Importantly, but unsurprisingly, the commission distinguished three areas "in which there is little to no high-quality evidence on the use of antipsychotics": The use of multiple concurrent antipsychotic medications in youth; the use of any antipsychotic in children under three (with only "minimal evidence" for use in kids ages three to five); and the long-term effects (greater than three years) of any of the antipsychotics.
In her comments to a draft of the study, Dr. Regina Cavanaugh, president of the Texas Society of Child and Adolescent Psychiatry, saw Turner's proposal as just another barrier to treatment: "As the new president of TSCAP, it is with a sad heart that I tell you that I no longer provide care to foster care children," she wrote. "...I gave up seeing foster care children within 2 years, as I was unable to provide the quality of care I believed was necessary. Caseworkers withheld consent for antidepressants for children who were sexually abused and suffering with depression and PTSD, and not responding to months of therapy...The time needed to do prior authorizations, and the growing restrictive formulary were not conducive in my practice setting."
Courtesy of David and Christina Harrison
A week before she went into foster care, Rachel Harrison looked healthy.
Courtesy of David and Christina Harrison
Rachel's parents say she appeared fatigued and ill during visitations while in CPS custody.
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Dr. Debra Atkisson Kowalski, chair of the Texas Society of Psychiatric Physicians' Child and Adolescent Committee, wrote that "increasing administrative burdens upon physicians to provide care could directly result in less care being available."
Upon presenting his measure to the House Public Health Committee, Turner said, "This bill does not deny any medication to any kid...We are not saying a blanket 'no'" to any medication. He called it "not a red light, just a cautionary light."
Picking up on vehicle-related metaphors, Federation of Texas Psychiatry lobbyist Steve Bresnen told the Public Health Committee that he was part of the original legislation that spawned the parameters: "We built a car. We didn't throw a wrench into the works...I'm afraid this bill will throw a wrench into the works."
Bresnen felt great affinity for the movement behind the parameters, claiming, "I wrote that legislation spontaneously, sitting at my desk." He took great umbrage at a previous speaker, part of the Church of Scientology's "Citizens Commission on Human Rights," who supported Turner's measure, perhaps in no small part because Scientology abhors psychiatry and its attendant medications.
"I'm not going to have the people who wrote the 2005 legislation slimed without responding," Bresnen said, pointing out the speaker's Scientology ties.
Also on the record as opposing the bill were members of the Texas Pediatric Society, the National Alliance on Mental Illness, and Mental Health America of Texas, the last two organizations heavily funded by drug companies.
On hand to testify, should any of the legislators on the committee have questions about the Texas AG's lawsuit, and its uncovering of extensive conflicts of interest and ghostwriting, was Cynthia O'Keefe, deputy chief of the office's Civil Medicaid Fraud division. Strangely, there were no questions.
Dr. George Santos, of the Harris County Hospital District's management board, and a member of the Texas Society of Psychiatric Physicians, also opposed the bill, saying he was "always a little bit nervous about legislative intrusions into doctor-patient relationships."
Santos added that the state's mental health experts were also keeping abreast of "the peer-review journal articles" in order to continue providing the best care for children in Medicaid.
As Santos wrapped up, committee member Garnet Coleman thanked him and said, "I trust that you're going to continue, as you always have, to protect the integrity of the practice of psychiatry."
"You wouldn't let me do anything else," Santos said.
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"Integrity" probably wouldn't be the first adjective that Rachel Harrison's family would use to describe what happened to her.
Rachel appears to have wound up in foster care after her father had a falling-out with an extended family member, who subsequently called CPS with an allegation that Rachel's mother had tested positive for marijuana while she was pregnant. While there were no signs of abuse or neglect, Rachel's parents at one point tested positive for cocaine. This was enough to remove Rachel from the home.
After Harris County District Court Associate Judge Stephen Newhouse found there was absolutely no evidence of abuse or neglect, and after expressing his bewilderment over why she was put on an antipsychotic in the first place, he returned Rachel to her family last May, 11 months after the state removed her.
Although the judge ordered DFPS to turn over Rachel's medical records to her family, DFPS has maintained they are departmental property and have not followed the judge's orders. In the end, Rachel's parents got the documents from the County Attorney. To this day, they say, they don't know the extent of the drugs she may have been prescribed. (Rachel's story was first reported by KRIV investigative reporter Randy Wallace, whose reports may have had a lot to do with why CPS ultimately changed its mind about terminating parental rights.)
The safety apparatus suggested within the parameters somehow failed to notice that Rachel was prescribed twice the state's recommended dosage of risperidone, without even having a clear diagnosis. However, it may not have been a big deal, because the notes of one of Rachel's doctor's reflect that the medication risks were "discussed with patient," that the patient was "counseled on recognizing medication side effects and adverse reactions" and that the patient "voiced understanding."
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