Report 2015-131 Recommendation 35 Responses

Report 2015-131: California's Foster Care System: The State and Counties Have Failed to Adequately Oversee the Prescription of Psychotropic Medications to Children in Foster Care (Release Date: August 2016)

Recommendation #35 To: Medical Board of California

Following the completion of the analysis (described in Recommendation 34), the Medical Board should take the appropriate follow-up actions that it deems necessary, including the investigation of physicians identified in its analysis.

Annual Follow-Up Agency Response From October 2021

The Board continues to place a high priority on these cases, pursuant to Business and Professions Code Section 2220.05. As the Board receives additional evidence, including medical records, related to existing complaints, or new complaints, the Board will investigate and take appropriate disciplinary action, when warranted. The Board views this recommendation as "Fully Implemented" because the Board taking is appropriate action.

California State Auditor's Assessment of Annual Follow-Up Status: Resolved

To the extent that the Medical Board performs investigations and takes other appropriate follow-up actions when it becomes aware of physicians who may have inappropriately prescribed psychotropic medications for foster children, it has resolved this recommendation.

Annual Follow-Up Agency Response From October 2020

While the Board places a high priority on these cases, the Board has only received five cases for possible investigation since 2017. Three cases were fully investigated and departures from the standard of care were not identified. The other two matters did not provide enough information to locate medical records or a response for a release was not provided.

Further, on January 9, 2020, Board staff participated in the workgroup meeting required by SB 377 (Chapter 547, Statutes of 2019). The Board is hopeful that the updated procedures required by SB 377 will facilitate its access to these records so the Board can continue to conduct investigations, and take appropriate disciplinary action, when warranted.

California State Auditor's Assessment of Annual Follow-Up Status: Pending

Annual Follow-Up Agency Response From October 2019

The Medical Board of California (Board) is currently still in the same position as it was last year when the update was provided. However, SB 377 (McGuire, Chapter 547, Statutes of 2019) was signed into law and this bill will change the process for the Board to obtain authorizations for medical records for foster youth cases. SB 377 requires judicial council forms to be revised, by September 1, 2020, to include a request for authorization by the foster youth or the foster youth's attorney to release the foster youth's medical information to the Medical Board of California (Board), in order to ascertain whether there is excessive prescribing of psychotropic medications that is inconsistent with the standard of care. SB 377 also requires the California Department of Social Services (CDSS), by January 1, 2020, to convene a working group consisting of specific stakeholders, including the Board, to consider various options for seeking authorization from a foster youth or their attorney, for release of the foster youth's medical information regarding psychotropic medication prescribed between January 1, 2017, and July 1, 2020, and CDSS must report to the Legislature by April 15, 2020, on those options and on any recommendations to best reach those children and their attorneys to seek authorization. This bill will allow the Board to get authorizations to release medical records for foster youth as part of the judicial council process, so when the Board's expert identifies cases of potential inappropriate prescribing, the Board can obtain the medical records, investigate, and take disciplinary action, if appropriate. Once this bill becomes effective, the Board anticipates that the process to investigate past and future cases will be significantly improved.

California State Auditor's Assessment of Annual Follow-Up Status: Pending

Annual Follow-Up Agency Response From October 2018

The Medical Board of California (Board) is in the same position it was in a year ago when the last update was provided. The Board needs to obtain the appropriate authorizations for medical records so it can move forward to investigate physicians. Although the Board continues to work with the Department of Social Services, the Board is not receiving these authorizations. At this point, it appears that a legislative change may be necessary in order for the Board to obtain the necessary patient records so it can investigate these cases.

California State Auditor's Assessment of Annual Follow-Up Status: Pending

Annual Follow-Up Agency Response From October 2017

The Medical Board of California (Board) requested assistance from the Department of Social Services (DSS), since the data provided to the Board did not include the names of the foster children receiving the prescriptions. Per the data use agreement, DSS is to facilitate contact with county child welfare agencies, the juvenile courts, county counsel, children's attorneys and other relevant entities, to assist the Board in obtaining child-specific information, including relevant medical records. The Board and DSS worked with the relevant entities to create an authorization letter to send to current and former foster children and their guardians, as appropriate, to receive authorization to obtain the medical records of the foster children. DSS staff sent out 33 letters to last known addresses of foster children who had transitioned out of foster care. Unfortunately, some of those letters came back as undeliverable/returned. DSS staff also reached out to the counties on * children to see if there was a medical rights holder who could authorize the release of information. Of those children, * had a legal guardian with medical rights who were sent the letter and authorization form. The remaining * children in those counties will require court orders to obtain the release and the medical records. The Board will work with DSS on the process to move forward on seeking court orders. DSS staff are also preparing the letters and authorization forms for the children in the remaining counties to be sent out. The Board has received * releases from individuals who have agreed to allow the Board to look into the care and treatment provided. The Board is working to obtain authorization for the medical records. This will then begin the Board's normal complaint and investigation process to determine if discipline is warranted. It is important to note, that without the authorization for the medical records, the Board cannot move forward with investigating these matters.

* We redacted the number here because of its small size.

California State Auditor's Assessment of Annual Follow-Up Status: Partially Implemented

1-Year Agency Response

The Medical Board of California (Board) has requested assistance from the Department of Social Services (DSS), as the data provided to the Board does not include the names of the foster children. Per the DUA, DSS is in the process of providing technical assistance, which includes, but is not limited to, facilitating contact with county child welfare agencies, the juvenile courts, county counsel, children's attorneys and other relevant entities to assist the Board in obtaining child-specific information, including relevant medical records. The Board and DSS worked with the relevant entities to create an authorization letter to send to current and former foster children and their guardians, as appropriate, to receive authorization to obtain the medical records of the foster children. The first round of letters has gone out to foster children who have transitioned out of foster care, and the next round of letters will go out this week to the guardians of foster children still in the foster care system. Once authorizations to obtain the records are received by the Board and the child-specific medical records are obtained, the Board will follow its normal complaint and investigation process to determine if discipline is warranted.

California State Auditor's Assessment of 1-Year Status: Pending

6-Month Agency Response

The Medical Board of California (Board) has completed the first step of requesting assistance from the Department of Social Services (DSS), as the data provided to the Board does not include the names of the foster children. Per the DUA, DSS is in the process of providing technical assistance, which includes, but is not limited to, facilitating contact with county child welfare agencies, the juvenile courts, county counsel, children's attorneys and other relevant entities to assist the Board in securing a court order authorizing it to obtain child-specific information, including relevant medical records. Once the child-specific medical records are obtained, the Board will follow its normal complaint and investigation process to determine if discipline is warranted.

California State Auditor's Assessment of 6-Month Status: Pending

60-Day Agency Response

The Medical Board of California (Board) has completed the first step of requesting assistance from the Department of Social Services (DSS), as the data provided to the Board does not include names of foster children. Per the DUA, DSS will provide technical assistance, which includes, but is not limited to, facilitating contact with county child welfare agencies, the juvenile courts, county counsel, children's attorneys and other relevant entities to assist the Board in securing a court order authorizing it to obtain child-specific information, including relevant medical records. Once the child-specific medical records are obtained, the Board will follow its normal complaint and investigation process to determine if discipline is warranted.

California State Auditor's Assessment of 60-Day Status: Pending

All Recommendations in 2015-131

Agency responses received are posted verbatim.