COLUMBIA — A 12-year-old girl from Columbia is one of five children representing Missouri's 13,000 children in foster care in a class-action lawsuit filed Monday. The suit alleges that the Missouri Department of Social Services and its Children's Division have looked the other way while powerful psychotropic drugs have been used unsafely on foster children.
St. Louis University School of Law Legal Clinics, along with Children’s Rights and the National Center for Youth Law, filed the complaint against Jennifer Tidball, acting state director for the Department of Social Services, and Tim Decker, director of the Children’s Division.
The suit alleges that Tidball and Decker unlawfully allowed children to be placed on psychotropic drugs without safeguards in place — a violation of a child’s 14th Amendment right to be free from harm while in state custody.
Most psychotropic medications have not been approved by the Food and Drug Administration to treat mental health disorders in children as they can impact cognition, emotions and behavior, according to the lawsuit. Psychotropic drugs are often used as "chemical straight-jackets (sic)" to control foster children's behavior. To make matters worse, they are being used for problems the drugs weren't designed to treat.
“Few children, even those children and adolescents in foster care, suffer from schizophrenia or bipolar disorder — the predominant diagnoses for which antipsychotics have FDA approval for use with children. Yet antipsychotics are some of the most frequently prescribed drugs given to foster children,” Bill Grimm, the directing attorney of child welfare at the National Center for Youth Law, said in a news release Monday about the lawsuit.
The lawsuit was filed in U.S. District Court, Western District of Missouri, Central Division.
'Too many,' 'too much,' 'too young'
The lawsuit argues that the widespread use of psychotropic drugs creates a number of risks for the children taking them.
For example, children given psychotropic drugs are three times more likely to be diagnosed with Type 2 diabetes than children who are not medicated, and children who were given an antipsychotic drug were 50 percent more likely to have diabetes than non-medicated children, according to the lawsuit.
But children prescribed too many psychotropic medications, or at dosages too high, or children who are prescribed when they are too young, are at even greater risk because "they are often living with caretakers who do not have detailed knowledge of their trauma background, mental health needs, or medical history," according to the lawsuit.
That was the case for the 12-year-old Columbia girl, referred to only by her initials in the lawsuit. In her last three years in foster care, the girl was prescribed "multiple psychotropic medications, as many as five at a time," while neither her caregivers or physicians were provided with her up-to-date medical records. "As a result, she has been harmed and put at further risk of harm," the suit alleges.
At one care facility, the girl could be seen "visibly, involuntarily shaking," and though a volunteer observed it and the child herself complained about it, the staff denied it was happening. The drug, the antipsychotic Abilify, warns that patients should stop taking the drug and contact a physician if they experience "uncontrolled muscle movements."
The girl was also placed on an antipsychotic drug Strattera for attention deficit disorder, though she had received conflicting diagnoses about whether she had the disorder. In the fall of last year, she began to get in fights and was placed in "physical holds" and restraints repeatedly — six times in a period of 10 days.
She had been given Seroquel, and when the drug was discontinued, her aggression ceased, according to the suit. Seroquel has not been approved by the FDA for use in children, the suit states.
The girl gained more than 15 pounds in three months while on the drugs and had hallucinations.
A consistent pattern
The lawsuit alleges that the state routinely fails to provide foster parents with the medical records of the children in their care. That makes finding treatment for foster children difficult, said Melissa Shelton, a foster parent in Missouri who participated in a conference call about the lawsuit with the news media Monday. She said she'd been left in the dark when it came to a child's medical history.
"I have rarely — and I feel like it may be never — been presented with medical information from the case workers upon their arrival at my home with the children," Shelton said. "No documentation. No history."
Shelton said that's just one of the flaws in the foster care system that impacts an inestimable number of children in a negative way.
“The foster care system’s abject failure to oversee and closely monitor the use of these powerful drugs exposes Missouri’s most vulnerable citizens to serious, and even permanent injury,” said Sara Bartosz, deputy director of litigation strategy for Children’s Rights.
Bartosz said that although the lawsuit focuses on only five Missouri children in foster care who have been overexposed to psychotropic drugs, the case will impact the estimated 4,000 foster care children who are prescribed such medications without the proper safeguards.
The lawsuit doesn't seek monetary damages beyond court costs. Instead, it seeks:
- that medical records be reviewed, updated electronically and delivered to foster caretakers when a child is placed;
- that a clear and effective informed consent policy be developed that a responsible adult would sign before a child is given psychotropic medication;
- that a mandatory training program for social workers and foster caretakers be developed for the safe administration of psychotropic drugs in children;
- that a secondary review system that targets "red flags" in prescription procedures for children in the foster care system be created.
"It’s time that Missouri is held accountable to the children in its care it promised to protect," Bartoz said.
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