Statement from Carole Keeton Strayhorn
Thursday, December 14, 2006
(Austin)-- They're everybody's children, and nobody's children. They are the forgotten children in the Texas foster care system.
My report, Texas Health Care Claims Study -- A Special Report on Foster Children, reveals shocking evidence of the system's failure regarding the care provided to our foster children.
A nine-year-old foster child with cerebral palsy and quadriplegia had not been given her medication for at least one month.
A three-year-old foster child with brain cancer and 200 medical claims had his payment and care level lowered. Another foster child who just turned three years old was placed in a private psychiatric hospital for 10 days. Before her hospitalization, she had been prescribed a bundle of psychotropic medications, including antipsychotics, antidepressants, a sedative, stimulant and mood stabilizer.
An 18-year-old foster child spent 94 percent of one year in three different psychiatric hospitals. She went to the emergency room four times and then had to have her arm amputated because of infection from injuries.
I found foster children were sometimes dumped in psychiatric hospitals, and were often left by caseworkers for up to three months after they were approved for discharge -- that's absolutely unacceptable and at an unnecessary cost to the state to boot.
Foster children with HIV and AIDS are not always receiving consistent care and not all foster children that should be tested for HIV are being tested.
An eight-year-old foster child with HIV and a feeding pump was placed in a 1,300 square foot mobile home with four other foster children, although DFPS licensed the home to care for only four children, not five.
This report raises many red flags pointing to areas of potential fraud and abuse that I am referring to the Office of Inspector General at the Health and Human Services Commission to investigate. My report, as the Forgotten Children report did, gives these children something they desperately need -- a voice.
I found a significant potential for fraud and abuse in Medicaid claims for Texas' foster children. Especially noteworthy are prescription patterns, psychiatric hospitalizations and the questionable medical treatment and care received by some foster children.
Medicaid claims from 2004 and 2005 show that our foster children are being prescribed powerful, mind-altering psychotropic drugs at an alarming rate.
In fiscal 2004, Texas spent $39 million on 436,480 prescriptions for nearly 24,000 foster children.
60 percent of all medications prescribed were for psychotropic drugs, at a cost of $29.9 million, half of which were spent on expensive antipsychotic drugs like Risperdal and Zyprexa, at an average cost of $229 per prescription.
The Food and Drug Administration has not approved most of these drugs for use in children, the effectiveness of these drugs is in question, and the long-term consequences on learning, growth and development have not been determined.
According to experts, Dr. Daniel Safer and Dr. Julie Zito, who assisted my staff, "While psychotropic medications may be beneficial in treatment of mental disorders, a pill cannot solve all of the emotional issues and problems foster children face while in care."
Shockingly, I found that DFPS has no rules, guidelines, or monitoring procedures concerning the psychiatric hospitalization of foster children. This lack of oversight greatly increases the potential for waste, fraud and abuse.
In fiscal 2004, 1,663 foster children were admitted to psychiatric hospitals at a cost of $16 million; 286 of these children were nine years old or younger.
The Department of Family Protective Services does not effectively identify medically fragile foster children, the majority of which are misclassified as needing only routine guidance and supervision.
These medically fragile foster children have been diagnosed with Down syndrome, cerebral palsy, paralysis, spina bifida, blood disorders, heart disease and cancer.
I am urging the Office of Inspector General to fully investigate potential fraud and abuse identified in this report.
DFPS should hire a physician to serve as a fulltime medical director responsible for health care for Texas' foster children.
In April 2004, I recommended DFPS create a "medical passport" for each foster child, which would follow each child as they move from one placement to another. I again call upon DFPS to immediately implement this long-overdue recommendation that would dramatically improve health care for our forgotten children -- which could be done by using a simple paper copy system until an electronic version is available.
The medical director should be responsible for ensuring that a foster child's medical passport be received by the foster child's caregiver within 48 hours of being placed in a foster home or facility.
HHSC should require prior authorization for prescriptions to address the dispensing of non-FDA approved psychotropic medications for children.
DFPS and the Department of State Health Services should seek lower-cost, less restrictive alternatives to psychiatric hospitalization and immediately develop rules for the psychiatric hospitalization of foster children.
The medical director and the Department of State Health Services should evaluate the case files of all medically fragile foster children and develop best practices for care.
DFPS in coordination with HHSC and the Department of State Health Services should study complementary treatments to psychotropic medications -- such as therapy, diet, exercise, therapeutic activities and mentor programs.
The HHSC Office of Inspector General and the State Auditor should review the quality of the physical environments in which foster children live and make recommendations to improve standards for living conditions.
My first investigation into the Texas foster care system in 2004 -- Forgotten Children -- documented the tragic failure of the system.
Part of that report focused on psychotropic medications and care prescribed to our foster children. The findings caused me deep concern and led to my decision to look into this aspect of the system more closely.
Given the distressing findings contained in this report, I hope the state will not delay in adopting recommendations, which have been crafted to help mend this broken system.
I hope our state's leadership and the health and human service agencies will work to make things better for our state's most vulnerable children. To view the full report, go to www.window.state.tx.us.
Texas is great, but we can do better. We have to -- for the sake of our children.