December 15, 2006
By A.J. Bauer
AMERICAN-STATESMAN STAFF

Children in the state's foster care system are largely over-drugged and overlooked, according to a report released Thursday by state Comptroller Carole Keeton Strayhorn.

The report includes 48 policy recommendations and focuses on the prevalence of psychotropic drug prescriptions among foster children. Such drugs are designed to alter the mental activity, behavior, perception or mood of those who take them.

Strayhorn's office hired researchers to review psychotropic prescription rates among foster children. They found that in a random sample of 472 children, half received three classes of psychotropic drugs concurrently, and 27 percent received four or more.

In 2004, 37 percent of the state's foster children received one or more prescriptions for the drugs.

According to the review, there has been virtually no legitimate clinical trial on the efficacy of prescribing multiple psychotropic drugs to children, which, given the prevalence of such practices in Texas, raises concern, Strayhorn said.

"There are red flags all over the place that point to fraud and abuse," said Strayhorn, who lost her bid for governor this year and is leaving office in January.

In her report, Strayhorn called on the Health and Human Services Commission's Office of Inspector General to investigate her myriad accusations of potential fraud. She also repeatedly criticized the Department of Family and Protective Services, which is responsible for the foster program.

The report criticized the slow implementation of a "medical passport" system that would allow foster children's records to follow them as they are moved from place to place and the lack of guidelines concerning the psychiatric hospitalization of foster children.

Strayhorn said she has seen evidence of foster children being "dumped" into psychiatric hospitals by overwhelmed foster parents, helped by the lack of rules outlining the reasons for which foster children can be admitted.

State Sen. Jane Nelson, R-Lewisville, who chairs the Senate Health and Human Services Committee, said that many of Strayhorn's recommendations are in the process of being enacted.

She said a study released after Strayhorn's review was conducted revealed a 7 percent decrease in psychotropic prescriptions.

The "medical passport" also is being developed, Nelson said.

"There are just so many tentacles to it, including concerns over privacy protections and parental rights," Nelson said. "I would like to have had it done but want to make sure it's done properly."

Patrick Crimmins, spokesman for family and protective services, said he had not had a chance to read through the whole report. But, he said, "we disagree with the assertion that the medical care and medical needs of foster children are being ignored."

Strayhorn said she commissioned her latest report after completing a broader study of the state's foster care system, which she released in April 2004. That report helped spark the reform legislation in 2005.

ajbauer@statesman.com; 445-3851

Foster care report

The 227-page report on medical care for Texas' 20,000 foster children makes 48 recommendations for improvement. They include:

•A state investigation by the Health and Human Services Commission into potential fraud and abuse.

•Hiring a physician at the Department of Family and Protective Services as full-time medical director for foster children.

•Requiring prior approval for prescriptions to address the dispensing of non-FDA-approved psychotropic medications.

•Seeking lower-cost and less restrictive alternatives to psychiatric hospitalization.

•Developing rules for psychiatric hospitalization.

http://www.statesman.com/news/content/news/stories/local/12/15/15foster.html