Report Defends Care at Orangewood Shelter

The county’s Health Care Agency on Wednesday responded to charges that doctors improperly medicated abused and abandoned children at an emergency shelter, but the findings did not fully satisfy some county supervisors and other critics.

The agency’s response comes a little more than a month after the Juvenile Justice Commission released a highly critical study charging that county psychiatrists placed the health of children in jeopardy by prescribing powerful drugs without recording diagnoses, failed to keep accurate charts of some patients and changed drugs with questionable frequency.

The Health Care Agency said a committee of top officials investigated the allegations over the last month and found “no instances of substandard or unorthodox treatments or medication prescribing practices” at the Orangewood Children’s Home.

The agency’s response cited a variety of reforms that officials have imposed since 1994, when a former mental health supervisor at Orangewood complained to county superiors that a psychiatrist over-medicated young patients, mixed prescriptions improperly and gave children adult dosages.

County supervisors and members of the Juvenile Justice Commission said Wednesday that the agency’s response, while welcomed, left many questions unanswered and didn’t provide the level of detail they were hoping to receive.

“If this is the Health Care Agency’s complete response, I will be extremely disappointed,” Supervisor Todd Spitzer said. “It only deals with half the picture. It doesn’t detail who is accountable for the multiple breakdowns in the system designed to protect children.”

Board of Supervisors Chairman William G. Steiner, who first called for the commission investigation three years ago, said the agency’s response “gives some reassurance that current conditions [at Orangewood] are not jeopardizing children.”

“There have been some significant improvements,” Steiner added. “But I think, given the problems of the past, it’s natural to feel skeptical.”

In that vein, Steiner said he wants county Chief Executive Officer Jan Mittermeier’s office to independently check on conditions at Orangewood and for the Juvenile Justice Commission to complete a follow-up report in one year.

“There is still much that must be done,” he added.

The Juvenile Justice Commission’s findings were based in part on several confidential reports and audits that the commission subpoenaed from Children and Youth Mental Health Services, a division of the mammoth Health Care Agency. Attorneys for the agency unsuccessfully fought the subpoena in court, arguing that the documents should remain confidential.

The response released Wednesday said the Health Care Agency followed up on the recommendation of those earlier audits by creating a prescription guideline manual that is given to all psychiatrists.

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The agency has also hired a child psychiatrist to oversee medication practices at Orangewood and Juvenile Hall and to provide training to other doctors. Nonmedical staff at the facilities will receive lectures this winter on the effects and side effects of common medications.

Overall, the agency’s own investigation found “no evidence [that] current medication practices . . . were outside the usual, customary practices in prescribing for children.”

Cynthia Stokke, chairwoman of the Juvenile Justice Commission, said she was pleased that the Health Care Agency responded to all of the panel’s recommendations. But she said the response lacked adequate details about what is being done to correct the problems.

“They have provided some generalities, but we are looking for more specifics and more action,” she said.

Stokke said some type of independent group is needed to examine medication practices and make sure the promised improvements are sustained. “The whole reason this happened was because there was no oversight to begin with,” Stokke said. “They need someone who will sit there and say, ‘What’s going on here?’ ”