Prescription for disaster: New Mexico’s lax oversight puts kids in danger

Don Usner / Searchlight New Mexico

Three of Barnes' grandsons at home.

In 2015, Jane Barnes, a research scientist in her early 60s — “a tired old woman,” in her words — was desperate to rescue her grandsons.

Their mother — Barnes’ daughter — was a meth addict; their father was a violent felon who knocked out the boys’ teeth and sent them to the hospital in need of stitches. By the time New Mexico’s Children, Youth and Families Department (CYFD) took custody, the children had been traumatized by years of domestic violence, abuse and neglect. The agency placed them in foster care, where they were abused and neglected all over again.

The older boys screamed in their sleep. The baby banged his head in the crib. All four urgently needed therapy.

What they got instead were monthly visits to a “high-risk prescriber,” Albuquerque psychiatrist Edwin B. Hall, who would soon be under criminal investigation in the overdose deaths of 36 patients and accused of overprescribing to hundreds of foster children. For the boys, Hall wrote dozens of prescriptions: for antipsychotics, mood stabilizers, anticonvulsants and sedatives, none of the drugs proved safe or effective in children so young.

The medications filled a shopping bag.

“The boys had morning meds, and at lunch, they got meds at school,” Barnes ticks down the list. “At around 3:30 or 4 they got meds. And before they went to bed they got meds. The only one who wasn’t on six or seven meds a day was the baby.”

For nearly 20 years, the world’s leading psychiatrists and researchers have condemned this practice, which is so notorious it has its own catchphrase: “Too much, too high, too young.” The Centers for Disease Control and Prevention, the U.S. Department of Health and Human Services, the National Institutes for Mental Health and the General Accounting Office all warn against giving antipsychotics or multiple psychiatric medications to children. Hundreds of medical studies confirm that these drugs can cause extreme obesity, diabetes, heart disorders, high blood pressure and irreversible tremors in children. They are also believed to harm the developing brain.

At least 44 states have introduced formal protocols or programs to boost oversight and monitoring of psychotropic drug use by children. Federal law requires such oversight. The risk of over-drugging children — particularly those in foster care and on Medicaid — is so widely recognized that most states took steps to track and reduce the problem by 2012.

Not New Mexico.

George Davis

“It’s the negligence of inattention,” says George Davis, former director of psychiatry for CYFD. “It takes monitoring, expertise and regulatory teeth to solve this problem. The state lacks all three. That’s really what’s happening.”

A three-month investigation by Searchlight New Mexico has found that the state lacks the most basic safeguards to protect children on Medicaid and in foster care. An analysis of Medicaid pharmacy claims for children 18 and under, in fiscal year 2016 (the most recent data available), revealed:  

  • Doctors in New Mexico wrote 136,000 psychiatric drug prescriptions for nearly 30,000 New Mexican children, an average of 4.5 prescriptions per child. This means that of the 305,000 kids on Medicaid in 2016, more than 10 percent of them took psychiatric drugs.
  • The most dangerous of these were antipsychotic drugs; New Mexico physicians wrote 19,300 prescriptions for Risperdal, Zyprexa and Abilify and others, including some for children under age 5.
  • Doctors handed out 70,000 prescriptions for stimulant medications to treat attention deficit disorder in 13,000 children. Medical experts say their jittery behavior is almost certainly traced to trauma; instead of masking the behavior with drugs, they need therapeutic help to recover.

Searchlight’s made numerous requests over a five-month period to interview the secretaries of CYFD and the Human Services Department (HSD): none were answered. Four public records requests yielded scant or no useful information. The state refused to provide information in Medicaid pharmacy receipts that would reveal ages of patients and the precise medications they received. In doing so, HSD cited privacy laws, though Searchlight specified it was not seeking personal information.

CYFD says it lacks the power to enact effective guidelines.

“We can advocate,” says Bryce Pittenger, director of behavioral health at CYFD. “We can submit proposals, but that final say is not ours. And that actual obligation is not ours.”

'Killing them slowly'

Don Usner / Searchlight New Mexico

Barnes with her grandsons at home.

“The leadership completely lacks the courage to take action for the protection of children,” says Davis, who, until his retirement in 2017, spent more than 10 years trying to implement medication guidelines to safeguard the children in state custody. There are about 2,500 youths in foster care annually, with some 200 more in juvenile justice lockups.

Some of the youths had psychosis — they benefited from being on an antipsychotic, Davis says. But he also saw 8-year-olds who gained 40 pounds in a single year on the drugs, and didn’t need them. “We’re killing them slowly,” he says.

Davis says he first started working on “best practice” guidelines for youths in 2006, but “I couldn’t get CYFD or HSD to publish them.” Between 2013 and 2017, he met with a task force to hammer out a more comprehensive set of guidelines intended to “red flag” doctors who prescribed psychiatric drugs to children. That, too. disappeared down a bureaucratic hole.

“Is it just incompetence or is it obstruction?” wonders Davis, a child and adolescent psychiatrist now in private practice.

Bryce Pittenger, who praises Davis for his efforts while in office, says CYFD did take action by publishing an internal document in 2016 that, she says, raised consciousness within the agency.

A child's medical cocktail

Don Usner / Searchlight New Mexico

Barnes' youngest grandson at home.

Jane Barnes was determined to do “whatever it took” to bring her grandsons home. What it took was endurance — first, to cope with a devastating string of family tragedies, and then to cope with the child welfare system. “The stupidity and the neglect and the jaded employees at CYFD that are wanting to do a good job but can’t because of the limitations set by upper-level people? Oh, it’s just unbelievable,” she says.

Between 2014 and 2016, psychiatrist Hall — now under state investigation, according to a spokesman from the New Mexico Attorney General’s office — started one of Barnes’ grandsons on Risperdal, an antipsychotic medication associated with life-threatening health problems. One of its most horrifying side effects is gynecomastia, a condition that can cause boys to develop breasts as large as DD-size. A double mastectomy is the only treatment option.

Barnes recalls tagging along on a visit to Hall’s storefront office in 2015, and says she was stunned when Hall added another drug to the cocktail. He offhandedly prescribed Lamictal, a mood stabilizer, for the 6-year-old. The drug comes with a black box warning of a severe skin reaction that can lead to blindness, organ failure and death. “Beware of rash!” Hall tossed off, according to Barnes’ recollection.

In Oct 2017, after a 17-month investigation, the New Mexico Medical Board found Hall had over-prescribed medications that led to the overdose deaths of six adult patients; his license was summarily suspended. A year later, the attorney general’s office alleged that 30 additional patients in Hall’s care died of overdoses. He is also being investigated for child abuse and Medicaid fraud, law enforcement sources say. 

Big problems, small bodies

Parents who show up in a doctor’s office with an out-of-control child are desperate for help. The child may be in danger of being suspended from school or about to kicked out of a foster home.   

Psychotropic drugs can be lifesavers, says Mark Olfson, a Columbia University psychiatry professor and leading researcher in the field. They can reduce suffering and dramatically turn a child’s life around.

“These children may be small, but they have enormous problems,” says Olfson, who stresses that the key is to prescribe wisely and with appropriate monitoring.

This off-label application is legal, but it means the medication is used in ways that aren’t FDA-approved, on populations for whom there is no proof of effectiveness or safety. As the saying goes, “children are not small adults.” The doses that help a middle-aged patient with schizophrenia might spark terribly different outcomes in a child.

In a 2010 study, researchers at Tufts University studied psychotropic medication use in children and teens in 47 states over a 10-year period. They found that its use in the general population hovered at 4 percent, while in the foster system it was high as 52 percent. In some states, more than 40 percent of foster children took three or more of the drugs.

That has been the case in New Mexico, which has had one of the highest “polypharmacy” rates in the nation. Between 2002 and 2007 (the most recent data available), the rate increased by 26 percent — making it the second highest in the country. (The first was Washington.)

Child poverty, excessive trauma, scant oversight and a severe shortage of mental health professionals have created the perfect storm in New Mexico, leaving thousands of children needing services they don’t receive, and thousands of others receiving services they shouldn’t get. Only 12 percent of the state’s psychiatric needs are met, according to the Kaiser Family Foundation.

'We're done'

Jane Barnes’ youngest grandson sits at a kitchen table tackling a bowl of pasta. “I’m going on a long, long walk today!” he announces between bites. A sense of normalcy prevails in the sunny, split-level house on a quiet cul-de-sac. His twin brothers are off at school; the 8-year-old is in a residential treatment facility.  

 Nothing about their lives has been easy since the adoptions came through nearly two years ago.

The boys have struggled with PTSD and other diagnoses, unspecified disruptive behavior disorder and attachment disorder. These problems were masked by the drugs. 

Barnes found a Santa Fe psychiatrist who assessed the shopping bag full of pills that CYFD had relinquished when she took custody of the boys. He was still overseeing their transition off the drugs when two CYFD employees paid a house call. The agency had learned what Barnes was doing and they had come, she says, to insist she follow Dr. Hall’s orders.

“I said: ‘You don’t know a thing about medications, and I’m betting your supervisors don’t know a thing about medications. And my grandsons are taking drugs they shouldn’t be. So we’re done. We’re just done.’”

It took four months to get them off the pills. Then one morning, they were eating breakfast in a restaurant when the 7-year-old looked up and said, “Eggs. Bacon.” He was moving his eyes around the room. There were breakfast foods listed on the walls in big bright letters. “Sausage!” he said. “Toast.” 

He was reading. “He hadn’t been reading before, and all the sudden he was reading,” Barnes says. “It was amazing. It was absolutely amazing. And I thought, he’s off the pills and now he can read. And I thought, he’s OK. He’s going to be OK.”

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