Following pressure from foster youth advocates, legislation that would have scaled back patient protections for Californians prescribed the most powerful psychiatric drugs will no longer be heard by the state Legislature this year.
Assembly Bill 3285 had been promoted by a sponsor and a lobbyist with close ties to the pharmaceutical industry – companies that stand to profit from fewer restrictions on the medications known as antipsychotics.
The drugs, which can cost the public health system up to $1,000 a month, are proven effective for adults with schizophrenia and bipolar disorder. But they are often used “off label” – with less proven success – to treat children and teens with behavioral challenges and histories of trauma.
That made the bill introduced Feb. 21 by Assembly Member Jacqui Irwin (D) controversial from the day youth and health policy advocates learned of it last month. The proposed legislation was the subject of an April 27 article published by The Imprint.
Poonam Juneja, a senior attorney with the Oakland-based National Center for Youth Law, said she is pleased to hear the bill is not moving forward, essentially halting “its effort to reduce oversight on prescription of antipsychotics to vulnerable individuals.”
Foster children are prescribed the medications “at far higher rates than other children in the United States, even though these medications are often not approved for use on children and can cause serious, life-threatening side effects,” Juneja said. “It is important to create strong protections to ensure the safety of those prescribed these serious medications, not to reduce existing safeguards.”
Karie Portillo Guerra, Assembly Member Irwin’s communications director, did not respond to email communication.
Irwin’s legislation aimed to scale back oversight on the most expensive psychotropic drugs – in their mildest form, drugs to treat attention-deficits, and in their most extreme, drugs known as antipsychotics designed to treat psychosis. Her bill sought to change state law so that quality-of-care and cost reviews of antipsychotic drug prescriptions paid for by Medi-Cal take place annually, instead of monthly.
The legislation was described by its sponsor, the nonprofit California Access Coalition, as “more crucial than ever” during the coronavirus pandemic, to help psychiatric medications flow more freely to the homeless suffering from severe mental illness. The bill’s sponsor, the California Access Coalition, has nine “corporate partners” all drug companies, among them pharmaceutical giants Eli Lilly, Johnson & Johnson, Pfizer and PhRMA.
Its original language did not exclude children from most of its basic provisions. But draft amendments were circulated by a lobbyist in recent weeks that, if formally introduced by Irwin, would have exempted youth in foster care from the rolled-back patient protections. Even with the amendments, however, former foster youth eligible for public health benefits until age 26 – as well as Californians on Medi-Cal who were not connected to foster care – would have been impacted.
James Gross, a lobbyist for the California Psychiatric Association, worked to push the bill. His lobbying firm, Neilsen Merksamer, is one of the state’s most influential, and includes among its clients the pharmaceutical giants Merck & Co., Johnson & Johnson and Novo Nordisk.
Gross discussed the bill with a reporter this week – clarifying that he was speaking for himself, and not for Irwin’s office, his firm or his client. He said although he has pharmaceutical clients who supported the bill, it was driven by his clients in the California Psychiatric Association, who include prescribers of antipsychotic medications and often suffer “bureaucratic snafus” when they attempt to continue their patients’ medication regimens.
“Yes, I’ve represented the pharmaceutical industry for a very long time,” said Gross, a prominent Sacramento lobbyist. “But I think my credibility on these issues speaks for itself.”
In a sign of special interests’ sway in the state capitol, Gross said he was willing – very quickly after several meetings with advocates – to propose bill language that would exempt youth in foster care from the proposed change to the public health system.
The meetings were prompted in early April by Scott Bain, a well-respected principal consultant for the state Assembly’s Committee on Health. Bain reached out to the Oakland-based National Center for Youth Law for feedback on the bill proposal, a group he had worked with years earlier on a package of successful bills that protect foster youth from excessively prescribed psychotropic drugs, particularly antipsychotics.
But Gross said “this bill was never intended to impact that population.” Although the bill’s original language did not specify the ages of patients who would no longer receive monthly treatment reviews, Gross said as the bill was drafted, “none of us were even thinking about foster kids.”
He also said he had not considered the potential impact on thousands of former foster youth who remain on Medi-Cal until age 26, and noted that the population was not mentioned to him in the more than two hours he discussed AB 3285 with advocates. He described that population as a group that is not clearly legally defined, and therefore could not be excluded from the bill’s provisions.
There are six California laws protecting youth currently in foster care from the unsafe prescribing of psychotropic medications. Many of the drugs – particularly at high dosages and in combination – can be dangerous when prescribed to young people, with questionable benefits other than to sedate troublesome behavior, youth advocates have long argued. Side effects of antipsychotic drugs can be irreversible, including obesity, diabetes and facial tics.
The drugs are also expensive, and under current law, when doctors prescribe them they must receive authorization from specially trained board-certified psychiatric pharmacists. There is widespread agreement that those reviews can lead to delays, but blame is shared: problems getting prescriptions approved can come from state pharmacy reviewers, and also from doctors who do not properly complete the necessary forms.
Last month, legislative leaders instructed the chairs of policy committees in both houses to select only the most urgent bills having to do with the coronavirus, homelessess and wildfires. Assembly Bill 3285 apparently did not make the cut. It is not scheduled to be heard in the Assembly’s Health Committee this month, following a decision by the committee’s chair, Assembly Member Jim Wood (D), a dentist and the former mayor of Healdsburg.
When asked why he thought the bill didn’t progress through the lower house, Gross said: “I can only assume that Dr. Wood did not feel that this had the level of urgency that was needed in this COVID environment.”
The lobbyist went on to say that the bill’s intent had been misinterpreted by the youth and health policy advocates, who did not understand how the Medi-Cal system worked and how delayed treatment authorizations “can go on a very long time.” Gross said they look “very negatively” on psychotropic drugs in general. “I think they are anti-psychotropic and anti-antipsychotic,” he said. “They are biased against the medications.”
But advocates for vulnerable children and families said even with foster youth exempted from the law, the need for the bill had been poorly articulated, and poorly supported by facts. Policy experts working for several influential nonprofits met with Irwin’s office with representatives from the state Department of Health Care Services in recent weeks, to express their concerns about her proposed legislation the proposal to dial back oversight of anti-psychotics.
“We were asking questions, but that doesn’t mean we didn’t understand the bill,” said Jackie Thu-Huong Wong, vice president of policy and advocacy for the Campaign to End Child Poverty in California. Wong – a former consultant to state Senate President Pro Tem Darrell Steinberg, and former health education consultant to the California Department of Education – said she and others felt the need to stand up for the interests of young people who grow up in foster care, and who too often become the homeless adults the bill purported to serve.
“We laid out very clear questions,” Wong said. “One was, do you have the data that indicates that this was a problem? And the reaction was ‘We have anecdotal data.’”
Karen de Sá is the Safety Net Reporting Fellow for The Imprint, and a former investigative reporter for the San Francisco Chronicle and the San Jose Mercury News. She can be reached at firstname.lastname@example.org.