http://www.palmbeachpost.com/news/dosed-in-juvie-jail-drug-firms-pay-state-1491309.html
Dosed in juvie jail: Drug firms pay state-hired doctors
Drugging juveniles: Doctors hired to evaluate kids in state custody
have taken huge payments from drug companies
Locked up and dosed: Some experts and
insiders charge that after the handcuffs
come off, many juveniles in state custody
are 'chemically restrained’ with
antipsychotic drugs that produce a
tranquilizing effect
Seroquel Manufacturer:
AstraZeneca. Uses:
Approved for treating
schizophrenia in teens
ages 13 to 17 and for
treating bipolar manic
episodes in children ages
10 to 17. Amount DJJ
bought: 217,563 tablets
between mid-2006 and
mid-2008
Abilify Manufacturer: Bristol-Myers Squibb.
Uses: Approved for treating schizophrenia in
teens ages 13 to 17, for treating bipolar
manic episodes in children ages 10 to 17,
and for treating irritability associated with
autism in children ages 6 to 17. Amount DJJ
bought: 55,156 tablets between mid-2006
and mid-2008.
Images courtesy of:
Ray Graham/Palm Beach Post

Reporter: Michael LaForgia
Palm Beach Post, Staff Writer
By MICHAEL LAFORGIA
Palm Beach Post Staff Writer


Posted: 5:40 p.m. Sunday, May 22, 2011

SECOND OF TWO PARTS

In Florida's juvenile jails, psychiatrists entrusted with diagnosing and prescribing drugs for wayward children have
taken huge speaker fees from drug makers - companies that profit handsomely when doctors put kids on
antipsychotic pills.

The psychiatrists were hired by a state juvenile justice system that has plied kids with heavy doses of the powerful
medications, and the physicians have prescribed anti­psychotics even before they were approved by federal
regulators as safe for children.

One in three of the psychiatrists who have contracted with the state Department of Juvenile Justice in the past five
years has taken speaker fees or gifts from companies that make antipsychotic medications, a Palm Beach Post
investigation has found.

In two years, the four top paid doctors combined to accept more than $190,000 - all while working for DJJ. Three of
the four psychiatrists still are seeing patients in state jails and residential programs.

In at least one case, the number of Medicaid prescriptions a psychiatrist wrote for children rose sharply around the
time he was paid, The Post found.

"That's very, very scary," said Jude Ann Prisco, a Palm Beach County mother whose child took psychiatric drugs
while recently locked in a program. She said it never occurred to her that DJJ doctors might take money from drug
companies. "I'm very upset by that, and I think they need to get some new guidelines."

Responding to The Post's findings, newly appointed DJJ Secretary Wansley Walters recently ordered a sweeping
investigation into how antipsychotics are used in state jails and programs for kids. She declined to comment further,
however, citing the probe.

DJJ doctors took payments as powerful antipsychotics flowed into state jails and homes. Child advocates say the
widespread use of these drugs amounts to a policy of controlling children through "chemical restraint."

"This is a serious, legitimate and possibly life-threatening issue that requires investigation, reformation and possibly
prosecution," said Circuit Judge Ronald Alvarez, who has sat on the juvenile court bench in Palm Beach County for
12 years.

DJJ relies heavily on the judgment of its contract doctors: In state juvenile jails and residential programs, the
psychiatrists ultimately decide whether children should get medication - and which drugs kids should take.

Florida doesn't have disclosure laws

Doctors prescribed heavy doses of antipsychotic drugs for children in DJJ custody even before the drugs were
deemed safe for kids.

Seroquel, for example, wasn't approved for kids until late 2009. Between mid-2006 and mid-2008, DJJ bought at
least 217,563 tablets of Seroquel for children in the department's custody.

The state has no rules requiring drug companies to disclose payments to doctors. DJJ has no policy requiring
contracted doctors to disclose conflicts of interest. In overhauling health care last year, Congress enacted a
measure that requires all drug companies to disclose payments and gifts to doctors. However, that part of the law
won't take effect until 2013.

DJJ doesn't track prescriptions going into its jails and programs. The rationale behind the department's system is
that doctors, with help from nurses and other program staff, always prescribe drugs appropriately.

"The idea was, if kids did not have a medical need for psychotropic medication, then there wouldn't be any purpose
in giving (antipsychotics) to them," said DJJ spokeswoman Samadhi Jones.

Last Tuesday, six days before this story was published, DJJ's chief medical director, Lisa Johnson, took the unusual
step of issuing a strongly worded memo to DJJ's contracted and state-employed doctors.

The note, among other things, cautioned psychiatrists against prescribing anti­psychotics and other drugs for
reasons that aren't approved by the federal government, except in extreme cases. It also reminded doctors that they
aren't to use the drugs "as a means of punishment, discipline, coercion, restraint or retaliation."

'
Quid pro quos' violate anti-kickback laws

The topic of doctors taking payments from pharmaceutical companies has become increasingly controversial in the
past four years, after the federal government accused some companies of paying illegal kickbacks to physicians.


POST INVESTIGATION SPURS ACTION

Responding to The Post’s findings, newly appointed Department of Juvenile Justice Secretary Wansley Walters
ordered a sweeping investigation into how antipsychotics are used in state jails and programs for kids. She declined
to comment further, citing the probe.

ABOUT THIS SERIES

In charting the state Department of Juvenile Justice’s use of prescription drugs, The Palm Beach Post analyzed
department drug purchasing information and state Medicaid billing data and reviewed thousands of pages of DJJ
inspection reports, drug company disclosure records and court documents. The Post also conducted dozens of
interviews with state officials, attorneys, medical experts, advocates and child psychiatrists.

The task was complicated by DJJ’s inability to access its own records easily. Theoretically, the department can track
prescriptions, but the system is hampered by ‘functionality concerns,’ a spokeswoman said.

Asked about drugs dispensed to children, DJJ could provide information only for a two-year period ending in mid-
2008, and only for its 25 jails and a fraction of its residential programs. The lock-ups represent only about one-fifth
of all juvenile jails and residential homes in Florida.

No information was available on the amounts of antipsychotic drugs dispensed in the more than 100 remaining
programs for juveniles, which are run by private contractors.

— Michael LaForgia

ABOUT THE REPORTER

Michael LaForgia has reported on Florida’s pill mill crisis, spurring arrests and reforms at the state and local levels,
and exposed loopholes in Florida law that put children at risk in summer camps. He joined The Palm Beach Post in
2006.