By NICK CAHILL
SACRAMENTO, Calif. (CN) — A troubling state audit released Tuesday found that childen in the California foster system are prescribed psychotropic drugs at higher rates than are children outside the foster system, with many receiving dosages that exceed recommended guidelines.
California, which has the largest number of foster children in the nation, must overhaul the process in which powerful drugs such as Ritalin and Prozac are prescribed to children, the state auditor says.
During the 2014-15 fiscal year, investigators found that 9,300 foster children were prescribed approximately 96,000 psychotropic prescriptions paid for by the state’s MediCal system — 10 prescriptions on average per child. Further, nearly 75 percent of the prescriptions were given to children between the ages of 12 to 17.
Counties failed to monitor the children’s prescriptions and did not always get parental approval for the use of the antidepressants. The children were also not always taken to recommended follow-up doctor visits after being given heavy doses, State Auditor Elaine Howle says.
Howle adds that lax state oversight is to blame, and that California doesn’t have a “comprehensive” plan for monitoring the administration of medications to foster children. The entities responsible for overseeing mental health services for the state’s 79,000 foster children — the Department of Social Services and the Department of Health Care Services — have failed to maintain accurate medical records.
Poor recordkeeping made it difficult for auditors to identify the exact types and amounts of psychotropic drugs prescribed to foster children.
“Consequently, neither agency can completely identify which foster children statewide are prescribed psychotropic medications or which medications those children are prescribed,” the 137-page report states.
Auditors reviewed the case files of 80 foster children in counties such as Los Angeles and Sonoma and found that 18 had been advised by doctors to take dosages that exceeded the state’s recommended maximums. Records also revealed that 11 children were given multiple psychotropic medications from the same medication class, while a third were given prescriptions without the required parental consent.
While the audit doesn’t explicitly question the Medi-Cal doctors’ prescribing patterns, it does highlight the disparity in psychotropic prescription rates between foster youth and non-foster children. Nearly 12 percent of California’s foster youth were prescribed the drugs during 2014-15, while outside data suggests that 4 to 10 percent of non-foster youths were given psychotropic drugs.
The state’s apparent oversight failures were addressed by lawmakers Tuesday, as the state Assembly unanimously passed a bill that would require welfare regulators to report data regarding psychotropic medications prescribed to foster children. Lawmakers noted that the state has spent $226 million on psychotropic medications for foster children over the last decade, nearly 72 percent of the total drug spending for foster youth.
Under Senate Bill 1174, MediCal doctors’ prescribing patterns of psychotropic drugs would be examined by the Medical Board of California every five years in order to reign in overprescribing.
“Our foster youth face enough challenges today without being subjected to inappropriate prescribing practices,” Assemblyman Freddie Rodriguez, D-Pomona, said in support of the bill.
In recent years many states have reevaluated and changed guidelines due to concerns that doctors are overprescribing psychotropic drugs to foster children. Illinois now has a watchlist of high-risk prescribers, while Colorado can require follow-up meetings and a letter between doctors and foster patients.
California’s proposal now heads to Gov. Jerry Brown for final approval.
The audit recommends that counties do a more thorough job of analyzing prescriber requests for psychotropic drugs and require that all foster children receiving new medications receive follow-up appointments within 30 days.