About a third of psychiatrists serving Florida’s juvenile jails and prescribing drugs to incarcerated youths have accepted payments from the drug companies that manufacture antipsychotic medications, according to an investigation by the Palm Beach Post. Massive amounts of the medications have been purchased and administered by the state juvenile justice system, which has no method for tracking prescriptions and diagnoses to see whether the drugs were prescribed appropriately.

A spokeswoman for the Florida Department of Juvenile Justice told the Post that the department “expressly prohibits the use of these medications as a chemical restraint.” A former spokesman, however, acknowledged that doctors serving the state’s jailed youths do prescribe the drugs off-label—or for uses that are not approved by the U.S. Food and Drug Administration.

In our series Dollars for Docs, we've been reporting on drug company payments to doctors and the ethical issues and conflicts of interests raised by such financial ties within the medical industry.

The phenomenon of widespread off-label use of psychiatric medications—and poor recordkeeping—isn’t a new one, and it’s not limited to Florida’s juvenile detention centers. In an investigation last year by Youth Today—which we noted at the time—only five state juvenile systems were able to provide data on antipsychotic expenditures that included original diagnoses. In those five states—Connecticut, Louisiana, New York, Texas, and West Virginia—more than 70 percent of prescriptions for incarcerated youth were for off-label uses such as the treatment of general mood disorders, attention deficit hyperactivity disorder (ADHD), or post-traumatic stress disorder (PTSD).

As far back as 1998, the Los Angeles Times reported that foster children in California were being drugged with antipsychotics and other mood-altering medications, despite potentially lethal risks. Often there was very little documentation, if any, as to why the drugs were prescribed.

We noted earlier this month that a government report also found problems with overmedication and off-label use of antipsychotics in nursing homes, even though the drugs also can be lethal for elderly patients with dementia. In response to the report, the government’s top Medicare and Medicaid official raised concerns about the ties between pharmaceutical companies and the doctors and pharmacies that serve nursing homes.

Also in medical conflict-of-interest news today, the Chicago Tribune reported on the case of a surgeon who implanted heart devices that he himself invented and was collecting royalties for. The heart device had not yet received FDA approval. The doctor blamed the lapse on the manufacturer, which had incorrectly believed that it didn’t need FDA approval.

The hospital told the Tribune that it now informs patients in writing if doctors are receiving royalties for a device, but the surgeon still faces a lawsuit.

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