Missouri Can’t Dodge Claims of Overmedicating Foster Kids

(CN) – A federal judge refused to dismiss a landmark child advocacy case accusing Missouri of overprescribing psychotropic drugs to children in foster care and failing to maintain adequate medical records to monitor the potential abuse of such drugs.

In the first federal class-action lawsuit of its kind, child advocacy organizations Children’s Rights and the National Center for Youth Law sued Missouri on behalf of foster children last summer for allegedly overprescribing psychotropic drugs to foster care children.

According to child advocates, powerful psychotropic drugs are often prescribed to foster children not with the best interests of the child in mind, but simply to make the children less troublesome.

“Giving a pill to sedate the child or older person is a quicker and easier response than training caregivers and staff (to provide) non-pharmacological, safer and in many instances more effective treatment,” Bill Grimm, an attorney with the National Center for Youth Law, said in a statement in June.

On Monday, U.S. District Judge Nanette Laughrey denied the state’s motion to dismiss the children’s due process claims.

The judge was particularly concerned that the state, by its own admission, fails to maintain complete medical records for the foster children in its care, and does not provide updated health information to foster parents or doctors.

“The absence of the medical records itself creates an unreasonable risk of harm and the defendants are aware of that risk as well,” Laughrey wrote in a 33-page opinion.

The state also has no oversight system for catching “red flags” regarding psychotropic prescriptions that may be an off-label use or an exceedingly high dosage for a young child, according to the ruling.

“Plaintiffs effectively allege that systematic administrative review is needed because doctors may not be acting, or may lack sufficient medical records to act, in the best interests of the children,” Laughrey wrote. “It is the defendants’ failure to implement specific administrative safeguards that puts plaintiffs at a substantially higher risk of serious harm. This risk is aggravated for foster children because psychotropic drugs may be prescribed to benefit social workers or foster parents, rather than for the interest of the child.”

More than 30 percent of Missouri’s 13,000 foster children are on at least one psychotropic medication, according to the ruling, with 20 percent taking two or more psychotropic medications at the same time. This is almost twice the national rate of such prescriptions.

One of the plaintiff children, a 14-year-old boy, has been prescribed up to seven different psychotropic drugs at once, and his medications have changed constantly during his two and half years in state custody, as he moved through eight different foster care placements.

He has suffered serious side effects as a result of the medications, including hypothyroidism, hearing voices, and suicidal thoughts.

Two other foster children named in the case, siblings aged 3 and 2, have already been prescribed psychotropic medications, at least one of which has not been approved for use in children under age 5, according to court records.

Judge Laughrey rejected the state’s argument that a doctor’s prescription of a medication itself protects the state from the due process claims when the doctor lacks access to a complete medical record.

“Plaintiffs allege that the physicians prescribing medications to foster children in Missouri are not provided with complete medical records for those children, and that the foster care givers or case workers presenting the children to the doctors often lack adequate knowledge concerning the child’s social and medical history,” Laughrey said. “Thus, even if a fully informed physician’s assessment that a child should be medicated might constitute sufficient process, it arguably cannot be sufficient in the absence of a full picture of the child’s medical history and social profile.”

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