An audit conducted this summer revealed that children in Florida's foster care system are being prescribed powerful psychotropic medications at alarmingly high rates. In many cases, state child welfare officials are failing to properly document prescriptions, resulting in children taking powerful medications with scant medical records available to justify them.
Over 2,200 children that are currently in Florida's foster care system—around one in 10—are prescribed psychotropic medications, reported the Tampa Bay Times. For foster children over the age of 13, more than one in three are on this kind of medication, which includes treatments for conditions like ADHD, depression, anxiety, and schizophrenia.
According to state rules, "the physician or psychiatric nurse recommending the psychotropic medication is required to complete and sign a medical report," and each prescription "is required to be documented on a medication log. The case manager must obtain the medication logs at each home visit and include the medication logs in the child's case file" with the Florida Safe Families Network (FSFN), the state's child welfare agency.
Yet a state audit released in July found "no records of the psychotropic medications prescribed in the case file in the state's primary case management system," according to the Tampa Bay Times. "Logs that record the frequency and dosage of psychotropic medication were missing from 66% of case files reviewed, and authorization records were not found in more than one-third of the case files."
Even more troubling, the audit found that the state welfare agency did not document prescriptions in 57 out of the 60 cases of children prescribed opioid medication that were reviewed.
"These documentation deficiencies occurred because the State agency did not have adequate controls to ensure the [child protective investigators] and case managers maintained the children's case files in FSFN in accordance with State requirements," the audit reads. "Without adequate controls in place, the State agency could not ensure that children in foster care received the necessary monitoring and care. As a result, the children's quality of care and health and safety may have been at risk."
This lack of documentation has had severe effects on many children in Florida's foster care system. Without proper documentation, children can end up taking unnecessary medications or not getting the prescriptions they actually need.
In one case where the state did not properly maintain medication logs for one 16-year-old, Medicaid claim data revealed that "the child was prescribed five different psychotropic medications during [calendar years] 2019 and 2020 and up to four different psychotropic medications during the same month."
One foster parent who spoke to the Tampa Bay Times said that her 5-year-old foster child had been rendered almost "catatonic" from an anti-seizure drug. The boy didn't seem to have epilepsy (he only had seizures when running a fever), and there were no records showing that a judge or the boy's biological mother had approved the medication, yet he was given the drug anyway.
But Florida isn't alone in overmedicating children in foster care. Investigations from several other states also revealed negligence from state child protection agencies when it came to managing prescriptions for these drugs. In April, a district judge sharply criticized Texas' Department of Family and Protective Services (DFPS) for mishandling psychotropic prescriptions for children in state custody.
"I need a plan. They are not getting medications. They are overmedicated," Judge Janis Graham Jack told DFPS Commissioner Stephanie Muth. "They don't have adequate diagnosis or reasons for these drugs. Just because your placements don't know how to handle children doesn't mean they should be drugged like this to the point the monitors said some of them are almost catatonic."
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