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Chemical straitjackets: Lawsuit claims Missouri foster kids prescribed too many meds

Two national child advocacy organizations have filed a federal lawsuit against the Missouri Department of Social Services, alleging that children in the state’s foster care system are over-prescribed psychotropic medications with little oversight.

“They’re prescribed off-label, to control behaviors,” said Bill Grimm, an attorney for the National Center for Youth Law, which filed the lawsuit on Monday. “While many other states have instituted some sort of oversight … Missouri has very little to none of those safeguards in place.”

The suit seeks class action status. State officials declined comment,  citing pending litigation.

The five plaintiffs, identified by their initials, include 2- and 3-year-old sisters who were allegedly prescribed Risperdal, an antipsychotic not approved by the Food and Drug Administration for children younger than 5. Another plaintiff, age 12, was prescribed five medications at once, and experienced hallucinations. St. Louis University School of Law's Legal Clinics served as co-counsel. 

It’s not uncommon for children in foster care to be prescribed psychotropic drugs at higher rates than other children with Medicaid coverage, according to a federal review of other states. Many children in foster care have experienced traumatic events and abuse in their past, which may trigger a need for intensive psychiatric care, child advocates say. 

Children who move through several households over the course of their childhood may not have complete medical records, leaving doctors and foster parents in the dark.

But Missouri's prescribing practices are outside of the norm. Thirty percent of foster care children in Missouri were on psychotropic medication in 2012, according to data from Missouri’s Medicaid program that was first published by the Columbia Missourian. The national rate is 18 percent.

On a conference call, child advocates said this abnormal rate is a result of the state’s lack of oversight for prescriptions written for children in its care. Missouri has no central system to maintain medical records for kids in state care.

“There is a lack of will, there is a lack of urgency, and children are being placed in harm’s way,” said Sara Bartosz, deputy litigation director of Children’s Rights, a New York-based advocacy group. “The state agency knows it.”

Approximately 13,000 Missouri children are in foster care. All plaintiffs named in the case remain in in the state’s custody, their attorneys said.

Follow Durrie on Twitter: @durrieB

Editor's note: This post has been updated to include SLU Law. 

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Durrie Bouscaren
Durrie Bouscaren covers healthcare and medical research throughout the St. Louis metro area. She comes most recently from Iowa Public Radio’s newsroom in Des Moines, where she reported on floods, a propane shortage, and small-town defense contractors. Since catching the radio bug in college, Bouscaren has freelanced and interned at NPR member stations WRVO, WAER and KQED. Her work has aired on All Things Considered, KQED’s The California Report, and Harvest Public Media, a regional reporting collaborative.
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