Dallas Morning News investigates relationship between Texas doctors, pharmaceutical companies, foster children given unapproved psychiatric drugs

The introduction to the Dallas Morning News investigation story:

AUSTIN – One in three Texas foster children has been diagnosed with mental illness and prescribed mind-altering drugs, including some that the federal government has not approved for juveniles, state records show.

Many of these drugs are prescribed by doctors who have a financial stake in pharmaceutical companies' success, a Dallas Morning News investigation has found. Dozens of physicians who treat children in state custody supplement their salaries with tens of thousands of dollars in consulting and speakers' fees, and they use drug company grants to fund their research projects.

Accepting this money is not illegal, nor is it frowned upon in most medical circles. Many of the state's leading medical experts receive income or grants from drug
companies, money that has funded groundbreaking scientific advances. And financial ties between doctors and pharmaceutical firms are frequently self-reported by physicians on their Web sites, conference programs and journal articles.

But while the psychiatric drugs given to foster children cost millions of taxpayer dollars a year, it's hard to know how much the doctors prescribing them are making from pharmaceutical companies. Texas, like most states, does not require disclosure.

The most prominent researchers can easily make $15,000 a year from each drug company they consult for, plus fees for speaking engagements that top $1,500 an event, according to financial disclosure forms some researchers are required to file because they work for state universities. Research grants often exceed $100,000, these records show.

Texas health officials say the overwhelming majority of these doctors have dedicated their careers to improving the mental health of foster kids, who have far higher rates of mental illness than the average child. They sacrifice time that could be spent on private-insurance patients, for whom doctors say they are paid more.

And officials say there are strict and effective rules to ensure that doctors' relationships with drug companies don't affect their prescriptions, including a ban on enrolling foster children in most clinical trials and guidelines on which drugs they should prescribe. A new health management policy was implemented this year to help oversee children's doctors' appointments, medication and health records – all of which state officials say will continue to curb unnecessary prescriptions.

Concerns about how much children in state custody are medicated continue, though. Some advocates have reported cases of multiple drugs being prescribed by doctors who weren't psychiatrists or pediatricians, and who spent less than 10 minutes examining their young patients. Foster care providers, who, until recently, had poor access to children's full medical records, are often the ones seeking the treatment for
troubled children.