State to boost oversight of psychotropic drug prescriptions to foster children

State officials have agreed in a federal court settlement to build a system that guards against over-prescription of psychotropic drugs to the 13,000 children in Missouri foster care.

The settlement, which on July 15 gained preliminary approval from U.S. District Judge Nanette K. Laughrey, stems from a class-action suit filed in 2017 by several foster children through next friends. The plaintiffs were represented by Saint Louis University School of Law Professor John Ammann in addition to attorneys from two nonprofit organizations — Children’s Rights and the National Center for Youth Law — and the international law firm Morgan, Lewis & Bockius.

The plaintiffs had alleged in their complaint certain “outlier” prescription practices in Missouri whereby children in foster care were receiving “too many psychotropic medications, too much medication, or at too young an age.” Such practices, they claimed, put foster children at increased risk of Type II diabetes and can lead to “psychosis, seizures, irreversible movement disorders, suicidal thoughts, aggression, weight gain, organ damage, and other life-threatening conditions.”

The agreement, which runs 74 pages including exhibits, calls for state officials to create a more robust oversight system. It is designed to ensure record-keeping, monitoring, informed consent, secondary reviews and rigorous training for case-management and resource-provider staff. The state also will form a Psychotropic Medication Advisory Committee to further inform state policy. A third-party monitor will verify that the state is complying with all of these terms.

Ammann hailed the settlement as “very thorough” and likely the first of its kind nationwide. One unusual aspect of the litigation, he observed, was the “tremendous” amount of resources put in by all litigants to reach a compromise.

“We met on multiple occasions in person and multiple occasions on the phone,” Ammann said. “It showed good faith on the part of both sides.”

The Missouri Attorney General’s office did not respond to a request for comment.

Ammann said SLU Law students also worked on the case and were “invaluable to the process.” For example, student Aida Herenda came up with language to make the new procedures easier to understand for both foster parents and case workers.

Leccia Welch, senior director of child welfare and legal advocacy at the NCYL, said in a written statement: “Children in foster care across the country are being administered dangerous dosages and combinations of psychotropic medications instead of receiving appropriate mental health services to address complex trauma. We are hopeful that Missouri’s willingness to address these harmful practices will shine a spotlight on the need for reform.”

In a separate written statement, Samantha Bartosz, deputy director of litigation strategy at Children’s Rights, said that her organization hoped “that this lawsuit will generate significant attention and serve to improve the lives of children in foster care across the country.”

The class members and their legal representatives have until Oct. 23 to submit their objections, support or comments. The judge has scheduled a hearing for final approval on Nov. 20 in Kansas City.

The case is M.B. et al. v. Tidball et al., 2:17-cv-04102.