By Karen de Sa February 21, 2015
Over the course of a decade, California lawmakers have considered a dozen bills to regulate the use of psychiatric drugs in the nation's largest foster care system. Yet, despite the alarm over children medicated as young as 4 and teens so doped they drooled and became obese, just one became law: a bill to speed up court approval so foster children could get drugs more quickly.
Pushed in 2004 by residential group home directors and psychiatrists, Assembly Bill 2502 sailed to the governor's desk with no opposition even as a succession of bills that would have scaled back prescribing died in committees.
Now, with youth advocates cheering a major new legislative push to curb overprescribing in foster care, the years of setbacks are forcing an uneasy question: This time, will things finally change?
Beginning Tuesday with a Senate Human Services Committee hearing, lawmakers will consider four new bills in the wake of this newspaper's yearlong investigation "Drugging Our Kids."
The newspaper found that although California tasked the juvenile court with reining in reckless prescribing as early as 1999 -- making it unique in the nation -- the number of foster children receiving psychiatric drugs over the last decade remains at almost 1 in 4 teens. Well over half of those children were prescribed antipsychotics, drugs that are poorly studied in children and can cause debilitating side effects -- but blockbuster moneymakers for pharmaceutical companies.
Those numbers indicate the state has urgent work to do, said retired Los Angeles Superior Court Judge Terry Friedman, who sponsored the bill that requires California's juvenile courts to approve all psychotropic prescriptions in foster care.
Friedman said while some children need medications to manage their emotional health, the current rates are "alarming and disappointing" -- given that the "clear goal" of the bill he pushed 16 years ago "was to stop overmedication."
"It seemed painfully evident that kids were being medicated for behavioral-control purposes and that just seemed inappropriate, excessive and dangerous," he said.
However, history shows the new controls may have difficulty passing if they increase workloads, raise costs or run into opposition from groups concerned that easy access to medications could be hampered. Lobbyists representing doctors and group homes have long had powerful voices in the state Capitol.
"Care delayed is care denied," said Randall Hagar, a lobbyist for the California Psychiatric Association, "so we would look at the time elapsed between the time a doctor said, 'I think this kid needs a med,' and when they get the med. And if that's too long, then bad things happen."
Carroll Schroeder, executive director of the California Alliance of Child and Family Services, said the residential group homes he represents have similar concerns.
Any new controls, he said, should not prevent a child from getting "the right treatment or therapies at the right time in the right dosage." The 2004 bill his alliance sponsored required the courts to rule on med requests within seven days, addressing what his members described as harmful delays in prescription authorizations.
But Senate Majority Leader Bill Monning, D-Carmel, said new legislation is needed -- and he is confident it will pass because of a heightened public awareness, a coordinated group of senators and a problem too big to ignore. Monning's bill would provide courts with second medical opinions and require health exams before a child is prescribed an antipsychotic.
"I clearly see these as health care issues and fundamental human rights issues," Monning said.
State Sens. Jim Beall, D-San Jose, and Holly Mitchell, D-Los Angeles, and Assemblyman David Chiu, D-San Francisco, are also crafting bills with guidance from the National Center for Youth Law that would ensure better monitoring of medicated foster children; require regular reports on prescribing; train caregivers and social workers; and drive down prescribing in group homes where medications are most heavily used.
From 2001 to 2011, similar legislation that would have ensured patient rights as basic as having doctors review medical records before prescribing repeatedly failed.
Legislative efforts to require reporting on the number of foster children prescribed drugs also failed repeatedly, even when amended versions shrank them to pilot projects in just a few of the state's 58 counties. One such bill in 2004 aimed to "reveal gaps in the state's ability to adequately regulate the use of psychotropic medications."
Former foster youth Jennifer Rodriguez, now executive director of the San Francisco-based Youth Law Center, testified before the Assembly in 2006 about the need for tighter controls. She implored the state to fund "nontraditional mental health stress relief like dance lessons, gym memberships and recreational activities," as well as services to connect kids with relatives and caring, committed adults.
Rodriguez spoke from experience, telling lawmakers in a videotaped hearing that at age 12 she was given sedatives in her first group home, where she had trouble sleeping. That progressed to antidepressants "and before long, I was on four different prescriptions," she testified. "I was alternately sleeping in class and then bouncing off the walls. My hands were shaking so bad I couldn't even hold a pencil."
Five years later, the advocacy group Rodriguez once led, the California Youth Connection, tried again to obtain health care protections for foster youth that most kids growing up in families would receive. The Foster Care Mental Health Bill of Rights would have strengthened youths' right to refuse medications, granted them age-appropriate information on potential side effects, and required that they be informed if prescribed medication had not been tested on children.
But county mental health directors expressed concerns, saying the bill could "create complicated clinical consequences."
Friedman hopes California leaders will pay attention to the children's voices this time around. "What's important really should be set by the kids rather than by the professionals," Friedman said. "I'm not suggesting anarchy, but the system exists for them and we need to listen to them."
Contact Karen de S at 408-920-5781.