Last month, Gabriel Myers, age 7, died by suicide in his South Florida foster home, hanging himself on an extendable shower hose.
The boy, 4 feet tall and 67 pounds, was taking two powerful psychiatric drugs at the time of his death, neither of which had been approved by his parent or a judge, as required by state law.
On Friday evening, George Sheldon, head of the agency charged with Gabriel's care, said he expects the tragedy to lead to major reforms in the state's foster care system.
"We've got to get a heck of a lot better in terms of our oversight of psychotropic drugs,'' said Sheldon, who has been secretary of the Department of Children and Families for about six months. "I'm not antimedication. When these drugs are appropriately administered, with appropriate oversight, they can potentially be lifesaving. If that doesn't happen, it can have a devastating impact."
Gabriel was taking Vyvanse, an ADHD drug, and Symbyax, a combination of the antipsychotic Zyprexa and the antidepressant Prozac, when he killed himself. Symbyax carries a "black box" warning that it might lead to suicidal behavior among children and adolescents, especially when first prescribed.
Documents made public in connection with a state investigation into Gabriel's death show that foster care workers repeatedly ignored their responsibility to get consent for psychotropic medications prescribed while the boy was in the state's care.
On six separate occasions, Gabriel's caseworker, Lawrence Chusid, documented that DCF had "parental consent" for the child's medications. But in the hundreds of records in Gabriel's file released by DCF late last month, there is only one form signed by his mother, Candace, a blanket authorization for medical treatment for her son.
It is dated June 29, the same day she was taken into police custody after being found unconscious in her car behind a Denny's restaurant with powder cocaine, crack and oxycodone in her possession. Gabriel, then 6, was in the back seat.
Candace Myers, who completed her jail sentence in Florida and is now serving time for probation violations in Ohio, has declined to speak with reporters.
State law requires that parents be "expressly informed" about changes in a child's medication while he is in state custody or for a court to approve such prescriptions. A DCF spokeswoman acknowledged Friday that the consent procedure had not been followed in Gabriel's case. Chusid, an employee of ChildNet, the foster care provider in South Florida, is on leave.
In addition to the lack of oversight in Gabriel's case, Sheldon said he recently learned that some DCF workers and physicians have misinterpreted the law to mean that parental consent or a judicial order is not needed if a psychotropic drug is being used for a nonpsychotherapeutic use.
For example, a doctor could prescribe an anticonvulsant for seizures, rather than as a mood stabilizer, and avoid the consent process.
As Frank Platt of DCF's Office of Family Safety put it in an e-mail to a query in February, "We depend on the prescribing physician to determine the use of the medication."
Sheldon left no doubt Friday night that he intends to plug such loopholes and that every prescription for psychotherapeutic drugs will require consent, regardless of use.
"My view is the department becomes the parent of the child, and if I'm the parent and my child is being prescribed something like Lexapro or a drug for seizures, I'm damn sure going to find out whatever I can about the drug," he said. "The department should be going the same direction."
Foster care advocates had long suspected DCF was under-counting prescriptions and over-counting consents. In September, the department reported to the Florida Senate that only 4,894 psychotherapeutic prescriptions had been written in 2008. Of that number, DCF said it had obtained a parental consent or a court order for "99 percent."
Andrea Moore, executive director of Florida's Children First, which supports foster care legal services across the state, said she knew the data were wrong. For one thing, most foster kids are on Medicaid and that agency's data showed much higher prescription rates.
"I asked DCF why it was giving the Senate such crappy data," she said. "It was not consistent with our experience."
Sheldon has tapped the deputy director of Moore's group, Tampa lawyer Robin Rosenberg, to the committee investigating Gabriel's death. The group, which is expected to issue its report later this month, is led by Jim Sewell, former assistant commissioner of the Florida Department of Law Enforcement and also includes the state's drug czar Bill Janes, Rajiv Tandon, a psychiatrist with the University of Florida, and Medicaid's pharmacy director Ann Wells.
Sheldon, whose brother died by suicide two years ago after changing antidepressant medications, said Gabriel's file shows the boy had been under extreme stress, particularly in his last few days.
"He was told his mother no longer had visitation rights, that he would probably be going back to Ohio, where he alleged he had been abused; the doctor changed his medication, he changed foster homes and he got a new counselor," Sheldon said. "All those things should raise red flags."
The Centers for Disease Control and Prevention does not keep statistics on the suicide rate for children under the age of 10. But Dr. Nicholas Putnam, a child psychiatrist in Encinitas, Calif., said suicides are extremely rare in children that young.
"It's just that when children and teens commit suicide, it gets so much attention," he said.
Sheldon called Gabriel's death "extremely regrettable," adding, "It ought to mean something."
Jonathon Myers, the boy's uncle in Plantation, hopes for the same thing. He and his wife cared for Gabriel, whom they had not met before he came into their care, from the time he was taken into state custody until mid October.
When Gabriel, who said he had been sexually abused before moving to Florida, began inappropriately touching classmates at school, the uncle and his wife decided the boy needed more intensive treatment than they could provide. Gabriel was in his second nonfamily foster placement when he died.
"The therapist we hired said he needed residential care with 24-hour supervision and we told the state that," Myers said. "My opinion is that he needed things a pharmacy couldn't provide."
Times researcher Will Gorham contributed to this report. Kris Hundley can be reached at firstname.lastname@example.org or (727) 892-2996.