Health records neglected, lost for some foster children

Foster children in San Diego County have Rady Children's Hospital to help keep track of their health records and maintain quality medical care, but many others elsewhere in California are not as fortunate.

Foster youths are frequently moved from home to home. That usually involves a change in physicians and dentists that can increase the chances of their records, called "health passports," being left incomplete ---- especially when a child is moved from one county to another, according to child welfare advocates.

For example, at Ventura County's Casa Pacifica, a center for abused, neglected and severely disturbed youths, pediatrician Catherine M. Sever and resident nurse practitioner Maryellen Dyer-Parziale recite a litany of examples in which they say spotty record-keeping contributed to foster children not receiving proper medical treatment before and after being admitted to their facility.

In one instance, a child was diagnosed with a potentially life-threatening cardiac arrhythmia. A defibrillator was surgically implanted in his chest ---- a procedure that would typically require regular follow-up exams. But for 2 1/2 years, he apparently received no treatment; any relevant doctors' reports for that period were absent from his health passport file.

In another case, a boy entering Casa Pacifica was diagnosed with a severe growth hormone deficiency. An appointment was made with an endocrinologist.

However, before the boy could see the specialist, he was transferred to a foster facility in another county. He was transferred back about four years later to Casa Pacifica, where a review of his health passport file showed nothing to suggest that he'd received any treatment for his condition.

Whether any doctors reviewed his health passport file during that time remains unknown. What is known, according to Sever and Dyer-Parziale, is that his growth is now permanently stunted.

"There's a huge amount of medical neglect out there," said Casa Pacifica's executive director, psychologist Steven E. Elson, "and follow-up care as these kids move from home to home is miserable."

Discerning health-related issues among foster children, Elson and other experts say, can be made more difficult by the fact that many have been abused and are distrustful of adults.

Fearful of drawing attention to themselves, they often will not complain about otherwise unnoticeable medical conditions. County social workers, meanwhile, who are tasked with ensuring that foster children receive proper medical attention, typically are not trained to recognize those conditions.

The same is true with many foster parents. About 90 percent of California's foster children live in private foster homes or with relatives, as opposed to more highly regulated group institutions such as Casa Pacifica and Escondido's unique San Pasqual Academy, a residential school for foster youths. Such specialized locations have health care providers on staff who understand the value of maintaining comprehensive medical records, experts say.

"If you're a foster parent with six little foster kids at home, you're trying to get dinner on the table, the dishes cleaned and the laundry done," says Michael Bruich, executive director of New Alternatives Inc., which manages San Pasqual. "I'm not sure the most important thing on their mind is the health passport."

With California's longstanding budgetary woes, there are fewer public health nurses to make sure that medical reports make it into the files, and fewer social workers to make sure that those files are properly forwarded each time a foster child is transferred within the system, critics point out.

Still, says Carol Brown, a veteran public health nurse in Alameda County who chairs a statewide task force that is assessing health services for foster youths, "There's no blame here. It's not the people working in the system; they're all working as hard as they can. It's the system itself."

San Marcos foster mother Patty Boles, president of the North County Foster Parents Association, agrees with Brown that most who toil in the foster care field work tirelessly to benefit children in the system. Yet she doesn't mince words when assessing the overall efficiency of that system.

"They'd be better off," she said, "blowing it up and starting all over."

Bruich, who's been in the foster care field in San Diego since 1978, isn't so sure.