The fact of the matter---as Jon McClellan is well aware---Washington State had absolutely NO psychotropic drug policy for children in State Custody until after I brought my son home in January of 2005. In the process of researching how I could to rescue my son from the Washington State children's psychiatric facility he referred to in his testimony as, "my State hospital;" I discovered that Washington State in fact had no mechanism or protocol to provide for Informed Consent to protect children in Washington State custody. I informed Children's Administration that I was not going to just go away---just because I was able to force them to comply with the Law and return my son to me---didn't mean that I was going to forget what I had learned.
The Psychotropic Drug Policy was developed within a couple months of Isaac's return home, and is titled "The Dope on Drugs." In my opinion, the policy protects primarily the State of Washington. It is plain to me that Washington State's Psychotropic Drug Policy was developed to protect prescribers, the State of Washington, and the State's employees and contracted Mental Health Service providers from liability. It is my opinion that the policy as written ensures that the children in State custody are still available to use as guinea pigs in research; can be given psychiatric drugs EXPERIMENTALLY with impunity while giving the appearance of protecting foster children in State custody from harm.
It is in fact experimental to give drugs "off-label" for symptoms and diagnoses for which the drugs have not been FDA approved; to give drugs to children that have not been tested for safety and efficacy in children and do not have FDA approval for pediatric use; is the definition of Human Experimentation. the term, "off-Label" sounds innocuous, which is why it is used; it makes Human Experimentation acceptable, but calling it a "standard practice" belies the truth, and does not meet the STANDARD for being given the distinction.
The policy offers the children in state custody very little care or protection in real world terms. The reason I say this, is two-fold. Primarily, it is because the policy would not prevent what was done to my son from happening to another child. In fact, it in effect, allows Jon McClellan to use children in Drug Trials without the parent's consent. The final paragraph on the second page of Washington's psychotropic drug policy for children in state care states, "The informed parental consent or court order needs to be a general authorization for the administration of psychotropic medications at the direction of a qualified, licensed physician so that a change in the consent or court order is unnecessary when there is a need for the physician to adjust the medication." How could any reasonable person believe that a one time general consent is even ethical, much less claim that a one time general consent will protect a child from being harmed from teratogenic psychotropic drugs? It is simply ludicrous. A one time general consent is simply for the State of Washington's convenience; it does little to protect children from iatrogenic harm.
When developing a policy to protect and defend children, it is unwise to proceed as if they do not have the same needs as everyone else; to offer them LESS than we would expect for ourselves and our own children, speaks to the lack of thoughtful consideration given to protecting children in State custody. So what purpose does this policy serve? The policy does not serve the purpose to protect children in state care so much as it serves to cover the State's ass while putting on a "show of protection;" for state wards. A one time general consent is, on the face of it, unethical; it does nothing more than pay brief lip-service to what Informed Consent actually entails. This policy is a shameful excuse for an effort that is supposedly intended to protect children. There is no way in hell a general authorization would be sufficient to protect a child against the type of off label drugging of emotional and behavioral problems quantified by this investigation. (The THIRD US Senate investigation into psychotropic drugging of children on Medicaid) It is because Jon McClellan and other members of the American Academy of Child and Adolescent Psychiatry have written practice parameters and treatment algorithms based on consensus which were then "validated" and implemented as Standards of Care by consensus, that this investigation is even necessary.
Washington's policy is "Interim Policy 97-10" and I first printed it on March 9, 2005--two months and three days after I brought my son home from Child Study and Treatment Center; it is still exactly the same and still fails to protect the children even half as much as it protects the State of Washington and unethical medical practitioners.
Another interesting thing about this policy is that it does not list even one of the newer, most prescribed, neuroleptic drugs like Risperdal, Seroquel, Geodon, Abilify, EVEN though these new neuroleptics are being prescribed off-label as a matter of course, and are on Washington's "Preferred Drug List" which are fraudulently billed to the Federal Medicaid Program. I say fraudulently, because in 2005, these drugs were not FDA approved for use in children, therefore not qualified for reimbursement through the Federal Medicaid program. The only neuroleptics listed on this policy were the older, cheaper neuroleptics only Thorazine was approved for use in children with schizophrenia:
From Isaac's Treatment Record at Child Study and Treatment Center:
The Report from the Evaluation and Treatment Conference lists Jon McClellan as the "Team Leader" dated 10-8-2001 and covers a two month period leading up to this conference, lists his current medications as: Zyprexa, 20 mg. at bedtime, since 9-7-2001. Zyprexa was started on 8-27-01 at 5 mg. increased to 10 mg on 8-30-2001 and increased to 15mg. on 9-4-2001. Risperdal 3mg. twice a day increased from 2mg. twice a day on 9-6-2001. Ativan .5 mg 3 x a day and 1 mg every four hours as needed not to exceed 6 prn doses in 24 hours, the report states the Ativan was adjusted several times beginning on 9-7--2001 when he was on 1 mg 3x a day. The Ativan was prescribed "in hopes of controlling Isaac's impulsive behavior"----not an indicated or approved use, for this highly addictive drug meant for short-term use---Another oddity of this report, is that it lists Cogentin 1 mg. as being started on 10-20-2001----although the entire report was prepared for a Review which took place on the 8th of October 2001. Thorazine discontinued on 8-16-2001, and a brief trial of Seroquel discontinued on 8-5-2001.
What this all means is that Jon McClellan had my son who was thirteen, on at least two and at times three neuroleptic drugs, that were not approved for use in children; the only neuroleptic drug approved for pediatric use at the time was Thorazine. The reason Jon McClellan claimed he did not need my consent is Washington State's Age of Consent Law for mental health and substance abuse treatment is thirteen. The purpose of this law is supposedly in order to enable kids whose parents are not supportive to access any substance abuse and mental health treatment they need. It is used by some professionals to exclude parents. My son may have been thirteen but it would have been obvious to a bright grade-school student that Isaac was totally in his own world; he lacked the capacity to give consent. The other reason he cited was illegal---he told me repeatedly, that since Isaac was a Ward of the State, he did not need my approval or consent. He actually said it was a "courtesy" for him to tell me anything about the drugs he was giving my son; not a requirement. State Law, Federal Medicaid Guidelines, the US Constitution, the Ethical Guidelines for Informed Consent and the Nuremberg Code all required that my consent be obtained; but Jon McClellan claimed he didn't need it!
In fact, when I was forced to relinquish custody of Isaac "voluntarily" I was assured that I would not lose my parental rights to provide consent to his treatment. I was forced to relinquish custody in violation of Federal Medicaid Law and Federal Child Welfare Policy by Washington State DSHS Region II Children's Administration staff who falsely claimed that it was required so Medicaid would continue to pay for Isaac's medical care. This was a lie used to coerce me to "sign a Voluntary Consent to Place Agreement. I believe this fraud was perpetrated so that the State of Washington could fraudulently collect foster care reimbursement funds to help pay the cost of his care. I was further manipulated into signing the agreement by the Children's Administration caseworker, who informed me if I refused to sign it, she would tell the Judge I was unable to act, "in my son's best interest."
I only learned this past year that the one time the law allowed for me to enter into the Court Record my take on the proceedings, was at that specific hearing. My son had by this time gone without the recommended treatment for his Left Temporal Lobe Epilepsy and PTSD for six years. Isaac had PTSD as a result of being violently assaulted and put in a closet in foster care when he was three. God only knows what else happened to him before that---The State of Washington does not have on record where he was for the two whole months prior to being placed in Margaret Manson's home where he was victimized. Jon McClellan knew Isaac had been victimized--he put it in his medical record stating that it was reported to CPS the first time Isaac was in Child Study and Treatment Center in 1995.
Why is it that I found no consent protocol for children in State Custody when I looked for one, and when I asked Children's Administration for a copy---there was nothing to give me? In 1997, a six-year-old boy, Domico Pressnell, died in foster care from the effects of taking multiple psychotropic drugs as prescribed---AND "Following the death of Domico Presnell, Washington's policies and procedures for the administration of psychotropic drugs to foster children came under withering scrutiny. Ultimately the case changed the way DSHS administers and allows drugs to be administered to foster children. The message went out powerfully to state administrators, foster care caseworkers and foster caregivers themselves that negligence will come at a steep price for everyone involved." Obviously, this statement is overly optimistic; DSHS administrators, didn't get the message...
Jon McClellan helps formulate Public Policy about Mental Health Treatment Services for children who are Wards of Washington State, and for children across the Nation---He has been published extensively in professional journals and is regularly quoted in National News outlets. Due to my personal experiences witnessing Jon McClellan "medically treat" my son, and from what I know about his research, I found his testimony in the US Senate disingenuous. Jon McClellan has been on the faculty at the University of Washington, for over two decades, and supervises interns at Children's Hospital and Medical Center in Seattle, and Child Study and Treatment Center in Lakewood. The man is listed as the sole author, if not listed among the authors, of Practice Parameters and Treatment Protocols for virtually every psychiatric diagnosis given to children. He was on the editorial board for the Professional Journal put out by the AACAP, a journal that still refuses to retract the reports of Study 329, an utterly fraudulent Drug Trial that falsely reported the safety and efficacy outcomes for the drug Paxil; including not reporting fatal outcomes of clinical trial participants. The drug was FDA approved as "safe and effective for pediatric use" because of falsely reported results from Study 329.
Statement of Dr. Jon McClellan
University of Washington
Senate hearing: December 1, 2011
“The Financial and Societal Costs of Medicating America’s Foster Children”
McClellan Testimony: Psychotropic Drugs in Children
Mr. Chairman and Members of the Subcommittee; thank you for inviting me to participate in this important discussion regarding the use of psychotropic medications in foster children.
I am a Child Psychiatrist at Seattle Children’s Hospital, a Professor at the University of Washington, and the Medical Director of Child Study and Treatment Center, the State psychiatric hospital for youth in Washington State.
The high risk practices identified by the GAO study raise significant concerns regarding the treatment of severely mentally ill and vulnerable youth. Although the focus of this study is on foster care, the concerns raised are relevant to all children and adolescents prescribed psychotropic drugs.
Children in foster care often have emotional and behavioral difficulties. The high rate of medication use in this population is not a new discovery, nor does the use of these drugs always imply bad practice. Several psychiatric medications have been studied and approved for use in children and adolescents. When prescribed correctly, these treatments can help reduce suffering and enhance the functioning of young people.
McClellan Testimony: Psychotropic Drugs in Children
However, it is also well documented that many children in the child welfare system do not receive high quality psychiatric services. Treatment too often occurs during times of crisis, without adequate support or access to skilled clinicians and programs capable of providing effective social and behavioral interventions.
In these situations, medications become stopgaps, used to prevent the child from hurting themselves or others, or to help control disruptive behaviors that threaten the child’s foster placement. The lack of effective long-term treatment exacerbates the risk for excessive and inappropriate medication use.
This problem is evident in the patterns of high-risk prescriptions identified by the GAO study. As a group, children in foster care were more likely than other children to be treated with multiple psychiatric drugs, and also were more likely to be treated with dosages that exceed recommended standards of care.
These practices impacted thousands of children. Some young people were prescribed as many as 10 different psychotropic drugs at the same time. Some children younger than 5 years of age were prescribed as many as 5 different medicines concurrently.
Unfortunately, such practices are not uncommon. At my State hospital, kids are often admitted taking four or more medications. A few years ago, one young boy admitted to Seattle Children’s Hospital was taking 13 different psychotropic drugs. There is no research that justifies these practices.
The most troubling finding of the GAO study is the use of psychotropic drugs in infants. Most of the prescriptions in babies were for antihistamines, some of which may have been used to treat other types of medical problems. Regardless, there is little research supporting the use of these medicines in very young children, and the prescriptions are concerning.
Furthermore, dozens of babies were prescribed antipsychotics, antidepressants, clonidine or lithium. Some infants were prescribed more than one drug. The use of psychotropic medications in babies defies both standard of care and common sense.
The findings of the GAO study strongly suggest the need for better oversight. The Best Principals outlined by the American Academy of Child and Adolescent Psychiatry provide a useful set of monitoring guidelines.
Washington State has implemented a model system to oversee psychotropic drugs. Criteria were developed to identify prescriptions that exceed safety thresholds, based on dose, number of medications or age of the child. For prescriptions flagged by this process, a second opinion by a child psychiatrist is required before the medication is dispensed. This oversight system has reduced high-risk prescriptions, and over a two-year period, saved the State 1.2 million dollars.
The results of the GAO study also strongly call for more research. A hodgepodge of prescribing practices occurs in part because none of our current treatments work well enough. Genetics and neurobiological sciences have advanced substantially over the past decade, in large part due to the leadership of the National Institute of Mental Health. Nonetheless, given the marked complexity of brain functioning, the underlying causes of most psychiatric illnesses remain unknown. Without known causes, research on intervention inevitably struggles. We need continued investment, both fiscal and intellectual, in order to develop safer and more effective treatments, and to eventually find cures.
Thank you for listening. (emphasis mine)
I would love for this "doctor" submit evidence in compliance with the Rules of Evidence required in every other type of civil or criminal proceeding in Courts of Law, except Involuntary Commitment hearings. There are none. It is a hypothesis that a genetic or neurobiological defect or disease causes any/every psychiatric diagnosis/es. Jon McClellan's statement is not "testimony" in an ethical medical or legal sense; it is more an excuse, justified by a presumed privilege. There is not any scientific basis or an ethical medical purpose for prescribing teratogenic drugs to children and adolescents, based on a hypothesis alone, since real world risks are disability and death. Jon McClellan is one of the psychiatrists who has led the way in recommending "a pill for every ill" psychopharmacology is the new psychiatry psychotropic drug marketing campaign.
Practice Parameters and Treatment Protocols are followed by psychiatrists, and other medical professionals. These parameters and protocols recommend drugs without the recommendations having definitive, empirically validated support. Jon McClellan's "testimony" was not the truth and nothing but; it was more of a self-serving defense of the bio-psychiatry pharmaceutical treatment paradigm; with no evidence offered for the validity, safety, and/or effectiveness of this "psycho-pharmacological treatment." Drugging children for what may be the effects of abuse, deprivation and trauma as if the effects (their injuries) are evidence the child has an unidentified genetic or neuro-biological condition; is social and political control of children and/or their parents; not medicine. Clearly to NOT address the real world environmental and inter- and intra- personal deficits which are clearly causal factors; adds insult to injury, to say the least.
While deprivation, and physical abuse can cause biological damage, and the detrimental effects of trauma--particularly a brain injury, can cause neurological deficits, as well as behavioral, emotional and social difficulties, does that mean a child who has had these horrific experiences has a disease that is neurobiological and/or genetic in origin? According to Jon McClellan, apparently, that is what it means---I wonder how a normal child can become genetically and/or neurobiologically diseased and/or defective, from not having their needs consistently met? There is a major difference between genetics and epigenetics... How is it that the failings of the adults in children's homes, and in their communities is not seen for the causal factors that they are, but instead minimized or dismissed while it is claimed that children are mentally ill due to an unidentified (illusory) neurobiological disease and/or a genetic defect?