Colorado has poor controls over the administration of powerful psychotropic medication to youths in corrections facilities, with state officials unable to show they are doing enough to monitor for harmful side effects, according to a state report released Tuesday.
The report, which focused on the state’s Division of Youth Corrections, sampled the medical records of 60 youth offenders, 57 of whom were prescribed psychotropic medication.
“We found almost no evidence that vital signs such as blood pressure, weight and heart rate were taken when youth entered the facility or when medications were changed, in accordance with national standards,” said the report, released by the Office of the State Auditor.
Some medical monitoring did occur, but when it was recorded, it was deficient in 29 percent of cases, the report found.
The report recommended that Colorado put in place a new system for oversight of medication prescribing for those in youth corrections and strengthen consent policies for their use of psychotropic medication.
“We will move with all due speed to immediately begin implementation of the recommendations,” said Julie Krow, director of Colorado’s Office of Children, Youth and Families, in a prepared statement. The office, part of the state Department of Human Services, oversees the youth corrections division.
The state will require the contractor that supplies physicians to youth corrections to take “immediate action to ensure youth in our facilities have been correctly diagnosed and are receiving the correct medication for their diagnoses in the correct dosage at the correct time,” Krow said.
Youth corrections had a daily population of about 851 youths committed to facilities in fiscal 2013, ranging in age from 10 to 21.
The report was released during a Legislative Audit Committee hearing. It found that about $633,000 was spent on prescription medication for youths in corrections in 2013, with about 82 percent of that paying for psychotropic medication. That prescription spending did not include youths in residential community centers, which the report did not track.
“It was a report that was very disturbing to members of the audit committee, and it therefore generated a great deal of emotion and a great deal of concern and a lot of questions around those concerns,” said Sen. Lucia Guzman, D-Denver.
The audit committee asked youth corrections officials to give an update on reforms to psychotropic monitoring in 90 days.
“The concern from our standpoint was the timeline for them completing these recommendations, which was at the end of 2015 and into 2016 in some instances,” said Guzman, chairwoman of the audit committee. “Most committee members felt that because this is about kids — and kids that need help — to wait until the end of 2015 and into 2106 was really not acceptable.”
While some doctors say the prescribing of psychotropics can help children suffering with mental disorders, others say the medications are overprescribed, often to children whose trauma experiences can cause them to act out in ways that result in a misdiagnosis.
Studies have linked the drugs to rapid weight gain, diabetes and even the growth of breasts in boys.
The release of the report follows an investigation by The Denver Post into high levels of prescribing psychotropics to the state’s foster children.
The Post found Colorado foster children are given antipsychotics, a type of psychotropic, at a rate 12 times that of other kids on Medicaid. The Post also found that Colorado is among a minority of states that doesn’t track which foster children get such medications and how much.
The audit report released Tuesday found “wide variation in the policies and practices across facilities and among psychiatric prescribers in the approach to medication monitoring, including which drugs are closely monitored and what criteria are followed for baseline testing and ongoing monitoring for efficacy and side effects.”
It also found that in 13 of the 60 cases sampled there was no evidence that medical staffers obtained consent for treatment with psychotropic medications. In another six cases, there was no evidence that the facility had discussed the benefits and risks of all medications being given to the child.
In one case, a patient received the wrong medication, according to the report, conducted for the state auditor by Lansing, Mich.-based Health Management Associates.
In another case, a psychiatrist’s note was found in a medical file that stated: “Seems the plan to taper Risperdal never happened.”
Risperdal is an antipsychotic manufactured by Johnson & Johnson, originally to treat schizophrenia in adults. Johnson & Johnson paid $2.2 billion to settle a federal investigation that alleged the company had fraudulently marketed Risperdal to treat children for uses that the Food and Drug Administration had not approved.
