4 year old girl dies from clonidine overdose

[Hurricane]

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http://www.boston.com/yourlife/health/blog/2007/02/psychiatrist.html#more

Kifuji began treating Riley in August 2004 and diagnosed her with attention deficit hyperactivity disorder and bipolar disorder. She prescribed the medications, including clonidine, a blood pressure drug for adults that is also sometimes given to children to reduce aggressiveness and help them sleep. Prosecutors allege that Riley's parents, Michael and Carolyn Riley, intentionally killed their daughter in December by giving her a clonidine overdose.

more detailed article here

Seems like this case may be used as a referendum on medicating children in general.

Thoughts?

 

[OldPsychDoc]

Thoughts?

Let's see, abusive parents, possible factitious disorder by proxy, not a mention AT ALL of how the meds were SUPPOSED to be administered.

Yep, it's all the DOCTOR'S FAULT!!!!! 😡

 

[Mr. McDuck]

What? It says right in the quote he posted that the parents killed her by giving her an overdose. How does that imply it's the doctor's fault?

 

[Big Lebowski]

What? It says right in the quote he posted that the parents killed her by giving her an overdose. How does that imply it's the doctor's fault?

Interesting, though, that the article states the prescription for clonidine was filled/refilled 15 times between August and November. It did not give much detail other than the pharmacy reported receiving appropriate prescriptions. Clearly the parents are ill, but someone needs to look into how and why that happened. Unless these were fraudulant prescriptions, someone was writing or authorizing them. Assuming they were using the same pharmacy (sounds like they were), I would hope they contacted the physician for clarification.

 

[sdn1977]

Obviously - multiple issues at hand here & certainly not much detail to go on, nor should we "try" this or judge this here.

But...if an rx is only prescribed for a 7-10 day supply, refiliing it that many times might not be unreasonable.

However....to be the child's advocate...I was put in an awful position of filling rxs for a child from about the age of 4 until she turned 7 when the family's insurance required them to use mail order....then...I lost track - until recently, when they returned due to insurance change. The child is now 9.

She had been treated since the age of 4 with a mixture of many, many antipsychotics, ssris, atypicals and amphetamine cogeners. Some for long periods & some for short periods (too short to actually see therapeutic benefit, but long enough to see adverse effects). I actually saw this child 50% of the time mom filled the rxs & she definitely had a "drugged" affect - even for such a small child.

The issue I had is - this was all being prescribed by a family practice physician - not a psychiatrist. I'm 15 minutes from a child-adolescent psychiatric university practice. Every time I filled an rx - I verified it & reminded this physician with the current medications I was filling and documented the interaction. I spoke with mom about the medications, the many ways children are treated in our area for behavioral issues...as many ways as I could delicately put it that she might actually want to seek someone who specializes in this area. I am not in a position to judge if a physician, particularly in a specialty like this, is right or wrong - I have no basis on which to make that judgement. Nor am I making any judgement against family practice physicians prescribing for this population.

Now....2 years later...she is at the university center & has only 2 medications. I don't know why or what motivated the change....but - I was always uncomfortable every time I filled those rxs - the family practice physician is no longer in the area - again - I don't know why.

But...I feel "lucky" I wasn't caught in a similarly awful circumstance!!!!

 

[Anasazi23]

Something fishy going on...

http://www.foxnews.com/story/0,2933,261724,00.html

 

[sunlioness]

It looks like the parents are the most direct and real culprits here, based on that article. But I have to say . . . I don't have a lot of respect for that psychiatrist either. I don't have a problem appropriately medicating children who need it, but it sounds like here he did whatever the parents wanted. Of course I wasn't there. I can't speak to what he observed, his thoughts, and whether they were reasonable or not.

 

[Doctor Bagel]

Something fishy going on...

http://www.foxnews.com/story/0,2933,261724,00.html

Yeah, I guess that's not surprising. The most damning thing I think is the fact that the parents tried to get more pills than were prescribed. For the SSI thing, I guess they could try to claim again that they were unsophisticated and just believed what the one evil doctor told them. What a screwed up family -- I think the dad has some pending child molestation charges against him.

I'm really curious to hear the doctor's side of the story.

 

[whopper]

If you do some research online, there is some coverage that tells the doc's side.

The doctor did claim that the parents were using the meds not as prescribed and did warn them of the dangers of doing so.

However IMHO that still does not justify her diagnosing a 2 year old kid with ADHD & Bipolar. To simply state that you warned the parents to not give a fatal dose IMHO does not protect you from malpractice. Medicating a child and branding them with a dx which from my understanding (correct me if I'm wrong) has no basis in the standard of care does satisfy the definition of malpractice. IT does cause harm. The side effects, and parents justifying what could be normal behavior as disease behavior causes harm to a child's upbringing. The doc IMHO has to also be able to justify why she would dx a 2 year old with ADHD & Bipolar.

What suprises me is Tufts is defending the doc saying she did what was "standard of care" which I find hard to believe. I haven't seen any standard of care that lets you dx a kid with ADHD & Bipolar at age 2.

OTher online sources mention the kid was actually put on quite a few meds, and the kid had siblings which were also heavily medicated by the same doc.

The only reason why I didn't outright condemn this doc was aside from that I haven't read the kid's chart, I thought since this doc is the director of the clinical program at Tufts, and because she had specialized training in child psyche, she may have known something that could justify a dx of bipolar & ADHD at age 2.

I've done research on this and asked several attendings and all of them claim there is no standard of care for what she did. One though did state there is a theory that early age onset of bipolar may exist as early as age 2, but its still in the phase where it cannot be considered standard of care to treat a patient on that basis.

Anyways, not only are the parents and the doc suspect, IMHO the institution is suspect as well if they're going to claim her actions were standard of care when supposedly they aren't.

If anyone has any data that supports the doc's actions as standard of care please post it.

 

[watermen]

If you do some research online, there is some coverage that tells the doc's side.

The doctor did claim that the parents were using the meds not as prescribed and did warn them of the dangers of doing so.

However IMHO that still does not justify her diagnosing a 2 year old kid with ADHD & Bipolar. To simply state that you warned the parents to not give a fatal dose IMHO does not protect you from malpractice. Medicating a child and branding them with a dx which from my understanding (correct me if I'm wrong) has no basis in the standard of care does satisfy the definition of malpractice. IT does cause harm. The side effects, and parents justifying what could be normal behavior as disease behavior causes harm to a child's upbringing. The doc IMHO has to also be able to justify why she would dx a 2 year old with ADHD & Bipolar.

What suprises me is Tufts is defending the doc saying she did what was "standard of care" which I find hard to believe. I haven't seen any standard of care that lets you dx a kid with ADHD & Bipolar at age 2.

OTher online sources mention the kid was actually put on quite a few meds, and the kid had siblings which were also heavily medicated by the same doc.

The only reason why I didn't outright condemn this doc was aside from that I haven't read the kid's chart, I thought since this doc is the director of the clinical program at Tufts, and because she had specialized training in child psyche, she may have known something that could justify a dx of bipolar & ADHD at age 2.

I've done research on this and asked several attendings and all of them claim there is no standard of care for what she did. One though did state there is a theory that early age onset of bipolar may exist as early as age 2, but its still in the phase where it cannot be considered standard of care to treat a patient on that basis.

Anyways, not only are the parents and the doc suspect, IMHO the institution is suspect as well if they're going to claim her actions were standard of care when supposedly they aren't.

If anyone has any data that supports the doc's actions as standard of care please post it.

That little girl is 4 years old...not 2.

 

[Doctor Bagel]

That little girl is 4 years old...not 2.

She was diagnosed and started being medicated at 2.

 

[Adam_K]

Other media accounts of the parents are less sympathetic. According to those, they used her prescription meds as behavioral control agents ever since she was prescribed them (at the age of 28 months). The last couple days of her life are particularly instructive in this regard. Besides showing what can only be politely described as poor parenting, I think that the case sheds some welcome light on another underlying issue, namely treating normal childhood behavior as an illness.

I can't find the article right now, but a prominent child psychiatrist was quoted as saying something like: "It is difficult to distinguish between bipolar disorder and temper tantrums at such an age."

Yeah, I'd say it is impossible.

 

[Anasazi23]

Having just come off a long stint in child psychiatry, I too, have questions about this case.

The hottest and what appears to be the longest debate in the concept of childhood bipolar. There are lots who claim it can't exist. In my rotation, we diagnose and medicate children as young as 4....and that was for a somewhat extreme case.

There are ways to distinguish childhood bipolar from ADHD or even tantrumns, but sometimes it can be difficult. Sometimes simply looking at the child can give a clue to organicity and would in some cases, maybe justify giving the child some medication - even for the parents' sake. In this light, we can talk about everything from maple syrup urine to fragile x, Lesch-Nyhan, and other problems.

I'm just glad I have no interest in child psychiatry. The consents alone were enough to drive me insane. 🙂

 

[whopper]

I've seen docs medicate young kids and slap on the label, but usually only in the case where the kids were doing something dangerous such as wielding a knife and putting it against another kid's throat.

Agree Anasazi. I'm not going into child psyche for the same reason. You can't really tell what's really going on with the kids unless you're with them 24-7.

I brought up the same subject in a previous thread. I brought up an analogy of the Nanny 9-11 and Supernanny shows.

Put a child psychiatrist in the same scenario and I'm wondering how many of those psychiatrists would've medicated those problem kids. The same kids seemed to be doing fine when supernanny gave them some swift discipline or told the parents what they were doing wrong (showing favorites, rewarding bad behavior).

 

[Doctor Bagel]

So I'm just a first year medical student and know nothing, but the one thing I read about this case that really bugged me was that the psychiatrist supposedly used the family history in making her diagnosis of this kid. Yeah, I get that these illnesses have a genetic component, so ignoring family history's a bad idea. However, I just got the idea that maybe she just assumed this kid was bipolar because everyone in her family was poor and unstable. Honestly, it sounded a bit like eugenics to me.

 

[whopper]

So I'm just a first year medical student and know nothing, but the one thing I read about this case that really bugged me was that the psychiatrist supposedly used the family history in making her diagnosis of this kid. Yeah, I get that these illnesses have a genetic component, so ignoring family history's a bad idea.

Read the same.

First, by all means ask around and don't feel stupid being a first year. Rome wasn't built in a day. In just a few years, YOU TOO CAN BE A PSYCHE POWERHOUSE!

Genetics is a component, but that in and of itself cannot allow one to dx a disease...(hmm, your brother has schizophrenia so now we're going to med you up even though you have no sx....)

OK so maybe the kid did show some sx. How the heck can you differentiate between a 2 y.o. kid acting out and bipolar or ADHD? I can't think of any standard that will allow you to do so, and I've asked and looked around for one. Still can't find one.

Also, it may have been possible that the same doc in question may have (mis)diagnosed the siblings.

There's a lot of screwy things, and the fact that the kid's siblings were also diagnosed doesn't defend the doc or the parents. In fact it can be argued that it points to the doc & the parents overmedicating all the children.

The only way IMHO that this doc and the parents can be excused if there were some standard of care that allows for a doc to dx a 2 year old with ADHD &/or Bipolar. That only excuses the medical treatment. It doesn't excuse the death, which may have been a case where the parents intentionally tried to medicate the child against the advice of the prescription--which is what the articles online currently suggest. Reiterating that we also haven't seen the charts, so we can't officially judge the case. All our talk it just based on what we're hearing--however none of what I've read can justify what's happened.

 

[Hurricane]

Genetics is a component, but that in and of itself cannot allow one to dx a disease...(hmm, your brother has schizophrenia so now we're going to med you up even though you have no sx....)

Plus, I thought that first-degree relatives of someone with bipolar are actually more likely to have unipolar depression than bipolar disorder.