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Some California Foster Children Are Being Prescribed High Amounts of Antipsychotics

By Paul Gaita 08/18/16

A new investigation into the prescribing habits of the state’s foster care doctors reveals the troubling overmedication of foster children. 

Some California Foster Children Are Being Prescribed High Amounts of Antipsychotics

An in-depth report by the Bay Area News Group has revealed that a small number of physicians that treat California’s foster children are prescribing high amounts of psychotropic drugs, often in combination with other drugs that generate harmful side effects. The investigation, which continues an award-winning series from 2014 called “Drugging Our Kids,” examined prescription data from Medi-Cal benefit claims from about 1,200 California psychiatrists and other medical providers who prescribed psychotropic drugs to foster children over a five-year period (2009-2014).

Their research revealed the following:

• More than 100 doctors prescribed antipsychotics to at least 75% of their patients who were receiving psychiatric drugs, which was more than double the average rate. In one case from San Bernardino County, a single psychiatrist prescribed antipsychotics to 328 foster children, or 85% of the patients to whom he prescribed some form of psychiatric drug between 2009 and 2014. The U.S. Food and Drug Administration has given limited approval to the use of such medications for younger patients, citing numerous side effects including obesity, diabetes and irreversible tremors.

• Fifty-six doctors prescribed two or more anti-psychotics for more than 60 days to at least 11 of their patients. A Monterey psychiatrist prescribed combinations for 50 of her patients, which accounted for 7% of the foster children statewide on a similar drug regimen. In the case of the aforementioned San Bernardino doctor, he was found to have changed prescriptions of antipsychotics, or combinations of antipsychotics, for his patients on a regular basis. The American Academy of Child and Adolescent Psychiatry stated that there is “no clear evidence to support the use of more than one antipsychotic in either adults or youths.”

• Issues of objectivity and judgment were raised by the actions of many physicians. Of the 25 highest prescribers, seven were found to conduct research for drug manufacturers, including the aforementioned San Bernardino doctor, who was listed as an investigator for Shanti, which conducted clinical trials for a variety of childhood disorders.

• Fourteen doctors employed outdated methods of sedation for troubled patients, including one doctor who prescribed an antipsychotic for a kindergartner. The same doctor was also found to be training psychiatry residents at a children’s center in San Diego.

• In the case of the seven highest prescribers in the state, all were previously identified in 2010 as part of a nationwide senate investigation into doctors prescribing mental health drugs at “astonishingly” high rates. None of the seven—or any on the list—was ever disciplined by state boards.

The investigation did not reveal dosage levels or physicians’ diagnoses, which would determine which drugs were “off-label,” or prescribed for uses not approved by the FDA. It also cited lobbyists for California psychiatrists, who countered claims of over-prescription by noting that doctors must undergo a newly mandated review process that is reducing the use of antipsychotics on a statewide level; currently, prescription of psychotropic drugs for foster children is down throughout California, from 13.5% in 2012 to 12% in 2015.

The report’s authors also invited more than two dozen of the physicians listed among the highest prescribers to comment on the report. Of that group, only three agreed to be interviewed, including Dr. Michael Barnett, a psychiatrist for two group homes in Visalia. He attributed his inclusion on the list to his practice of prescribing low doses of the antipsychotic Seroquel as a non-addictive sleep aid which can also “augment” antidepressants. “A lot of times it’s difficult to tease out why they’re breaking things or punching holes in the wall,” he noted. “I’m going to stop that behavior as quickly as I can to protect the child, so I will use any medication that I think will help with that.” 

Lawmakers have taken exception to that stance. Governor Jerry Brown passed three bills in 2015 that require greater oversight on the part of foster and group home parents and administrators, as well as state child welfare workers, in regard to prescribing psychotropic drugs to children.

Three additional bills will soon be reviewed by the State Assembly and Senate, including SB 1174, which would establish the first routine monitoring process of prescribers and alert the state medical board about doctors who prescribe outside standard limits. Efforts such as these may help to stem the tide of what Rochelle Trochtenberg, a California advocate for foster care—and a former foster youth who was heavily medicated while in the system—calls “numbers [that show] we don’t really treat, we use chemical restraints. Medications are so overused—and so significantly—that it’s outrageous there’s such a lack of leadership in holding doctors accountable, and holding the system accountable.”

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Paul Gaita lives in Los Angeles. He has contributed to the Los Angeles Times, Variety, LA Weekly, and The Los Angeles Beat, among many other publications and websites. 

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