Palm Beach Post

Dosed in juvie jail: Drug firms pay state-hired doctors

By Michael LaForgia

Monday May 23, 2011

Palm Beach Post Headline

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.

 

The subject takes on a new dimension when it involves doctors who care for children in state custody, said Eric Campbell, a professor at Harvard University who researches medical conflicts of interest.

 

“In my eyes, the role of government is to ensure that people who are left in our care, who are vulnerable and need help, actually get that help,” Campbell said. “And potentially exposing them to inappropriate prescriptions, when the benefit of those goes to the individual physician, I see as especially problematic.”

 

In general, if doctors prescribe drugs in exchange for payments from pharmaceutical companies, the quid-pro-quo arrangement violates state and federal anti-kickback laws, said Ryan Stumphauzer, a former federal prosecutor and founding member of South Florida’s Medicare Fraud Strike Force.

 

Stumphauzer, who now is in private practice in Miami, added that The Post appears to have unearthed “some truly stunning and troubling data.”

 

Click here to read the full article and to make comments: http://tinyurl.com/drug-company-paid-psychs

 

A list of the pharma paid Department of Juvenile Justice psychiatrists:http://www2.palmbeachpost.com/news/juvidrugs/index2.html

 

List of Florida psychiatrists with their number of Medicaid prescriptions for psych drugs for all ages:

 

http://www2.palmbeachpost.com/news/juvidrugs/index.html?cbResetParam=1