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Spokane, Washington  Est. May 19, 1883

Foster Kids On Potent Drugs State Lacks Safeguards To Protect 1 In 5 On Psychotropic Medications

Seattle Post-Intelligencer

One out of every five children in Washington state’s foster care system is on potent mood-altering medications. Yet the state has no safeguards to protect the children who swallow these sometimes toxic pills.

As a result, foster children have suffered hallucinations, loss of bowel control, abnormal heartbeats - even death.

The state does not chronicle the problems children experience with these drugs. Officials aren’t even sure how many of their troubled wards take behavioral medications, a six-month investigation by the Seattle Post-Intelligencer found.

Foster parents are given virtually no special training for handling the drugs. And there is no requirement that a child’s biological parents or family members be told about the medications.

In 1992, records show, 19 percent of the children who entered foster care received prescriptions for psychotropic medication paid for by the state of Washington. Foster children were 10 times more likely to be given mood-altering drugs than other children whose medical bills were paid with tax dollars.

Health professionals say the number of foster children getting drugs has grown since 1992, but the state stopped keeping count five years ago and has no idea how many foster children are being drugged or what drugs they are taking.

While the numbers are fuzzy, the consequences are clear:

A 4-year-old girl was rushed to intensive care with an erratic heartbeat after her foster parents accidentally doubled her daily dose of anti-depressants - a dose already far above the maximum recommended for her age and weight. The foster parents said neither their doctor nor social worker had warned them of the hazards of the drug, amitriptyline.

A 5-year-old boy tried to kick out the windows in a bus, covered himself with feces and tried to run naked down the street after being given powerful antidepressants. His foster mother said she never was warned of the side effects.

A 13-year-old boy sent into foster care in 1995 during the Wenatchee sex-ring trials heard voices and suffered memory loss after being put on high doses of the anti-depressant Zoloft. He later tried to kill himself.

Domico Presnell died. The wavy-haired 6-year-old failed to wake up in his Seattle foster home last April 21. A toxic level of amitriptyline was found in his blood.

Two months earlier, Domico’s caseworker at the Department of Social and Health Services, the agency in charge of foster care, had sought to intervene. Social worker Monica Tate wrote in the Service Episode Record of her “concern of children on my caseload, including Domico, being prescribed medications for their behavior, i.e. Ritalin, amitriptyline, etc., without my consent.” The state, she said, lacked “policies, rules and regulations” for monitoring such medications.

Nearly a year after Domico’s death, DSHS still hasn’t adopted a drug policy to protect children in foster care.

Rosie Oreskovich, head of the DSHS Children’s Services division, said the agency is considering changing some drug policies in light of Domico’s death, but doesn’t want the job of second-guessing doctors.

“This case makes it very clear to me that there are some things in our system we can improve,” she said. “But to say that this death is the result of what Children’s Services did or did not do is wrong.

“I can’t be in a position where I have social workers reviewing the work of a physician,” said Oreskovich, whose division runs foster care for the state.

However, Michael Mirra, an attorney with Columbia Legal Services, a public interest law firm, said foster children depend on the state for their safety. “When the state presumes to take a child into its care, it incurs an enormous obligation,” he said.

The lack of state laws or guidelines not only leaves social workers largely helpless to guide foster parents, but the children’s biological parents and grandparents also have no way of knowing what kinds of drugs the children are getting.

“I would have never had my son put on medications,” said Carolyn Presnell, Domico’s birth mother.

Many children benefit from the growing array of medicines that target mental disorders. But parents can keep an eye on their children’s reactions to drugs - and might even seek a second opinion - while a foster child’s side effects sometimes get overlooked.

“I’ve seen too many holes in the medical records of foster kids,” said Maxine Hayes, chief of child and maternal health for the state Department of Health.

That’s why a growing number of states have taken extra steps to protect foster children.

Oregon passed a law in 1993 after the sudden death of 7-year-old Bobby Jackson from prescribed anti-depressants at his Eugene group home. The law requires that caseworkers, parents and other involved adults be notified when a child in state care is prescribed behavioral drugs.

In California, a judge must approve giving psychotropic drugs to any foster child. Dr. Michael Malkin, who reviews the drugs for Los Angeles County judges, said that deters doctors from dispensing risky anti-psychotic drugs en masse.

“The psychiatrist is usually beseeched by the group home operator to medicate the kids,” said Malkin, who tries to substitute milder medications that don’t cause permanent facial tics, heavy sedation and other side effects.

In Washington, psychotropics - stimulants, sedatives, antidepressants and anti-psychotics - flow unchallenged from doctors to wards of the state.

A committee of outside experts convened by DSHS to look into Domico’s death recommended late last week that Washington consider adopting laws similar to those in Oregon and California.

DSHS Secretary Lyle Quasim referred questions on the department’s policies to Oreskovich. She said the agency is trying to improve its tracking of drugs and medical care but doesn’t see the need for new laws to mandate such action.