ABLECHILD: State’s Audit Reveals Rampant Abuse of Psychotropic Drugs on Children in State Care

by Joe Hoft

A recent audit conducted by the Massachusetts Office of the State Auditor reveals that the Department of Children and Families (DCF) apparently is really bad at doing its job and the fact that the well-being of children is at stake makes the incompetence incomprehensible.

The DCF is tasked with providing services to children who are at risk and victims of abuse or neglect. The services the state is responsible for providing include adoption, guardianship, foster care, housing stabilization, and family support.

Specifically, AbleChild is interested in the section of the audit that reviews the oversight of the drugging of children with serious psychiatric mind-altering drugs. The audit reviewed the period from July of 2019 to December of 2023.

During the audit period, 3,899 (22%) of the 17,891 children in DCF’s protective custody were prescribed at least one psychotropic medication. During the audit period, the number of prescriptions filled for each drug category included 1,065 prescriptions for anti-anxiety meds, 21,585 Antidepressants, 10,564 Antipsychotics, 10,776 Mood Stabilizers, and 48,453 Stimulants. Clearly, chemical behavior modification is a common practice, and the state’s DCF social workers are required to participate in, follow, and document the medication history of each child under their care.

To help caseworkers provide the required services, a child is provided a physical Medical Passport that records its healthcare services while in state custody. Social Workers are required to review these physical passports every six months to keep the children’s related medical records in iFN (electronic information system) updated with their most recent healthcare information.

In Massachusetts, it is required that the Courts approve antipsychotic medication use in children in the state’s protective custody. The audit revealed that “the Department of Children and Families did not always obtain or renew court approval before children in its protective custody were administered antipsychotic medications.” This is a problem because the court needs to know that the drug regimen is safe and effective. Furthermore, the courts have oversight of children who are too young to consent to the drug treatment and act as a neutral party.

The audit also found that “the Department of Children and Families did not properly maintain healthcare records in iFamilyNet (iFN) for children in its protective custody who received psychotropic medications.” Keeping up-to-date records is essential to ensure that the child is not being overprescribed with toxic mind-altering drugs. There is no oversight, leaving the children in custody at risk.

Additionally, the DCF did not list and/or update the psychotropic medications prescribed to children in their medical passports, which clearly can lead to overprescribing of dangerous mind-altering drugs and serious, if not deadly, adverse events. And with the lack of documentation, the DCF also did not document follow-up doctor appointments and recommended psychosocial services. How can these deficits possibly help children in the state’s care?

Most egregious, the DCF did “not document its consent in iFamilyNet for children in its protective custody to receive psychotropic medications.” In fact, in 94% of the children in the audit who were “prescribed at least one psychotropic medication from MCO sample did not have the required documentation of DCF’s consent or court approval for psychotropic medications.” One has to wonder, how could these prescriptions continue/change or increase without the proper documentation? It’s interesting to note that the Mass DCF argued that it was not required to “document consent for routine healthcare (for example, psychotropic medication, not including antipsychotics).” Psychotropic medication is “routine?” Just because a judge did not have to sign off on all the other mind-altering drugs prescribed to kids, the state’s caseworkers just didn’t document any of the drug prescriptions. Doesn’t sound like a safe practice.

The DCF also “did not ensure that children received recommended psychosocial services in conjunction with their prescriptions for psychotropic medications.” In other words, children in the state’s care were not only drugged with serious mind-altering drugs but did not get the necessary therapy that is recommended in conjunction with the drugging.

Of great concern to AbleChild is the number of children who received mind-altering drugs that exceeded the dosages recommended by the Food and Drug Administration (FDA). “The Department of Children and Families should provide more oversight for children in its custody receiving psychotropic medication in amounts and dosages that exceed United States Food and Drug Administration recommendations.” Apparently 20% of the children in the audit received dosages that exceeded the FDA recommendations. Beyond the caseworker’s culpability, one must wonder what information was being used by the doctors prescribing the drugs to determine which drugs to prescribe and at what levels.

So, let’s recap. The adults tasked with oversight of the state’s at-risk children failed to document the children’s healthcare services, did not get court approval to administer/continue antipsychotic medications, did not list prescribed medications in their medical passports and received mind-altering drugs in excess of FDA recommendations. Wow. What exactly were the caseworkers tracking if not this important drug information?

That there were serious problems with the handling of psychiatric drug information for the state’s at-risk youth population, is not in question. One must wonder, though, what are the consequences for such obvious failures? Will employees be independently reviewed and dealt with accordingly? What responsibility do the prescribing doctors have when it comes to oversight? Will mandated procedures be put in place where none exist today? Were there adverse events associated with the improper control and oversight of medication prescribing?

These questions were not raised by the auditor. A promise to “follow up in six months and track progress” was made by the auditor. It’s a promise, but will Massachusetts’ at-risk kids be safe until then? It is of interest to note that Massachusetts and Florida are the only two states that actually audit psychotropic drug use among its at-risk youth population. Sadly, based on news reports, Florida also failed in its duties to protect the children in the state’s custody.

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ABLECHILD: State’s Audit Reveals Rampant Abuse of Psychotropic Drugs on Children in State Care