Massachusetts Fails to Ensure the Safe Administration of Psychotropic Medications to Children in Foster Care

(Boston, MA) — The Massachusetts Department of Children and Families (DCF) lacks an oversight system and qualified staff to ensure that foster children are safely and appropriately administered psychiatric prescriptions, according to an expert report released today by attorneys for Children’s Rights, who represent foster children in a lawsuit against the state. Authored by Dr. Christopher Bellonci, professor of Child and Adolescent Psychiatry at Tufts University School of Medicine, the report includes findings that are echoed in sworn deposition testimony by DCF’s director of psychiatry, Dr. Russell Livingston.

Dr. Bellonci’s report revealed the following systemic inadequacies exposing children in DCF care to potential medical risk:

  • DCF has not implemented an information management system capable of tracking the utilization of psychotropic medications within the Massachusetts foster care population. “DCF has no simple means of being able to determine on any given day what medication a child in their care is taking,” according to Dr. Bellonci.
  • DCF caseworkers are charged with providing consent to children’s prescriptions, but do not receive adequate training to undertake this duty in an informed way.
  • DCF lacks any system to raise and monitor “red flags” signifying the presence of a medical risk of harm to children, such as children taking four or more medications simultaneously.

“Massachusetts fails to meet the minimum standards of care for foster children with mental health needs,” said Marcia Robinson Lowry, executive director of Children’s Rights. “Instead of providing adequate therapeutic services and ensuring the safety and effectiveness of medications, DCF relies on scanty records, a faulty information system and unevenly trained staff that cannot possibly protect foster children who are prescribed powerful psychiatric drugs.”

The report comes on the heels of a December 2011 U.S. Government Accountability Office study, showing that almost 40 percent of foster children in Massachusetts are prescribed psychiatric medications, compared to slightly more than 10 percent of children in Massachusetts outside of state custody. Among the five states studied, Massachusetts was noted to have the highest percentage of foster children on psychiatric drugs.

Some of Dr. Bellonci’s findings are shared in a sworn deposition by DCF’s director of psychiatry, Dr. Livingston: “It’s not at all uncommon you would find that some of the records do not have a complete psychopharm history, what has been tried before and what was the outcome. So that increases the risk…the child will get another immediate trial of something that has been proven to be useless or potentially problematic.”

In addition to the sworn testimony of senior officials from DCF and the Executive Office of Health and Human Services, the report also examined the case files of three named plaintiffs from the April 2010 class action lawsuit brought by Children’s Rights against the state’s child welfare system. The review of the named plaintiffs’ case files “revealed a pattern of children being prescribed medications that were not warranted, helpful and, at times, appeared to cause significant side effects.” He noted various shortcomings in DCF’s ability to treat the children:

  • Poor record-keeping in the case file of Child A, who was administered psychotropic medications for over four years before they were documented in his case file in April 2006. Other notes in his case file showed that he had not been getting his dose of Wellbutrin, an antidepressant. However, the case file did not reflect that Child A was ever diagnosed with depression.
  • Unwarranted and excessive prescriptions in the case file of Child B, who was just 6 years old when he was hospitalized for post-traumatic stress disorder (PTSD). During the hospital stay he was administered Clonidine, Depakote, Concerta, Zoloft, Celexa, Trazadone, Focalin, Geodon, Abilify, Risperdal and Adderall. None of these medications are approved for PTSD.
  • Absence of a second opinion potentially exposing kids to inappropriate medications in the case files of Child C, who was treated with a host of powerful psychotropic drugs that were not indicated and may have caused significant side effects, including a hand tremor. At no point during eight years of this drug regimen was a second opinion or independent medical consultation obtained to better understand the child’s specific psychiatric needs.

Dr. Bellonci, who is also the senior consultant at the Walker School in Massachusetts for children with special education needs and mental illnesses, is a renowned national consultant on the mental health of foster children and adolescents. He has over 20 years of experience providing psychiatric treatment to thousands of kids across the country, including children in DCF wards.

Attorneys for Children’s Rights, with Boston law firm Nutter McClennen & Fish LLP, filed the lawsuit known as Connor B. v. Patrick in April 2010, charging DCF with failing to meet constitutional requirements and its legal duty to ensure the safety and well-being of children in its custody. A trial is set for January 21, 2013.

More information about Children’s Rights’ campaign to reform the Massachusetts child welfare system can be found at the Massachusetts Class Action Page.