For foster kids, oversight of prescriptions is scarce
Source: USA Today
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Fosterchildren are of special concern to some experts who fear atypicalanti-psychotics may be prescribed without the careful oversight usuallyprovided by birth parents.
The vigilantmedical monitoring that is needed by foster children on anti-psychotics”is still unusual, unfortunately” in the USA, says Moira Szilagyi, aRochester, N.Y., pediatric endocrinologist who specializes in fosterchildren.
There are no numbers collectednationally, but Paul Vincent of the Child Welfare Policy and PracticeGroup believes there has been an upswing in the use of atypicals byfoster kids in the past few years. His Montgomery, Ala., firm consultsfor state child welfare agencies, reviewing many of their healthservices.
Some state data obtained by USA TODAY through Freedom of Information Act requests appear to support his observations.
•In California, Med-Cal prescription claims for atypicals for kids infoster care increased 77% between 2001 and 2005, to 70,879. The actualnumber is probably higher because the state does not get complete datafrom managed-care providers, which cover the majority of fosterchildren.
• In Illinois, the number ofchildren covered under the state’s public health care program — notjust foster children — who had an atypical prescription went up 39%between fiscal years 2003 and 2005, to 17,746.
Kidsas young as 4 are getting prescriptions for anti-psychotics, Vincentsays, sometimes from unqualified counselors. “They aren’t psychiatristsor even psychologists. I have considerable worry about the accuracy ofthese diagnoses.”
The safety of these drugsis of most concern to Andrea Moore, a Coral Springs, Fla., attorney.Judges appointed her to represent foster kids a few years ago. Severalchildren she represented started lactating after takinganti-psychotics, a recognized side effect of the drugs. A 12-year-oldgirl with a history of heart problems became short of breath on Geodon,an atypical that can cause arrhythmias. “The doctor prescribing it didnot even have her medical history,” Moore says.
Geodonhas a proven “modest” effect on heart rhythms in adults, says IliseLombardo, medical director for the U.S. Geodon team at Pfizer Inc.,maker of the drug. The clinical impact of this rhythm change is unknownbut is being studied in adults, she says; safety and effectivenessstudies in kids are underway, too. The drug’s label says patients withcertain heart problems shouldn’t take it.
InFebruary, Florida’s health care agency ordered an independentinvestigation into why the number of Medicaid children takinganti-psychotics nearly doubled in the past five years. The numbersjumped from 9,500 to 17,900.
A new Floridalaw adds some protections for foster children, but it has loopholes,Moore says. “I’m still hearing about problems with overprescribing andunder-monitoring.”