Earlier this year, a congressional subcommittee chairman declared that "one particularly troubling health care coordination issue is the monitoring of foster children's medication."

And a year ago, the Texas comptroller decried the increasing use of psychotropic medications for foster children, noting that "the (U.S.) Food and Drug Administration has not approved most of these drugs for use in children, the effectiveness of these drugs is in question, and the long-term consequences on learning, growth and development have not been determined."

Nationwide, medical experts and lawmakers are expressing concern that the escalating use of psychotropic medications could be placing foster children at risk. From state to state — and even county to county within states — a patchwork of rules and regulations dictates when and how the drugs can be prescribed to children who are in the foster care system.

A Democrat and Chronicle investigation into the issue shows there can be distinct local variations. State data obtained under the Freedom of Information Law show, for instance, that per capita Medicaid expenditures for many psychotropic drugs for foster children in Monroe County were significantly higher than in Erie County but lower than in Onondaga County.

Social services officials in 15 states said one of their most pressing issues was "overprescribing psychotropic drugs to foster children," according to an October report from the U.S. Government Accountability Office. Officials there said New York was not one of the states.

One Congressman, Jim McDermott of Washington, said in an interview last week that he intends to hold a hearing to determine whether a federal agency should ensure medications are properly and safely prescribed to foster children.

McDermott, a former child psychiatrist, said the issue is not one that lends itself to easy or "cookie-cutter" answers.

"Basically, what we need to do is gather more information," said McDermott. "It's easy to make snap judgments on something like this. I think that would be something that's not good for kids."

New York has not had an official review of how the prescription of psychotropic medications to foster children compares with other states. But a statewide review could be forthcoming.

The state Office of Children & Family Services this month will take steps to ensure that social service officials are receiving proper consent before prescribing psychotropic medications to foster children.

OCFS officials plan to issue a directive to counties highlighting the proper consent process, said agency spokeswoman Sandra Brown.

"It's a proactive measure to put some controls on this," she said.

The agency also plans to dissect data to see whether there is a significant difference between counties in how medications are prescribed to foster children, Brown said.

Angela Burton, an associate professor of law at the City University of New York School of Law, said she will seek support for an analysis of the issue in New York, and hopes to get help from researchers and nonprofit children's rights organizations.

Burton, the former director of the Children's Rights and Family Law Clinic at Syracuse University College of Law, pointed out that other large states — including Texas and Florida — found high rates of psychotropic drug use for foster children. In response, those states have either enacted or are considering reforms.

"Our children are probably experiencing some of the same issues, and it would serve us well and serve our children well to find out what's going on," she said.

"I think clearly children are already ... the disenfranchised and voiceless members of society," Burton said. "And children in foster care and children in juvenile detention facilities are even further removed from the public eye."

Vera Sharav, the founder and president of the Alliance for Human Research Protection, said she expects the same troubling trends would be found in New York as were found in other states.

"You have to have the political will to look under the rock," she said.

GCRAIG@DemocratandChronicle.com

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Emphasis added by H4K Editor