CORPUS CHRISTI, Texas (CN) — Describing the failings of Texas group homes to track children’s medications and supervise sexually aggressive kids, the latest report from monitors overseeing the state’s foster care was met with frustration Wednesday by the federal judge who ordered reforms.
“I was kind of depressed reading this,” Senior U.S. District Judge Janis Graham Jack said at the start of a hearing about an account her two monitors filed late last month, detailing issues they documented during their inspections of 14 residential treatment centers from Dec. 1, 2021, to Dec. 31, 2022.
Jack, 77, has been Texas’ de facto child welfare chief since her December 2015 ruling finding “rape, abuse, psychotropic medication, and instability are the norm" for kids in its understaffed foster care system, and many age out at 18 lacking rudimentary skills, not knowing how to answer a phone, cook a meal or fill out a job application.
She determined Texas was violating foster kids’ 14th Amendment due process rights to adequate care and a safe, secure, and suitable placement while in state custody. She issued an injunction and ordered the state to track child-on-child abuse and stop placing kids in homes without 24-hour supervision.
Critics say Jack’s extensive remedial orders are expensive micromanaging of the Texas Department of Family and Protective Services and Health and Human Services Commission, the two agencies that manage foster youths and residential care operations. The work of the two monitors shepherding reforms and their staff has cost Texas more than $41 million and counting.
But the difficulties of overcoming the state’s deeply entrenched problems are evidenced by the churn at the top of the two agencies. Since the class action was filed in 2011, both DFPS and HHSC have had six commissioners.
Jack welcomed the appointment of Stephanie Muth to lead DFPS starting early this year by Governor Greg Abbott, who is also a defendant in the lawsuit, due to Muth’s experience in executive positions with HHSC.
But she warned Muth on Wednesday she was tired of the state’s foot-dragging.
A Bill Clinton appointee, Jack has held Texas in contempt twice for violating her orders and threatened Wednesday to do so again for problems with medications and placing children in unlicensed settings such as DFPS offices and hotels.
“We still don’t have anything but bad news for these children,” Jack told Muth. “And I know you are new on the job, and I didn’t drop much on you in the first hearing. But from here on out it’s not going to be good.”
“I need a plan. They are not getting medications. They are overmedicated," she added. "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."
The monitors reviewed the files of 161 children at the 14 residential centers they visited and found that 75, or 47%, were prescribed four or more psychotropic drugs. Most were teenagers but the youngest was 8.
DFPS has guidelines for the care of children prescribed this number of drugs but the monitors determined it is not following them.
For instance, the agency has not kept up with a process called a psychotropic medication utilization review, according to Paul Yetter, lead plaintiffs’ counsel.
Yetter, a partner in the Houston firm Yetter Coleman, said of the 75 heavily medicated children the monitors looked at, all but one either had no recent medication review in their files or were taking different drugs than specified in their files because it had been over a year since their last review.
Attorneys for DFPS and HHSC pushed back, arguing that the medication issue is outside the scope of Jack’s injunction and remedial orders, which have been upheld by the Fifth Circuit.
Jack did not buy it.
"There’s an injunction in place that you must put these kids in placements free from the risk of unreasonable harm," she said. "Apparently without a specific remedy for psychotropic drugs they are not going to keep them from risk of unreasonable harm for the administration of drugs.”
On Yetter’s request, Jack ordered DFPS to do a medication review within 30 days for all of the 9,035 children in Texas’ long-term care who have been prescribed four or more psychotropic drugs.
She also criticized DFPS for not issuing citations for residential treatment facilities that failed to provide constant line-of-sight monitoring or one-to-one supervision for children documented to be sexually aggressive, even overnight, as specified by their care plans.
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