Lack of data blamed for over-medicating foster children in Sonoma County

SACRAMENTO ­- State Sen. Mike McGuire on Monday called on top state health care and social services officials to respond to what he has called a “scathing” state audit criticizing the overuse of psychotropic medications among children in the foster care system.

During a joint state Senate committee hearing in Sacramento, McGuire repeatedly echoed the audit’s main findings: foster children are getting too many psychotropic drugs, their dosages are too high and they are being prescribed the mind-altering medications without the court authorization required by state law.

At the heart of the problem, McGuire said, is the lack of accurate data and monitoring of the use of psychotropics.

“We do have a failure at all levels,” the Healdsburg Democrat said. “We have challenges related to data. … We have social workers right now who aren’t even entering the dosages of what that foster youth is using.”

Jennifer Kent, director of the state Department of Health Care Services, and Will Lightbourne, director of the Department of Social Services, assured lawmakers that they take the auditor’s findings seriously and are trying to address them in a timely manner.

“The data is far from perfect,” said Kent, adding that her department was “committed” to sharing data with other agencies when appropriate, as well as improving the type of data used to monitor and track medications used to treat foster children’s mental health issues.

Lightbourne called for “roadmap” of collaboration among the different government agencies responsible for caring for the state’s tens of thousands of foster children.

“I think we are making headway, though,” Lightbourne said.

Sonoma County was among four counties selected for review in the state’s audit, but the findings were indicative of statewide trends, the report said. The others were Los Angeles, Madera and Riverside.

The audit found Sonoma County often failed to show that it properly tracked cases in which foster kids were prescribed multiple psychotropic drugs from the same class, which the state discourages; failed to show it was reviewing cases where drug dosages exceeded state guidelines; and did not show that youths were receiving adequate follow-up visits after being prescribed new psychotropic medications.

Many children in the foster care system suffer from emotional and behavioral issues and often have greater need for mental health care than children in the general population.

A former foster youth, Tisha Ortiz, now 24, testified Monday that she was repeatedly given “various powerful drugs,” including an anti-depressant not approved for children, as well as a high dose of lithium.

“At one point I was I was on four different medications, two anti-psychotics, an anti-depressant and a mood stabilizer,” she said. “And I would swallow these pills every day, even though they were prescribed as needed. This meant that I would take six pills in the morning and six pills at night for a total of 12 pills per day.”

Ortiz said she often objected to all the medications she was being prescribed but her concerns were repeatedly dismissed by her doctor, who told that “I didn’t know what I was talking about.”

Tisha said her sessions with her doctor consisted of “five minute” discussions about what medications she should be taking, and that what she needed was therapeutic behavioral services to help deal with her “self-injurious behaviors as well as trauma-focused therapy for the sexual and physical abuse I had experienced.”

Ortiz pointed out that doctors and anyone who works with foster youth need to be educated on trauma and understand the differences between behaviors and actual mental illnesses.

The hearing, which was co-chaired by Sen. Holly Mitchell, chairwoman of the Budget Subcommittee 3 on Health and Human Services, lasted about four hours and consisted of several panels, beginning with the testimony from the State Auditor Elaine Howle, who outlined the key findings of the audit.

“The very first finding that we had was that children in the California foster care system have been authorized psychotropic medications in amounts that exceed state recommended guidelines,” said Howle.

Howle also highlighted the practice of prescribing more medications than are allowed for a child’s specific age. The audit, which included an analysis of individual cases, found that in many instances kids were not given timely follow-up visits with their prescribing doctors.

“We actually had some examples in the report where children were suffering from side effects for months on end before they were actually seen by physician for a follow-up visit with respect to that particular prescription,” said Howle.

At the end of the hearing, McGuire said he would schedule a hearing at the beginning of 2017 to get a status report from state health and social services officials on their efforts to make changes to the use of psychotropic drugs in the foster care system.