By Ike Swetlitz | July 9, 2019
Editor's note: This story is a follow up to the Searchlight investigation (Prescription for disaster) into how antipsychotic medications have been prescribed, often with little oversight, to the most vulnerable children in state custody.
In February, Trent John sat down at his desk in the Children, Youth & Families Department and opened up a password-protected Excel spreadsheet. A list of psychotropic medications prescribed to most of the foster-care children in New Mexico popped up on the screen.
There were 31 pages chock full of detail about antipsychotics, antidepressants, anticonvulsants, and other drugs that treat serious medical conditions — and that also require careful monitoring and review. Of the nearly 2,500 kids in foster care, about 500, or one-fifth of the population, received one or more of these drugs.
“This is really going to be able to help us do a lot of good work for the kids,” said John, bureau chief of children and family support services at CYFD. “I was excited when I got [it].”
It was the first time in recent memory that CYFD was given such detailed information, and officials hailed the development as a major step toward the safekeeping of children in its custody.
“If you took my own kid and gave them a bunch of medications and never told me about it, I would be horrified,” said CYFD Secretary Brian Blalock. “We have to be sure that the same thing [isn’t] happening for the kids in the state’s care.”
For over a decade, CYFD has dragged its feet in this responsibility, a Searchlight New Mexico investigation found last year. Among other issues, the agency has not employed a child psychiatrist to review its cases since November 2016, when George Davis, the former psychiatry director, retired.
CYFD is taking steps to fix these problems. The department is working on upgrading its computer system to make it easier to analyze records and identify doctors who prescribe inappropriate medication.
“Really, we should have a bright, bright neon sign that pops up out of the computer when we look at that kid’s file,” Blalock said.
The data are also part of the solution.
For the first time, CYFD can see exactly who is prescribing what medicines to which children.
Reviewing the cases enables the department to “make sure this is an appropriate medication that this child should be on, so we’re not overmedicating children,” John said.
CYFD has already identified 49 kids whose cases warrant further scrutiny, according to spokesperson Charlie Moore-Pabst. That number reflects about 10 percent of the kids whose electronic data the department has so far received.
Studies show that kids in foster care are more likely to be prescribed psychotropic medications compared to the general public, and often without appropriate follow-up.
“Every state needs this work done,” said Anna Johnson, senior policy associate for the National Center for Youth Law and a specialist in the issue of psychotropic prescribing to foster children. “No state has the answer. There’s no national model out there.”
Without such oversight, physicians can go years writing dangerous prescriptions, either out of ignorance, improper training, or outright malice. New Mexico’s insufficient oversight enabled Edwin Hall, a child psychiatrist in Albuquerque, to write hundreds of potentially harmful prescriptions, many for foster children, Searchlight reported last year.
Hall surrendered his medical license in March 2018 after an investigation by the New Mexico Medical Board found that he had irresponsibly prescribed medicines to a variety of patients, six of whom died from overdoses.
The state Attorney General is investigating Hall, and a recent legal filing indicates that the office has evidence that he defrauded the state’s Medicaid program. The state is seeking more than $270,000 from Hall, according to a document filed May 31 as part of Hall’s bankruptcy proceedings.
But the problem extends beyond one bad doctor. New Mexico lacks the comprehensive oversight that would allow CYFD staff to quickly and easily identify suspicious prescribing patterns.
To remedy this, CYFD worked with New Mexico Sen. Bill Tallman (D-Bernalillo) in the last legislative session on a bill to provide for stricter regulations in the prescribing practices to foster children. The bill called for cooperation between state agencies and private companies that collect data on prescriptions of these drugs.
Interest in the issue has also reached the upper echelons of state government. Blalock, appointed in January by Gov. Michelle Lujan Grisham, personally sought advice on Tallman’s bill. In February, he sent an email to Johnson, whose organization has shepherded similar legislation and policy in other states.
The email, the subject line of which read “Help?”, languished in Johnson’s spam folder for weeks, while Tallman’s bill died a quiet death in a busy legislative session.
Despite that setback, the department is finding ways to implement some of the bill’s measures.
In theory, CYFD should have access to all information regarding medications prescribed to children in its custody. In practice, it does not.
That’s because foster parents, doctors and other prescribers frequently neglect to forward that information to CYFD, said Moore-Pabst. And even when they do, the records are stored in physical file folders, under lock and key — not in an electronically searchable database.
Medical, legal and family records are held by disparate agencies in New Mexico, many of which traditionally have been hesitant to share information. For instance, most foster children in New Mexico are on Medicaid, a program that is overseen by the Human Services Department. That means that HSD has primary access to medication data, which it is now sharing with CYFD.
Gov. Lujan Grisham has sought to improve coordination between HSD, CYFD and other agencies by reviving the Children’s Cabinet, an agency tasked with overseeing all child-related issues. And when it comes to monitoring psychotropic medications, that coordination appears to be happening.
“We’re really developing a very collaborative relationship with HSD,” said Bryce Pittenger, CYFD’s director of behavioral health services.