On June 6, 2009, the Topeka Capital Journal reported on the death of a Kansas toddler, Destiny Hager, and the confirmation by an autopsy that the child died of fecal impaction, after taking Seroquel and Geodon, with "antipsychotic drugs present in concentrations considered therapeutic in adults."
Child psychiatrist, Vernon Kliewer, diagnosed Destiny with bipolar disorder and prescribed the drugs. State regulators recently "completed a two-year investigation of Kliewer that found the doctor violated Kansas law while treating Destiny and five other children," the Journal reported.
A September 14, 2007 petition filed by the Kansas Board of Healing Arts, says Kliewer diagnosed Destiny with Bipolar Disorder in March 2006, at three years old, and she died on April 4, 2006.
The petition contains 6 counts and details the prescribing of multiple drugs by Kliewer to six children including two more three-year-olds, one four-year-old and two two-year-olds. In one case, he began treating a child at two years old and between January 2003 and November 2006, prescribed a total of 9 drugs for the girl, including Risperdal, Abilify, Seroquel, and Geodon.
"The doctor negotiated a settlement in February with the Board of Healing Arts that didn't require him to admit wrongdoing," the Journal said. "He voluntarily stopped treating patients under age six."
The Board placed Kliewer's medical license on indefinite probation and ordered him to pay $13,079 to cover the investigation expenses, the Journal reported. Kliewer must also have another physician monitor his treatment of bipolar patients.
"Tragically, most physicians have not been trained or encouraged to think rationally about the hazards of monotherapy, let alone polypharmacy in children," says Dr Grace Jackson, author of Rethinking Psychiatric Drugs: A Guide to Informed Consent and the new book Drug Induced Dementia — a perfect crime.
"Mental health professionals have an ethical duty to inform parents about the potential lethality of drug combinations," she advises.
On June 5, 2009, Dawdy posted a link to the FDA's briefing package on Furious Seasons, available to members of the advisory panel, and posted portions of the introduction by FDA psychiatry products chief, Thomas Laughren, including the following comments on side effects caused by the drugs:
"Adverse reactions that can occur with drugs in the class of atypical antipsychotic drugs include, among others, somnolence, weight gain, increases in blood lipids and glucose, acute extrapyramidal symptoms, and tardive dyskinesia.
"These risks are of particular concern in pediatric patients because of the life-long nature of these disorders and the fact that these patients are considered particularly vulnerable, in part because they may be exposed for many decades, and in part because of possible effects on growth and development,"
In April 2009, Gabriel Meyers, a seven year old Florida boy, committed suicide by hanging in the bathroom of a foster care home. In the last few days of his life: "He was told his mother no longer had visitation rights, that he would probably be going back to Ohio, where he alleged he had been abused; the doctor changed his medication, he changed foster homes and he got a new counselor," George Sheldon, secretary of the Department of Children and Families, stated in the May 12, 2009 St Petersburg Times.
In the year leading up to his suicide, Gabriel had been on the stimulant drugs Adderall and Vyvanse, the SSRI antidepressant Lexapro, Zyprexa, and Eli Lilly's Symbyax, a drug containing both Zyprexa and Prozac, recently FDA approved for "treatment resistant" depression.
Gabriel was on Symbyax and Vyvanse when he died and neither prescription had been authorized by either his parents, or a court order signed by a judge, in violation of Florida law. He was listed as being on only Adderall in the Department of Children and Families' database.
"On six separate occasions, Gabriel's caseworker, Lawrence Chusid, documented that DCF had "parental consent" for the child's medications," according the May 9, 2009, St Petersburg Times.
"But in the hundreds of records in Gabriel's file released by DCF late last month, there is only one form signed by his mother, Candace, a blanket authorization for medical treatment for her son," dated June 29, 2008, the Times reports.
The labeling on Prozac and Symbyax, contains a black box warning of an increased risk of suicide in children. Instead of discouraging the concomitant use of these two powerful medications, Lilly has encouraged such practices by "designing its own "combination" capsule which contains both Prozac and Zyprexa," says attorney, Andy Vickery, of the Houston law firm, Vickery, Waldner & Mallia, who is involved in Zyprexa suicide litigation.
"The actual number and rate of completed suicides for patients in clinical trials on antipsychotic drugs, as submitted to the FDA, is higher on Zyprexa than on any of the other drugs in this class," he reports.
"Specifically," he says, "Lilly reported that, of 2500 patients on Zyprexa, there were 12 completed suicides, as compared to none on placebo."
For several years, a system called the Medicaid Drug Therapy Management Program was supposed to be monitoring the prescribing habits of doctors for children covered by Florida Medicaid. However, Gabriel's shrink, Dr Sohail Punjwani, had been red-flagged as having "problematic" prescribing practices in every quarter since the monitoring began in 2006.
According to the Miami Herald: "Punjwani defended the use of psychiatric drugs on children, even if they are not approved for such use, saying the lack of approval stems from the reluctance of drug makers and the medical establishment to launch clinical trials on children."
"The anti-psychotic drugs, he added, are used routinely to treat mood instability and insomnia among children," the Herald reported.
The doctor told the Herald that he did not even remember Gabriel. On May 12, 2009, the Herald reported that a "lawmaker who chairs a state Senate committee on children has asked the state to investigate the doctor who treated a foster child who killed himself."
"In separate letters to the Florida Board of Medicine and the Agency for Health Care Administration, state Sen. Ronda R. Storms, a Brandon Republican who chairs the Children, Families and Elder Affairs Committee, requested investigations leading to a "full report," according to the Herald.
Following Gabriel's death, DCF Secretary Sheldon directed a review of the files for every Florida foster child to ensure that any child prescribed psychotropic drugs was accurately recorded in the Department's system. He also directed a verification of the existence of a parental consent, or a court order signed by a judge, authorizing each child to receive such medication.
The results of the review in a May 28, 2009 report indicate: "No record of consent or judicial order was found for 16.2% of the 2,669 children receiving psychotropic medication."
On December 13, 2006, four-year-old Rebecca Riley died in a Hull, Massachusetts as a result of a drug overdose. At a mere 28-months-old, Dr Kayoko Kifuji, a psychiatrist at Tufts New England Medical Center in Boston, diagnosed Rebecca with ADHD and bipolar disorder, and subsequently prescribed, Seroquel, Depakote, an antiseizure drug, and clonidine, a blood pressure medication.
The medical examiner noted, "Rebecca's heart and lungs were damaged and found that this was due to prolonged abuse of these prescription drugs, rather than one incident," according to police reports.
The legal filings show the two other Riley children, ages 6 and 11 at the time of Rebecca's death, were also diagnosed with bipolar disorder and ADHD, by the same doctor, and kept on the same 3-drug cocktail for years.
Rebecca's parent have been charged with murder under the theory that they overdosed the child in attempt to sedate her and she did not bring in government disability payments.
On February 7, 2007, the day after the parents pleaded not guilty to the charges, Dr Kifuji entered into a voluntary agreement with the Massachusetts Board of Registration in Medicine to not practice medicine pending an investigation. "The Agreement entered into by Dr. Kifuji will remain in effect until further order of the Board," the Board's February 7, 2007 press release stated.
In April 2008, attorney, Andrew Meyer Jr, filed a malpractice lawsuit against Dr Kifuji on behalf of Rebecca's estate. "This child was subject to mostly telephone prescriptions and a slipshod diagnosis," he told the Boston Globe on April 4, 2008.
In an editorial titled, "How many more Rebecca Rileys?," in the January 9, 2009 Patriot Ledger, Dr. Jacob Azerrad, author of From Difficult to Delightful in Just 30 Days wrote: "To diagnose a 2-year-old as bipolar by adult standards is crazy.""A key issue is the misuse of psychiatric diagnostic labels to explain bad behavior in children," he wrote. "This has resulted in the drugging of young children to a degree unprecedented in our history."
"Our preschool children are far too young to defend themselves," he said. "It's up to parents to "say no to drugs" and teach their children that life is meant to be learned and experienced — it's not just a pill to be swallowed."
On March 5, 2009, Weymouth News reported that a "psychiatrist who prescribed drugs for the late Rebecca Riley, who was four at the time of her death, can be charged with malpractice."
"A Suffolk County tribunal determined on March 5 that there was enough evidence to charge Dr. Kayoko Kifuji," the News noted.
"Rebecca Riley's doctor now the target of a grand jury," was the headline in the May 1, 2009 Patriot Ledger. "Already the target of a civil medical malpractice lawsuit, the psychiatrist who prescribed the drugs that killed 4-year-old Rebecca Riley is now the subject of a grand jury criminal investigation," reporter Lane Lambert wrote.
"If the grand jury does find the...psychiatrist criminally liable for Rebecca's death, she could face involuntary-manslaughter charges," Lambert noted.
Evidence of the grand jury investigation surfaced "amid fresh legal action in both the civil and criminal cases," Lambert said. "Kifuji's lawyers asked a Suffolk County judge to postpone her deposition in the civil case indefinitely, and close the entire court record to the public."
Kifuji's attorney "said a deposition would force the doctor to claim her Fifth Amendment right not to incriminate herself while the grand jury was looking at the case," according to the report. The judge denied both motions, it noted.
An attorney for Rebecca estate said Kifuji is scheduled to give a deposition in the civil case on July 6, 2009, after the grand jury is finished. In the March 5, Weymouth News article, Kifuji's attorney said the murder charges against the Rileys make it difficult to decide if she can be faulted for Rebecca's death.
"This is not something bizarre that she (Kifuji) did," he said. "A number of fine doctors feel this was appropriate."
