Medication Nation

Miami Herald: Broward child’s suicide raises questions about medication

A Broward foster child who killed himself last week had been prescribed powerful psychiatric drugs, some of which the FDA does not approve for children.
BY CAROL MARBIN MILLER
April 21, 2009

Gabriel Myers, the 7-year-old Broward boy who hanged himself in the shower of his foster home

Weeks before his death, Gabriel Myers, the 7-year-old Broward boy who hanged himself in the shower of his foster home, had been prescribed a powerful mind-altering drug linked by federal regulators to an increased risk of suicide in children.

In all, Gabriel had been prescribed four psychiatric drugs, two or three of which he was taking at the time of his death, said Jack Moss, Broward chief of the state Department of Children & Families. Moss said he is not sure which medications the boy was taking because Margate police took the foster home’s medication log as part of an investigation into Gabriel’s death last week.

Three of the psychotropic drugs carry U.S. Food and Drug Administration ‘’black box'’ label warnings for children’s safety, the strongest advisory the federal agency issues. Three of the medications are not approved for use with young children, though they are widely prescribed to youngsters ‘’off label'’ – meaning doctors can prescribe the drug even if not formally approved for that use.

In 2005 – reacting to a series of stories in The Miami Herald that as many as one in four foster children were prescribed potentially dangerous mind-altering drugs – state lawmakers approved a law aimed at curbing their use. Children’s advocates now question whether the law is being ignored.

Gabriel was being treated by a Broward psychiatrist who is on a list of Florida doctors that the state Agency for Health Care Administration red-flagged as having ‘’problematic'’ prescribing practices, said Robert Constantine, director of AHCA’s Medicaid Drug Therapy Management Program, which tracks prescribing of psychiatric drugs to children.

The list flags doctors with a high volume of prescriptions of mental-health drugs or potentially dangerous combinations of the medications.

Dr. Sohail Punjwani has been on the list every quarter in which regulators have monitored the prescribing of psychotropic drugs since the program was created in 2006, said Constantine, a professor at the University of South Florida’s Mental Health Institute. The practices of about 17,000 Florida doctors who prescribe medications to children on Medicaid are studied every quarter, and about 300 to 450 end up red-flagged on the list.

And though Florida law requires that either a parent or judge consent to the use of psychotropic drugs on foster children, a source with knowledge of the boy’s case said Gabriel already had been taking a three-drug cocktail when Broward Circuit Judge Lisa Porter was informed at a March 11 hearing. The judge approved the medications over the objection of a court-appointed guardian, the source said.

‘’We are devastated,'’ said Jon Myers, the boy’s maternal uncle, who cared for him from June through October 2008. “Gabriel’s problems could not be solved by a pharmacy.'’

Four feet tall and 67 pounds, with short-cropped brown hair, Gabriel was a bright, charming and often sweet little boy, those who knew him say.

But he already had a sad past hinting at a troubling future. Records obtained by The Miami Herald show Gabriel may have been molested by an older boy while he was living with grandparents in Ohio, while his mother was in jail.

On Thursday, Gabriel locked himself in a bathroom and hanged himself with a detachable shower head after arguing with the 19-year-old son of his foster dad about his lunch, Moss said.

DCF petitioned a judge on Tuesday to unseal the boy’s records in response to requests from The Herald and other media, spokeswoman Leslie Mann said.

Punjwani told The Miami Herald that he is board certified as a child psychiatrist. He did not recall Gabriel, but Punjwani said he was part of a ‘’huge'’ group practice and may have been one of many clinicians to treat the boy.

Punjwani defended the use of psychiatric drugs on children, even if they are not approved for such use, saying the lack of approval stems from the reluctance of drug makers and the medical establishment to launch clinical trials on children.

The anti-psychotic drugs, he added, are used routinely to treat mood instability and insomnia among children.

Gabriel originally had been prescribed Vyvanse, an attention deficit/hyperactivity disorder drug approved for kids aged 6 through 12, Lexapro, an anti-depressant which is not approved for children, and Zyprexa, an anti-psychotic drug that also is not approved for kids, said Moss.

Both Punjwani and Moss said they think the Lexapro and Zyprexa were discontinued in recent weeks, and that a drug called Symbyax – which contains the medication in Zyprexa along with another antidepressant – was substituted.

Symbyax, recently approved for severe depression, is among a group of commonly prescribed anti-depressants, such as Prozac and Paxil, that the FDA warned in 2003 were linked to an increase in ‘’suicidal thoughts or behaviors'’ among children. Symbyax is not approved by the FDA for use on children.

Dr. David L. Katz, professor of public health at Yale University’s medical school, called the use of such drugs on youngsters ‘’extremely risky,'’ He questioned whether the boy needed to be taking such powerful medications absent a diagnosis of schizophrenia. ‘’These are medications that are potent and potentially dangerous,'’ Katz said. “They certainly are powerful drugs for anybody, let alone a 7-year-old boy.'’

Jon Myers, the uncle who cared for Gabriel after abuse investigators found him in a car in a Denny’s parking lot after his mother had passed out, questions whether Gabriel needed such potent medications to begin with.

Myers said the boy’s pediatrician had discontinued all psychotropic drugs while Gabriel lived with him, and the boy did well, earning A’s and B’s at the Hollywood Christian Academy.

‘’We did not have any issues with him having tantrums,'’ Myers said. “He would get upset, like little boys do.'’

A week or two before Gabriel died, his grandfather in Ohio expressed concerns that the boy sounded overmedicated. ‘’My father said that the last conversation he had a couple of weeks ago Gabriel sounded like he was too drugged,'’ Myers said.

“He sounded like he was doped up.'’