent or a judge to have such a prescription.
But in hundreds of cases in which a judge's consent reportedly was obtained, the date of that order came either long before — or long after — the prescription started.
* A 17-year old in Polk County reportedly got court approval for psychotropic drugs in January 2000, but did not receive prescriptions for four medications – Risperdal, Adderall, Depakote and Buspirone – until May 2006.
*A 14-year-old in Charlotte County got a judge's consent in February 2003, but Clozapine and Depakote were not prescribed until July 2008.
John Cooper, DCF's acting assistant director of operations, acknowledged shortcomings in the state's database but said the medication start date could simply reflect the most recent prescription for a long-standing medication.
Andrea Moore, a longtime advocate for foster children, said that's no excuse. State law requires judges to regularly review the appropriateness of psychotropic prescriptions, she said, especially if the medication is changed.
"A consent signed two years earlier is not a valid consent,'' said Moore, former executive director of Florida's Children First. "That's particularly important when you're talking about atypical antipsychotics where serious questions have been raised about their long-term side effects."
Conversely, in more than 100 cases, there was an unusually long delay between the medication start and the court order.
* A 14-year-old in Miami-Dade started taking Abilify in March 2000, but a court order was not received until December 2004.
* A 12-year-old in Orange County was prescribed Trazodone and Adderall in July 2004; court consent did not come until April 2008
DCF Secretary George Sheldon ordered a thorough review of all kids on psychotropic drugs last month after the suicide of Gabriel Myers. Myers, who had been in state custody for 10 months, was on Symbyax, as well as Vyvanse, for ADHD.
The state's database shows only one other foster child, a 13-year-old in Marion County, currently taking Symbyax. DCF's Cooper declined to comment on why the drug did not appear more frequently.
Symbyax has not been approved for children, although the practice that employs Gabriel Myers' psychiatrist is currently recruiting adolescents for a clinical trial of Symbyax for bipolar depression.
The most popular medicine on the state's database is Adderall. The next three most prescribed drugs, Risperdal, Seroquel and Abilify, are all antipsychotics
DCF's data show the sense of urgency among caseworkers as they scrambled through files in the aftermath of Gabriel Myers' suicide. Of the 2,433 court orders in the report, 187 of them are dated after April 16, the day the boy took his life. That includes the record of a 7-year-old in Palm Beach County who had been taking Adderall since November 2005.
The agency's database showed that 1,653 of the 2,669 foster children taking psychotropic drugs have multiple prescriptions. However, the state's tracking system is unable to easily identify kids on several different drugs at one time rather than multiple prescriptions for the same drug.
"We've noticed there are system limitations," said DCF's Cooper, who added that the system requires users to work through 12 screens to enter data. "As part of the Q.A. (quality assurance) process, we're trying to get a better idea of what's going on."
Moore, the foster child advocate, wonders why DCF released the data before checking it against Medicaid's records of the same children, a step DCF promises to take.
"When we've compared those two databases in the past, we've found significant under-reporting by DCF," she said. "At least Secretary Sheldon is trying to put pressure on them to get it right. But there's no reason, in my opinion, to trust the data they currently have."
Kris Hundley can be reached at firstname.lastname@example.org or (727)892-2996.
CORRECTION NOTICE: Earlier versions of this story contained erroneous prescription and court order dates.