GAO seeks information on off label drugging of foster children

At the request of Congress, GAO is seeking information regarding cases in which state foster children have been prescribed psychotropic medication outside of federal regulations or accepted medical standards of practice.  These may include very young foster children prescribed certain kinds of psychotropic drugs, children prescribed psychotropic drugs in dosages that exceed accepted standards, children prescribed psychotropic drugs for purposes other than a medically accepted indication, or children taking numerous psychotropic drugs concurrently.  If you have information about state foster children being prescribed psychotropic medication outside of regulatory and/or medical guidance and are willing to provide details, please e-mail GAO at


Fish & Richardson, US DOJ Settle Medicaid Fraud and Abuse of Children Case Against Pennsylvania Psych Facility

From Vince Boehm:

Stefan Kruszewski is a Harrisburg, PA psychiatrist and a personal hero who was hired by the Bureau of Program Integrity in the Pennsylvania Department of Public Welfare.

He was fired in 2003 after he uncovered widespread abuse and fraud in the bureau. His efforts to clarify the causes of death in four children and one adult in the state’s care were blocked when he was denied postmortem or coroner’s reports and hospital records.

Some of the patients were taking as many as five antipsychotic medications at the same time-something Dr Kruszewski says is “hard to justify.” When he warned that off-label use of the drugs was potentially harmful to patients and could expose the state to liability he was told that “it’s none of your business”.

Kruszewski says, “I was terminated because I did my job. It turns out that drug companies and politicians were influencing the drugs prescribed for patients.”

Dr. Kruszewski sued for-profit Youth and Family Centered Services and its subsidiary Southwood Psychiatric Hospital (YFCS) in Pennsylvania for Medicaid fraud and abuse of children at its residential
treatment facility.

This suit was settled yesterday.

For immediate release:

Fish & Richardson and the U.S. Department of Justice Settle Medicaid Fraud and Abuse Case at Southwood Psychiatric Hospital in Pennsylvania

April 23, 2009 —

PROSPERITY, PA — (Marketwire) — 04/23/09 — Fish & Richardson announced today that it, along with the U.S. Department of Justice, settled a lawsuit that had alleged substantial Medicaid fraud and the abuse of children at for-profit residential treatment facilities operated by Youth and Family Centered Services and its subsidiary Southwood Psychiatric Hospital (YFCS) in Pennsylvania. Fish represented Dr. Stefan P. Kruszewski, a board certified psychiatrist who had discovered and exposed fraud and abuse, but was then fired from his position as a medical consultant for the Bureau of Program Integrity in Pennsylvania’s Department of Public Welfare. The United States government intervened to seek a resolution with regard to certain activities occurring in 2005. Under the settlement, YFCS, in addition to agreeing to pay a $150,000 fine to reimburse federal Medicaid funds, has agreed to implement comprehensive new treatment standards, an extensive compliance program, as well as increased government oversight of their programs. This settlement is the first resolution by the United States of a failure of care case involving Pennsylvania psychiatric residential treatment facilities.

YFCS runs three residential facilities in Pennsylvania for children aged 6 to 18 who have been deemed to require psychiatric care by the state. The government intervened in Dr. Kruszewski’s case to address a wide variety of serious quality of care concerns at these facilities, including woefully inadequate staffing and use of physical restraints which posed significant risks to the health and safety of the children housed in the YFCS facilities. As a result, YFCS allegedly submitted Medicaid reimbursement requests for inadequate or worthless treatment.

“This was a case of the exploitation of children for profit,” said Thomas Halkowski, a principal of Fish & Richardson in the firm’s Wilmington office, who, along with Thomas Melsheimer, a principal in Fish’s Dallas office, represented Dr. Kruszewski in the case. “Dr. Kruszewski should be commended for having the courage to come forward to protect this vulnerable group from further mistreatment. Because of his actions, we now have an agreement that provides a new standard of care to help safeguard the well being of those children in Pennsylvania who are housed in YFCS’s facilities. This agreement should also be a warning shot across the bow of other residential treatment facilities in Pennsylvania of the level of care they should be administering to Pennsylvania’s children.”

Because the Medicaid payments were administered through a joint federal/state Medicaid program, the U.S. government intervened in the case and became a party to the lawsuit and settlement agreement. The federal government has reserved the right to bring criminal charges and to exclude YFCS from Medicaid reimbursement programs in the future.

About the Attorneys

Thomas L. Halkowski is a Principal in the Wilmington, Delaware office of Fish & Richardson, where he focuses his practice on intellectual property and other complex litigation, including False Claims Act litigation. He was previously a Senior Trial Attorney for the United States Department of Justice. Tom Melsheimer is a Principal in and Managing Principal of Fish & Richardson’s Dallas office. His trial practice includes complex civil and criminal litigation in state and federal courts, emphasizing intellectual property, antitrust, and False Claims Act litigation. Mr. Melsheimer was an Assistant United States Attorney for the Northern District of Texas from 1990 to 1993.

About Fish & Richardson

Fish & Richardson is a leading global law firm unlike any other law firm in the world. With 450 lawyers practicing intellectual property, litigation, and corporate law, Fish has redefined IP law for a market that values IP as a fundamental business asset. Fish was recently named one of the leading IP law firms in the U.S. by Managing Intellectual Property magazine (MIP, February 2009). The firm handles more patent litigation than any other law firm, both in federal district courts (IP Law360, January 2009) and the International Trade Commission (IP Law & Business, June 2008); and is the No. 1 patent firm for the world’s most innovative companies (IP Law & Business, November 2008).

Amy Blumenthal
Blumenthal & Associates
(617) 879-1511

Foster “Mom” on Drugs Kills Baby; Biological Mother Brokered Baby for Govt.-paid Drugs

An absolute nightmare… this just came over email:

“Have ya’ll heard about the Ga woman who forgot her foster infant inside a hot minivan. The baby died. She managed to get her two adopted kids in the house, but claims because she was taking rx for strep throat she forgot the baby. See the story below.

Bio mom made a deal with the state- traded baby for treatment of bipolar. The irony here, the bio mom lost custody because she was taking rx and could harm the child. The foster parent was taking rx and killed the child.

A blogger from Ga wrote, regarding the bio mom:

It is my understanding that Ms. Carter (Jessica Scovil’s Mother) sought public services for treatment of a mental health disorder-bipolar disorder (or manic depression) because she is 19, she is not covered under her parent’s health insurance and did not have the funds herself to see treatment, so she turned to our Dept of Health and Human Services to see if there were any programs that might help fund treatment for her (ie,medication, counseling/therapy, etc). 

When it was learned that she was a new mom of a 4 (four) month old infant, the social worker decided that she was not capable of caring for her infant. As I understand it-a deal was brokered. The State of GA would fund her treatment as long as baby Jessica was temporarily signed over to foster care. In other words, Jessica’s parents made a deal with the devil, and it didn’t take ’em long to realize it.

They got legal representation and tried to bring their baby girl home. A hearing was set for September 16, 2008, where it was expected Jessica would be returned to her parents. Unfortunately, the foster mother ensured the Mother would never again have custody of her child by baking the baby in her vehicle. 

Jessica was returned to her parents and family as a corpse.

The State of Georgia and Wendy Obsborne are solely responsible for this child’s death-and we’ve yet to hear another peep about prosecuting Ms. Osborne-who by all rights should be in JAIL for what she did.

If she were the natural mother of baby Jessica she would have been arrested on the spot for killing that innocent baby. But since she’s on the State of Georgia’s payroll as a foster “parent”, she’s going to get off scott free.

No charges filed.

http://www.ajc. com/metro/ content/metro/ stories/2008/ 09/03/baby_ death_heat. html
9-month old dies in hot minivan

Foster mother said she had taken prescription medication, forgot baby was in vehicle
The Atlanta Journal-Constitutio n
Wednesday, September 03, 2008

A 9-month-old girl died Tuesday after her foster mother said she forgot the infant inside a hot minivan for more than two hours, officials said.

Jackson County sheriff’s deputies are still investigating Wendy Osborne’s account. The 29-year-old Nicholson woman told Jackson County Sheriff deputies that she came home from a doctor’s appointment about 2:30 p.m., unloaded her two adopted girls but forgot about the baby in the car seat.

Osborne, a foster parent for five years, said she took a nap, waking around 5 p.m. Maj. David Cochran of the sheriff’s department said at that point she remembered the baby in the minivan.

State Child Advocate Tom Rawlings identified the girl as Jessica Marie Scovil. The infant, who had lived with Osborne for five months, was pronounced dead by emergency personnel called to the scene, Cochran said.

Osborne told deputies she had been sick for several days and was prescribed medication for strep throat, which may have contributed to her drowsiness. A toxicology report has been ordered, and charges could be filed.

Two other foster children who had been living with Osborne were removed from the home, Cochran said.

The state Division of Family and Children Services, which oversees the foster care system, is also investigating the death, said spokeswoman Dena Smith. She said there had been no indications of problems with Osborne as foster mother.

Rawlings said if Osborne’s version is correct, he would tend to oppose criminal charges.

“I usually look at these kinds of situations as there but for the grace of God go I,” he said.”

Foster Care Shrinks Face State Discipline

Texas doctors who prescribed drugs faced state discipline

12:31 AM CDT on Sunday, August 17, 2008

By EMILY RAMSHAW / The Dallas Morning News

“AUSTIN – More than 20 doctors who have prescribed psychiatric drugs to foster children have also been disciplined by the state – some for allegations as serious as sexually exploiting a patient or missing a fatal drug complication. 

Also Online

The doctors account for just a small fraction of the 300 top-prescribing foster care physicians, most of whom have committed their careers to child psychiatry. But they raise questions about how closely the state monitors the doctors who treat Texas‘ most troubled children.

One of the doctors, an Arlington psychiatrist, prescribed mind-altering drugs to 27 foster children in 2003, the same year a young male patient accused him of molestation.

This wasn’t the first such allegation. Throughout the 1990s, the doctor was repeatedly accused of overmedicating patients, and entering young boys’ hospital rooms late at night to kiss and touch them, though the allegations weren’t brought to the medical board until 2003. There’s no way to know whether the doctor, who has since been convicted and incarcerated, victimized any foster children.

Among the other doctors cited by the state medical board for infractions:

•A Killeen psychiatrist prescribed psychiatric drugs to 96 foster children in 2002 despite a nearly 10-year history of citations for abusing alcohol, marijuana and cocaine, and refusing to take drug tests. His license was revoked in 2003, according to medical board records.

•An Abilene doctor, who has prescribed psychiatric drugs to 1,200 foster children since 2002, failed to order enough lab tests or coordinate with another doctor to monitor the level of lithium they were treating a patient with. The patient died, and the medical board determined that lithium toxicity may have contributed to her death, according to state records. The doctor still has his license.

•A Mineola psychiatrist had his license suspended in 2005 for touching a patient “in an intimate manner while demonstrating massage techniques,” according to medical board records. The doctor, who recently retired, prescribed psychiatric drugs to 79 foster children between 2002 and 2007. The doctor said the incident did not involve a foster child, and he rarely worked with them.

None of the other doctors could be reached for comment.

Unless a doctor has been convicted of a crime against a child or had his medical license revoked, he can prescribe drugs for children in state custody. Texas health officials check criminal records for doctors who have been convicted of sexual assault or injury to a child, but otherwise, they rely on the Texas Medical Board’s judgment to determine who’s fit to practice.

The medical board punishes doctors for violations and can put heavy restrictions on them – including bans on working with children and oversight of their practices – for a decade or longer, said Jill Wiggins, a board spokeswoman. Once those orders are terminated, she said, the doctors “can practice like anyone else.”

But these serious medical board violations are either rare or unreported. Last fiscal year, the board took disciplinary action against just 300 of its 59,000 doctors. Of the 7,000 annual complaints against Texas doctors, 7 percent result in sanctions.

Monitoring this behavior doesn’t generally fall to the U.S. Drug Enforcement Administration, either. A spokesman for the agency, which registers doctors who prescribe medicine, said his department rarely deals with “medical practice” issues – those are handled at the state level.”