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Texas Foster Care Investigation - Children as young as 3 are drugged with antipsychotics

Sat, 13 Nov 2004

The Dallas Morning News reports that Texas comptroller, Carole Keeton Strayhorn, who hade conducted an investigation of the foster care system, concluded that up to $4 million a year might be wasted on drugs given to foster children for mental illnesses such as schizophrenia, bipolar disorder and depression.

Her investigation shows that 60% of children in the Texas foster care system are being drugged with powerful psychotropic drugs that have not been approved for children. Yet, "Children as young as 3 are receiving powerful, mind-altering drugs."

She suspects foster children are being given psychiatric drugs "so they're more docile, or so doctors and drug companies can make a buck."

A mother reported her son's experience with the antipsychotic drug, Zyprexa: "He put on a tremendous amount of weight, 85 pounds to be exact," she said, adding that as doctors continued to increase his medications starting at age 5, he experienced troubles in school and with the law and was hospitalized repeatedly."

The Houston Chronicle reports that Risperdal and Zyprexa - made up half of the drugs prescribed to foster children in Texas. These drugs are among the most dangerous of psychotropic drugs. They carry new FDA-required warnings about diabetes, blood clots and strokes.

Dr. Tony Appel, a neuropsychologist from Florida who examined the Texas records agrees: "We're taking away their future. We're taking away their ability to relate to people; trust, love caring, ability to put yourself in the other person's shoes and see how they see you. We take all that away from these children. We blunt their emotion."

Ever protective of the drug industry, the Texas Medical Association expressed skepticism about Comptroller Strayhorn's concerns. It is appalling that the Texas Medical Association sees nothing wrong in violating medicine's first principle, "do no harm" - if doing harm increases profits for psychotropic drug manufacturers.

See also, Foster Kids on Mind-Altering Drugs? Posted By: Mandi Bishop 11/11/2004, http://www.woai.com/troubleshooters/story.aspx?content_id=168321B6-DF50-4A2F-83D1-1789D8F2A18A

Watch This Story: http://video.woai.com/viewer/viewerpage.php?Art_ID=55809&tf=woaiviewer.tpl

See also: Texas Keye News broadcasts 7/23/2004 and 9/30/ 2004 at: http://keyetv.com/investigativevideo/

Contact: Vera Hassner Sharav
212-595-8974

The Dallas Morning News
Drug fraud alleged in foster care
Strayhorn believes kids are getting unnecessary psychiatric medication
November 12, 2004
By ROBERT T. GARRETT /

AUSTIN Comptroller Carole Keeton Strayhorn suspects foster children are being given psychiatric drugs so they're more docile, or so doctors and drug companies can make a buck.

Mrs. Strayhorn on Friday demanded a year's worth of records on drugs given to foster children, and she vowed to investigate and share evidence of fraud with the Legislature and the Health and Human Services Commission.

The comptroller cited her authority as the head of a Medicaid fraud task force that advises the commission.

She immediately drew skepticism from the Texas Medical Association and political rival Gov. Rick Perry that her investigation will be either helpful or necessary.

But two mothers of children placed by the state into foster care praised Mrs. Strayhorn's effort, saying her year-old crusade against misuse of mental health drugs among the state's 17,000 foster children had helped save the lives of their children.

"If it wouldn't have been for the care and concern of the comptroller, Mrs. Strayhorn, my daughter would not be alive today," said Elain Philpott of Port Neches.

Ms. Philpott said an unnecessary antipsychotic drug dulled her 15-year-old daughter's senses and caused other problems during the six years she was in foster care.

Mrs. Strayhorn said up to $4 million a year might be wasted on drugs given to foster children for mental illnesses such as schizophrenia, bipolar disorder and depression.

"Children as young as 3 are receiving powerful, mind-altering drugs," she said.

Commission spokeswoman Jennifer Harris said it has launched a two-track review of whether poor children on Medicaid - including foster children - receive proper medicine for mental illness.

One is an ongoing review of drug claims by its beefed-up anti-fraud unit. The other is a review of "clinical data" on mentally disturbed children who receive Medicaid to see if policies need to be changed or if doctors need continuing education about mental health drugs.

Dr. John Holcomb of the Texas Medical Association said Mrs. Strayhorn has "a serious misunderstanding" of whether off-label use of drugs is appropriate.

"Hogwash," retorted the comptroller, whose son, Mark McClellan, runs the Food and Drug Administration. "I understand the use of off-label drugs, and I understand that most of these drugs are not approved for use in children."

She questioned actions by two Texas doctors who aren't psychiatrists but have prescribed mental health medications to foster children. A third, she said, co-owns a pharmacy that dispenses the drugs.

"It is not uncommon for some [foster] children to have up to 14 different prescriptions," she said.

Mrs. Strayhorn began reviewing foster care last year after stories in The Dallas Morning News found problems with the state's financial oversight of some foster care operators.

Ms. Harris said Mrs. Strayhorn will get the requested data "as long as it doesn't violate federal law protecting a patient's confidentiality."

Nov. 12, 2004, 11:39PM
Houston Chronicle Austin Bureau
Strayhorn will probe drug use on children
Comptroller asks for medical data on children in foster care
By POLLY ROSS HUGHES
Copyright 2004

AUSTIN - Comptroller Carole Keeton Strayhorn launched an investigation Friday into potential fraud and abuse in a foster care system that spends $4 million a year on mind-altering "Physicians are prescribing these drugs for children as young as 3 years old," Strayhorn said.

"I can't imagine prescribing mind-altering drugs for a 3-year-old baby."

Strayhorn said she's asking the Health and Human Services Commission to hand over detailed Medicaid records so she can track which drugs are prescribed for individual foster care children and whether fraudulent patterns exist.

"I am requesting prescription drug and claims data for foster children for an entire year to determine whether these medications are being prescribed to make the children more submissive," she said, "or to line the pockets of unscrupulous and uncaring doctors and pharmaceutical companies, or both."

The Texas Medical Association issued a statement saying Strayhorn has "serious misunderstanding" about the use of such drugs in children and said her examination so far does not put the drug data in a clinical context to tell whether the drugs were prescribed appropriately.

"Hogwash," she responded, adding that she understands the drugs have not been approved for use in children.

"I also understand that no child needs to be on 14 different drugs, and I severely question a 3-year-old being put on (the antipsychotic) Risperdal and a radiologist in San Antonio prescribing psychotropic drugs to children in El Paso."

Privacy concerns

Health and Human Services Commission spokeswoman Jennifer Harris said that the commission's inspector general and the Department of State indicated that Strayhorn's request will be subject to federal privacy law.

"We're willing to provide her with any information that she requests as long as it doesn't violate federal law protecting a patient's privacy," she said, adding that the commission already is overseeing a similar study.

HHSC's Inspector General Brian Flood and Health Commissioner Eduardo Sanchez are conducting a broad review into all children who receive Medicaid and are prescribed psychiatric drugs, but Strayhorn wishes to specifically examine medications prescribed to abused or neglected children in the state's foster care custody.

The commission oversees four major social service agencies and reports directly to Strayhorn's political rival Gov. Rick Perry.

Earlier report cited

Strayhorn spokesman Mark Sanders said Strayhorn, as chairman of a Medicaid fraud task force that reports to the Legislature every two years, already has access to confidential Medicaid information and has authorization to sign confidentiality agreements with the agency.

Widespread psychiatric drug use in foster children came under scrutiny earlier this year in Strayhorn's major report, "Forgotten Children," which also detailed physical and sexual abuse of foster care children and unsanitary living conditions.

"My report uncovered the fact that large numbers of psychotropic drugs are being prescribed to children in the foster care system, even though, according to the Food and Drug Administration, many of these drugs are not labeled for use in children and have serious side effects such as suicidal tendencies, diabetes and cardiac arrhythmia," Strayhorn said.

She said she was alarmed that in her review of a single month of data, two antipsychotic drugs - Risperdal and Zyprexa - made up half of the drugs prescribed to foster children.

Federal warning issued

Last June, these two drugs, along with Clozaril, Seroquel, Geodon and Abilify, became subject to a Food and Drug Administration warning of dangerous side effects.

The warning states the drugs carry an increased risk for hyperglycemia and diabetes and that the safety and effectiveness of the drugs has not been established for children.

The FDA also issued a warning last spring that adults and children taking 10 commonly prescribed antidepressants must be closely monitored for worsening depression and increased risk of suicide.

The drugs include Paxil, Luvox, Celexa, Lexapro, Wellbutrin, Effexor, Serzone and Remeron. Parents who joined Strayhorn at a press conference credited her actions for helping save the lives of children.

Child heard 'voices'

Lori Holland of Austin said her son experienced highly disturbing side effects when placed under powerful psychiatric drugs.

On Zyprexa, he began hearing "voices in his head," she said.

"He put on a tremendous amount of weight, 85 pounds to be exact," she said, adding that as doctors continued to increase his medications starting at age 5, he experienced troubles in school and with the law and was hospitalized repeatedly.

Holland said she thinks her son's problems were the result of post-traumatic stress after suspected sexual abuse around the age of 4 or 5 years old.

She said he was removed from his family's home as a preteen when he committed a crime that victimized a younger child in the home.

After being sent to a facility in Lockhart called Pegasus, she said, he has been weaned off the psychiatric drugs, is attending high school and playing baseball.

Earlier, depending on the doctor in charge, he was variously diagnosed as suffering from attention deficit disorder, bipolar disorder, schizophrenia or sociopathy.

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