Psychotropic Drugs Banned For Foster Kids State Ruling, In Wake Of Boy’s Death, Says Biological Parent Or Judge Must Approve Use Of Mood-Altering Medication

Stimulants, sedatives and antidepressants no longer will be given to foster children without permission from a biological parent or a judge, state officials have decided.

The proposed rule, scheduled to take effect July 1 and similar to regulations in 24 other states, was adopted partly because of the death of 6-year-old Domico Presnell from amitriptyline poisoning last year. The antidepressant, better known as Elavil, had been prescribed because the boy was hyperactive and had trouble sleeping.

“Given the risk and uncertainty with psychotropic medications, we’re going to make them nonroutine,” said Rosie Oreskovich, head of the Children’s Administration in the state Department of Social and Health Services.

The boy’s biological mother, a recovering drug addict who was working to regain custody, did not know her son was taking amitriptyline. She has sued the state and Dr. Daniel Stowens, who prescribed the antidepressant.

Officials said it would have been inappropriate for the state agency or social workers to second-guess a doctor’s decision to prescribe medication.

The boy’s death was featured in a Seattle Post-Intelligencer series examining state oversight of foster children who are given psychotropic drugs.

Stowens, a neurologist whose medical license was suspended after the death, said he had assumed the boy was being seen by a pediatrician.

In reality, the boy went more than a year without seeing another doctor before he died April 21, 1996.

Stowens, 49, who treated dozens of Medicaid-covered foster children after opening a pediatric neurology office in 1993, said it was only after Presnell’s death that he realized there was no assurance that the foster parents of troubled or fragile children would be able to administer potent medication properly.

“I assumed that there was some supervision of the foster home,” Stowens said.

“I assumed that there were case managers acting as advocates for children who would pull a child out of a home if there were some reason to worry about the foster parent,” he said. “I assumed they had some way of determining which foster parents can handle medically fragile children.”

Washington’s new policy, similar to a 3-year-old Oregon law, covers Ritalin, Prozac, lithium and any other drug intended to “affect or alter thought processes, mood, sleep or behavior.”

If a parent or legal guardian is unwilling, unable or unavailable to consent to use of such behavioral medicine, social workers could seek permission in juvenile court.

Oreskovich said letters about the regulation would be sent to judges around the state soon.

The state Medical Quality Assurance Commission withdrew Stowens’ right to treat behavioral problems in November and suspended his medical license in February, saying he failed to transfer all his psychiatric patients to other doctors by the deadline.

The state Health Department accused Stowens of endangering patients by frequently exceeding maximum recommended doses for potent drugs like amitriptyline.

Stowens said he and other specialists sometimes exceed guidelines when normal doses prove ineffective. He said none of his patients had been harmed by the dosages he prescribed.

A five-member medical disciplinary panel is scheduled to review the charges against Stowens next month.