Scrutiny of doctors who prescribe psychotropic drugs to California foster children intensified Monday, with growing calls for regulators to consider whether financial relationships with pharmaceutical companies may be driving the excessive use of medication.
The outcry came from a leading consumer advocacy group as lawmakers stepped up their efforts to rein in reckless prescribing and the California Medical Board vowed to widen its investigation in response to this newspaper's ongoing series "Drugging Our Kids." On Sunday, the newspaper reported that prescribers in the foster care system received more than twice as much as the typical California doctor in payments from big drug companies for meals, gifts, travel, speaking and industry-sponsored research. The newspaper also found that last year doctors who prescribed the most to California foster youth, on average, accepted almost four times as much as those who fell in a lower-prescribing group.
"We've known for years that the problem of drug manufacturer payments to doctors appears to have an out-sized influence in their prescribing practices," said Carmen Balber, executive director of the nonprofit group Consumer Watchdog. "But this investigation was particularly disturbing because of the patients it affects. The conflict of interest is clear in these cases, and we think that action is long overdue."
In a letter to the California Medical Board sent Monday, Balber's Santa Monica-based organization called on the state licensing agency to expand its current investigation of doctors who may be overprescribing to foster youth "to determine if children are inappropriately being prescribed or overprescribed because of drug manufacturer payments to their physicians." Balber said the prescribing has not only cost taxpayers millions of dollars in payments for possibly unneeded drugs, but has also put the children's health at risk. The newspaper's report on industry ties, she added, "makes clear that the state has failed to take the steps necessary to protect children."
Kimberly Kirchmeyer, executive director of the California Medical Board, noted there is no law prohibiting doctors from accepting drug industry promotional funds. The newspaper found pharmaceutical companies spent more than $14 million to woo foster care prescribers from 2010 to 2013.
But the payments may constitute "unprofessional conduct," Kirchmeyer added, and that could warrant additional scrutiny. She said the agency plans to look into whether these doctors "have a reason to prescribe, are they appropriately prescribing, or are they prescribing medication inappropriately to support the pharmaceutical company?"
The medical board has been looking into whether specific doctors are overprescribing psychotropic medications to foster youth since the newspaper published its first installment of "Drugging Our Kids" in August, which revealed that almost 1 in 4 foster teens are prescribed psych meds. Many of the drugs are being prescribed to control troublesome behavior instead of the severe mental illnesses they are approved to treat. They can have debilitating side effects, such as rapid weight gain, higher risks of diabetes and severe lethargy.
The newspaper's original findings drove state Sen. Jim Beall, chair of the Senate Human Services Committee, to push for more detailed information from the state Department of Health Care Services on prescribing practices to foster youth.
On Monday, Beall, D-San Jose, met with California's director of social services, Will Lightbourne, to discuss the request he and Los Angeles Democratic state Sen. Holly Mitchell submitted to health care officials last week. The two senators have called on Health Care Services Director Toby Douglas to release geographic and demographic information on prescribing patterns, including tallies of foster children on multiple medications and high doses, as well as those being prescribed drugs for conduct "disorders" — more information than the state has been willing to release so far.
Beall said he will use the data to draft legislation aimed at improving the oversight and monitoring of psych medication use in foster care. The bill could require regular reports and analysis of county-level prescribing trends and establish a hotline for lawyers, judges, doctors and other caregivers who need guidance on medication. On Monday, after the newspaper's latest report, Beall said he also wants doctors' interactions with drug companies to be better monitored.
"The Social Services Agency should take all steps to ensure that there's no conflict of interest in medical care for any of our foster kids — and if that's happening right now, we're going to take action in the Legislature to make sure that doesn't happen," Beall said.
Marilyn Benoit — the former president of the American Academy of Child and Adolescent Psychiatry and current chair of the academy's task force that proposed guidelines on relations with drug companies — said the newspaper's unique look at foster care prescribers' link to drug companies is "concerning."
"This is a capitalistic country — you're supposed to market and advertise the products you make — there's nothing wrong with that," said Benoit, a child psychiatrist who oversees a Pennsylvania-based behavioral health center that treats foster youth. "But as prescribers, we have to be more scrutinizing and understand the difference between marketing and real scientific information about the medication we use."
Yet Benoit cautioned that although "research clearly shows that doctors can be influenced by gifts," her organization is advisory only and has no enforcement capabilities. She said doctors must take personal responsibility to draw the line. "When you're tied to the pharmaceutical industry," Benoit said, "then there could be a conflict of interest in your prescribing behavior."
Contact Karen de Sá at 408-920-5781.