A Critical Look At The Foster Care System
Medication of Children
MEDICATION OF CHILDREN
In Washington state, one out of every five children in the foster care system is on potent mood-altering medications. Yet the state has no safeguards in place regulating their use to protect the children who swallow the potentially toxic pills.
The state does not chronicle the problems children experience with these drugs, nor are officials even certain how many of their wards take behavioral medications. And the ranks of foster children being given psychotropic drugs have swelled over the years, experts say.
Says Aija Guedel, former president of the School Nurses Organization of Washington: "When I see foster children, most of them are on a stimulant, anti-depressant or anti-psychotic - or usually all three."
What are the results on the children? According to a six-month investigation conducted by the Seattle Post-Intelligencer:
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 anti-depressants. 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.
The psychotropic drug most often prescribed to foster children in Washington state over the past five years has been methylphenidate, or Ritalin, which costs the state about 17 cents per pill, according to the 1996 Formulary and Drug Use Guidelines used at Western State Hospital.
The second most commonly prescribed pill was the anti-depressant imipramine, costing about 2 cents a dose.
San Francisco youth activist Lyn Duff, herself a former foster child, describes her experience while in state care: "They put me on desipramine. A week later they took all the kids in a van to the doctor. He spent five minutes talking to us, with the other kids in the room."
"It's not unusual for me to have a child 9 years old on two or three psychotropic medications at one time," says Dr. Sharon Collins of Mercy Medical Center in Cedar Falls, Iowa.
The use of psychotropic drugs to control foster children in state care has long been documented.
In a landmark suit filed against the Illinois Department of Children and Family Services, the American Civil Liberties Union blamed the child welfare agency for much of the child abuse in the state.
One of four teenagers named in the class-action suit had been in state custody as long as he could remember. Although his mother and grandmother had told him they wanted him back, the 13-year-old had not received any services that might have helped to reunite his family.
In the meantime, he had been "warehoused" for three months in the Henry Horner Children's Center, where he was routinely drugged with psychotropic medication and in danger of assault, according to the suit.
One of the numerous terms of the consent decree stemming from the suit describes the use of these agents to control foster children:By January l, 1992, DCFS shall convene a reform panel to review and make recommendations regarding its policies and procedures concerning (i) the use of restraint and seclusion on children in care and (ii) the use of behavior controlling drugs including a prohibition on the use of such medication for the punishment of children, the convenience of caretakers or as a substitute for programming for children's needs.Has anything changed as a result of the Illinois action?
Pia Menon, a former attorney with the Chicago Public Guardian's Office, was assigned to investigate the Columbus-Maryville Children's Reception Center operated by Catholic Charities.
Her report, suppressed by Public Guardian Patrick Murphy, was described to author Renny Golden.
Menon recounts her findings on the use of drugs to control foster children: "Many teenagers are on psychotropic medications. Almost every child who comes into the system ends up on some kind of psychotropic medication--we're talking about four- and five-year-old kids who are on Prozac and Ritalin..."
"Give me a break--it's to quiet them down," she adds. "Generally, psychotropic medications take the place of nurturing."
But the use of medications is not limited to group care facilities and the Children's Reception Center. Menon explains:Caseworkers prefer that the child is medicated. It helps the foster care parents, who may not be qualified to deal with a disruptive child. Staff often have no idea what a drug does to the child. They dispense it like aspirin. There is absolutely no one to monitor kids on multiple meds.Prentis Caudill was a ward of the state. Both he and his sister endured the difficulties of placement in residential group homes and psychiatric facilities. "All you have to do is act up and they give you drugs," says Prentis. "The drugs were nice because they'd calm you down or put you to sleep for days."
What this all amounts to is a systematic assault on children who've already been removed from home, medicated, coded, misdiagnosed, therapized...
Adds Prentis: "They gave me Thyroxine. Sometimes your muscles twitch."
In California, judicial approval is required for giving psychotropic drugs to any foster child. Says Dr. Michael Malkin, who reviews the drugs for Los Angeles County judges: "The psychiatrist is usually beseeched by the group home operator to medicate the kids."
Dr. Malkin tries to substitute milder medications that don't cause permanent facial tics, heavy sedation and other side effects.
According to Malkim, the Judicial approval required in California deters doctors from dispensing risky anti-psychotic drugs en masse.
Oh, is that so?
A 1997 Los Angeles Grand Jury report indicates that foster children are frequently medicated with psychotropic drugs.
Not only are the children excessively medicated, but the conditions in group foster homes were found to be deplorable. The Los Angeles Times describes the Grand Jury findings:Many of the nearly 5,000 foster children housed in Los Angeles County group homes are physically abused and drugged excessively while being forced to live without proper food, clothing, education and counseling, according to a blistering report by the county grand jury.The Grand Jury found that children were given a variety of medications without the proper consent of a guardian or judge in nearly half of 158 audited cases. In another instance, a group home withheld drugs in hopes that a child would be ruled severely emotionally disturbed--thus drawing a higher rate of government payments.
The Grand Jury also identified inadequate psychotherapy for the children, with sessions of as little as five minutes being held, although therapists were billing for full-length sessions.
Said Andrew Bridge, executive director of the Alliance for Children's Rights: "We need to have small homes of six beds or less to deal with these kids in a therapeutic way and not simply put them away or drug them."
The 1991-92 San Diego County Grand Jury reached similar conclusions, extending its examination of the foster care system in another direction. Among its findings:Caseworkers, investigators and attorneys believe that some foster parents routinely complain of behavioral problems, insist that those behavioral problems require mental health therapy and then seek additional funds for regular transportation to the therapist and special care needs. These claimed behavioral problems are subjective and are not capable of being confirmed by objective tests.The Grand Jury suggested that "foster parent claims of behavioral problems in foster children not previously identified as having the problems should be carefully investigated."
In examining the improper use of controlling medications, the Grand Jury found that the medications in use ranged from mild depressants and hypnotics to strong psychotropic drugs.
It determined that the lack of money for medical treatment, the financial pressures on medical providers and a generalized lack of medical records for foster children all contributed to make it possible for unscrupulous foster parents to obtain medication for children who did not need to be medicated.
A committee of the U.S. House of Representatives examined many of these problems years ago, concluding that the foster care and child welfare systems were in dire need of reform.
A 1990 report issued by the Select Committee on Children, Youth and Families described the use of these mind-altering medications, and the bizarre treatments to which children in state care are frequently subjected: "In the state mental hospital in South Carolina, children who attempted suicide were stripped to their underwear, bound by their ankles and wrists to the four corners of their beds, and injected with psychotropic drugs."
Some critics charge that psychotropic medications are not only routinely provided as a method of controlling foster children, but as the means to obtain disclosure of non-events.
In Wenatchee, Washington, where allegations of a bizarre and highly improbable "sex ring" involving several prominent citizens came to surface, children alleged to be victims are apparently being provided medications and therapy as a means to elicit disclosure, critics charge.
Melinda Everett, who was among the primary witnesses for the prosecution, publicly recanted her testimony on a televised broadcast, claiming that it had been coerced.
Immediately on the heels of her public recantation, Melinda was seized from her grandparents' home. Writes syndicated columnist Paul Craig Roberts: "For the past several months the child has been involuntarily locked away in a psychiatric facility where she is under the exclusive control of 'recovered memory' therapist Cindy Andrews. No one--not even elected state representatives--has been permitted to see her."
Cindy Andrews, who is under contract with the state, is among the defendants in a civil suit in which Melinda Everett is a principal witness.
Melinda is not alone in her plight. More than a third of the alleged victims of the so-called "child sex ring" in Wenatchee were placed on psychotropic drugs paid for by the state once they entered foster care.
Are the Wenatchee children truly victims of a sex ring that included dozens of people with a local pastor as ringleader, or are they victims of a state sanctioned machine determined to extract testimony from them at any price? Their stories include:
A 12-year-old boy taking the anti-depressant Zoloft who heard voices telling him to hang himself by jumping off a milk crate with a rope around his neck. His counselor worried he was suffering from memory impairment as a side effect of the drug. He originally was sent to Pine Crest, but later was transferred to an institution in King County where he tried to kill himself. A 15-year-old developmentally delayed boy who became a chief witness in several of the cases after being sent to Pine Crest. He later attempted suicide while on psychotropic drugs. A boy described in medical records as "in denial" and "non-compliant" after his parents were sentenced to prison on sex charges. At age 9, in April 1995, he tried to run away from the foster home he shared with two other alleged sex-ring children. Doctors increased his dosage of Zoloft, and the fourth-grader "tried to stick (a) metal object through his chest," according to a DSHS episode report. He then entered a Seattle psychiatric hospital, where he was prescribed the anti-depressant amitriptyline.
In the case of one 13-year-old girl, her medical notes indicate that Andrews "apparently would like her on medications." The girl later was given Paxil.
The greatest irony to be found among these tragic circumstances is that a significant number of foster children have been removed from their homes for reasons alleged to be related to "neglect" stemming from substance abuse by their parents.
In Hawaii, an estimated 80% of cases involve substance abuse by parents, says John Walters, an assistant program administrator with its Department of Human Services.
While "historically, people have thought of substance abuse as an adult problem, substance abuse by parents has made it a children's problem, as well," said a spokesperson for the Massachusetts Department of Social Services.
Apparently, the child protective system has gone to great lengths to ensure that substance abuse is indeed "a children's problem," as its solution is all-too-often the traumatic removal of children from their homes, and the systematic turning of the children into drug-dependent wards of the state.
Copyright © 1997 - 2002 Rick Thoma
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Last Updated April 16, 1998