California lawmakers set to tackle excessive prescribing of psych meds to foster children

San Jose Mercury News - 01/31/2015
http://www.mercurynews.com/ci_27432987/california-lawmakers-set-tackle-excessive-prescribing-psych-meds

California lawmakers will consider a major overhaul this year of how the state cares for thousands of traumatized foster children, a sweeping effort to curb the excessive use of psychiatric drugs in the child welfare system.

Legislation to boost caregiver training, strengthen court oversight of prescriptions and give foster youth the right to alternative treatments is in the works in the state Senate to address problems revealed in this newspaper's yearlong investigation "Drugging Our Kids."

After years of growing concern -- but no legislative action -- new Senate President Pro Tem Kevin de León said he is "optimistic that oversight will result in overdue reform."

Psychotropic drug use in foster care is "one of the top issues on the child welfare agenda this session," said Susanna Kniffen, policy director at the nonprofit Children Now advocacy group.

With a half dozen legislators exploring bills, de León's staff has been working behind the scenes, attending meetings of a statewide reform group and meeting with advocates led by the Oakland-based National Center for Youth Law and lawmakers considering bills.

"When the government takes the extraordinary step of removing a child from their families because of abuse or neglect, it assumes the tremendous responsibility of ensuring they are cared for and not further abused or neglected by the system," de León said in an email.

This newspaper's series "on the overprescribing of psychotropic medications has shed a spotlight on a deeply troubling aspect of the system," de León said. "The Senate will be investigating the plight of the adolescents highlighted in these articles, as well as foster children generally."

The series revealed how many in the foster care system have come to rely on a drug-first approach to managing the behavior of thousands of troubled children. While the drugs do little to help abused and neglected youth cope with their trauma, they often lead to debilitating side effects, such as obesity, diabetes and tremors.

But there are signs that the legislative reform effort will not go unchallenged. Statewide associations representing foster care residential group homes and medical professionals are speaking out against a new state policy -- introduced in October, weeks after the newspaper's series began -- that makes it more difficult for doctors to prescribe antipsychotics to children on public benefits, including foster youth. Some of that sentiment may surface in legislation to oppose the new rule.

The final deadline to submit bills is not until late February, but preliminary language now being drafted would ensure that kids, caregivers, attorneys and judges are informed about medications and their side effects. The bills would also:

Grant kids the right to alternative treatments that do not involve powerful drugs, as well as the right to a second medical opinion when potentially dangerous combinations of drugs or high dosages are prescribed.

Train caregivers to understand medications' risks and benefits -- and better handle children who display difficult behaviors.

Ensure children on medications receive baseline monitoring so that side effects can be caught early.

Identify group homes where children are being overmedicated.

Empower public health nurses to ensure psych meds are used appropriately.
Youth advocates and former foster children such as Tisha Ortiz, of Hayward, applaud the flurry of legislative action.

"I am extremely happy now that lawmakers are trying to push this thing forward," said Ortiz, 22, who suffered through multiple moves and heavy doses of medications.

Ortiz -- who serves on a statewide expert panel examining the use of psychotropics -- said children, particularly in group homes, must be allowed to refuse medications without being punished like she was. She encouraged lawmakers considering bills to focus on allowing youth "to be more active in their treatment plans, rather than leaving them on the sidelines while everyone else controls them."

Lawmakers, including state Sens. Jim Beall, D-San Jose, and Holly Mitchell, D-Los Angeles, and Assemblyman David Chiu, D-San Francisco, have each submitted early language to the Legislative Counsel's Office, their staff members confirmed. Other bills that address prescribing psychotropics in group homes are also in the early stages.

The influential California Welfare Directors Association is working with Mitchell's office on legislation that would provide more information to judges, social workers and others in the lives of foster children about their medication and treatment history. That information would give judges who authorize medications more than just a prescriber's recommendation. It would include observations from social workers, caregivers and the children themselves.

"We've been very concerned about making sure that only kids who really need these drugs are getting them," said Frank Mecca, the welfare director association's executive director.

Yet, opposition has already surfaced over the state Department of Health Care Services' decision last fall to require that doctors receive extra authorization to prescribe antipsychotics to children 18 and younger in the public health system.

In a November letter to health care director Toby Douglas, the California Alliance of Child and Family Services representing group homes, the California Pharmacists Association and the California Academy of Child and Adolescent Psychiatry, among others, called the new policy "alarming" and stated it has resulted in "medically necessary medications" being delayed or denied.

"Even if, as recent media accounts report, there is an issue of overprescribing of antipsychotics to youth, the DHCS solution uses a shotgun approach to address a problem that needs surgical precision," the letter states.

But Chiu, who plans to co-author a bill, wants to make sure that medications are not being used as "a chemical restraint" for foster children who have been abandoned and uprooted, and sometimes lash out because of their trauma.

"For me, the steady increase in the use of psychotropic medications for our foster youth has been incredibly alarming, and the lack of standards to authorize the use of medications appears to be irresponsible at the least, and potentially life-threatening at the worst," Chiu said.

"Children's brains are still developing, and the idea of requiring a child to take one, two, three, four or even more mind-altering medications without taking other health impacts into account is irresponsible."