Posted on Tue, Jun. 09, 2009

Florida child-welfare administrators are largely ignoring a host of rules put in place to protect children from potentially dangerous -- and sometimes unnecessary -- drugs, according to a detailed state review of the records for more than 100 young foster children who are being given powerful psychiatric medications.

Caseworkers under contract with the state Department of Children & Families are failing to comply with almost every benchmark governing the use of psychotropic medication among foster children, according to the DCF report, obtained Tuesday by The Miami Herald.

''The deeper I get into this thing, the more my blood pressure rises,'' DCF Secretary George Sheldon said. ``This really is unacceptable.''

The study, which included 112 children younger than age 6, is the most recent measure of the state's progress in curbing mental-health drug use among foster children since the April death of a 7-year-old boy who had been given several psychiatric medications during a nine-month stay in foster care.

Recent revelations come only four years after state lawmakers passed legislation to curb the use of mental-health drugs among children in state care. The law requires, among other things, informed consent from a parent or judge, second-party review of doctors' prescriptions for the youngest children, and annual reports to the state Senate.

Among the most troubling findings, child advocates say, is the state's almost complete failure to seek a second opinion from a psychiatrist under contract with DCF before administering mental-health drugs to the youngest children in state care -- younger than age 6.

''We knew it was bad. We just didn't know it was this bad,'' said Andrea Moore, the former head of Florida's Children First, who has led efforts to reduce the state's reliance on mental-health drugs for almost a decade. ``It is more than frustrating, because children have been left at risk.''

Sheldon, who ordered the ongoing reviews, said he, too, is not surprised by some of the findings, though he was a bit struck at ``the number of places the system has broken down.''

''Some physicians don't want to be second-guessed. Some case-management agencies were aware of our policies, but haven't been communicating them to caseworkers. And you've got the department that hasn't been doing appropriate oversight,'' Sheldon said. According to the study, conducted over three days last week:

• Caseworkers did not complete a treatment plan for 83 children, or 74 percent of the 112 whose files were studied. The treatment plans are designed to ensure that troubled children receive psychological care, in addition to drugs, and do not become overly reliant on powerful medications.

• In more than 95 percent of the cases studied, the foster child's doctor did not review his or her plans with a consulting psychiatrist under contract with DCF to ensure the children in state custody are well cared for.

• In 72 percent of the files studied, caseworkers had entered inaccurate data in the state's computerized child-welfare database, called Florida Safe Families Network. Erroneous information included mistakes about the names of medications and dosages prescribed.

• Caseworkers had failed to obtain informed consent for the medications for 45 percent of the children studied.

The issue of consent has gained significance in the wake of the April death of Gabriel Myers, a 7-year-old foster child who hanged himself in the bathroom of his Margate foster home. A report in The Miami Herald that Gabriel had been on several mental-health drugs -- including anti-depressants linked to an increased risk of suicide among children -- prompted DCF's investigation on the use of such drugs.

For 36 percent of the kids, parents already had been stripped of their right to raise the children, potentially freeing the children for a possible adoption, the report said.

The lion's share of the 112 youngsters whose cases were reviewed last week were age 5, said DCF Family Safety Director Alan Abramowitz, and most of the children had a diagnosis of attention deficit/hyperactivity disorder.

None of the foster kids in Miami-Dade in the study younger than age 6 were taking mental-health drugs, and only three from Monroe County were on such drugs. Ten Broward County foster children younger than 6 were included in the study.

''What concerns me is that the Legislature may have taken action, a lot of attention was paid to it, we wrote a lot of policies -- and then just assumed those policies would be followed,'' Sheldon said. ``Frankly, there's got to be an enforcement arm that goes along with that, and an oversight arm.''