Doctors Undermine Major Drug Reform For Foster Kids

When the California Senate passed a package of bills in June to curtail the overprescribing of psychotropic medication to foster youth, lawmakers heralded it as an unprecedented attempt to protect the most vulnerable children in California. 

But despite months of hearings and debates crafting proposals, in the dying days of the legislative session, the California Medical Association along with the California Psychiatric Association, the California Academy of Child and Adolescent Psychiatry and the California Alliance of Child and Family Services, representing residential group homes, were able to get the centerpiece of the reform, SB 253, pulled from an Assembly floor vote. 

The opposition spent more than $1.4 million between Jan. 1 and June 30 lobbying the Legislature, according to the San Jose Mercury. Another bill, SB 319, by Sen. Jim Beall, which would establish a system for public health nurses to monitor and oversee anyone in foster care who is prescribed psychotropic medications, had its funding stripped a few weeks ago. 

“SB 253 is really key — it’s the linchpin of this whole package because the courts are the gatekeepers, and if the gatekeepers are not doing their job, everything else is not going to come together to solve the problem,” said Bill Grimm, senior attorney with the National Center for Youth Law, a major backer of the bills. “The opposition that’s been mounted by the medical community is unconscionable.”

SB 253, by Sen. Bill Monning, would have changed the juvenile courts' process for authorizing psychotropic drugs by prohibiting such drugs from being authorized without prior medical examination and ongoing monitoring of the child. Monning said he planned to reintroduce the bill next year. Along with SB 319, two other bills, SB 238 and SB 484, passed the Assembly yesterday and are headed for concurrence today in the Senate. 

On SB 319, National Center for Youth Law policy analyst Anna Johnson told the Contra Costa Times that the state's refusal to spend any money was especially disappointing because the federal government would pay 75 percent of the bill.

"If you want monitoring to happen, you have to mandate it" as many other states have, she said. Refusing to do so means "we're happy with passing that cost on to foster children's bodies" by "taking a big risk that children will continue to not be monitored on these medications, whether they're medically necessary or not."

SB 238 would establish training, data reporting, identify risky practices and alert counties so that they can act to reduce dangerous prescribing practices. SB 484 would require the identification of group homes suspected of using psychotropic medications inappropriately and specifies the factors to be used in pinpointing those facilities. Those group homes identified will be inspected to determine what policies or practices within the facility contribute to the misuse of psychotropic medications.

Of those foster children administered psychotropic drugs in California, 52 percent are given one or more anti-psychotics – a drug class with few FDA-approved indications for children and adolescents. According to the Quality Improvement Project, during fiscal year 2012-13, there were 104,688 pharmacy claim records for 12,025 children who received a paid claim for psychotropic medication. That’s nearly nine prescriptions per foster child in a single year.

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