By David Sessions
June 16, 2010
Seven-year-old Gabriel Meyers didn’t want soup for lunch one Thursday in April, 2009. When his 23-year-old foster brother sent Gabriel to his room for dumping his soup in the trash, Gabriel threatened to kill himself. He kicked his toys around his room, then locked himself in the bathroom.
Police reports say Gabriel was home sick that day from his elementary school in Margate, Fla., under the care of Miguel Gould, his foster father’s son. Around 1:00 p.m., city police responded to Gould’s frantic 911 call and found Gabriel had hanged himself.
A troubled child who had previously suffered from neglect, sexual assault, and abusive parenting, Gabriel spent the previous year shuttling among several foster parents while taking a constellation of antipsychotic medicines, including Lexapro and Vyvanse, to control his depression and attention deficit hyperactivity disorder. Like most children in Florida state foster care, Medicaid paid Gabriel’s medical expenses.
Just one month before his suicide, Gabriel’s doctor prescribed him Symbyax, an anti-depressant restricted for treatment of children. The medication’s FDA-required label features a warning that use of the drug by children or teenagers can lead to suicide.
Symbyax does not meet criteria established by Congress for Medicaid reimbursement., so it is illegal for Medicaid to pay for a prescription of the drug to a child. Sohail Punjwani, the doctor who prescribed Gabriel’s Symbyax, received a stern letter from the FDA about his history of over-prescribing mental health drugs.
According to a number of foster care experts who spoke with Politics Daily, children in foster care, who are typically concurrently enrolled in Medicaid, are three or four more times as likely to be on antipsychotic medications than other children on Medicaid. Alarmingly, many of these drugs are medically prohibited for minors and dangerous to the children taking them. Often young patients under state supervision are also prescribed three or four high-risk drugs at a time — all paid for by Medicaid.
State foster care programs and child protective services have had mixed success addressing the pervasiveness of dosing their clients with prescription psychotropic drugs. Using federal Medicaid monies to purchase dangerous prohibited prescriptions for children, which cost the government up to $600 per dose, is technically a violation of the law.
Now, the Senate Subcommittee on Oversight of Government Management, chaired by Democratic Sen. Daniel Akaka of Hawaii, has asked the Government Accountability Office to look into the drugging of foster care children. The investigators will attempt to account for estimates in the hundreds of millions of dollars of possible fraud arising from prescriptions for drugs explicitly barred from Medicaid coverage. The GAO is collecting data from Oregon, Massachusetts, Florida, Maryland, Minnesota, and Texas, to search for patterns of abuse. This effort marks the first time suspicion of Medicaid fraud related to psychotropic drugs has been examined at the federal level. According to Senate staffers working on the investigation, the committee will likely hold hearings on the matter later this year.