The release in late March of an alarming new report by federal investigators has confirmed in shocking new detail what has been known for years: Poor and foster care kids covered by Medicaid are being prescribed too many dangerous antipsychotic drugs at young ages for far too long -- mostly without any medical justification at all. The report by the U.S. Department of Health and Human Services (HHS) Inspector General examined in depth nearly 700 claims filed in 2011 in five of the biggest prescribing states -- California, Florida, Illinois, Texas and New York -- and discovered that two thirds of all the prescribing with these popular and costly "second generation antipsychotics" (SGAs) raised high-risk "quality of care" concerns.
The new report noted several disturbing examples, just a few months after an overmedicated teen in foster care, Steven Unangst, died in Antioch, California. The report cited a 10-old-year with ADHD given an antipsychotic -- without any medical documentation -- mixed in with other psych drugs; a 4-year-old on four psychotropic drugs, including two antipsychotics; and a 16-year-old with bipolar disorder on six psychiatric medications, including variously three antipsychotics. Among the side effects of this polypharmacy assault: "This child experienced paranoia, hostility, unstable mood, hallucinations, and suicidal thoughts. This child also experienced significant side effects potentially resulting from the prescribed drugs, including a 22-pound weight gain, insomnia, and edema (swelling) of hands and feet."
Perhaps even more damning, the report found, 92 percent of all kids on Medicaid receiving antipsychotics don't have any of the limited "medically accepted pediatric conditions" supposedly justifying their use. These "accepted conditions" include the authority to use antipsychotics even for autistic children as young as 5 for such dubious FDA-approved conditions as "irritability."
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Medicaid spends about $3.5 billion a year on antipsychotics for all ages, largely for unaccepted uses, with nearly 2 million kids prescribed them.
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But Medicaid programs are generally all too glad to look the other way at such antipsychotic spending run amok. Why? "They're not willing to go up against the doctors or the pharmaceutical industry," says Jim Gottstein, a crusading Alaska-based attorney with the Psychrights.org advocacy group; although he hasn't won a whistleblower fraud lawsuit yet, he has been pursuing legal strategies -- with the recent go-ahead of a federal appeals court -- to force state and federal Medicaid programs to follow federal law and to stop paying for fraudulent, unproven uses of the antipsychotics.
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it shouldn't be surprising to learn that federal officials aren't too keen on enforcing drugging protections for either nursing home residents (whose meds are usually paid by Medicare) or children on Medicaid. "The federal government has done absolutely nothing of significance to rein in overprescribing,"
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One sign of federal indifference, I have found, is that in 2012 the federal government touted to state agencies a Texas prescription monitoring program then so lax that Texas foster care children were 52 more times likely to be prescribed five or more psychiatric drugs at the same time than non-foster children, according to the GAO and a stinging ABC News report in 2011, based on the latest available data. But the Texas drugging "parameters," which helped turn too many kids into drooling, tremor-ridden "zombies," were lauded by ACF in 2012
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the guidelines panel originally praised by HHS was stacked with two drug company-subsidized academics cited in court records for helping defraud Medicaid -- and an accused child-molester psychiatrist who was fired from a state hospital and is now facing sexual assault charges involving five minors in his care.
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Jo Angel Rodriguez, a troubled 11-year-old girl who bounced around the foster care system until her death in 2009 that prompted a wrongful death lawsuit; it was quietly settled in 2013 with Pfizer, the maker of the antipsychotic Geodon. As reported by the San Antonio Current, she was taken to the Laurel Ridge treatment center and was first given the antipsychotic Abilify, which caused vomiting and diarrhea, then spurred withdrawn and later aggressive behavior. Solution? More drugs:
Indeed, just two months ago, a Philadelphia jury found that Janssen hid the breast-growth dangers of the drug Risperdal and owed $2.5 million to a 20-year-old autistic man who developed size 46 DD breasts as a teenager.
Contributing Editor, The Washington Monthly
Feds Pay for Drug Fraud: 92 Percent of Foster Care, Poor Kids Prescribed Antipsychotics Get Them for Unaccepted Uses
Posted: 04/30/2015 9:07 am EDT Updated: 04/30/2015 12:59 pm EDT