California children in the nation’s largest foster care system have long had their sadness, frustration and fears blunted with the strongest types of psychotropic drugs — medications with limited approvals for pediatric use that often cause debilitating side effects.

Now, after years of inaction, Sacramento lawmakers have gone far beyond any other state legislature to protect abused and neglected kids from receiving questionable psychiatric care that fails to treat the underlying causes for their trauma. Under three laws that took effect this year — and three more bills now on the governor’s desk — the Legislature has prompted aggressive efforts to reel back overprescribing known to cause obesity, diabetes, heavy sedation and irreversible tremors.

The unprecedented package of bills requires state agencies, caregivers, social workers, public health nurses and judges to better protect the state’s most vulnerable children.

The legislation is lauded by California’s foster care ombudsman Rochelle Trochtenberg, a former Los Angeles County foster youth who suffered on too many medications throughout her adolescence. Trochtenberg and other youth advocates have spent four years working with state agencies to reduce excessive prescribing. The lawmakers’ action speaks directly to foster youth, she said, affirming “you do have a voice, people are paying attention, and you deserve better care.”

A damning state audit released this week increased pressure on lawmakers to act. In a 131-page report, State Auditor Elaine Howle reported that the state and counties “have failed to adequately oversee the prescribing of psychotropics to children in foster care,” saddling them with too many meds, inappropriately high dosages, and little follow-up care or documentation.

“The state of California’s No. 1 job as the guardian of these kids is to protect their health and well-being, and we have failed miserably,” said state Sen. Mike McGuire, D-Healdsburg, who called for the audit and has authored a bill to revoke the licenses of doctors found to overprescribe. “There is a systematic failure at all levels of government to protect foster youth from overprescribers.”

McGuire and three other lawmakers began pushing for legislation and the state audit last year, following an expose published in the San Jose Mercury News. As many as 20 percent of foster children age 6 and older receive psychotropics, according to data compiled for senators, with the majority receiving antipsychotics — drugs that carry the most serious risks and are the least-studied on children.

The Food and Drug Administration approves antipsychotics only for the rare instances of schizophrenia, bipolar disorder and autism with irritability in children. But these drugs, along with a class of medications known as mood stabilizers, are often prescribed “off-label” to manage difficult behaviors — such as angry outbursts and suicidal thoughts — in foster children who have suffered trauma and abandonment.

Lawmakers working closely with the National Center for Youth Law in Oakland want more effective and less harmful treatments for any of the roughly 79,000 abused and neglected children moving through state care each year who need mental health services.

If signed into law, the three bills nearing final stages of approval would:

•Require juvenile courts to order a review anytime doctors prescribe certain drug combinations or prescribe to children age 5 or younger.

•Expand the Medical Board of California’s ability to investigate doctors who overprescribe.

•Ensure that counties provide enough effective, nonpharmaceutical therapies to meet foster children’s needs.

The bills’ authors are McGuire and fellow Democratic Sens. Bill Monning of Carmel and Jim Beall of San Jose.

In an emailed statement, Senate President Pro Tem Kevin de León, D-Sacramento, said the findings of the recent audit “underscore the continuing need to improve oversight, care, and accountability” of psychotropic prescriptions in the foster care system, an issue that many states across the nation confront.

He added that, although the Brown administration “has taken some meaningful steps and we enacted substantial reforms last year, the problems run deep and further reform is essential. The pending bills ... address shortcomings highlighted by the auditor and could meaningfully change these children’s lives. We look forward to seeing them become law.”

Lobbyists for physicians and the group home industry, along with county behavioral health directors, have fought many of the provisions in the proposed laws.

Robert Holloway, president of the California Academy of Child and Adolescent Psychiatry, asked members in an email alert this week to contact Gov. Brown and urge a veto on SB253. That measure aims to ensure through stepped-up juvenile court oversight that foster children receive necessary lab tests and screening, have their medical histories documented, and are granted second medical reviews in some cases.

Holloway argues the bill will delay urgent care for those who need it and saddle doctors with unnecessary paperwork. He also objects to the requirement that children 12 and older provide informed consent for their medications, calling them “ill-equipped” to grant such consent at that stage of life.

“This is a costly and flawed proposal with the potential for significant unintended consequences for youth who need, and benefit from, appropriately prescribed psychotropic medication,” Holloway stated.

Lobbyists representing physician groups also have opposed SB1174, which expands the authority of the Medical Board of California to investigate high-prescribing physicians and forward their names to the state attorney general, if warranted. The California Medical Association argues the bill will “target” physicians who work in group homes and juvenile halls and discourage well-meaning doctors from serving needy children.

But advocates are celebrating their bipartisan legislative victories, which are due in large part to the testimony of former foster youths.

Sarah Pauter, 27, is among them. Pauter of San Diego has testified before the state Senate and members of Congress, describing her 15 months on antidepressants, anticonvulsants and mood stabilizers while in foster care. She said the drug treatment did little to help her with her real problems — the grief of losing her family and witnessing domestic violence.

A former A student, Pauter said that by her junior year of high school her medication regimen left her so heavily sedated that she was placed with learning-deficient students. Since she stopped taking medication in 2006, she has earned a master's degree and launched a nonprofit agency to serve pregnant and parenting teens.

But not all foster youth have been so fortunate, she said, so the legislation is desperately needed.

In the past, “there was no one saying to these prescribers and these systems that if you’re not doing right by these kids there is going to be consequences,” Pauter said. “And now there is.”

Karen de Sá is a San Francisco Chronicle staff writer. Email: kdesa@sfchronicle.com

Children’s psychiatric medication

The Legislature has passed six bills that aim to contain the use of psychotropic medications in the state’s foster care system; another is pending. Three bills became law this year; three are now on Gov. Jerry Brown’s desk.

Laws in effect

SB319: Expands the authority of foster care public health nurses to monitor psychotropic prescriptions. (Author: state Sen. Jim Beall, D-San Jose)

SB484: Increases monitoring and enforcement of group homes where overprescribing of psychotropic medications is most prevalent. (Author: Beall)

SB238: Requires monthly reporting on foster children who’ve received psychotropic medications; training for professionals who work with and care for foster children; and expanded input to the juvenile courts that authorize prescriptions. (Author: state Sen. Holly Mitchell, D-Los Angeles)

Proposed laws

SB253: Strengthens juvenile court oversight of psychotropic prescribing by requiring second reviews in extreme cases, such as three or more medications at once and prescriptions for very young children, and mandates proof of follow-up care. (Author: state Sen. Bil Monning, D-Carmel)

SB1174: Strengthens the ability of the Medical Board of California to identify and investigate doctors who prescribe psychotropics excessively, with extreme cases forwarded to the state attorney general. (Author: state Sen Mike McGuire, D-Healdsburg)

SB1291: Holds counties accountable for providing mental health care to foster children that include non-drug therapies. (Author: Beall)