Department of Justice Inspector General Michael E. Horowitz announces the release of an Audit of Efforts to Safeguard Minors in Department of Justice Youth-Centered Programs.
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Showing posts with label drugging children. Show all posts
Showing posts with label drugging children. Show all posts
Thursday, March 21, 2019
Thursday, March 14, 2019
How To Make Money From Prison: Orphans, Martin Shkreli, & Drugging Children
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| https://www.orphan-star.com/ |
You mean to tell me that Little Shkreli is running a big ole pharmaceutical company all by himself from prison?
I do not believe it.
He has help.
To begin, he is just a funding keyman because he knows people who want to launder money.
You heard me.
This is an orphan drug program, where they test the drugs on tiny humans in far away lands, in exchange for food, funded through USAID, or other sophisticated financial fraud schemes.
Orphan drugs is an exclusive set of drugs for those 1 in 1,000,000 childhood diseases.
Whenever I see an orphan drug program, I immediately think of epigenetic human subject research testing, more intuitively recognized as using children of "The Poors" as lab rats, Drugging children.
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| http://druggingchildren.blogspot.com/ |
Martin Shkreli still running his drug company from prison, report says
Martin Shkreli, the disgraced pharmaceutical executive who is prison for securities fraud, still carries influence at his former drug company, now called Phoenixus AG, and may emerge from prison richer than ever, according to a Wall Street Journal report.
Shkreli and his company Turing Pharmaceuticals AG came under fire in 2015 for inflating the prices of rare drugs, including toxoplasmosis drug Daraprim, which had its price tag raised by more than 5,000 percent overnight.
In 2018, Shkreli was sentenced to prison for seven years, not for price gouging, but on conspiracy and securities-fraud charges.
Now 16 months into the sentence and equipped with a contraband cell phone, Shkreli is still running his company from behind bars, reported The Wall Street Journal.
A few weeks ago, he even called the company’s chief executive and tried to fire him, the report said, citing a person familiar with the exchange. Later, Shkreli agreed to suspend the CEO instead.
That activity could land Shkreli in trouble, the Journal reports, adding that the Federal Bureau of Investigation has interviewed associates about his role at Phoenixus.
However, Shkreli, who is 35, may find it a risk worth taking as he may even leave prison richer than when he went in, according to the Journal.
Phoenixus, in which he holds a 40 percent share, could be worth $3.7 billion by the time he is due to be freed in 2023, the report said. Plus, despite being in jail, he has been researching to acquire more rare drugs in various stages of development.
The newspaper reports that Shkreli has worked to consolidate control of the company and advised on two offers in 2018 to buy shares from existing shareholders at a steep discount.
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He also recently managed deals for Phoenixus, including a $20 million research deal with Orphan Star Therapeutics LLC to work on drug candidates for several rare diseases, and a licensing deal with Seelos Therapeutics, the Journal said.
Some of Phoenixus’ shareholders told the newspaper they were concerned about Shkreli’s influence on the company and are pushing for more transparency and a possible sale of the company. Others say they fear Shkreli may attempt to seize control of the company through complicated financial transactions.
Meanwhile, Shkreli owes the federal government at least $7.6 million and may be forced to sell some of his stake in Phoenixus.
Akeel Mithani, a Phoenixus board member, said told the Journal in an email that Shkreli “gets treated like any other shareholder” and that his cellphone use is known but limited to “business related communication” via his lawyers.
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Friday, May 4, 2018
Watch A Live CPS Kidnapping: President Donald J. Trump Proclaims May 2018 as National Foster Care Month
May is National Foster Care Month.
Have a great day!
Providing a stable, secure, and nurturing home environment is one of the greatest gifts a foster parent or guardian can give a child. This critical investment in their well-being, safety, and sense of belonging brings precious hope to children in need. We acknowledge, with gratitude, the tremendous sacrifices made by our Nation’s foster families as they open their hearts and lives and provide secure and supportive homes for the hundreds of thousands of infants, children, and youth in foster care.
We also take this opportunity to acknowledge that there is still much more we can do to prevent the abuse and neglect that forces children into foster care placements. For the fourth consecutive year, the number of children placed in foster care has increased, driven in part by the opioid crisis and drug abuse. My Administration is dedicated to bringing help and healing to families threatened by addiction so that parents and children can stay together in a safe and stable home environment.
In February, I signed into law the Family First Prevention Services Act, a law that aims to keep children at home and out of foster care by allowing States to use matching funds from the Federal Government for substance abuse prevention and treatment, mental health services, family counseling, and parenting-skills training. When it becomes necessary to place children or youth in foster care, this new law gives States incentives to reduce the placement of children in congregate care in favor of more desirable family atmospheres.
We are blessed that our country is filled with generous individuals and families who willingly welcome children in need into their homes so that they can experience loving guardianship and some of the joys of family life. Many of these heroic families provide foster care for children with complex medical and challenging psychological and behavioral needs. This month is an opportunity to raise awareness about the increasing number of children and youth entering foster care and to encourage Americans to invest in the lives of some of our Nation’s most vulnerable children and families.
NOW, THEREFORE, I, DONALD J. TRUMP, President of the United States of America, by virtue of the authority vested in me by the Constitution and the laws of the United States, do hereby proclaim May 2018 as National Foster Care Month. I call upon all Americans to observe this month by taking time to help children and youth in foster care, and to recognize the commitment of those who touch their lives, particularly celebrating their foster parents and other caregivers.
IN WITNESS WHEREOF, I have hereunto set my hand this thirtieth day of April, in the year of our Lord two thousand eighteen, and of the Independence of the United States of America the two hundred and forty-second.
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Have a great day!
President Donald J. Trump Proclaims May 2018 as National Foster Care Month
During National Foster Care Month, we reflect on the dedication of foster and kinship caregivers, faith-based and community organizations, and child welfare professionals who are improving the lives of children and youth in foster care throughout the country. Our Nation is deeply indebted to these selfless and compassionate Americans. We also observe this month, with sadness, the plight of innocent children who are in foster care because their lives have been disrupted by neglect or abuse.Providing a stable, secure, and nurturing home environment is one of the greatest gifts a foster parent or guardian can give a child. This critical investment in their well-being, safety, and sense of belonging brings precious hope to children in need. We acknowledge, with gratitude, the tremendous sacrifices made by our Nation’s foster families as they open their hearts and lives and provide secure and supportive homes for the hundreds of thousands of infants, children, and youth in foster care.
We also take this opportunity to acknowledge that there is still much more we can do to prevent the abuse and neglect that forces children into foster care placements. For the fourth consecutive year, the number of children placed in foster care has increased, driven in part by the opioid crisis and drug abuse. My Administration is dedicated to bringing help and healing to families threatened by addiction so that parents and children can stay together in a safe and stable home environment.
In February, I signed into law the Family First Prevention Services Act, a law that aims to keep children at home and out of foster care by allowing States to use matching funds from the Federal Government for substance abuse prevention and treatment, mental health services, family counseling, and parenting-skills training. When it becomes necessary to place children or youth in foster care, this new law gives States incentives to reduce the placement of children in congregate care in favor of more desirable family atmospheres.
We are blessed that our country is filled with generous individuals and families who willingly welcome children in need into their homes so that they can experience loving guardianship and some of the joys of family life. Many of these heroic families provide foster care for children with complex medical and challenging psychological and behavioral needs. This month is an opportunity to raise awareness about the increasing number of children and youth entering foster care and to encourage Americans to invest in the lives of some of our Nation’s most vulnerable children and families.
NOW, THEREFORE, I, DONALD J. TRUMP, President of the United States of America, by virtue of the authority vested in me by the Constitution and the laws of the United States, do hereby proclaim May 2018 as National Foster Care Month. I call upon all Americans to observe this month by taking time to help children and youth in foster care, and to recognize the commitment of those who touch their lives, particularly celebrating their foster parents and other caregivers.
IN WITNESS WHEREOF, I have hereunto set my hand this thirtieth day of April, in the year of our Lord two thousand eighteen, and of the Independence of the United States of America the two hundred and forty-second.
DONALD J. TRUMP
Saturday, April 21, 2018
Baby LK Report: Child Abuse Propaganda Month - Day 22, April, 2018
The official podcast of www.LegallyKidnapped.com and the only place to get your daily dose of the LK Report on what is going on in the Child Protection Industry.
Remember, it can happen to you.
Links to all sources may be found at Legally Kidnapped and
DruggingChildren.
Happy Child Abuse Propaganda Month!
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Friday, April 20, 2018
4/20 - Legally Kidnapped Report for April 20th, 2018
The official podcast of www.LegallyKidnapped.com and the only place to get your daily dose of the LK Report on what is going on in the Child Protection Industry.
Remember, it can happen to you.
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Sunday, November 13, 2016
An American Tragedy: Child Trafficking Secrets Revealed Featuring Beverly Tran
I am not a doctor, but that is an entirely different story for another time.
This is an interview I did in 2013 with some behind the scenes producers of PBS on the corruption within the child welfare system.
It looks like I have a temp plate for speeches, lol.
It looks like I have a temp plate for speeches, lol.
I give special thanks to Alan Licari of the United Earth Fund and Constance Cumbey for all your work in exposing the child welfare system.
"I'm on a mission..."
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Thursday, April 21, 2016
Michigan Medicaid Child Welfare Audit Neglects Foster Kids
I am going to just cut to the chase.
The only reason Michigan Children's Special Health Care Services passed its audit with flying colors, meaning no material conditions were found, is because you cannot audit foster care.
Yes, that is correct. Foster care is a privacy-protected state run program, for the best interests of the child, of course which means there is no ability to even properly conduct random sampling, let alone verify the legitimacy of services and billing.
Then, the audit reported that, as of June 2015, there are 4,005 delinquent accounts totalling $1,434,633 which should be referred to the Department of Treasury for collections.
For starters, if an individual, mostly parents, qualify for the this Medicaid funded program, more than likely, there is a strong possibility, the cannot afford to make the payments.
Remember, Children's Special Health Care Services provide services to children in poverty.
Poverty means they cannot afford traditional insurance.
Then, the audit neglects to state that this child welfare program also covers special health care for children in foster care, and everyone knows, you cannot audit foster care, particularly mental health services.
This would mean that the parents who have had their children placed under the auspices of the state, face the financial gauntlet of paying for billings of the foster care services or face termination of parental rights.
Then, my favorite question to beg is, "If the state collects the reimbursements of services for a child in foster care from the original parents, does this mean the state reimburses Medicaid?"
Quintessentially, this audit is fallacious crap.
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| Michigan's Children's Special Health Care Services Audit 2016 |
The only reason Michigan Children's Special Health Care Services passed its audit with flying colors, meaning no material conditions were found, is because you cannot audit foster care.
Yes, that is correct. Foster care is a privacy-protected state run program, for the best interests of the child, of course which means there is no ability to even properly conduct random sampling, let alone verify the legitimacy of services and billing.
Then, the audit reported that, as of June 2015, there are 4,005 delinquent accounts totalling $1,434,633 which should be referred to the Department of Treasury for collections.
For starters, if an individual, mostly parents, qualify for the this Medicaid funded program, more than likely, there is a strong possibility, the cannot afford to make the payments.
Remember, Children's Special Health Care Services provide services to children in poverty.
Poverty means they cannot afford traditional insurance.
Then, the audit neglects to state that this child welfare program also covers special health care for children in foster care, and everyone knows, you cannot audit foster care, particularly mental health services.
This would mean that the parents who have had their children placed under the auspices of the state, face the financial gauntlet of paying for billings of the foster care services or face termination of parental rights.
Then, my favorite question to beg is, "If the state collects the reimbursements of services for a child in foster care from the original parents, does this mean the state reimburses Medicaid?"
Quintessentially, this audit is fallacious crap.
HAPPY CHILD ABUSE PROPAGANDA MONTH
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Saturday, July 25, 2015
The Multi-billion Dollar Industry of Warehousing Children
State laws hiding child abuse in foster care are inclusive of all the States.
What goes on behind the closed doors of foster care is excluded and exempted from public scrutiny, the same way fraudulent billing of Medicaid pays for the horrific treatment of children in these restrictive institutions.
Another reason the States will make no movement to introduce sunshine policies is because of the push for privatization.
Many facilities are religious-based, with a secondary level of inpenetrability against audits or even contract compliance.
By privatizing child welfare services, the agencies not only self-report, but they handle internal complaints.
Think of it like this: If a child wants to file a complaint of abuse against a staff, the child would have to file the complaint with the staff person who engaged in the transgression.
Many children are placed in state care for the simplist reasons of poverty. The more a state cuts resources and services to families with young children, the more likely there is an increase in the rate of children being placed in care, in a system that was never designed to do much more than to bill Medicaid.
Poverty is not a crime, but according to child welfare law, it is.
Warehousing children is a multi-billion dollar industry of human trafficking which is too big to fail.
This is why there are confidentiality laws.
This is why the abuse is hidden.
An untold number of foster children in South Carolina custody are neglected, drugged, beaten and molested in group homes and institutions where the state warehouses them for millions of dollars a year at taxpayer expense.
Read the Series
Johanna Martin-Carrington, director of the Jenkins Institute for Children, said the allegations aren't true. “Children make those claims,” she said. “But we know it didn't occur.”
Institutions, such as psychiatric residential treatment facilities, are designed to offer an even higher level of care for children with more severe behavioral health needs.
Some children in group homes and institutions are considered “private placements.” Their parents retain legal custody, but have decided to place them in these facilities for treatment.
Voting is beautiful, be beautiful ~ vote.©
What goes on behind the closed doors of foster care is excluded and exempted from public scrutiny, the same way fraudulent billing of Medicaid pays for the horrific treatment of children in these restrictive institutions.
Another reason the States will make no movement to introduce sunshine policies is because of the push for privatization.
Many facilities are religious-based, with a secondary level of inpenetrability against audits or even contract compliance.
By privatizing child welfare services, the agencies not only self-report, but they handle internal complaints.
Think of it like this: If a child wants to file a complaint of abuse against a staff, the child would have to file the complaint with the staff person who engaged in the transgression.
Many children are placed in state care for the simplist reasons of poverty. The more a state cuts resources and services to families with young children, the more likely there is an increase in the rate of children being placed in care, in a system that was never designed to do much more than to bill Medicaid.
Poverty is not a crime, but according to child welfare law, it is.
Warehousing children is a multi-billion dollar industry of human trafficking which is too big to fail.
This is why there are confidentiality laws.
This is why the abuse is hidden.
An untold number of foster children in South Carolina custody are neglected, drugged, beaten and molested in group homes and institutions where the state warehouses them for millions of dollars a year at taxpayer expense.
Read the Series
Part I: Warehousing our Children: How South Carolina laws hide child abuse inside group homes
What's more, South Carolina keeps the abuse these children suffer secret by using state laws that shield group homes from almost any scrutiny.
Court records shed light on some of the worst cases, but this state-sanctioned secrecy makes it impossible for the public to weigh the difference between well-run group homes and those that resemble a Dickensian orphanage. Even parents who reluctantly send their children to these facilities for treatment can't figure out how to keep them safe behind closed doors.
When Jessica Freeman placed her daughter in Springbrook Behavioral Health last year, she had no idea the state had investigated the Greenville County home 95 times since 2000 for possible abuse and neglect — more than almost any other residential treatment facility in South Carolina. That's because the state Department of Social Services doesn't make the few records that are public readily accessible.
Freeman pulled her daughter from the facility last fall after a therapist told her that several Springbrook staff members had beaten an autistic child in an incident caught on a security camera.
“That's ridiculous,” Freeman said. “You can report a bad hamburger easier than you can report someone abusing your child.”
Springbrook administrator Mike Rowley would not discuss any specific case, but said most allegations made against the facility are cleared by the Department of Social Services.
“If we have anything substantiated, those employees are immediately terminated,” Rowley said. “We don't want them around other children.”
That's why other states have reduced their reliance on group homes by expanding foster family programs or finding relatives for these children to live with. But South Carolina has largely resisted change, dumping tens of millions of dollars every year into privately-run group homes for no other reason than that's how this state has always done it, some experts say.
“I can say, having done this work for 15 years nationally, that South Carolina is possibly the worst I've ever seen on that front,” said Ira Lustbader, the litigation director for Children's Rights, a New York advocacy group.
More than 100 group homes and institutions are scattered across the state, ranging from rural farms to sophisticated psychiatric compounds. At any given time, they house about a quarter of South Carolina's 4,000 foster children.
While group-home supporters acknowledge that some problems persist within the industry, they insist these facilities provide desperately needed services for troubled children who aren't suited for normal homes and have nowhere else to live.
But even Susan Alford, named the new Department of Social Services director late last year, finds South Carolina's numbers problematic.
“Our rate is too high,” Alford said. “We put too many children — especially in the 0 to 12 (age) range — we put too many of them in group homes. Our aim would be to try to decrease that number.”
Troubling findings
South Carolina isn't the only state faced with these problems. Published reports across the country detail a litany of horror stories in which children and teenagers in group homes have been overmedicated for mild behavioral issues, raped by their peers and lured into prostitutionwhile their temporary guardians aren't watching. But many other states are moving away from this model. Meanwhile, South Carolina continues shoveling hundreds of children a year into a system rife with complaints and concerns.
The Post and Courier reviewed lawsuits, visited group homes, filed open records requests and interviewed dozens of state leaders, child welfare experts, parents and former foster children for this series. Among other things, the newspaper's investigation found:
- Nearly a quarter of the children under 13 years old who entered the foster care system in 2013 were placed in group homes and institutions in South Carolina — by far the highest placement rate for this age group in the United States. By comparison, only 2 percent in Tennessee and 3 percent in North Carolina were placed in similar settings. The national average is 4 percent.
- Some children live for months, even years, in group homes because South Carolina fails to recruit enough foster families and the state pays them so little to participate. Some foster parents are paid less than $13 a day to raise a child.
- The South Carolina Department of Social Services spent $28.1 million in 2014 placing children in group homes — more than five times the amount the agency paid foster families. Group homes earn at least $86 per child per night.
- The Department of Social Services reviews hundreds of allegations of child abuse and neglect in group homes, institutions, foster homes and day care facilities every year, yet the agency's team of 10 investigators rarely finds enough evidence to support those claims. The state has investigated 484 allegations of abuse and neglect in group homes and institutions in the past five years, but has only been able to find evidence to prove 44 cases.
- South Carolina makes it easier to know which restaurants are infested with cockroaches than to pinpoint where children have been neglected, or worse, physically and sexually abused.
- Court records allege children who disclose that they've been abused in group care — by adults and each other — are often ignored because state caseworkers are so overloaded that they don't have time to weigh the allegations.
'Dangerous deficiencies'
In January, Children's Rights and the South Carolina Appleseed Legal Justice Center filed a federal lawsuit against South Carolina on behalf of 11 foster children who allegedly suffered from the Social Services agency's “dangerous deficiencies.”
The complaint contends children were abused, overmedicated, separated from their siblings, kept in solitary confinement, fed moldy bread — and the worst of it happened in group homes.
One 16-year-old girl reported that children at the Jenkins Institute for Children in North Charleston hoarded food because they were “frequently deprived.” The group home denied her medicine and feminine hygiene products, and she said a maintenance worker there asked her to take naked pictures of herself on a cellphone, according to the lawsuit.
The lawsuit also alleges that a teenager at Epworth Children's Home in Richland County was prescribed a “powerful psychotropic medication for the first time in his life.” The drug is used to treat bipolar disorder, even though the child had never been diagnosed and hadn't received a mental health evaluation at the group home, the complaint contends.
At Helping Hands, a group home in Aiken County, the lawsuit claims that a 9-year-old boy's toothbrush was smothered with feces.
Epworth Children's Home and Helping Hands did not respond to messages about the lawsuit.
The original complaint also contends that several unnamed group home employees and state caseworkers did nothing when some children tried to report the abuse. One caseworker allegedly told a child, “She had a lot of children on her caseload and so was limited in what she could do to help her,” the lawsuit stated.
Paula Fendley is the executive director for the Palmetto Association for Children and Families, an organization that represents many group homes in South Carolina. She said similar cases filed by Children's Rights in other states have been settled before trial.
“You can allege anything in a lawsuit, but you have to be able to prove it,” Fendley said. “If these things are, in fact, true, then I guess all of that will come out in the court.”
Most children in group homes in South Carolina have been placed there by the Department of Social Services as part of the foster system.
Institutions, such as psychiatric residential treatment facilities, are designed to offer an even higher level of care for children with more severe behavioral health needs.
Some children in group homes and institutions are considered “private placements.” Their parents retain legal custody, but have decided to place them in these facilities for treatment.
Haley's office directed questions about the lawsuit to the Department of Social Services.
Alford would not discuss the pending litigation. “Those are things that I just can't talk about,” she said.
Funding foster families
The federal lawsuit hinges on the widely-accepted premise that social services caseworkers in South Carolina are overwhelmed with work. They don't have time to keep track of all the children that they're charged to protect.
A Legislative Audit Council report published last year shows more than 30 percent of caseworkers statewide were each assigned at least 50 children to monitor, and a few were assigned more than 75. The Child Welfare League of America, a national advocacy group, recommends each caseworker manage no more than 17 families per month.
The Legislative Audit Council report and a string of child deaths prompted Statehouse hearings and calls to reform the child welfare agency. Former DSS Director Lillian Koller, who tried to scale back the number of foster children in group homes, resigned under pressure last year.
Still, the General Assembly has failed to pass any sort of major legislation to reform the Department of Social Services.
“It's not something that legislators get excited about because there's no glory in this,” said Sen. Katrina Shealy, R-Lexington, a member of the Senate DSS Oversight Committee.
“I know that everybody wants to talk about roads and jobs, and we do need to talk about those things and those are important, but if we don't save our children, we don't need our roads.”
Appleseed Legal Justice Center Director Sue Berkowitz said the Legislature needs to broaden its probe into the state agency because child deaths aren't the only problem it faces.
“There's so much more going on,” she said. “What hasn't been focused on is what's happening to our kids once they go into the system.”
Data provided by the Department of Social Services shows about a quarter of the 4,000 foster children in South Carolina lived in a group home, an emergency shelter or an institution on April 1. Experts, including the Department of Social Services director, say that's too many.
“The goal in child welfare is for you, as much as possible, to keep kids in families,” Alford said. “If you can't keep them with their biological family or put them in kinship care, then you're looking at foster care as the next best alternative. That should be your first priority.”
A national report published by the Baltimore-based Annie E. Casey Foundation this year said group homes aren't designed to offer the “individualized nurturing” that children need.
“In many cases, a child ends up living in a group placement simply because an agency has not found an appropriate facility,” the report's authors wrote.
On May 1, 2,310 foster homes were licensed to accept children in South Carolina — too few for the nearly 4,000 children in the system. But the child welfare agency can't recruit enough families, partly because they're paid so little to participate. Foster parents only make between $12.77 and $17.27 per child per night — no more than $6,303 a year to clothe, feed and care for a child.
In response to a public records request filed by The Post and Courier, the Department of Social Services said it spent $28.1 million in the 2014 fiscal year to house children in group homes and institutions, but only $5.5 million on foster families.
Critics argue it makes no sense that the state spends more than five times the amount of money to house less than a quarter of all foster children in group homes because many of them shouldn't be there in the first place.
“It's bad for kids, but it's also a total waste of taxpayer money,” said Lustbader, of New York's Children's Rights. “That's the part that doesn't get as much attention as it deserves.”
Some group facilities for children earn additional income from other agencies. The state Medicaid agency, for example, spent $23 million during the 2015 fiscal year on South Carolina children in psychiatric residential treatment facilities, which offer the highest level of care.
Most “Level 3” group homes — a step down from residential treatment facilities — pull in $151 per child per night, or more than $50,000 per child per year. “Level 1” and “Level 2” group homes largely accept children without any psychological problems and earn either $86 or $98 per child per night.
Meanwhile, a 2012 national report shows only five states paid foster families lower rates than South Carolina. Even some group-home advocates acknowledge these foster family payments aren't sufficient.
“It's less than you would pay to board your dog,” said Deborah McKelvey, the executive director of Windwood Farm, a combined “Level 3” group home and psychiatric residential treatment facility for boys in Awendaw.
South Carolina needs more foster families, she argued, but some group homes offer children a measure of security that a traditional family can't provide.
“I know the national picture says children under 12 shouldn't live in a group setting,” she said. “I say children under 12 frequently are too afraid to bond with a family. They feel safer in a group setting where they know somebody is awake 24 hours a day watching their back.”
Children eat family-style meals together at Windwood Farm, she said. They go to the beach. Windwood almost resembles summer camp, complete with an obstacle course, ponds for swimming and fishing, and a fitness trail, she said.
Jody Tamsberg, chairman of the Windwood Farm board of directors, said that even though South Carolina agencies pay Windwood significantly more than foster families to care for children in state custody, those payments don't cover its bills. The nonprofit group home still must raise at least $500,000 a year to break even, he said.
“I love good foster families and there are lots of them, but even the good ones, they can't take a kid that's been abused, that's on eight medications, that's totally out of control,” Tamsberg said. “There's got to be a place where they can come, stabilize, be safe and have skilled professionals — nurses and doctors — tend to them.”
Brendin and Faith
Brendin Cecere and his mom, Faith Rice, moved out of their Summerville house right before Thanksgiving three years ago following a physical fight between Rice and her ex-husband. The ordeal was particularly traumatic for Brendin, who is diagnosed with autism spectrum disorder.
“Brendin's whole world that he knew was done. Everything that was familiar — his routine, his home, his neighborhood — everything that he was familiar with, with the exception of school, was out of sorts for him,” Rice said. “By January, he pretty much broke down.”
Brendin, now 13 years old, threatened his mom with a knife. He hurt the dogs. He threatened to hurt himself, too.
“At that point, there wasn't anything more I could do but place him in a facility,” Rice said. “As much as it killed me, there was nothing more I could do.”
Brendin spent nine months at Three Rivers Behavioral Health, a psychiatric residential treatment facility near Columbia, and more than a year at Willowglen Academy, a similar facility in Kingstree. Rice believes he was abused at both homes.
At Three Rivers, Brendin's arms and chest were bruised, he told her, by a nurse who hit children with an open hand.
At Willowglen Academy, Brendin said a staff member broke his arm.
The Department of Social Services investigated Brendin's allegations at Willowglen Academy but determined his claims were not credible, Rice said. The group home told Rice that he fell out of a window and that children with behavioral issues or special needs like Brendin tend to embellish the truth.
“I said, 'What about these other kids that can't defend themselves, who are not verbally expressive like my son?'” Rice said.
She couldn't even get a copy of the official 11-page state investigation into Brendin's injury, she said. A Department of Social Services supervisor in Williamsburg County told her the document was protected by state law because the case was determined “unfounded.”
Three Rivers Behavioral Health and Willowglen Academy, both owned by out-of-state, for-profit corporations, did not respond to questions about Brendin.
The Department of Social Services opened 100 investigations into alleged abuse and neglect at multiple Willowglen Academy facilities and 97 investigations at Three Rivers since 2000, but the agency would not tell The Post and Courier how many of these allegations it could prove.
Brendin left Willowglen Academy late last year to live with his grandparents in Simpsonville. Rice, who was recently diagnosed with cancer, didn't feel safe choosing another group home. She's still trying to figure out what really happened last fall.
“I spoke to the SLED (State Law Enforcement Division) department. I spoke to Nikki Haley's office, who bounced me to Lindsey Graham's office,” she said. “Both offices told me they are not able to handle cases like this.”
'Looking for loopholes'
The South Carolina Department of Social Services receives hundreds of reports alleging abuse and neglect in foster homes, institutions, group homes and day care centers every year. But 10 years of DSS data shows the department rarely finds sufficient evidence to prove that a child has been abused in one of these “out-of-home” settings.
In 2010, for example, the department investigated 132 reports of abuse in group homes and institutions, but found enough evidence to prove only six cases. In theory, some cases were handed to local law enforcement agencies for investigation. But the Department of Social Services would not tell The Post and Courier how many abuse reports were handled by police or which agencies were involved.
Four years ago, this prompted some child advocates in South Carolina to question if these reports were always properly investigated. They wanted to know why the number of “founded” cases was so low.
The South Carolina Citizen Review Panels, three independent groups set up to evaluate child protective services, were particularly worried by a report that boys in a group home were sexually abusing each other as an initiation ritual.
At the time, Social Services explained that the incident was not “indicated,” or proven, by its Out-of-Home Abuse and Neglect division because child-on-child abuse is not specifically addressed in state law.
“They were looking for loopholes so they don't have responsibility. That's just crazy,” said Donna Xenakis, a former chairwoman of the Lowcountry Citizen Review Panel.
Only 13 reports of abuse in group homes and institutions were determined “indicated” or “founded” last year.
A team of 10 investigators at the Department of Social Services examined fewer than half of all reports filed in the 2014 fiscal year for out-of-home abuse and neglect. Some of the reports were “screened out,” the agency explained, because they did not meet the “statutory criteria” to warrant an investigation.
'Never going to change'
Jessica Freeman's adopted daughters Jaylin and Olivia were discovered bound together with a bungee-cord in their Tennessee home before they were taken into state custody more than 10 years ago.
“Jaylin came to me at 5 years old. She weighed 22 pounds and had STDs,” Freeman said.
Olivia, 4 years old at the time, weighed 23 pounds and also was sexually abused.
“They didn't talk,” she said. “They weren't potty-trained.”
The girls, now teenagers, require out-of-home treatment in group facilities in North Carolina.
“Both of my girls are going to need care like this for the rest of their life,” Freeman said. “It's overwhelming, as a mom, because you want to protect them and you want to keep them safe and you reach a point when you can't do that anymore.”
Last year, Jaylin lived at Springbrook Behavioral Health in Upstate South Carolina until her therapist told Freeman that staff members beat an autistic child in front of other children in the gymnasium.
“The reason why this stuff continues is because the children don't have a voice to speak up,” Freeman said. “I think as long as people are quiet it's not going to get any better.”
Mike Rowley, the administrator for Springbrook, said the facility takes every allegation seriously and self-reports any suspected child abuse case to the South Carolina Department of Social Services.
“I don't think there's anything we do that should be secretive,” Rowley said. “It's a great place for kids.”
The Department of Social Services denied an open records request filed by The Post and Courier to review any “Out-of-Home” abuse reports, even reports that determined abuse allegations in the group homes were valid. State law exempts these documents from disclosure, the agency's lawyer said.
“Confidentiality is such a big thing in child welfare,” Alford said. “By statute, a lot of what we do is not considered to be public knowledge. That's one barrier. I think the department is trying to be a lot more transparent.”
Alford acknowledged that potential child abuse in these facilities keeps her up at night.
“We have to be concerned with their safety all the time,” Alford said. “We're legally responsible for that by statute. We're morally responsible for it. Of course it concerns me.”
Berkowitz, the Appleseed Legal Justice Center director, said the Department of Social Services needs to admit its problems before the agency can solve them. She doesn't trust the department's own data.
“These are our poorest kids, our most vulnerable kids,” Berkowitz said. “I have heard so many people over the years and seen so many reports. 'We're going to fix this. We're going to fix that.' And I just think unless there is some structure that will require this to happen it's never going to change.”
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Saturday, May 2, 2015
According to Congress No One Cares About the Kids
According to the Government Accounting Office:
"There are no Federal Medicaid requirements regarding the appropriate prescribing of SGAs (Second Generation Antipsychotropics) to children."
According to HHS it is allowed to use foster children as test subjects for human research and billed to Medicaid:
"In addition to the provisions for waiver contained in §46.116 of subpart A, if the IRB determines that a research protocol is designed for conditions or for a subject population for which parental or guardian permission is not a reasonable requirement to protect the subjects (for example, neglected or abused children), it may waive the consent requirements in Subpart A of this part and paragraph (b) of this section, provided an appropriate mechanism for protecting the children who will participate as subjects in the research is substituted, and provided further that the waiver is not inconsistent with federal, state, or local law. The choice of an appropriate mechanism would depend upon the nature and purpose of the activities described in the protocol, the risk and anticipated benefit to the research subjects, and their age, maturity, status, and condition."
According to Congress, no one cares about poor kids because there are no civil rights in foster care and there is too much money to be made.
Voting is beautiful, be beautiful ~ vote.©
"There are no Federal Medicaid requirements regarding the appropriate prescribing of SGAs (Second Generation Antipsychotropics) to children."
According to HHS it is allowed to use foster children as test subjects for human research and billed to Medicaid:
"In addition to the provisions for waiver contained in §46.116 of subpart A, if the IRB determines that a research protocol is designed for conditions or for a subject population for which parental or guardian permission is not a reasonable requirement to protect the subjects (for example, neglected or abused children), it may waive the consent requirements in Subpart A of this part and paragraph (b) of this section, provided an appropriate mechanism for protecting the children who will participate as subjects in the research is substituted, and provided further that the waiver is not inconsistent with federal, state, or local law. The choice of an appropriate mechanism would depend upon the nature and purpose of the activities described in the protocol, the risk and anticipated benefit to the research subjects, and their age, maturity, status, and condition."
According to Congress, no one cares about poor kids because there are no civil rights in foster care and there is too much money to be made.
Voting is beautiful, be beautiful ~ vote.©
Friday, May 1, 2015
Feds Continue To Fund Medicaid Fraud in Child Welfare
Child welfare is a secret and profitable industry, whereby the profits are generated through non-profits, mostly in the name of God, in the form of Medicaid fraud.
April is Child Abuse Awareness month, followed by May being Foster Care Awareness month, two major public marketing propaganda campaigns to secure more kids to drug and bill for revenue-generation.
What this article leaves out are the reasons why the Feds pay for drug fraud with poor children:
Photo credit: Dai Sugano/The San Jose Mercury News/Bay Area News Group
April is Child Abuse Awareness month, followed by May being Foster Care Awareness month, two major public marketing propaganda campaigns to secure more kids to drug and bill for revenue-generation.
What this article leaves out are the reasons why the Feds pay for drug fraud with poor children:
- No one questions the work of christians;
- You cannot audit God;
- It is a multi-billion dollar industry too big to fail;
- Poverty is a crime;
- Child Welfare uses racial profiling.
- Drugging kids is a cheap restraint;
- Medicaid funding authorization is a judicial determination;
- There are no civil rights in child welfare.
Feds Pay for Drug Fraud: 92 Percent of Foster Care, Poor Kids Prescribed Antipsychotics Get Them for Unaccepted Uses
Photo credit: Dai Sugano/The San Jose Mercury News/Bay Area News Group
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."
So just how far outside the bounds of sensible prescribing must a doctor be that government approval to provide antipsychotics to a 5-year-old child is somehow considered too limiting? Yet that's precisely the sort of free-fire-zone prescribing underway now for 92 percent of those kids receiving antipsychotics in foster care and the broader Medicaid program.
The Inspector General's report also noted that over half of kids receiving antipsychotics are victimized by "poor monitoring" of the drugs' risky health side effects -- which can include breast growth in boys, cardiac arrest, extreme weight gain and diabetes.
But the report and most of the few mainstream media accounts ignored altogether an even more fundamental example of failed oversight: the federal government's lax monitoring of state Medicaid programs dispensing these potentially life-threatening medications to children
Medicaid spends about $3.5 billion a year on antipsychotics for all ages, largely for unaccepted uses, with nearly 2 million kids prescribed them. Nationally, about 12 percent of all the nation's 500,000 foster care children have received Medicaid-paid antipsychotics at some point, often because they haven't been offered proven, "trauma-informed" intensive therapies, according to Kamala Allen, director of Child Health Quality for the Center for Health Care Strategies.
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. Even so, "Prevention of [improper] payment [is] beyond our statutory authority," HHS's Center for Medicare and Medicaid Services (CMS) insisted in response to a related 2011 Inspector General report about massive overprescribing in nursing homes.
With that sort of philosophy, 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," says Bill Grimm, a senior counsel with the San Francisco-based National Center for Youth Law (NYCL) that has launched a PsychDrugs Action Campaign, now focused primarily on pending reform bills in the California legislature. "A mere 8 percent of the youth are receiving these drugs for 'medically accepted conditions,' so why is the federal government paying for the rest of them?" The agency within HHS charged with overseeing the joint federal-state Medicaid program, CMS, agreed to what Grimm and other critics see as mild suggestions from the IG to step up monitoring of pediatric antipsychotics, echoing the low-keyed stance of the GAO last year.
Facing little in the way of public accountability, officials at CMS and the sister Administration for Children and Families (ACF) overseeing foster care declined repeated phoned and emailed requests from me for comment on the specific, mounting criticisms of their prescription drug monitoring.
(They did send a few emails containing their assorted requirements that state governments send back their plans of "action." But these "protocols" don't require any specific, measurable goals or face any federal prescribing targets, mandates, sanctions or accountability, notes Anna Johnson, a policy analyst with NYCL. "Anything that the states copy and paste to send in will be approved," she says, describing what she sees as essentially a "toothless" charade.)
This lack of rigorous enforcement is especially disturbing in light of the real-world experience of clinicians who are seeking to help kids with emotional problems even as they've already been horrifically damaged by overdrugging. "I've certainly seen obesity up to a 100-pound weight gain in six months. Boys with gynecomastia [breast growth] have had breast lumps and have been lactating, and some of them have had mastectomies," says Harrisburg-based psychiatrist Dr. Stefan Kruszewski, who is also noted as a successful whistleblower in four separate lawsuits challenging illegal marketing of antipsychotics and dangerous psychiatric care. (That pattern was also involved in his own wrongful firing by a Pennsylvania welfare agency in 2003 after he reported medication-related deaths.)
"Imagine trying to be a 17-year-old black male in inner-city Philadelphia with breasts so large you should be wearing a D-cup bra -- and then trying to get along with your peers," he points out. "My introduction to this was a 16-year-old African-American boy and when I asked him to take off his shirt, he had massive breasts. He had been prescribed Risperdal for sleep for three years by his family doctor."
Federal Cheerleaders for Flawed Texas Response to Drugging Crisis
So just how bad is federal oversight? 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; they were subsequently revamped by state experts and replaced in 2013 with tougher standards that only began to take effect early last year.
Amazingly, 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.
Even so, the state has made some progress in recent years reining in psychotropic use. State officials and even outside reform advocates proudly note that the use of such drugs by foster care kids for more than 60 days dropped from 30 percent in 2004 to just under 20 percent in the fiscal year ending in August 2013. Professor F. Scott McKowan, the director of the Children's Rights Clinic at the University of Texas Law School, declares, "Our guidelines were the best in the nation when they came out [in 2005] and they've only gotten stronger. We did have a problem and we did something about it."
This sort of provincial pride, though, downplays some stubborn problems, such as the fact that nearly a third of Texas foster care kids of all ages are still placed on psychotropic medications for some period of time. In addition, the percentage of children 2 and under getting psychiatric drugs rose nearly 50 percent between 2005 and 2013, the years when the ballyhooed reforms were put in place -- and today, an alarming 62 percent of all foster care teens are on psych meds, with nearly two thirds of those medicated youth on antipsychotics. Strikingly, that is a rise from the 58.2 percent of foster teens using psych drugs in 2008 cited in the shocking 2011 GAO report that prompted national cries for reform.
Indeed, after nearly a decade of hyped reforms, by 2013, just over half of the Texas foster care kids getting psychotropic meds were still receiving antipsychotics, mostly for unproven and unaccepted uses. These off-the-rails practices are common in all states, but even amid a grim national picture, Texas stands out: Its antisychotic use is higher than the national average of 42 percent for medicated foster care children. (On the plus side, the total long-term use of antipsychotics, 60 days and over, has dropped about a third for foster care kids since 2004.)
"Kids' bodies aren't meant to take that many meds," says Susan Rogers, a leading reformer who served on the board of the Texas Federation for Children's Mental Health and was a foster care parent for nearly 30 years. Texas removes relatively fewer kids from their homes to live with strangers than most other states, so there is a higher proportion of those in Texas foster care who are more seriously disturbed than such children in other states, Texas officials argue. In some ways, Rogers found that to be true: "The severity of the kids' problems increased every five years and it got to the point we were running a mental health facility," she says, who gave up with her husband in 2011 after they couldn't handle a psychotic teen they took in who also sought to wreck their long-standing relationships with foster care officials.
"We would take in kids so strung out and crazy on meds that we had to try to make their psychiatrists back off," she says. Yet before she ceased being a foster parent, she found that state-funded psychiatrists and social workers were too often indifferent to the disastrous side effects of the antipsychotics they gave to troubled kids who shouldn't have gotten them in the first place. "We had a foster daughter who blimped right up on Risperdal, gaining 60 pounds and who was so miserable she became anorexic," she recalls. "I had to buy her a totally new cheerleader's uniform."
Yet the child's psychologist, psychiatrist and social worker all insisted that she just keep taking the "wonder drug" Risperdal that, it turns out, had been fraudulently marketed to Texas Medicaid and promoted by drug industry-funded influential doctors throughout the state. "The psychiatrist wouldn't take her off this, and I said I'm going to do this anyway even if I lose my license [to provide foster care]," she says, noting that she had to slowly taper her off the medication and work extra hours with the school system to ensure the girl got added therapeutic services. "I'd rather have her on nothing and be crazy than be like this," she told the professionals who didn't seem to know much -- or care -- about what was happening to the distraught girl.
"We were screwed by the state," she says now of the apparently corrupted practices and rigged protocols that harmed her foster children.
Even though Rogers averaged about four foster kids at a time, another key factor driving the relatively high percentage of kids on psychotropic medications in Texas is the continuing use of larger "congregate care" settings for many Texas foster care children. "I don't believe we are making progress, and we don't know what types of non-pharmaceutical services these children are getting," says Katherine Barillas, a policy fellow with the reform organization One Voice Texas. "What are we doing to ensure that children in foster care are getting appropriate, trauma-based assessments, not just psychological diagnoses that lead to medications?" But the role of larger group homes and facilities clearly isn't the sole explanation, because, by some measures, they comprise only about 12 percent of foster care placements.
The most significant reform in Texas to monitor, track and provide care has been the centralized role since 2008 of a managed health care firm, STAR Health. Using an electronic "health passport" and a series of medication assessments triggered by excessive prescribing, it has been hailed recently by some experts as a national model for its multi-level reviews.
But all that wasn't enough to protect 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:
A University of Texas Health Science Center resident moonlighting on a weekend shift prescribed Rodriguez a 1-milligram dose of Risperdal, another antipsychotic. When Rodriguez refused to take the pill, [the resident] gave her a 20-milligram shot of Geodon instead.
Three hours later, nurses found Rodriguez in her bed, unable to speak or move, with "shallow and labored" breathing. Due to a stunning breakdown in communication, as evidenced by facility records detailed in court, it took nearly two hours for an ambulance to show. When paramedics arrived, Rodriguez couldn't move her limbs and had cold, clammy skin. She gasped for air. Her lips were pale, and her blood pressure had tanked so low the paramedic couldn't get a reading.
Emergency room doctors later determined Rodriguez suffered from a cardiac arrhythmia that triggered a full-blown heart attack. She slipped into a coma and died the next day.
Her death took place when the Texas foster care guidelines and STAR Health were, in theory, all supposed to offer some level of protection. The prescribing doctor, now in private practice, and the treatment center have declined to comment on the tragedy. A year later, there were no major revisions offered in the new prescribing guidelines issued in 2010.
But the continuing dangers facing Texas foster care children shouldn't have been surprising to anyone paying attention to the dubious make-up of that 14-member "working group" designing the guidelines that were hailed by the federal government. Two of the 2010 foster care panel's most influential researchers, Dr. Peter Jensen, the founder of Columbia University's children's mental health research center, and M. Lynn Crimson, dean of the University of Texas's College of Pharmacy, were previously cited by the Texas Attorney General in its fraud lawsuit's court documents because they were paid by Johnson and Johnson to help lay the groundwork for an earlier set of corrupt psychotropic guidelines known as TMAP thatlooted Texas Medicaid and 16 other state programs. (Both have declined to talk to the press, including me.)
A third panelist, Dr. Charles Fischer, a child psychiatrist at Austin State Hospital, was fired in November 2011 because of allegations that he had molested teenage boys at this hospital during "counseling" sessions over a 20-year period, according to a Texas Medical Board order that temporarily suspended his license. Presumably, his alleged victims/patients may have been made more pliant by all the psychotropic medications he prescribed, but that wasn't addressed in the board's findings. One of the seven cases it described:
Patient 4 was a patient at the Austin State Hospital in 2004. Respondent [Fischer] was treating Patient 4 for psychological issue including past sexual abuse by a family member. At the time of his admission Patient 4 was approximately 15 years of age. During counseling sessions with Patient 4, conducted in Respondent's office behind a closed door, Respondent forced Patient 4 to perform oral sex on him. Respondent also performed oral sex on Patient 4.
Fischer was indicted in June 2012 on multiple child sex crimes involving five youthsunder his care and the case is still pending, with a pre-trial hearing set for late April. Fischer has denied wrongdoing and his latest attorney, "Gerry" Morris, declined to comment. His bail was revoked following an arrest in January 2013, when he was charged with public lewdness after being caught having sex with an adult in a park.
Virtually all of this has been public knowledge, easily available to federal officials. His firing in late 2011 -- along with the allegations of ethically questionable shilling for Johnson and Johnson raised against his two co-panelists -- were well publicized before the federal government in April 2012 started promoting in memos, conferences and webinars the apparently sham Texas guidelines the three helped craft. "Those three panel members who drafted the guidelines were ridiculous!" says Anna Johnson, the NCYL policy analyst, who was so alarmed by federal support for the Texas program that she and her colleagues sought to warn California officials and others. "Why the Texas Parameters are Not Safe and are Not Enough," one memo they drafted was headlined. "Texas parameters should not be adopted by California or other states," the document read, citing such flaws as allowing five psych drugs at one time before any review was triggered, later lowered to four in 2013.
State officials reject claims that the Texas foster care guidelines have been ethically compromised or undermined at any time. Indeed, the UT pharmacy dean, M. Lynn Crimson, still took his usual leadership role on the panel shaping the state's latest guidelines. Dr. James Rogers, the medical director of the state Department of Family and Protective Services, says of all of the guideline versions, "They've been significantly helpful. We reduced the use of meds, and they've been recognized by the Rutgers Center for Education and Research on Therapeutics as a national model." He dismisses with a laugh the ethical questions raised in the Texas Attorney General's lawsuit citing the drug industry-funded panelists: "That was just part of a lawsuit and the way it was handled by the prosecution. You know about lawsuits." He proclaims, "I can't imagine a better situation than we have here in Texas."
Still, the two Big Pharma-paid researchers were in the news again by January 2012 when the Attorney General went to trial against Johnson and Johnson, seeking $1 billion in damages. On the day the trial opened in Austin, the Dallas Morning Newsoutlined the J&J marketing scheme that masqueraded as "evidence-based" medicine offered in a fabricated algorithm of choices favoring the expensive new antipsychotics. The official name for these authentic-seeming guidelines was the Texas Medication Algorithm Project (TMAP). Indeed, the ruse worked so well that another HHS division, the Substance Abuse and Mental Health Services Agency (SAMHSA), adapted TMAP as part of its national evidence-based "toolkit" project and supported it even after the scheme was exposed in The New York Times in 2004, but ultimately disavowed it over a year later. It was first uncovered by a Pennsylvania government investigator, Allen Jones, who stumbled across a suspicious pattern of lucrative trip and perks given by drug companies to Pennsylvania state officials who influenced Medicaid drug selection.
A similar pattern seemed to be at work again for the foster care drug guidelines rolled out by Texas in 2010 and earlier years as "best practices" by some TMAP doctors and other drug company-paid influentials who had been lavished with pharmaceutical payouts once again. The news accounts were especially damning for the respected academics involved in both the foster care and TMAP guidelines panels. A shocking 86-page expert report for the Texas AG by Columbia University Medical School professor David Rothman ripped the veil off the alleged shady hustling of doctors trading their prestige for drug company money and gifts. As The Dallas Morning News reported on the esteemed university pharmacist and foster care panelist, M. Lynn Crimson:
[He was] a professor and member of the TMAP advisory panel in the mid-1990s when he "cultivated a financial relationship with J&J, accepting substantial fees and honoraria and soliciting research grants from the company," according to Rothman's report. "As a result, Dr. Crismon subverted the scientific integrity of his research and educational presentations, and biased his decision-making capacity as a member of TMAP."
A key component of creating the impression of scientific evidence for both TMAP and the foster care "parameters" was a series of rigged, skewed and ghost-written studies funded by Johnson and Johnson's Janssen division. Their goal: to tout the effectiveness of Risperdal while downplaying side effects, including weight gain, diabetes and male breast growth due to elevated prolactin levels.
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. "This was the first case related to the condition called gynecomastia that went to a jury, but thousands more lawsuits are lined up in Philadelphia, California, Missouri, and other locations," The Philadelphia Inquirer reported. "J&J paid $2.2 billion in 2013 to settle federal and state criminal and civil charges related to illegal marketing of the drug, but that did not stop individual lawsuits related to adverse events."
Helping make these sorts of deceptions possible were respected researchers, such as that foster care panelist Dr. Peter Jensen, who put their names on studies as principal author that were actually churned out by J&J's ghost-writing firms. Others just took the cash and cooked up studies with positive results pleasing to Jannsen's marketers. As the Texas Attorney general explained in a filing before the TMAP fraud trial: "Defendants thus 'seeded the literature' and increased the 'noise level' in the Texas health care community, including the Texas Medicaid community, with their false and misleading tale of Risperdal's superiority to other antipsychotics and suitability for off-label use on vulnerable populations."
In articles that the federal ACF chose to ignore before trumpeting Texas's foster care guidelines, The Houston Press and journalist Allison Bass explained just how Dr. Jensen was recruited to add his weight to these schemes. Johnson and Johnson's hired ghost-writers, Excerpta Medica, went shopping for an expert to sign on to a paper proclaiming Risperdal's superiority. The pseudo-study was included in the now-discredited 2010 "parameters" report promoting polypharmacy to a foster care system already eager to drug its young charges into submission if they misbehaved. Allison Bass, author of Side Effects, about the lawsuit over Paxil's suicidal dangers, outlined Dr. Jensen's role:
In yet another egregious example of ghostwriting outlined by Rothman, Excepta Medica drafted a study purportedly showing that Risperdal was the established treatment in children and adolescents with severe behavioral disorders and then went looking for some key opinion leaders (KOLs) to attach their names to the article. They finally found Dr. Peter Jensen, a pediatric psychiatrist (who was paid more than $80,000 by J&J in consulting and speaking fees between 2002 and 2004) to attach his name to the study, which was published in The European Journal of Child and Adolescent Psychiatry in 2007, again with no acknowledgement of the ghostwriter's role. Rothman cites example after example of overlap between the ghostwriter's draft and the published piece and concludes that "the authors improperly put their name on it and failed to credit EM's work."
Ultimately, J&J settled for $158 million shortly after the TMAP fraud trial started in January 2012, looking to end the battering to its image it was taking in court -- even before Rothman was to scheduled to testify about its misdeeds.
Federal Officials: We Can't Stop Groundless Drug Spending in the States
All the Texas Attorney General's revelations about the questionable panelists or the wave of Texas overdrugging didn't change federal officials' hands-off approach to state Medicaid and foster care programs. Part of the problem, of course, is that federal Medicaid officials still insist that they don't have the legal authority to stop paying for worthless and dangerous drug uses; that's in apparent opposition to a series of federal court rulings and Justice Department fraud lawsuit concluding, as in a $2.3-billion settlement with Pfizer, that the federal government has been defrauded when it's asked to pay for drug "uses that were not medically accepted indications and therefore not covered by those programs."
On top of that, federal officials apparently believe that they can't even advise the states to stop paying for these groundless uses of antipsychotics, although states do have the option to refuse to make fraudulent drug payments. For instance, a spokesperson for the Inspector General wrote me in a statement, "Medicaid coverage of drugs prescribed for non-medically accepted uses is permissible, at State option," indicating that the federal government, in turn, has no power to halt such uses.
"This doesn't make any sense," says Toby Edelman, a senior policy attorney with the Center for Medicare Services, which has been fighting CMS's ongoing failure to crack down on an epidemic of nursing home overmedication. "We're spending so much money, and the drugs are so dangerous. Don't tell me you can't try different strategies to stop it; if one doesn't work, try another -- even if you think you don't have statutory authority." But what's especially absurd to Edelman and other critics is the notion that federal officials think they're not allowed to suggest to state Medicaid authorities to stop paying for the unaccepted uses of these and other drugs. "That's totally bogus," she points out. "To say 'it's not our responsibility' while 92 percent of the [pediatric] Medicaid antipsychotic use is inappropriate and killing children, that's not acceptable."
At the same time, Department of Justice attorneys spend years building cases that have led to $26 billion in fines and settlements from the drug industry for defrauding Medicaid and illegal marketing to doctors and agencies, although such payouts are viewed in the industry as "chump change" given the billions in revenue annually each successful drug can make in the course of a typical 20-year patent. This struggle by DOJ to recover billions in waste will never catch up with Medicaid's heedless spending on unaccepted uses of antipsychotics. "They're just pretending to address the issue of overdrugging with a wink and a nod -- the Justice Department gets billions from drug companies for causing off-label uses that aren't supported by the law, while CMS is continuing to pay for these same prescriptions," Gottstein observes.
As a result, the hard truth is that no vulnerable populations, except in a few states, are granted any meaningful safeguards. Roughly 200,000 nursing home residentsannually, Toby Edelman points out, are given these potentially life-threatening medications without medical justification despite dire FDA "Black Box" warnings and rarely enforced laws going back nearly 30 years. Meanwhile, Medicaid gives close to 2 million kids antipsychotics overwhelmingly to control "bad" behavior rather than for any proven psychiatric uses. As Dr. David Rubin, the director of the Policy Lab at the Children's Hospital of Philadelphia, told Mental Health Weekly, "The medications are being used particularly for disruptive behavior and to control the children." Yet nearly half of all kids getting the drugs aren't getting other behavioral health services such as therapy, according to research by the Center for Health Care Strategies.
California: Nearly One in Four Foster Care Teens Is on Antipsychotics
California, for example, is one state whose controls over foster care antipsychotic prescribing are supposed to be monitored by HHS's Administration for Children and Families (ACF) under a 2011 law, but the agency has simply rubber-stamped California's and other states' slow-walked foster care medication plans -- with disastrous consequences for many of its 60,000 foster care children, according to critics and youth advocates. California is typical of most states that haven't bothered yet to even develop formal plans or have just crafted feeble "guidelines" that are rarely enforced; Illinois, Oregon and New York are among the few states that have sought to do more. A shocking five-part series by The San Jose Mercury News, published last year, highlighted dangerous overprescribing that showed that thousands of foster care kids over a decade -- nearly one in four foster teens -- had been essentially "chemically restrained" for their behavior with antipsychotics drugs that left many drooling, lethargic and obese.
That, in turn, has spurred the introduction of new state legislation to promote improved monitoring, the training of staff to use alternative approaches and the strengthening court oversight of prescribers -- after the legislature ignored the same crisis a decade ago. But if it wasn't for a single dedicated reporter, Karen De Sá, an investigative journalist with 20 years of experience specializing in covering social services, and a paper willing to give her over a year to develop the game-changing series, literally nothing would be happening to stir interest in reform.
But those long-overdue changes can't come too soon for Iris Hoffman, 18, who now works with a Sonoma County-based youth advocacy group, Voices, and the state-wide California Youth Connection, working to change the ongoing government failures to protect them and remedy abusive, overmedicated care. In testimony before a state senate health committee in February, she said, "Most of those medications prescribed to me were almost forced down my throat, and there's all kinds of punishments if you refuse your medication," she recalled about her adolescence, largely spent in assorted juvenile detention facilities and large group foster homes. "It's really hard to trust someone who's forcing you to take pills that you don't feel are right for you taking," she pointed out. "Seroquel, Abilify, Ativan -- all of the things I was prescribed before I was 16 -- they never helped me heal from the trauma I suffered."
Unfortunately for young people like Iris Hoffman still in the foster care system, they're especially endangered in large group homes, says Jennifer Rodriguez, a former California foster care youth and now executive director of the Youth Law Center. "Caregivers push to have youth evaluated for and prescribed psych meds in order to suppress problem behaviors in homes and keep control and order in often chaotic, institutional settings," she pointed out at hearings in February before a state Senate committee considering a reform package; the committee indeed passed it unanimously last week. Yet despite a sweeping legal settlement roughly a decade ago that was supposed to reduce the percentage of group homes, where 40 percent of all Medicaid antipsychotic prescribing for kids is concentrated, she told me, "The rate is about the same."
Equally troubling, not much has changed on the oversight front yet. Even so, there are mounting hopes for change because of the Senate committee's support of the reform bills. If passed, those bills would also enforce another promising development: newnon-binding quality care guidelines on psychotropics issued by state health officials in tandem with advocates from groups such as NYCL. Again, this initiative likely wouldn't exist yet -- after years of foot-dragging by California officials -- if it wasn't for the pressure created by The San Jose Mercury News series. The paper, in reporting these new guidelines, pointed out, "While many youth advocates applauded the recommendations as long overdue, they say legislation in the works is needed to ensure reforms are put into practice."
The need for genuine enforcement became clearer when Jennifer Rodriguez testified about how these dangerous medication practices a decade ago caused her and other young witnesses a range of alarming problems. "Heart murmurs, rapid weight gain, fertility problems, and emotional side effects worse than the original condition prompting meds," she told legislators. But the legislators did nothing then and, in the absence of a massive grass-roots campaign this time around, they may succumb again to powerful medical and drug company forces opposed to virtually any restrictions.
After all, as the San Jose Mercury News series pointed out, drugmakers spent more than $14 million in just three years to entice 60 percent of the state's foster care prescribers in amounts twice that paid other physicians.
After all, as the San Jose Mercury News series pointed out, drugmakers spent more than $14 million in just three years to entice 60 percent of the state's foster care prescribers in amounts twice that paid other physicians.
Edward Opton, an attorney with the National Center for Youth Law's PsychDrugs Action Campaign, has underscored why foster care kids are especially vulnerable. Even though they make up just 3 percent of all Medicaid children, they account for roughly 30 percent of all Medicaid behavioral spending for kids: "Foster children are a lucrative market for psychotropic drug sales. Unlike adults, they can't say, 'No, I won't take any more of that drug,'" he wrote in a recent column on the Mad in America website, reaching out for national support for a fledgling grass-roots campaign.
The very real dangers facing young people in California were perhaps best expressed in a powerful short documentary based on the prize-winning San Jose Mercury Newsseries. "They are California's most powerless children: abused, neglected, deeply traumatized," the film's narrator begins, as photos of kids rescued from addicted, violent and sexually abusive family members unfold; then the children, now grown, tell their own stories later in the movie. "When it came to managing their complicated histories, state foster care failed to provide them with a stable home: instead it gave them a pill...We found a system dependent on quick-fix, profit-driven pharmaceuticals to control troubled children."
A Psychiatrist Battles the Drugging Epidemic
It's hard for a psychiatrist like Dr. Stefan Kruszewski to undo all the damage wreaked by overmedication when his patients come to him. "About 95 to 97 percent of the children that I treat that are getting antipsychotics are given them for reasons that aren't approved by the FDA," says the Pennsylvania psychiatrist. The Harvard-educated doctor treats poor and uninsured teens as part of his private Harrisburg practice and also oversees their care as a psychiatric medical director of two Pennsylvania-based behavioral and addiction clinical care groups. Even those young patients who had been given antipsychotics for approved but controversial pediatric uses such as bipolar disorder are usually improperly diagnosed and treated, he finds, because their associated substance abuse which causes mood swings is almost never addressed before they're dosed with antipsychotics. "It doesn't make any sense," he points out. "They're not even being screened for [illegal or dangerous] drugs."
Just as troubling, he says, are the wide range of side effects they suffer that aren't much emphasized in the new federal Inspector General's report: "Many of the young patients I've seen have cardiac and metabolic problems, elevated prolactin levels [which causes breast growth in boys], neurological problems with severe tics, severe neuromuscular disorders," he observes.
In part because of his pioneering role as whistleblower, his extensive research on medications and addiction, and his work as a court-approved expert in legal and criminal cases involving prescription drugs, he speaks with special authority and long experience about the dangers of overmedication with antipsychotics. He also serves part-time as a member of the core faculty of Johns Hopkins University's Center for Drug Safety and Effectiveness, lecturing about prescription safety and utilization.
In the early 2000s, most of his fellow psychiatrists were falling under the sway of drug-industry-fueled boosterism and payments to promote the new "wonder drugs," atypical antipsychotics. But he soon sought to expose deadly overdrugging in government-funded residential treatment programs in 2001 as a consultant to a Pennsylvania welfare agency -- and then successfully challenged his 2003 firing. He subsequently went on to help expose the illegal marketing of antipsychotics by Pfizer and AstraZeneca after being hired to lecture his peers on the drugs. For good measure, he also won a Medicaid fraud settlement against a Pennsylvania psychiatric chain for abusive and dangerous care of youth.
So it's especially to disturbing to him that neither the youth he sees, ages 12 to 19 -- about a quarter of his practice -- nor their families have been warned about the side effects or even the potential benefits of the drugs they're given. Most commonly, those antipsychotics have been Risperdal, Seroquel and Abilify, given for bipolar disorder, insomnia (primarily Seroquel) and ADHD. Surprisingly, although there have been far more lawsuits over boys' breast growth resulting from Risperdal use, he's seen more of those side effects in his patients from the heavily sedating Seroquel because it's so widely prescribed, often for insomnia.
One of the key challenges in slowing the epidemic of overmedication, Kruszewski observes, is this dilemma: "We have to overcome the expediency of giving a prescription to solve a problem that will actually make the problem worse. As long as doctors are being expedient in their prescription writing, we can't win this battle."
Can Medicaid Kids Survive the Wave of Unchecked Prescriptions?
Unfortunately for Steven Unangst, he didn't have a doctor like Stefan Kruszewski looking out for him. Just a few months ago, in December 2014, the 16-year-old foster youth died in his bed after friends and family saw him drooling and staggering around "like a drunken zombie," the San Jose Mercury News quoted his grandmother as saying. She saw him on the afternoon before he died during a supervised visit, but her pleas to the social worker to take him to the hospital were ignored. "A 16-year-old child does not just die peacefully in their sleep," Karla Garvey said later. "Nobody paid attention to this child."
A coroner's report this month found that he had ingested a deadly combination of anti-anxiety, painkillers, alcohol and anti-depressant drugs, but only one of the drugs -- Zoloft -- was formally prescribed him, the San Jose Mercury News reported. But the coroner's report said there were no signs that this was a deliberate attempt to end his own life, and his death underscores just how shoddy protections can be for those in foster care. As the newspaper reported, "The lanky, curly-haired skateboarder received no medical attention -- even though the day before he died, a social worker had difficulty waking him up and relatives later filmed him struggling to walk and even keep food in his mouth."
Other young people have somehow managed to survive the assaults of needless medication, and are turning to grass-roots activism to raise awareness about this ongoing crisis. Young adults like Cecelia Najera, 23, a speaker and advocate with California's Youth in Mind, seeks to use her own experiences to better protect others. Starting as a low-income, depressed kid at 13, also labeled as having ADHD, she kept getting plied with more and more meds but given little in the way of useful therapy. "The drugs were forced on me: 'You take these,'" she recalls. By the time she reached college in 2011, still on Medicaid, she was feeling suicidal but the college clinic's only solution was to refer her to a strip-mall osteopath who put her on high doses of the mood stabilizer Depakote and the antipsychotic Seroquel to add to the ADHD stimulant and antidepressant Prozac. "I became more suicidal and zombified," she says -- and she even suffered petite mal-type seizures. Within two weeks of starting the risky new regimen, she cracked up and had to be committed to a hospital to prevent her from killing herself. After her release, she gradually found herself by connecting to other young people with mental illness through drop-in centers and peer counseling. She still takes some lower doses of two medications, but with peer counseling and her activist work, plus volunteering at a juvenile justice center, she's found a new purpose: fighting stigma against young people with mental illness. "I'mnot my mental illness; I live with it and I thrive," she points out.
The activism by groups of former foster care youth and young people with mental illness battling overmedication is particularly robust in California. But this local and state work has become especially critical because of the political vacuum they are filling: Virtually none of the leading national health or children's advocacy groups (with the exception of the Anne E. Casey Foundation) has yet chosen to make this a top priority. As a result of this inaction, too many vulnerable children, especially in foster care and Medicaid, have no protections against risky antipsychotics and other drugs that they may not even need: "I was given all these medications, but I wasn't functioning," as one former California foster care youth who asked to remain anonymous recalls. For those still trapped in the system in her state, she says, "I need to advocate for them." But at the national level, the federal government still isn't looking out for their best interests.
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