Sacramento's foster children could benefit from anti-drug legislation

Reformers view Gov. Jerry Brown as most likely obstacle to halting overmedication

A lengthy campaign to end the forced drugging of California’s foster children inched forward on a state Senate vote last week. But advocates worry that the comprehensive legislation won’t make it past Gov. Jerry Brown’s frugal veto pen.

“We think our biggest issue is going to come down to money,” said National Center for Youth Law policy analyst Anna Johnson. “The governor has a history of not signing children’s initiatives. It’s not really part of his legacy.”

The startup cost for implementing the four-piece package of bills would be $5 million in the first year, and then $4 million annually after that. Considering the state spends north of $25 million a year on doping its foster population, Johnson foresees making up the price tag, and then some, through reducing prescriptions, especially for high-power psychotropic medications that have been linked to overdoses, suicides, organ failure—and even boys developing breasts.

“There’s just so many kids at risk … for long-term disabilities,” said Johnson, whose organization sponsored the legislation. At best, these children lose out on care and support, she said, “because we pretend we’re treating them with a drug that’s not giving them what they need.”

Locally, 12 percent of Sacramento County’s 3,744 foster children—age 20 and younger—were on psychotropic meds last year, according to data from the state Department of Social Services. That’s down from 14 percent the year prior—though the number of medicated children actually increased by more than a couple dozen—and is on par with California’s top-populated counties.

In Contra Costa County, which has less than half of Sacramento’s foster care population, the rate of psychotropic medication stood at almost 17 percent. At 10.3 percent, Orange County had the lowest medicated foster population among counties with both managed care and fee-for-service Medi-Cal recipients.

Johnson says those numbers should be in the low single digits and nowhere near the teens. “It shouldn’t be this high,” she told SN&R.

The government has agreed for some time. While the issue came to the fore in 2006, it was a December 2011 report from the U.S. Government Accountability Office that revived interest in addressing the overmedication of foster children. The GAO determined that foster children in five states “were prescribed psychotropic drugs at higher rates than nonfoster children,” and that these prescriptions were “more likely to have indicators of potential health risks.”

This February, California lawmakers convened a joint oversight hearing on the matter and lambasted a fragmented system that struggles to track what happens to its most vulnerable youths.

Listing diabetes, obesity, heart disease and death as a sampling of the serious health effects associated with doping foster kids with drugs not developed for them, state Senator Jim Beall cited an urgent need to educate caregivers about alternative treatment methods and create avenues to report abuse. “We can’t use psychotropic drugs as a crutch to modify behavior,” he said. “Thousands of children are counting on us to do a better job.”

Beall co-authored the four bills now before the Assembly for consideration. Among other things, they require juvenile court judges to be more scrutinizing about psychotropic drug plans; broaden the role of public health nurses; and create a process for the state to identify and flag group homes “that have disproportionately high levels of psychotropic drug usage,” according to bill language.

More than half of medicated foster children reside in group home settings, state data shows.

The legislation’s goal isn’t to prohibit the use of this class of drugs—with names like Citalopram Hydrobromide, Clozapine and Risperidone—but to make sure decisions are based on sound medical practice and informed decisions, said William Grimm, a senior attorney for the National Center for Youth Law who testified at the oversight hearing. Too many foster kids shuttle from placement to placement, swapping caretakers and prescribers who are not provided a comprehensive medical or trauma history. At another point of the prescription assembly line, group homes use drugs as a quick-fix for difficult residents because they’re understaffed and inadequately trained, Grimm told lawmakers.

That’s what happened to Ashley Drake, who rotated through 13 group homes around the Sacramento area during her youth. She says staff ignored her unless she made attempts on her life. “They were just throwing me inside the mental hospital,” she said. “You were always doped up in there. That’s kind of their way of handling things.”

While Johnson viewed the Senate vote as a significant step forward, she’s not convinced the bills will survive the Assembly and Brown, even with the potential cost savings they bring. “Politicians don’t really like cost-savings analysis,” she said. “While this seems to be a priority in word, it might not be a priority when it comes to our wallet.”

During the joint oversight hearing, Senator Mike McGuire acknowledged that past reforms died in appropriations or by not getting signed. “That’s where we have faced challenges as a state,” he said. “These foster youth don’t have the time. And the longer we wait, the worse the outcome is for the foster youth.”

A spokesman for Assembly Speaker Toni G. Atkins said it was too early for his boss to render an opinion on whether the bills would make it through this house intact.