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For foster kids, oversight of prescriptions is scarce

May 2, 2006 | USA Today
Foster children are of special concern to some experts who fear atypical anti-psychotics may be prescribed without the careful oversight usually provided by birth parents.

The vigilant medical monitoring that is needed by foster children on anti-psychotics "is still unusual, unfortunately" in the USA, says Moira Szilagyi, a Rochester, N.Y., pediatric endocrinologist who specializes in foster children.

There are no numbers collected nationally, but Paul Vincent of the Child Welfare Policy and Practice Group believes there has been an upswing in the use of atypicals by foster kids in the past few years. His Montgomery, Ala., firm consults for state child welfare agencies, reviewing many of their health services.

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 in foster care increased 77% between 2001 and 2005, to 70,879. The actual number is probably higher because the state does not get complete data from managed-care providers, which cover the majority of foster children.
  • In Illinois, the number of children covered under the state's public health care program not just foster children who had an atypical prescription went up 39% between fiscal years 2003 and 2005, to 17,746.

Kids as young as 4 are getting prescriptions for anti-psychotics, Vincent says, sometimes from unqualified counselors. "They aren't psychiatrists or even psychologists. I have considerable worry about the accuracy of these diagnoses."

The safety of these drugs is of most concern to Andrea Moore, a Coral Springs, Fla., attorney. Judges appointed her to represent foster kids a few years ago. Several children she represented started lactating after taking anti-psychotics, a recognized side effect of the drugs. A 12-year-old girl with a history of heart problems became short of breath on Geodon, an atypical that can cause arrhythmias. "The doctor prescribing it did not even have her medical history," Moore says.

Geodon has a proven "modest" effect on heart rhythms in adults, says Ilise Lombardo, medical director for the U.S. Geodon team at Pfizer Inc., maker of the drug. The clinical impact of this rhythm change is unknown but is being studied in adults, she says; safety and effectiveness studies in kids are underway, too. The drug's label says patients with certain heart problems shouldn't take it.

In February, Florida's health care agency ordered an independent investigation into why the number of Medicaid children taking anti-psychotics nearly doubled in the past five years. The numbers jumped from 9,500 to 17,900.

A new Florida law adds some protections for foster children, but it has loopholes, Moore says. "I'm still hearing about problems with overprescribing and under-monitoring."

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