Contra Costa County foster youth’s mysterious death under investigation — (San Jose Mercury News)

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San Jose Mercury News

Karen de Sá, kdesa@mercurynews.com

01/12/2015 06:42:28 PM PST

ANTIOCH — A 16-year-old foster youth who was taking psychotropic medications was found dead in his bed late last month – and now police and state social services officials are investigating why he didn’t receive medical care after he showed signs of being heavily impaired.

Results of an autopsy and toxicology tests are weeks away, so investigators say it’s still far from clear why the otherwise healthy teen died or what, if any, substances contributed. But Steven Unangst’s alarming stupor and mysterious death underscore ongoing concerns about the care and supervision of California foster children who are prescribed potentially dangerous psychiatric medications — a subject of this newspaper’s yearlong investigation “Drugging Our Kids.”

Steven Unangst shows text messages he received late last year from his 16-year-old son Steven, who died in an Antioch foster home on Dec. 19, 2014. The text conversation centered on the medications the teen was prescribed for anxiety. The phone number at the top was blurred out for privacy. (Dai Sugano/Bay Area News Group))
 Family and friends are now grief-stricken, and simultaneously angered over the Dec. 19 death of Steven, a floppy-haired skateboarder in his third year at Pittsburg High School.
 “A 16-year-old child does not just die peacefully in their sleep,” said Steven’s grandmother, Karla Garvey, who had cared for the boy for much of his life and was stunned to see him drooling and staggering around “like a drunken zombie” during a supervised visit the afternoon before he died.
She said she begged the boy’s social worker to take him to the hospital but was told his odd behavior may have been because he was adjusting to an increased dose of Zoloft, his prescribed antidepressant.

While psychiatrists consulted by the newspaper said it’s highly unlikely that a modest change to his antidepressant could alone be responsible for Steven’s death, experts say the tragedy should send a clear message to child welfare workers who care for emotionally fragile kids on psychiatric drugs.

“The caregiver and the social worker, they need to feel the urgency and take action immediately to make sure the youth’s health isn’t in danger,” said Jennifer Rodriguez, executive director of the San Francisco-based Youth Law Center and a former California foster youth who felt neglected when she experienced debilitating side effects from psych meds.
Rodriguez said she often hears foster parents complain that they don’t have enough training about “really scary side effects or how the drugs interact with over-the-counter meds or even street drugs.”By all accounts, Steven’s death is unusual. An average of three or four children died each year while placed out of their homes in foster care, according to state Department of Social Services numbers from 2008 through 2013.

What is not rare is the questionable overuse of medication in foster care, which is now the subject of a statewide investigation by the California Medical Board, spurred by the newspaper’s ongoing series.

Nearly 1 out of 4 adolescents in state foster care receive psychotropic medications, the newspaper found, more than three times the rate for all teens nationwide. And since foster kids often bounce among caregivers who know little about their medical histories, experts worry they often don’t receive enough monitoring.

Steven had been living in the Antioch foster home of Dorothy Brown since his 16th birthday last August. Three other foster children have been moved from her home since Steven’s death, according to state and county officials.

Efforts to reach Brown and Steven’s social worker were unsuccessful, and the agency that employed both of them — Families for Children, a nonprofit adoption and foster family agency — chose not to comment, as did the psychiatrist who prescribed his medication and had been treating him since 2013.

This family photograph, taken by his father, shows Steven Unangst on his 16th birthday in August 2014. (Courtesy of Steven Unangst)

At the time of his death, Steven had been prescribed Zoloft and the sedating antihistamine Vistaril to treat depression, anxiety and sleep problems, according to relatives and records.

Zoloft is approved for use on children suffering from major depression and obsessive-compulsive disorder. Vistaril is sometimes prescribed with Zoloft to reduce the side effect of tremors, or to help with anxiety or sleeplessness, but it is generally used short term.

Four child psychiatrists consulted by the newspaper about the medications prescribed for the roughly 5-foot-10, 150-pound teen, said they were not uncommon.

But one cautioned that Zoloft and Vistaril together could cause dizziness, drowsiness and impaired thinking. According to the FDA, Vistaril can cause “hypersedation” and “stupor.”

Last year, Steven had been removed from his grandmother’s home after police were called during a sibling’s violent outburst. He had been increasingly missing school and scout meetings since then and told his girlfriend’s father that he yearned to return to his grandmother.

On Dec. 18, the day before his death, he slept until noon and was again absent from school. Later that afternoon, Garvey and Steven’s father (who shares the same name) waited anxiously at a Subway sandwich shop for the teen to arrive for a supervised visit. They had planned to treat him to his favorite meatball sandwich and deliver his Christmas gifts.

But Unangst and Garvey said they were shocked as Steven stumbled across the parking lot into the sandwich shop with his social worker’s help. In a cellphone video taken by his father and shared with the newspaper, Steven struggles to eat his sandwich and keep his eyes open. He tells his father he doesn’t know what’s wrong and said he had taken his pill the night before, fallen asleep at 9 p.m., and slept until noon.

“His eyes were rolling around in his head, he was slobbering, he couldn’t sit up straight,” Garvey said. “I said: ‘This child needs to go to the hospital, something’s wrong.’ ”

Garvey said she convinced the social worker to call Steven’s psychiatrist, but he was able only to leave a message and then took Steven to the foster home.

“If this kid couldn’t go to school and couldn’t walk, why wouldn’t you take him to the doctor?” said Todd Whitmire, Pittsburg High’s principal, who described Steven as bright and highly capable.

On Jan. 2, weeks after the boy’s death, Garvey said she spoke with the boy’s psychiatrist, who was “adamant” that the drug combination he was prescribed could not have been fatal or caused the symptoms Steven displayed in the sandwich shop. Garvey said the psychiatrist told her she had increased the dosage of Zoloft but that after hearing the social worker’s phone message about an “adverse reaction,” she recommended cutting it in half.

Contra Costa County spokeswoman Lynn Yaney said local officials are awaiting results of the Antioch police investigation and autopsy reports. “Our job is to take care of kids and keep them safe, and when something like this happens it is absolutely devastating,” she said.

Meanwhile, Garvey has tried to explain to Steven’s two younger cousins why he wasn’t coming home. “God really, really needed him up in heaven for an important project,” she said. “So the angels came and got him.”

An April 16 article in the San Jose Mercury News states:

“Steven had been prescribed psychiatric drugs while in foster care — including Zoloft, Trazodone and Vistaril to treat anxiety, depression and suicidal thoughts, records show. He told friends and relatives in the months leading up to his death that he desperately wanted to return to his grandmother. Zoloft, an antidepressant, was found in Steven’s bloodstream after he died, but not in a fatal dose by itself.”