{"id":638917,"date":"2018-10-26T07:00:50","date_gmt":"2018-10-26T13:00:50","guid":{"rendered":"https:\/\/nmpolitics.net\/index\/?p=638917"},"modified":"2018-10-26T15:24:13","modified_gmt":"2018-10-26T21:24:13","slug":"prescription-for-disaster-nms-lax-oversight-puts-kids-in-danger","status":"publish","type":"post","link":"https:\/\/nmpolitics.net\/index\/2018\/10\/prescription-for-disaster-nms-lax-oversight-puts-kids-in-danger\/","title":{"rendered":"Prescription for disaster: NM\u2019s lax oversight puts kids in danger"},"content":{"rendered":"<div id=\"attachment_638926\"  class=\"wp-caption module image alignnone\" style=\"max-width: 771px;\"><img loading=\"lazy\" decoding=\"async\" class=\"size-large wp-image-638926\" src=\"https:\/\/nmpolitics.net\/index\/wp-content\/uploads\/2018\/10\/dju_20181024_Barnes_45-771x514.jpg\" alt=\"Jane Barnes\u2019 grandsons\" width=\"771\" height=\"514\" srcset=\"https:\/\/nmpolitics.net\/index\/wp-content\/uploads\/2018\/10\/dju_20181024_Barnes_45-771x514.jpg 771w, https:\/\/nmpolitics.net\/index\/wp-content\/uploads\/2018\/10\/dju_20181024_Barnes_45-336x224.jpg 336w, https:\/\/nmpolitics.net\/index\/wp-content\/uploads\/2018\/10\/dju_20181024_Barnes_45-768x512.jpg 768w, https:\/\/nmpolitics.net\/index\/wp-content\/uploads\/2018\/10\/dju_20181024_Barnes_45-1170x780.jpg 1170w, https:\/\/nmpolitics.net\/index\/wp-content\/uploads\/2018\/10\/dju_20181024_Barnes_45.jpg 1200w\" sizes=\"auto, (max-width: 771px) 100vw, 771px\" \/><p class=\"wp-media-credit\">Don Usner \/ Searchlight New Mexico<\/p><p class=\"wp-caption-text\">Three of Jane Barnes\u2019 grandsons at home.<\/p><\/div>\n<p>In 2015, Jane Barnes, a research scientist in her early 60s &#8212; \u201ca tired old woman,\u201d in her words &#8212; was desperate to rescue her grandsons. Their mother &#8212; Barnes\u2019s daughter &#8212; was a meth addict; their father was a violent felon who knocked out the boys\u2019 teeth and sent them to the hospital in need of stitches. By the time New Mexico\u2019s Children, Youth and Families Department (CYFD) took custody, the children had been traumatized by years of domestic violence, abuse and neglect.<\/p>\n<p>The agency placed them in foster care, where they were abused and neglected all over again.<\/p>\n<p>The older boys screamed in their sleep. The baby banged his head in the crib. All four urgently needed therapy. What they got instead were monthly visits to a \u201chigh-risk prescriber,\u201d Albuquerque psychiatrist Edwin B. Hall, who would soon be under criminal investigation in the overdose deaths of 36 patients and accused of overprescribing to hundreds of foster children. For the boys, Hall wrote dozens of prescriptions: for antipsychotics, mood stabilizers, anticonvulsants and sedatives; none of the drugs proved safe or effective in children so young.<\/p>\n<p>The medications filled a shopping bag.<\/p>\n<p>\u201cThe boys had morning meds, and at lunch, they got meds at school,\u201d Barnes ticks down the list. \u201cAt around 3:30 or 4 they got meds. And before they\u00a0went to bed they got meds.\u00a0The only one who wasn\u2019t on six or seven meds a day was the baby.\u201d<\/p>\n<aside class=\"module align-left half type-aside\">\n<h3>About this article<\/h3>\n<p>This article comes from\u00a0<a href=\"http:\/\/searchlightnm.com\/\" target=\"_blank\" rel=\"noopener\">Searchlight New Mexico<\/a>, a nonprofit, nonpartisan news organization dedicated to investigative journalism. Read its Raising New Mexico series\u00a0<a href=\"https:\/\/nmpolitics.net\/index\/series\/raising-new-mexico\/\" target=\"_blank\" rel=\"noopener\">by clicking here<\/a>. Support its work\u00a0<a href=\"https:\/\/www.newsmatch.org\/organizations\/searchlight-new-mexico\" target=\"_blank\" rel=\"noopener\">by clicking here<\/a>.<\/p>\n<\/aside>\n<p>For nearly 20 years, the world\u2019s leading psychiatrists and researchers have condemned this practice, which is so notorious it has its own catchphrase: \u201cToo much, too high, too young.\u201d The Centers for Disease Control and Prevention, the U.S. Department of Health and Human Services, the National Institutes for Mental Health and the General Accounting Office all warn against giving antipsychotics or multiple psychiatric medications to children. Hundreds of medical studies confirm that these drugs can cause extreme obesity, diabetes, heart disorders, high blood pressure and irreversible tremors in children. They are also believed to harm the developing brain.<\/p>\n<p>At least 44 states have introduced formal protocols or programs to boost oversight and monitoring of psychotropic drug use by children. Federal law requires such oversight. The risk of over-drugging children &#8212; particularly those in foster care and on Medicaid &#8212; is so widely recognized that most states took steps to track and reduce the problem by 2012.<\/p>\n<p>Not New Mexico.<\/p>\n<p>\u201cIt\u2019s the negligence of inattention,\u201d says George Davis, former director of psychiatry for CYFD. \u201cIt takes monitoring, expertise and regulatory teeth to solve this problem. The state lacks all three. That\u2019s really what\u2019s happening.\u201d<\/p>\n<p>A three-month investigation by Searchlight New Mexico has found that the state lacks the most basic safeguards to protect children on Medicaid and in foster care. An analysis of Medicaid pharmacy claims for children 18 and under, in fiscal year 2016 (the most recent data available), revealed:<\/p>\n<p>\u2022 Doctors in New Mexico wrote 136,000 psychiatric drug prescriptions for nearly 30,000 New Mexican children, an average of 4.5 prescriptions per child. Of the 305,000 kids on Medicaid in 2016, this means that more than 10 percent of them take psychiatric drugs.<\/p>\n<p>\u2022 The most dangerous of these were antipsychotic drugs; New Mexico physicians wrote 19,300 prescriptions for Risperdal, Zyprexa and Abilify and others, including some for children under age 5.<\/p>\n<p>\u2022 Doctors handed out 70,000 prescriptions for stimulant medications to treat attention deficit disorder in 13,000 children. Medical experts say their jittery behavior is almost certainly traced to trauma; instead of masking the behavior with drugs, they need therapeutic help to recover.<\/p>\n<p>Searchlight\u2019s made numerous requests over a five-month period to interview the secretaries of CYFD and the Human Services Department (HSD): none were answered. Four public records requests yielded scant or no useful information. The state refused to provide information in Medicaid pharmacy receipts that would reveal ages of patients and the precise medications they received. In doing so, HSD cited privacy laws, though Searchlight specified it was not seeking personal information.<\/p>\n<p>CYFD says it lacks the power to enact effective guidelines.<\/p>\n<p>\u201cWe can advocate,\u201d says Bryce Pittenger, director of behavioral health at CYFD. \u201cWe can submit proposals, but that final say is not ours. And that actual obligation is not ours.\u201d<\/p>\n<h3>\u2018Killing them slowly\u2019<\/h3>\n<p>\u201cThe leadership completely lacks the courage to take action for the protection of children,\u201d says Davis, who, until his retirement in 2017, spent more than 10 years trying to implement medication guidelines to safeguard the children in state custody. There are about 2,500 youths in foster care annually, with some 200 more in juvenile justice lockups.<!--more--><\/p>\n<p>Some of the youths had psychosis &#8212; they benefited from being on an antipsychotic, Davis says. But he also saw 8-year-olds who gained 40 pounds in a single year on the drugs, and didn\u2019t need them. \u201cWe\u2019re killing them slowly,\u201d he says.<\/p>\n<p>Davis says he first started working on \u201cbest practice\u201d guidelines for youths in 2006, but \u201cI couldn\u2019t get CYFD or HSD to publish them.\u201d Between 2013 and 2017, he met with a task force to hammer out a more comprehensive set of guidelines intended to \u201cred flag\u201d doctors who prescribed psychiatric drugs to children. That, too. disappeared down a bureaucratic hole.<\/p>\n<p>\u201cIs it just incompetence or is it obstruction?\u201d wonders Davis, a child and adolescent psychiatrist now in private practice.<\/p>\n<p>Bryce Pittenger, who praises Davis for his efforts while in office, says CYFD did take action by publishing an internal document in 2016 that, she says, raised consciousness within the agency.<\/p>\n<h3>A child\u2019s medical cocktail<\/h3>\n<p>Jane Barnes was determined to do \u201cwhatever it took\u201d to bring her grandsons home. What it took was endurance &#8212; first, to cope with a devastating string of family tragedies, and then to cope with the child welfare system. \u201cThe stupidity and the neglect and the jaded employees at CYFD that are wanting to do a good job but can\u2019t because of the limitations set by upper-level people? Oh, it\u2019s just unbelievable,\u201d she says.<\/p>\n<p>Between 2014 and 2016, psychiatrist Hall &#8212; now under state investigation, according to a spokesman from the New Mexico Attorney General\u2019s office &#8212; started one of Barnes\u2019 grandsons on Risperdal, an antipsychotic medication associated with life-threatening health problems. One of its most horrifying side effects is gynecomastia, a condition that can cause boys to develop breasts as large as DD-size. A double mastectomy is the only treatment option.<\/p>\n<p>Barnes recalls tagging along on a visit to Hall\u2019s storefront office in 2015, and says she was stunned when Hall added another drug to the cocktail. He offhandedly prescribed Lamictal, a mood stabilizer, for the 6-year-old. The drug comes with a black box warning of a severe skin reaction that can lead to blindness, organ failure and death. \u201cBeware of rash!\u201d Hall tossed off, according to Barnes\u2019 recollection.<\/p>\n<p>In Oct. 2017, after a 17-month investigation, the New Mexico Medical Board found Hall had over-prescribed medications that led to the overdose deaths of six adult patients; his license was summarily suspended. A year later, the attorney general\u2019s office alleged that 30 additional patients in Hall\u2019s care died of overdoses. He is also being investigated for child abuse and Medicaid fraud, law enforcement sources say.<\/p>\n<h3>Big problems, small bodies<\/h3>\n<p>Parents who show up in a doctor\u2019s office with an out-of-control child are desperate for help. The child may be in danger of being suspended from school or about to kicked out of a foster home.<\/p>\n<p>Psychotropic drugs can be lifesavers, says Mark Olfson, a Columbia University psychiatry professor and leading researcher in the field. They can reduce suffering and dramatically turn a child\u2019s life around.<\/p>\n<p>\u201cThese children may be small, but they have enormous problems,\u201d says Olfson, who stresses that the key is to prescribe wisely and with appropriate monitoring.<\/p>\n<p>This off-label application is legal, but it means the medication is used in ways that aren\u2019t FDA-approved, on populations for whom there is no proof of effectiveness or safety. As the saying goes, \u201cchildren are not small adults.\u201d The doses that help a middle-aged patient with schizophrenia might spark terribly different outcomes in a child.<\/p>\n<p>In a 2010 study, researchers at Tufts University studied psychotropic medication use in children and teens in 47 states over a 10-year period. They found that its use in the general population hovered at 4 percent, while in the foster system it was high as 52 percent. In some states, more than 40 percent of foster children took three or more of the drugs.<\/p>\n<p>That is the case in New Mexico, which has one of the highest \u201cpolypharmacy\u201d rates in the nation. Between 2002 and 2007 (the most recent data available), the rate increased by 26 percent &#8212; the second highest in the country. (The first was Washington.)<\/p>\n<p>Child poverty, excessive trauma, scant oversight and a severe shortage of mental health professionals have created the perfect storm in New Mexico, leaving thousands of children needing services they don\u2019t receive, and thousands of others receiving services they shouldn\u2019t get. Only 12 percent of the state\u2019s psychiatric needs are met, according to the Kaiser Family Foundation.<\/p>\n<h3>\u2018We\u2019re done\u2019<\/h3>\n<p>Jane Barnes\u2019s youngest grandson sits at a kitchen table tackling a bowl of pasta. \u201cI\u2019m going on a long, long walk today!\u201d he announces between bites. A sense of normalcy prevails in the sunny, split-level house on a quiet cul-de-sac. His twin brothers are off at school; the 8-year-old is in a residential treatment facility.<\/p>\n<p>Nothing about their lives has been easy since the adoptions came through nearly two years ago.<\/p>\n<p>The boys have struggled with PTSD and other diagnoses, unspecified disruptive behavior disorder and attachment disorder. These problems were masked by the drugs.<\/p>\n<p>Barnes found a Santa Fe psychiatrist who assessed the shopping bag full of pills that CYFD had relinquished when she took custody of the boys. He was still overseeing their transition off the drugs when two CYFD employees paid a house call. The agency had learned what Barnes was doing and they had come, she says, to insist she follow Dr. Hall\u2019s orders.<\/p>\n<p>\u201cI said: \u2018You don\u2019t know a thing about medications, and I\u2019m betting your supervisors don\u2019t know a thing about medications. And my grandsons are taking drugs they shouldn\u2019t be. So we\u2019re done. We\u2019re just done.\u2019\u201d<\/p>\n<p>It took four months to get them off the pills. Then one morning, they were eating breakfast in a restaurant when the 7-year-old looked up and said, \u201cEggs. Bacon.\u201d He was moving his eyes around the room. There were breakfast foods listed on the walls in big bright letters. \u201cSausage!\u201d he said. \u201cToast.\u201d<\/p>\n<p>He was reading. \u201cHe hadn\u2019t been reading before, and all the sudden he was reading,\u201d Barnes says. \u201cIt was amazing. It was absolutely amazing. And I thought, he\u2019s off the pills and now he can read.\u00a0And I thought, he\u2019s OK. He\u2019s going to be OK.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"<p>At least 44 states have introduced formal protocols or programs to boost oversight and monitoring of psychotropic drug use by children. Not New Mexico.<\/p>\n","protected":false},"author":1,"featured_media":638926,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[11],"tags":[234,142,117,107],"class_list":["post-638917","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-news-and-analysis","tag-children","tag-crime","tag-health-care","tag-roundhouse","series-raising-new-mexico"],"_links":{"self":[{"href":"https:\/\/nmpolitics.net\/index\/wp-json\/wp\/v2\/posts\/638917","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/nmpolitics.net\/index\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/nmpolitics.net\/index\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/nmpolitics.net\/index\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/nmpolitics.net\/index\/wp-json\/wp\/v2\/comments?post=638917"}],"version-history":[{"count":5,"href":"https:\/\/nmpolitics.net\/index\/wp-json\/wp\/v2\/posts\/638917\/revisions"}],"predecessor-version":[{"id":638930,"href":"https:\/\/nmpolitics.net\/index\/wp-json\/wp\/v2\/posts\/638917\/revisions\/638930"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/nmpolitics.net\/index\/wp-json\/wp\/v2\/media\/638926"}],"wp:attachment":[{"href":"https:\/\/nmpolitics.net\/index\/wp-json\/wp\/v2\/media?parent=638917"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/nmpolitics.net\/index\/wp-json\/wp\/v2\/categories?post=638917"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/nmpolitics.net\/index\/wp-json\/wp\/v2\/tags?post=638917"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}