Psychiatric Drugs – Killing Children

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St. Petersburg Times

Florida Department of Children and Families review finds shortfalls in monitoring of foster children on psychiatric drugs
By Kris Hundley, Times Staff Writer
In Print: May 29, 2008

Spurred by the shocking suicide of a 7-year-old on psychiatric drugs, the agency in charge of Florida’s foster children has discovered serious shortcomings in its monitoring of kids on such powerful prescriptions.


Gabriel Myers
After reviewing its files, the Department of Children and Families determined it had under-counted the number of foster kids on such medications as Risperdal and Adderall, overlooking hundreds of cases.

It also has failed to meet its legal requirement that such prescriptions be given only after parental consent or court order.

On Thursday, DCF said a review of the files of more than 20,000 children currently in the state’s foster care showed 2,669, or 13.19 percent, are taking one or more psychotropic medications.

That compares to about 4 or 5 percent of children in the general population who are on such prescriptions.

Of those foster children taking drugs, DCF discovered 16 percent had no proof either a parent or judge had signed off on the prescription, as required by a 2005 Florida law.

“That is unacceptable,” said DCF’s secretary George Sheldon. “We’re going to bring every single case of a foster child on drugs into compliance with the law.”

Concerns about pediatric use of anti-psychotic and anti-depressants have been growing along with increased warnings of such side effects as suicide, diabetes and weight gain. Few of the drugs have been tested or approved by the FDA for children, though physicians can prescribe them for this age group.

Robin Rosenberg, a Tampa lawyer and deputy director of Florida’s Children First, said advocacy groups like hers have been fighting for oversight of psychotropic drugs for years. “We’re not as far along as we should have been if the state had followed up on serious concerns starting in the late 1990s,” she said. “It’s a shame we’re in this place today.”

Sheldon, who was named to the top job at DCF in October, left no doubt that he had been deeply affected by Gabriel Myers, the 7-year-old who hanged himself on a shower hose in south Florida in mid-April. The boy was in his third foster home and on Vyvanse, a medication for ADHD, as well as Symbyax, a combination of anti-psychotic and anti-depressant.

Though his caseworker repeatedly said Gabriel’s mother had agreed to the medications, that was not true. The boy’s psychotropic medications also had not been entered in the state’s tracking system.

To correct ongoing problems, Sheldon set a deadline of June 5 for action on cases without consent. This could include scheduling new doctors’ appointments, gaining informed consent from parents or expediting a judge’s review of the prescription.

Sheldon said he also was going to focus on the cases of 73 children under age 6 found to be on psychotropic drugs.

“I want a sense of urgency, but I also want to get it right,” he said. “I want to move forward, but I think it’s important for the agency to apologize for misinformation it may have put out in the past.”

Flaws in DCF’s record-keeping became clear in the immediate aftermath of Gabriel’s death. An initial review of the state’s database showed only 1,950 kids on psychotropic prescriptions. After a thorough review of individual records, however, that number grew by more than 700.

Preliminary data released in mid-May also showed some questionable dates on judicial consent. Though it’s not inconceivable a judge might sign an order on a Saturday or Sunday, early returns showed weekend consent orders on 129 occasions.

The final database, including information on types of drugs and diagnoses, was not available Thursday. Sheldon said a summary of the drug data would be posted on the DCF Web site and updated weekly.

“I’ve got a lot more confidence in these numbers than I had two weeks ago,” he said. “But any database is only as good as the quality of the information being put into it.”

One ongoing area of concern, Sheldon said, is the validity of any consent given by parents whose kids are in the state’s custody.

“A parent whose child is taken into our care is going to sign virtually anything and that’s not informed consent,” he said. “My preference is that the biological parent have a dialog with the psychiatrist.”

Now that DCF has a handle on the number of foster children on psychotropic drugs, Sheldon said the department can begin to address the bigger issue of the efficacy of such drugs.

He has asked an independent panel investigating Gabriel Myers’ death to make recommendations on improving DCF’s oversight of these medications. Sheldon said a second-party review of all such prescriptions might be necessary; currently, only prescriptions for kids under age 6 require such review.

DCF has set up a page on its web site that tracks the progress of the panel investigation into the boy’s suicide. The page includes a photo of the smiling boy.

“We have his face on the screen watching us to see how well we learned from his life and death,” Sheldon said. “We cannot let him down.”

Source: http://www.tampabay.com/news/health/medicine/article1005344.ece

Risperdal-Caution, Graphic Content

Internal AstraZeneca reports and e-mails written by company officials show they knew a decade ago that their psychiatric drug Seroquel caused diabetes and major weight gain, plaintiffs’ lawyers said Friday after releasing dozens of the previously sealed documents.

“They not only failed to warn about the risk of diabetes, but they marketed it as not having that risk,” said Houston attorney Ed Blizzard, one of the lead attorneys representing roughly 15,000 plaintiffs suing the British drugmaker.
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Disabled Boy Killed by Psychiatric Drugs

Miami Herald
PSYCHIATRIC DRUGS
Lawsuit says too many psychiatric drugs killed boy
A disabled boy was lethally overmedicated, a lawsuit contends, as outrage continues over a child’s suicide while on several drugs last month.
BY CAROL MARBIN MILLER

Amid a wide-ranging debate over the proper use of mental health drugs on troubled children, the mother of a disabled boy who died in 2007 is claiming in a lawsuit the boy was overdosed by a cocktail of psychiatric drugs, including two powerful anti-psychotics.

Martha Quesada, the mother of 12-year-old Denis Maltez, filed a wrongful death and medical malpractice lawsuit Monday in Miami-Dade circuit court, claiming Denis’ psychiatrist, Dr. Steven L. Kaplan, and the now-shuttered Rainbow Ranch group home overmedicated Denis and failed to properly monitor his condition …

Quesada’s lawsuit was filed amid a high-profile investigation by the Department of Children & Families into the death last month of Gabriel Myers, a 7-year-old foster child who had been taking a cocktail of mental health drugs. DCF Secretary George Sheldon appointed a task force to study Gabriel’s case, and the use of psychiatric drugs on foster kids.

‘TOUGH’ TO HANDLE

Kaplan did not return calls for comment. In a June 2007 article in The Miami Herald, Kaplan said ”it’s possible” Denis would have been sleepy at school if he had not been given his medications at the right times. But, Kaplan added, “I never saw him dopey or sleepy.”…

According to the 28-page lawsuit, Glatt stopped taking Denis to doctors at Jackson Memorial Hospital after he arrived at the group home in May 2006, and substituted Kaplan ”without the consent of [Denis's] mother.” Kaplan was treating several group home clients, the suit claims.

Kaplan prescribed and refilled four mental health drugs: Seroquel and Zyprexa, both anti-psychotic medications; Depakote, an anti-seizure drug sometimes used to stabilize moods; and Clonazepam, a tranquilizer. The lawsuit says the drugs were used “as chemical restraints to control Denis’s behavior.”

Though some of the medications are not approved by the Food and Drug Administration for use on children and carry strong warnings about possible side-effects, Kaplan ”took no steps to ensure that Denis was not suffering any adverse effects from these medications,” the suit claims.

In fact, the suit claims, Kaplan examined the boy only once between between May 26, 2006 and May 23, 2007, the day Denis died.
There were warning signs that the drugs may have been harming the boy, according to the suit, filed by by Fort Lauderdale attorneys Maria Elena Abate and Howard Talenfeld.
In June 2006, teachers at Denis’s school, Ruth Owens Kruse Educational Center, reported the boy was sleeping through class. …

DCF would not discuss the investigation with a reporter Tuesday.

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More on Gabriel Myers

St. Petersburg Times
DCF must do better
A Times Editorial
May 12, 2009
A little boy in foster care is dead by his own hand, but a poorly functioning child welfare system also is responsible. Last month, 7-year-old Gabriel Myers hanged himself on an extendable shower hose while in a South Florida foster home. At the time he was taking a combination of psychotropic medications, one of which carries a warning that it might lead to suicidal behavior in children. State law was ignored in giving the child the medicines without consent from his mother or a judge. In the final outrage, this child was given risky drugs but not the intense attention he so obviously needed.
St. Petersburg Times staff writer Kris Hundley reported that at the time of his death, Gabriel was taking Vyvanse, an ADHD drug, and Symbyax, a combination antipsychotic and antidepressant, which warns of heightened suicide risk in children particularly when first prescribed.

Six times, Gabriel’s caseworker had documented that the Department of Children and Families had parental consent for the medication. But there was no such consent. Gabriel’s mother signed a general medical authorization on the same day she was found unconscious in her car with powder cocaine, crack and oxycodone in her possession. But when a child is in state custody, a parent must give explicit consent after being “expressly informed” about changes in a child’s medication, including being told of medications’ benefits and risks and about alternative treatments.
That never happened in Gabriel’s case, and it appears this case is not unique. It has been a common practice for DCF workers and physicians to fail to obtain parental consent when a psychotropic drug is for a nonpsychotherapeutic use, under the mistaken impression that the law didn’t require it.
And foster care advocates say that DCF’s internal records are abysmal in tracking children taking psychotropic medications. This also suggests that proper consents are not being obtained.
DCF Secretary George Sheldon is responding appropriately to Gabriel’s tragic death. He is closing the loophole that allowed the prescribing of mood-altering drugs without parental consent. He has named an impressive committee to investigate Gabriel’s death and make recommendations. Sheldon also made public the details of Gabriel’s situation rather than try to cover up DCF’s failings. That alone bodes well for an honest accounting and a sincere desire to reform.
But to prevent a similar situation, Sheldon will have to look beyond a caseworker’s failure to inform a parent and address a system’s failure to adequately meet Gabriel’s needs.
Gabriel said he had been a victim of sexual abuse before moving to Florida, which means he should not have been placed in any foster home where there were small children present. As Gabriel started engaging in inappropriate touching, he was bounced from one foster placement to another to protect other children. This kind of shuffling can add trauma to a child who is already at risk.
Gabriel also didn’t receive all the behavioral therapy he needed, and he lost the therapist with whom he had established a relationship. Sheldon noted that in the days before his suicide Gabriel changed medications, moved to a new foster home and received a new therapist.
Sheldon has it right when he says that Gabriel’s death “ought to mean something.” State law needs to be followed when prescribing medication for children in foster care. And particularly when it comes to damaged children, there has to be a recognition that drugs are no substitute for basic human care and attention.

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Psychiatric Drugs Implicated in Another Child’s Death

Patriot Ledger
Rebecca Riley’s doctor now the target of a grand jury
Little girl’s parents to go on trial in her overdose death

By Lane Lambert
May 01, 2009

BOSTON — Already the target of a civil medical malpractice lawsuit, the psychiatrist who prescribed the drugs that killed 4-year-old Rebecca Riley is now the subject of a grand jury criminal investigation.

The Plymouth County grand jury probe of Dr. Kayoko Kifuji came to light on Thursday, in court documents from the Suffolk County civil case.

It’s not clear how long the grand jury has been examining Kifuji’s action. A spokeswoman for District Attorney Tim Cruz declined to confirm or deny whether a grand jury is investigating Kifuji.

If the grand jury does find the former Tufts-New England Medical Center psychiatrist criminally liable for Rebecca’s death, she could face involuntary-manslaughter charges.

Rebecca’s parents, Michael and Carolyn Riley, will go on trial later this year on first-degree murder charges in the little girl’s overdose death at their Hull home in December 2006.

Conviction for involuntary manslaughter carries a sentence of up to 20 years in prison, though Massachusetts sentences typically are 3 to 5 years. But legal experts say a criminal conviction would be highly unlikely for Kifuji, given the circumstances of the Riley case.

“It’s a very hard case to make,” Massachusetts Lawyers Weekly publisher David Yas said. “You could get it out of the grand jury, but in court it would be an uphill battle.”

Kifuji diagnosed Rebecca as bipolar with attention deficit disorder when she was 2∏. Kifuji prescribed the powerful blood pressure medication Clonidine and anti-seizure drug Depakote.

A medical examiner ruled that Rebecca died from an overdose of those drugs and over-the-counter cold medicine. Carolyn Riley says her daughter died of pneumonia, not the drugs.

Kifuji voluntarily gave up her medical license in February 2007, soon after Rebecca’s parents were charged.

Court evidence of the grand jury investigation surfaced amid fresh legal action in both the civil and criminal cases.

On Wednesday, Kifuji’s lawyers asked a Suffolk County judge to postpone her deposition in the civil case indefinitely, and close the entire court record to the public.

Kifuji’s attorney, Bruce Singal, said a deposition would force the doctor to claim her Fifth Amendment right not to incriminate herself while the grand jury was looking at the case. But the judge denied both motions.

Ben Novotny, an attorney for Rebecca Riley’s estate, says Kifuji is scheduled to give her deposition on July 6, after the grand jury is finished. She was to have given the deposition today.

For the deposition Novotny said Kifuji will be asked about “pretty much all her (medical) conduct,” starting with explaining the bipolar diagnosis.

Singal couldn’t be reached for comment. In the court document that mentions the grand jury, Singal says Kifuji “strenuously denies any allegations that her treatment of Rebecca was negligent, let alone criminal.”

Link to story: http://www.patriotledger.com/archive/x342375156/Rebecca-Riley-s-doctor-now-the-target-of-a-grand-jury

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Investigation Into Drugging of Foster Children

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South Florida Sun-Sentinel
After 7-year-old’s suicide, officials order look at drug use of other Florida foster children
Jon Burstein
April 29, 2009
MARGATE – In the aftermath of 7-year-old Gabriel Myers’ suicide, state child welfare officials will review the case files of every foster child in Florida to see how many are on mind-altering drugs.

The head of the Department of Children & Families also took the rare step Wednesday of appointing a panel to examine the circumstances surrounding Gabriel’s death. The child hanged himself April 16 with a shower hose in the bathroom of his Margate foster home.

“It is difficult for any of us to comprehend how a child so young could have deliberately and consciously made the decision to end his life,” DCF Secretary George Sheldon said. “But in order to help prevent this type of tragedy from happening again, it is critical we review all available information to determine the factors that led to Gabriel’s death.”

Four weeks before his suicide, Gabriel was prescribed Symbyax, which is a combination of the generic forms of the anti-depressant Prozac and the anti-psychosis drug Zyprexa. He already had been taking Vyvanse, a drug to treat attention deficit/hyperactivity disorder.

Sheldon has asked his agency to examine how many of the more than 20,000 foster children in Florida are taking psychotropic drugs. A DCF study in 2005 concluded that one in every four foster children was on a mood-altering drug.

Child advocates in the state have long criticized what they have described as the rampant use of psychotropic drugs on foster children.

“One of our concerns is that they use the medications as ‘chemical restraint’ and not as a medication to treat a disease or condition,” said Andrea Moore, executive director of Florida’s Children First.

Child welfare records released last week indicate Gabriel started taking Symbyax even though there apparently was no court order in place. Under Florida law, parental consent or a judge’s order is needed before a foster child can be administered a psychotropic drug.

“We need to develop a refined protocol for the use of these types of drugs in our children,” Sheldon said. “I want to ensure that prescription drugs of this nature are used appropriately, always under medical and judicial supervision and with consultation with DCF staff.”

To delve into Gabriel’s death, Sheldon appointed a five-member panel to be led by Jim Sewell, a former assistant commissioner with the Florida Department of Law Enforcement.

Jon Myers, Gabriel’s uncle, said he hopes that something good will come out of DCF’s actions.

“We realize (child welfare officials) have a tough job and the idea is that they learn from this and pass some laws which are in the best interest of the children,” Myers said.