Thousands of California’s foster care kids may be overdrugged with psychotropic medications, often without medical follow-up or a legally required approval from a judge or parent, according to a stinging report by the California State Auditor.

“The state and counties have failed to adequately oversee the prescribing of these medications,” wrote auditor Elaine M. Howle.

The long-awaited report, released in August by State Auditor Elaine Howle, mirrors many findings of Bay Area News Group’s investigative series “Drugging Our Kids.” Those stories, which appeared in Southern California News Group publications, including this one, highlighted how only 10 percent of the state’s 1,280 highest prescribers were responsible about 50 percent of the time a foster child was given an antipsychotic, one of the most powerful classes of psychiatric drugs.

This series found these drugs are often prescribed in foster care to control kids who act out — not to treat the severe mental illnesses the medications are approved to treat. The consequences can be devastating to foster youth, especially those who receive multiple antipsychotic medications, placing them at high risk for obesity, diabetes, extreme lethargy and tremors.

The problems partly are a result of a division of labor when it comes to oversight. Two departments oversee foster kids and their medications, but neither could completely identify which foster children are prescribed psychotropic medications or even which medications they are taking.

“California’s oversight approach for its administration of foster care and monitoring of psychotropic medications appears to be piecemeal,” Howle said, adding that there isn’t strong “system-level oversight.”

Psychotropic medications include antidepressants, mood stabilizers and antipsychotics. Typically, such drugs can provide big benefits for people with psychiatric illnesses, but they often come with serious adverse side effects.

More than 79,000 children are in foster care in California, and nearly 12 percent of them were prescribed those medications last year. Studies show far fewer children who aren’t in foster care take such medications, typically 4 percent to 10 percent.

BETTER THAN AVERAGE

The current rate of drug prescriptions among foster children represents an improvement, down more than 7 percent since 2013.

Still, major concerns remain.

“Despite the decrease in the overall number of foster children receiving psychotropic medications, state data show that nearly half of these foster children had paid antipsychotic medication prescriptions,” the auditor wrote. “Antipsychotics pose a particular risk for children because they have a high risk of severe side effects. Nevertheless, the state data show that antipsychotics made up nearly 35 percent of all paid prescriptions for psychotropic medications for foster children.”

Trends in Orange, Los Angeles, Riverside and San Bernardino counties were going in the right direction, data show, with each county having fewer kids on these meds in 2015 than two years earlier.

All four counties also had fewer kids on the meds than the state average — but in L.A., not by much. The state average was 11.8 percent.

• In L.A. County, 11.6 percent of foster kids were on psychotropic meds.

• In San Bernardino County, 10.3 percent.

• In Riverside County, 9.6 percent.

• In Orange County, 8.8 percent.

Foster kids were most likely to be medicated in Sonoma and Sutter counties, where 22.7 and 19.8 percent of foster children, respectively, had filled prescriptions.

The least-medicated kids were in Madera and Kings counties, which had 4.9 and 6.7 percent of foster kids, respectively, on such meds.

TOO MUCH?

In addition to the statewide data, the auditor reviewed detailed case files for 20 foster children in each of four counties — Los Angeles, Madera, Riverside and Sonoma. The idea was to track the amount and frequency of medication for those 80 children.

“We found that many foster children had been authorized to receive psychotropic medications in amounts and dosages that exceeded the state’s recommended guidelines,” the auditor wrote.

Those circumstances, the auditor added, “should have prompted the counties responsible for their care to follow up with the children’s prescribers.”

That didn’t quite happen. One-third of the foster children prescribed new psychotropic medications did not receive follow-up care with prescribing physicians or other health care providers in a timely manner, the auditor said.

Eleven of the 80 children tracked were taking multiple medications within the same drug class, which also runs afoul of guidelines.

Eighteen were taking the meds in dosages that exceeded the state’s recommended maximum limits.

“Medications that exceed the state’s recommended guidelines may be appropriate under some circumstances, and we are not questioning prescribers’ medical expertise,” the auditor wrote. “However … the counties did not contact the prescribers to ensure the safety and necessity of the medications in question …

“Compounding these concerns is the fact that many of these children do not appear to have received follow-up visits or recommended psychosocial services in conjunction with their prescriptions for psychotropic medications.”

DO BETTER

The audit comes at a crucial time in a years-long effort to fix the system: The last three pieces in a package of Legislative reforms are now on Gov. Jerry Brown’s desk, awaiting his response:

• Senate Bill 253, from Sen. Bill Monning, D-Carmel, would create a more rigorous court process for the prescribing of potentially harmful psychotropic drugs to foster children.

For example, judges would have to get a second doctor’s opinion before prescribing psychotropic drugs in the riskiest cases, including prescriptions for foster children 5 and younger or multiple antipsychotics for any foster youth.

• Senate Bill 1291, from Sen. Jim Beall, D-San Jose, would require better transparency and tracking of mental health services for foster kids in every California county.

• And Senate Bill 1174 from Sen. Mike McGuire, D-Healdsburg, the most controversial of the legislative efforts, would require annual monitoring of high-prescribing doctors and would allow the California Medical Board to crack down on violators by revoking their licenses.

The auditor said everyone should do a better job of serving foster children, recommending that:

• The Legislature should demand an effective oversight structure and require periodic evaluations of state data to identify physicians who may be inappropriately prescribing medications.

• The Department of Social Services and individual counties should monitor requests for authorization of psychotropic medications; make sure there’s court approval or parent consent before prescribing psychotropic medications; ensure physicians follow up within 30 days of prescribing a new psychotropic medication; and ensure that proper mental health services are received along with psychotropic medications.

Officials from the counties and state agencies agreed with the auditor’s recommendations and said they are making changes.

“Although not reflected in the audit, mental health services provided to our foster youths has increased 35 percent in the last few years,” said Riverside County spokesman Ray Smith. “Riverside County has implemented many of the state’s guidelines for overseeing psychotropic medications. As part of those efforts, the county uses public health nurses — an emerging best practice — to help oversee and track use of these medications.”

A few of the changes made over the past year include a multidisciplinary medication review team; procedures to monitor requests for psychotropic medication; new procedures with the juvenile court to expedite review hearings; and other procedures to ensure follow-up within 30 days for foster youth prescribed new psychotropic medications.

Elizabeth DenBleyker, spokeswoman for the Orange County Social Services Agency, said child welfare professionals have long advocated for better access to behavioral and mental health therapies for children, as well as better understanding of the use of medications.

Orange County has a protocol to gain court approval for all recommended psychotropic medications for children and has public health nurses at Juvenile Court. Their prescription and administration are reviewed regularly at the court level as well, she said.

“When children are placed into foster care, Child and Family Services staff assume the role of parent, a responsibility we take very seriously,” DenBleyker said.

Marlene Hagen, director of San Bernardino County Children and Family Services, noted the county has one of the lowest rates of foster children on psychotropic medication. Hagen added her agency “has worked diligently to ensure our children receive comprehensive care and support services necessary for their successful treatment.”

The number of foster youth on psychotropic medications has been dropping, but is still troubling, the state auditor concluded. Here are numbers for the fiscal year ending in 2015.

Bay Area News Group reporter Tracy Seipel contributed to this report.

BY THE NUMBERS

79,166

Children in foster care in California.

11.8%

Foster kids in California prescribed psychotropic drugs.

4%-10%

Estimated rate of psychotropic use among children not in foster care.

1 in 3

Foster children who take psychotropic drugs but weren’t seen for follow-up care in a timely manner.