By Tara Green
Psychiatrists working for the Florida Department of Juvenile Justice, entrusted with the health of children in state custody, accepted thousands of dollars from drug companies. While earning huge fees as speakers for manufacturers of anti-psychotic pills, the doctors also wrote prescriptions for psychiatric drugs for children in the DJJ system. The Palm Beach Post News broke the story of this medical conflict of interest which one former federal prosecutor calls “truly stunning and troubling.”
Post reporter Michael LaForgia found that one in three of the psychiatrists who held contracts with the Department of Juvenile Justice (DJJ) to treat children in the system also either accepted gifts from drug companies or appeared as a paid speaker for those companies. LaForgia’s research revealed that the doctors prescribed anti-psychotic drugs prior to those drugs receiving approval from the FDA for pediatric use. One of the psychiatrists whose work LaForgia investigated wrote significantly more Medicaid prescriptions for children during the period he was working for the pharmaceutical companies. The combined pharmaceutical company payments to the four highest paid DJJ-affiliated psychiatrists totaled nearly $200,000.
The Post’s story prompted Wansley Waters, the recently appointed secretary of the DJJ, to order an investigation into the prescription of antipsychotic drugs to children in the state program. Citing the investigation, Waters declined further comment on the situation. However, Circuit Judge Ronald Alvarez, a 12-year veteran of the Palm Beach County juvenile courts, stated that “This is a serious, legitimate and possibly life-threatening issue that requires investigation, reformation and possibly prosecution.”
Lack of regulation at the federal, state and county helped contribute to this situation. Neither the federal government nor the state of Florida requires drug companies to disclose payments to physicians. The Florida DJJ has no policy in place asking doctors working for the agency either to reveal or to avoid conflicts of interest. The DJJ also has no tracking system for drugs prescribed to children in its care, instead relying on the judgment of doctors to write prescriptions in the childrens best interest.
Less than a week before the Post broke the story, the DJJ’s chief medical director, Lisa Johnson, sent a memo to all contracted and state-employed doctors working with children in the system. In that memo, she warned psychiatrists against prescribing anti-psychotics and other medication except for reasons approved by the federal government. The memo also reminded doctors not to use drugs as “as a means of punishment, discipline, coercion, restraint or retaliation.”
As the pharmaceutical companies move to expand their market everyone becomes a potential “patient” to be medicated. Children in the care of the state, unable to refuse treatment and without direct parent or guardian involvement in their daily lives are especially vulnerable. The Post story is a commendable (and, unfortunately, these days, all too rare) instance of the mainstream media living up to its watchdog role, fulfilling the famous description of journalism’s mission to “comfort the afflicted and afflict the comfortable.” We hope the Pulitzer committee has made note of Michael LaForgia’s tremendous work in bringing about reforms in the medical pill mill culture.