31-05-2011, 02:55 AM
Huge doses of potent antipsychotics flow into state jails for troubled kids
Drugging juveniles: Doctors hired to evaluate kids in state custody have taken huge payments from drug companies
Interactive: Compare prescribing habits among DJJ psychiatrists who received payments. Plus, see prescribing habits for more than 3,800 psychiatrists around Florida who billed Medicaid.
By MICHAEL LAFORGIA
Palm Beach Post Staff Writer
Updated: 5:39 p.m. Tuesday, May 24, 2011
Posted: 7:51 p.m. Saturday, May 21, 2011
Florida has plied children in state juvenile jails with heavy doses of powerful antipsychotic medications.
The pills, widely viewed as the "big guns" of psychiatry, can cause suicidal thoughts and other dangerous side effects.
Yet, in state-run jails and residential programs, antipsychotics were among the top drugs bought for kids - and they routinely were doled out for reasons that never were approved by federal regulators, a Palm Beach Post investigation has found.
Reacting to the newspaper's findings, the head of Florida's Department of Juvenile Justice ordered a sweeping review of the department's use of antipsychotic medications. As it stands now, DJJ doesn't track prescriptions and has no way of telling whether doctors are putting kids on pills simply to make them easier to control.
"This is a very important issue," said Broward County Public Defender Howard Fink elstein, whose office represents children in juvenile court. "If kids are being given these drugs without proper diagnosis, and it is being used as a 'chemical restraint,' I would characterize it as a crime. A battery - a battery of the brain each and every time it is given."
In some cases, the drugs are prescribed by contract doctors who have taken huge speaker fees and other gifts from makers of antipsychotic pills, companies that reap staggering profits selling medications, The Post found.
The medications have poured out at such a rate, said one former inmate, that even a confused teenager could tell that this wasn't how things were supposed to be.
"The questions recently brought to our attention are serious, and deserve answers based on a careful, thorough and independent review of the facts," said Wansley Walters, who was appointed DJJ secretary in January by Gov. Rick Scott. Citing the ongoing probe, Walters declined to answer questions about how the department has handled the potent medications.
A look at the sheer numbers of drugs purchased, though, suggests a startling story is unfolding in state homes for wayward kids.
In 2007, for example, DJJ bought more than twice as much Seroquel as ibuprofen. Overall, in 24 months, the department bought 326,081 tablets of Seroquel, Abilify, Risperdal and other antipsychotic drugs for use in state-operated jails and homes for children.
That's enough to hand out 446 pills a day, seven days a week, for two years in a row, to kids in jails and programs that can hold no more than 2,300 boys and girls on a given day.
No central tracking
Private companies run most of DJJ's 116 residential programs. When it comes to tracking drugs going into these homes, the state can't easily collect and analyze information. A former spokesman estimated that gathering data about drugs most recently used in jails and programs would take 2½ months.
For this story, DJJ provided drug information only for its 25 jails and for three programs, a fraction of all residential homes statewide, and only for a two-year period ending in mid-2008.
Some companies that operate homes for children don't have drug reporting requirements written into their state contracts.
Interviews suggest that these homes, too, hand out plenty of drugs. One representative of a private company estimated that a third of the kids in the company's residential programs are taking antipsychotics and other psychiatric medications.
Antipsychotics target certain parts of the brain to produce a tranquilizing effect. Medical experts disagree about whether they're appropriate for regular use in children. The pills can cause suicidal thoughts in kids, as well as weight gain, high blood sugar, diabetes, heart problems and uncontrollable facial twitches and body tics, clinical trials have shown.
Even so, antipsychotics were among the top drugs bought for children in state-operated jails and residential programs.
'Out like a light'
Paula was 14 and living in Palm Beach County when police hauled her in as a runaway. At the station, she kicked over a table and got arrested, she said. Though it was her first offense, a juvenile judge committed her to a program.
The Post is protecting Paula's identity because she was arrested as a juvenile, and she still is a teenager. She said she refused to take drugs in DJJ custody, but added that she saw a lot of Seroquel.
Every morning at the camp in Okeechobee, she said, one of her bunk mates, 17-year-old Desire, would take several hundred milligrams. Every evening, she would swallow several hundred more, Paula said. Sometimes, she would "cheek" the medication and share it with the other girls. More often, she would pass out in her bed.
"She would take them, come back, probably mess around for about half an hour, and then out like a light," Paula said. "By the time we all woke up at 6 o'clock the next the morning, I mean, she's still laying in bed and won't get up. We usually would have to push her out of the door by the time we went to breakfast."
For kids in DJJ custody, the state buys enough Seroquel to make such doses possible: More than 217,500 tablets in 24 months . The department bought more of the heaviest Seroquel tablets, at 400 milligrams, than it did of any of five lighter tablets.
DJJ has continued dispensing the drug even though Florida has claimed it was harmful. In March, the state alleged in a lawsuit against AstraZeneca, the maker of Seroquel, that the drug "produced dangerous side effects."
The Seroquel regimens described by Paula amounted to alarmingly high doses, said Dr. Glenn Currier, an associate professor of psychiatry at the University of Rochester in New York.
"That is an over-the-limit adult dose for refractory schizophrenics" - people who are severely mentally ill and not responding to normal amounts of medication, Currier said. "I have heard of doses that high in large adult males. But not in girls."
Paula said Desire didn't hallucinate or hear voices. "She just seemed like a normal kid who would be in the 'hood. You know, trying to show up everybody. It just seemed normal to me," Paula said. However, she added, her friend had a penchant for acting out.
"She was definitely one of the more rampant ones, so I guess they were trying to, like, kind of calm her down and keep her subdued throughout the time she was there."
The representative of the private program operator, who spoke on condition of anonymity because the company still does business with Florida, said children in DJJ programs often are drugged needlessly.
"We were doing a disservice to the public because we were claiming the kids were being treated. In reality, we weren't treating them. We were medicating them," the representative said. "It was a fraud. It is a fraud, all the way around."
Dangerous behavior
Kids in DJJ custody can be dangerous, and difficult to handle. At the Palm Beach Regional Juvenile Detention Center, inmates have punched guards, and children attack each other fairly regularly, police reports show.
Still, under no circumstances does DJJ allow the use of drugs to control children's behavior, spokesmen said. "DJJ expressly prohibits the use of these medications as a chemical restraint. We have policy in our health services manual, mirrored in our mental health services manual, that speaks directly to this," spokeswoman Samadhi Jones said.
Former spokesman Frank Penela acknowledged, however, that DJJ doctors prescribe Seroquel and other drugs "off-label," for uses that never were approved as safe by the U.S. Food and Drug Administration. Examples include using antipsychotics to counter sleeplessness, anxiety or post traumatic stress disorder.
Responsible child psychiatrists often prescribe drugs off-label, relying on studies conducted by other doctors, said Dr. Robert Hendren, director of child and adolescent psychiatry at the University of California, San Francisco. He added, though, that antipsychotics should be given to children as a last resort.
"These are big guns," Hendren said, "and they should be used really cautiously."
Antoinette Appel, a Tamarac neuropsychologist, said she was suspicious of the amounts of drugs used by DJJ. "They're not allowed to put kids in restraints, so they put kids in restraints this way," Appel said.
Hendren said antipsychotics can be valuable tools for curbing extreme behavior, but said they shouldn't be given lightly. "They can be used to sedate kids to make them seem like they're not problems," he said. "People would say they were zombie-like."
Chemical control'?
David Clegg was 17 and already a repeat offender in 2008 when he was arrested in Jacksonville on burglary and larceny charges. He landed at the Gulf Coast Treatment Center in Fort Walton Beach.
Weeks into his time there, David was languishing. He sat in classes at the program and rocked back and forth. He wouldn't talk. He couldn't get up to walk by himself, and he needed help using the bathroom. Ultimately, he lost 30 pounds and couldn't control his bladder or bowels.
Though he suffered from an unspecified mental illness, the condition wasn't treated, according to a lawsuit filed in 2009. Instead, David "was subjected to a chemical control regimen" intended not to help him, but to "chemically restrain him," the lawsuit said.
The case, originally brought against DJJ, the home's private operator, a health care provider and staff members, was settled in April for an undisclosed amount.
Parents' consent lacking
Jones, the DJJ spokeswoman, stressed that kids in custody are put on drugs only with the consent of a parent or guardian, and that drugs are given only as part of a treatment plan that includes psychotherapy.
"They're administered under a doctor's care and there are overlapping layers of monitoring and checks and balances," Jones said.
Inspection records show that the department's monitoring system has failed repeatedly in jails and programs across Florida.
In at least 40 cases since 2008, DJJ files have lacked proof that parents or guardians gave consent before children were put on medications, were apprised of possible side effects or told that doctors were adding drugs or adjusting dosages.
At Impact House, a residential program in Jacksonville, one child was put on drugs, taken off them, or had dosages and combinations adjusted six times in a six-month period. He began on Risperdal and ultimately was put on Seroquel. His files contained no evidence that anybody ever had notified his parents to gain consent.
In at least 32 instances, treatment plans contained inconsistencies or problems with the way workers tracked psychiatric medications. At Gulf Academy in Clearwater in 2009, four children's files lacked proof that a psychiatrist consulted key notes before making diagnoses.
In at least 11 cases, workers gave out medicine haphazardly, didn't keep proper dosage records or failed to monitor kids for side effects. In 2010, nurses at Alachua Regional Juvenile Detention Center in Gainesville mistakenly gave a child the wrong medicine for several days in a row, and then, according to an inspection report, falsified records to hide the error.
Children 'on edge'
Interviews suggest that antipsychotics also can make children irritable and aggressive.
In Okeechobee, Paula said, she could tell when her bunk mates' medications were wearing off.
One evening, Paula said, a nasty storm swept over the Okeechobee camp, making the lights flicker in the cafeteria as she worked in the kitchen. Rather than send the girls out to get their daily doses, camp workers herded them in for dinner.
What happened next made a lasting impression on Paula. The room was packed with about 70 girls, and a third or more of them were coming off their meds, she said. One group started fighting, and then another, until the entire pack was tangled in a wild melee.
"Trays start flying and food starts hitting people in the face, and people are climbing over each other to try to hit each other," Paula said.
If the girls weren't taking antipsychotics, "I don't think they would be this on edge, this irritable," she said. "It was absolute chaos."
Staff writer Adam Playford and staff researcher Niels Heimeriks contributed to this story.
FIRST OF TWO PARTS
In charting the state Department of Juvenile Justice's use of prescription drugs, The Palm Beach Post analyzed department drug purchasing information and state Medicaid billing data and reviewed thousands of pages of DJJ inspection reports, drug company disclosure records and court documents. The Post also conducted dozens of interviews with state officials, attorneys, medical experts, advocates and child psychiatrists.
The task was complicated by DJJ's inability to access its own records easily. Theoretically, the department can track prescriptions, but the system is hampered by functionality concerns,' a spokeswoman said.
Asked about drugs dispensed to children, DJJ could provide information only for a two-year period ending in mid-2008, and only for its 25 jails and a fraction of its residential programs. The lock-ups represent only about one-fifth of all juvenile jails and residential homes in Florida.
No information was available on the amounts of antipsychotic drugs dispensed in the more than 100 remaining programs for juveniles, which are run by private contractors.
ABOUT THE REPORTER
Michael LaForgia has reported on Florida's pill mill crisis, spurring arrests and reforms at the state and local levels, and exposed loopholes in Florida law that put children at risk in summer camps. He joined The Palm Beach Post in 2006.
http://www.palmbeachpost.com/news/state/...90021.html
Drugging juveniles: Doctors hired to evaluate kids in state custody have taken huge payments from drug companies
Interactive: Compare prescribing habits among DJJ psychiatrists who received payments. Plus, see prescribing habits for more than 3,800 psychiatrists around Florida who billed Medicaid.
By MICHAEL LAFORGIA
Palm Beach Post Staff Writer
Updated: 5:39 p.m. Tuesday, May 24, 2011
Posted: 7:51 p.m. Saturday, May 21, 2011
Florida has plied children in state juvenile jails with heavy doses of powerful antipsychotic medications.
The pills, widely viewed as the "big guns" of psychiatry, can cause suicidal thoughts and other dangerous side effects.
Yet, in state-run jails and residential programs, antipsychotics were among the top drugs bought for kids - and they routinely were doled out for reasons that never were approved by federal regulators, a Palm Beach Post investigation has found.
Reacting to the newspaper's findings, the head of Florida's Department of Juvenile Justice ordered a sweeping review of the department's use of antipsychotic medications. As it stands now, DJJ doesn't track prescriptions and has no way of telling whether doctors are putting kids on pills simply to make them easier to control.
"This is a very important issue," said Broward County Public Defender Howard Fink elstein, whose office represents children in juvenile court. "If kids are being given these drugs without proper diagnosis, and it is being used as a 'chemical restraint,' I would characterize it as a crime. A battery - a battery of the brain each and every time it is given."
In some cases, the drugs are prescribed by contract doctors who have taken huge speaker fees and other gifts from makers of antipsychotic pills, companies that reap staggering profits selling medications, The Post found.
The medications have poured out at such a rate, said one former inmate, that even a confused teenager could tell that this wasn't how things were supposed to be.
"The questions recently brought to our attention are serious, and deserve answers based on a careful, thorough and independent review of the facts," said Wansley Walters, who was appointed DJJ secretary in January by Gov. Rick Scott. Citing the ongoing probe, Walters declined to answer questions about how the department has handled the potent medications.
A look at the sheer numbers of drugs purchased, though, suggests a startling story is unfolding in state homes for wayward kids.
In 2007, for example, DJJ bought more than twice as much Seroquel as ibuprofen. Overall, in 24 months, the department bought 326,081 tablets of Seroquel, Abilify, Risperdal and other antipsychotic drugs for use in state-operated jails and homes for children.
That's enough to hand out 446 pills a day, seven days a week, for two years in a row, to kids in jails and programs that can hold no more than 2,300 boys and girls on a given day.
No central tracking
Private companies run most of DJJ's 116 residential programs. When it comes to tracking drugs going into these homes, the state can't easily collect and analyze information. A former spokesman estimated that gathering data about drugs most recently used in jails and programs would take 2½ months.
For this story, DJJ provided drug information only for its 25 jails and for three programs, a fraction of all residential homes statewide, and only for a two-year period ending in mid-2008.
Some companies that operate homes for children don't have drug reporting requirements written into their state contracts.
Interviews suggest that these homes, too, hand out plenty of drugs. One representative of a private company estimated that a third of the kids in the company's residential programs are taking antipsychotics and other psychiatric medications.
Antipsychotics target certain parts of the brain to produce a tranquilizing effect. Medical experts disagree about whether they're appropriate for regular use in children. The pills can cause suicidal thoughts in kids, as well as weight gain, high blood sugar, diabetes, heart problems and uncontrollable facial twitches and body tics, clinical trials have shown.
Even so, antipsychotics were among the top drugs bought for children in state-operated jails and residential programs.
'Out like a light'
Paula was 14 and living in Palm Beach County when police hauled her in as a runaway. At the station, she kicked over a table and got arrested, she said. Though it was her first offense, a juvenile judge committed her to a program.
The Post is protecting Paula's identity because she was arrested as a juvenile, and she still is a teenager. She said she refused to take drugs in DJJ custody, but added that she saw a lot of Seroquel.
Every morning at the camp in Okeechobee, she said, one of her bunk mates, 17-year-old Desire, would take several hundred milligrams. Every evening, she would swallow several hundred more, Paula said. Sometimes, she would "cheek" the medication and share it with the other girls. More often, she would pass out in her bed.
"She would take them, come back, probably mess around for about half an hour, and then out like a light," Paula said. "By the time we all woke up at 6 o'clock the next the morning, I mean, she's still laying in bed and won't get up. We usually would have to push her out of the door by the time we went to breakfast."
For kids in DJJ custody, the state buys enough Seroquel to make such doses possible: More than 217,500 tablets in 24 months . The department bought more of the heaviest Seroquel tablets, at 400 milligrams, than it did of any of five lighter tablets.
DJJ has continued dispensing the drug even though Florida has claimed it was harmful. In March, the state alleged in a lawsuit against AstraZeneca, the maker of Seroquel, that the drug "produced dangerous side effects."
The Seroquel regimens described by Paula amounted to alarmingly high doses, said Dr. Glenn Currier, an associate professor of psychiatry at the University of Rochester in New York.
"That is an over-the-limit adult dose for refractory schizophrenics" - people who are severely mentally ill and not responding to normal amounts of medication, Currier said. "I have heard of doses that high in large adult males. But not in girls."
Paula said Desire didn't hallucinate or hear voices. "She just seemed like a normal kid who would be in the 'hood. You know, trying to show up everybody. It just seemed normal to me," Paula said. However, she added, her friend had a penchant for acting out.
"She was definitely one of the more rampant ones, so I guess they were trying to, like, kind of calm her down and keep her subdued throughout the time she was there."
The representative of the private program operator, who spoke on condition of anonymity because the company still does business with Florida, said children in DJJ programs often are drugged needlessly.
"We were doing a disservice to the public because we were claiming the kids were being treated. In reality, we weren't treating them. We were medicating them," the representative said. "It was a fraud. It is a fraud, all the way around."
Dangerous behavior
Kids in DJJ custody can be dangerous, and difficult to handle. At the Palm Beach Regional Juvenile Detention Center, inmates have punched guards, and children attack each other fairly regularly, police reports show.
Still, under no circumstances does DJJ allow the use of drugs to control children's behavior, spokesmen said. "DJJ expressly prohibits the use of these medications as a chemical restraint. We have policy in our health services manual, mirrored in our mental health services manual, that speaks directly to this," spokeswoman Samadhi Jones said.
Former spokesman Frank Penela acknowledged, however, that DJJ doctors prescribe Seroquel and other drugs "off-label," for uses that never were approved as safe by the U.S. Food and Drug Administration. Examples include using antipsychotics to counter sleeplessness, anxiety or post traumatic stress disorder.
Responsible child psychiatrists often prescribe drugs off-label, relying on studies conducted by other doctors, said Dr. Robert Hendren, director of child and adolescent psychiatry at the University of California, San Francisco. He added, though, that antipsychotics should be given to children as a last resort.
"These are big guns," Hendren said, "and they should be used really cautiously."
Antoinette Appel, a Tamarac neuropsychologist, said she was suspicious of the amounts of drugs used by DJJ. "They're not allowed to put kids in restraints, so they put kids in restraints this way," Appel said.
Hendren said antipsychotics can be valuable tools for curbing extreme behavior, but said they shouldn't be given lightly. "They can be used to sedate kids to make them seem like they're not problems," he said. "People would say they were zombie-like."
Chemical control'?
David Clegg was 17 and already a repeat offender in 2008 when he was arrested in Jacksonville on burglary and larceny charges. He landed at the Gulf Coast Treatment Center in Fort Walton Beach.
Weeks into his time there, David was languishing. He sat in classes at the program and rocked back and forth. He wouldn't talk. He couldn't get up to walk by himself, and he needed help using the bathroom. Ultimately, he lost 30 pounds and couldn't control his bladder or bowels.
Though he suffered from an unspecified mental illness, the condition wasn't treated, according to a lawsuit filed in 2009. Instead, David "was subjected to a chemical control regimen" intended not to help him, but to "chemically restrain him," the lawsuit said.
The case, originally brought against DJJ, the home's private operator, a health care provider and staff members, was settled in April for an undisclosed amount.
Parents' consent lacking
Jones, the DJJ spokeswoman, stressed that kids in custody are put on drugs only with the consent of a parent or guardian, and that drugs are given only as part of a treatment plan that includes psychotherapy.
"They're administered under a doctor's care and there are overlapping layers of monitoring and checks and balances," Jones said.
Inspection records show that the department's monitoring system has failed repeatedly in jails and programs across Florida.
In at least 40 cases since 2008, DJJ files have lacked proof that parents or guardians gave consent before children were put on medications, were apprised of possible side effects or told that doctors were adding drugs or adjusting dosages.
At Impact House, a residential program in Jacksonville, one child was put on drugs, taken off them, or had dosages and combinations adjusted six times in a six-month period. He began on Risperdal and ultimately was put on Seroquel. His files contained no evidence that anybody ever had notified his parents to gain consent.
In at least 32 instances, treatment plans contained inconsistencies or problems with the way workers tracked psychiatric medications. At Gulf Academy in Clearwater in 2009, four children's files lacked proof that a psychiatrist consulted key notes before making diagnoses.
In at least 11 cases, workers gave out medicine haphazardly, didn't keep proper dosage records or failed to monitor kids for side effects. In 2010, nurses at Alachua Regional Juvenile Detention Center in Gainesville mistakenly gave a child the wrong medicine for several days in a row, and then, according to an inspection report, falsified records to hide the error.
Children 'on edge'
Interviews suggest that antipsychotics also can make children irritable and aggressive.
In Okeechobee, Paula said, she could tell when her bunk mates' medications were wearing off.
One evening, Paula said, a nasty storm swept over the Okeechobee camp, making the lights flicker in the cafeteria as she worked in the kitchen. Rather than send the girls out to get their daily doses, camp workers herded them in for dinner.
What happened next made a lasting impression on Paula. The room was packed with about 70 girls, and a third or more of them were coming off their meds, she said. One group started fighting, and then another, until the entire pack was tangled in a wild melee.
"Trays start flying and food starts hitting people in the face, and people are climbing over each other to try to hit each other," Paula said.
If the girls weren't taking antipsychotics, "I don't think they would be this on edge, this irritable," she said. "It was absolute chaos."
Staff writer Adam Playford and staff researcher Niels Heimeriks contributed to this story.
FIRST OF TWO PARTS
In charting the state Department of Juvenile Justice's use of prescription drugs, The Palm Beach Post analyzed department drug purchasing information and state Medicaid billing data and reviewed thousands of pages of DJJ inspection reports, drug company disclosure records and court documents. The Post also conducted dozens of interviews with state officials, attorneys, medical experts, advocates and child psychiatrists.
The task was complicated by DJJ's inability to access its own records easily. Theoretically, the department can track prescriptions, but the system is hampered by functionality concerns,' a spokeswoman said.
Asked about drugs dispensed to children, DJJ could provide information only for a two-year period ending in mid-2008, and only for its 25 jails and a fraction of its residential programs. The lock-ups represent only about one-fifth of all juvenile jails and residential homes in Florida.
No information was available on the amounts of antipsychotic drugs dispensed in the more than 100 remaining programs for juveniles, which are run by private contractors.
ABOUT THE REPORTER
Michael LaForgia has reported on Florida's pill mill crisis, spurring arrests and reforms at the state and local levels, and exposed loopholes in Florida law that put children at risk in summer camps. He joined The Palm Beach Post in 2006.
http://www.palmbeachpost.com/news/state/...90021.html
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