A book published in 2013 has revealed how psychiatrists and drug companies using the labels “bipolar children” and “attention deficit hyperactivity disorder (ADHD have caused unimaginable harm to children while reaping great profits for themselves.

pills2Author Enrico Gnaulati PhD entitled his book “Back to Normal: Why Ordinary Childhood Behavior Is Mistaken for ADHD, Bipolar Disorder, and Autism Spectrum Disorder”

An excerpt from the book cites the widely publicized case of Rebecca Riley who died at age 4 in her Plymouth County, MA home on December 13, 2006. According to a state autopsy report Rebecca died of heart and lung failure caused by an overdose of psychotropic drugs.

Dr. Kayoko Kifuji, a Tufts–New England Medical Center child psychiatrist had diagnosed Rebecca with ADHD and bipolar disorder when she was two years old.

From age 2 until Rebecca’s death at age 4, Kifuji had prescribed increasing doses of Clonidine (a blood-pressure drug given for ADHD), Depakote (an anti-seizure drug used for mood disorders), Zyprexa and Seroquel (an antipsychotic drugs used for schizophrenia and bipolar cases)

None of these drugs has ever been approved by the Food and Drug Administration for use on toddlers her age.

Doctors get around this because it’s legal for them to use their discretion and “medical instincts” to prescribe any drug they choose for bipolar symptoms in children. If they

feel a drug approved for adults might help a little child they are free to prescribe it.

Drug companies have taken advantage of this loop hole with spectacular marketing of psychiatric drugs to doctors specifically directed at promoting off-label use.

A recent estimate is that up to 8 million American kids are on one or more psychiatric drugs.

And these are expensive drugs – in 2011 a bottle of 180 tablets of 500 mg cost $708.00 for Depakote $708 and  $1,048.00 for Seroquel.

Drug representatives know that drugging children is very lucrative as doctors, parents and teachers all have altitude and see to it that the kids take all their medication on schedule in time for the next re-fill prescription. Gwen Olsen worked 15 years as a drug rep for Johnson & Johnson and Bristol-Myers Squibb. She stated “Children are known to be compliant patients and that makes them a highly desirable market for drugs, especially when it pertains to large profit-margin psychiatric drugs, which can be wrought with noncompliance because of their horrendous side-effect profiles.”

In other words, some adults know better than to take drugs with terrible side-effects but the kids just do what they are told.

The ethical level of child psychiatrists is no better than that of the drug companies.

Dr. Joseph Biederman heads up the research programs for pediatric psychopharmacology at Harvard University’s teaching hospital.

Historically the label “manic behavior” was applied to adults who didn’t sleep for days on end, believed they had superhuman abilities and unlimited energy, and talked non-stop. Dr. Biederman managed to re-define manic to apply to kids. If the toddler showed irritability, tantrums or rapid mood swings the child had “manic behavior”. Thus any normal 2 year old became “manic” and the bipolar diagnosis in children increased 40 times thanks to his work.

Not surprisingly a Senate hearing in 2008 revealed that Dr. Biederman had received $1.6 million in speaking and consulting fees from various pharmaceutical-industry giants who manufactured antipsychotic medications for use on children thought to have bipolar disorder. Dr.Biederman was found to be on the payroll at AstraZeneca, the makers of Seroquel, which is among the most frequently prescribed drugs for bipolar disorder with kids

Rebecca Riley was taking Seroquel when she died at age 4.

National attention was brought to the topic of bipolar children and psychiatric medication because both of Rebecca’s parents went on trial and were convicted of murder for their attempts to exaggerate their child’s symptoms to the doctor in order to receive disability payments and for giving Rebecca higher dosages of the drugs prior to asking the psychiatrist if that was ok.

But the facts about Dr. Kayoko Kifuji careless medical care for this family are almost unbelievable.

Soon after Rebecca died, Dr Kifuji was temporarily stopped from practicing as part of a voluntary agreement with the state’s medical licensing board. But in the summer of 2009 she resumed her clinical practice at Tufts Medical Center when the grand jury declined to indict her.

In 2010 Dr. Kifuji was given a grant of personal immunity to testify for the prosecution in the murder trials of the parents. She revealed that she frequently approved a higher dose of the drugs after the mother had admitted that she had already increased the child’s dose. The psychiatrist also was seeing two other siblings in the same family and all 3 children were diagnosed as bipolar and ADHD and given antipsychotic drugs.

Having shifted all the responsibility and blame to the parents during this trial and having gone back to work with children, Dr. Kifuji in 2011 stilled faced a malpractice suit brought by the estate of Rebecca Riley.

Records revealed in this lawsuit presented the true facts about Dr. Kifuji and her care.

Long before she had earned her credentials as a child psychiatrist (she failed board certification 3 times before being passed) Dr.Kifuji had been diagnosing children as young as 2 as bipolar and hyperactive giving them powerful cocktails of mood-altering drugs to quiet them. 99% of her child patients got prescriptions.

Dr. Kifuji said she “trusted the mother” (Carolyn Riley) to tell her how the children were behaving and reacting to the drugs. Because the doctor saw all three children in one hour – 20 minutes a piece – she relied almost exclusively on what the mother told her about the kids in order to diagnose them and increase drug dosages for them.

The mom who had no medical training was also given the task of keeping tabs on Rebecca’s heart rate and blood pressure for “any signs of problems” from the mix of 4 drugs. Dr. Kifuji was originally trained as a pediatrician but she admitted she didn’t know there was a blood pressure cuff in her psychiatric office where she could have easily checked the child herself. She also stated she didn’t take Rebecca’s pulse with her fingers because the mom told her the child’s pulse “was within normal range.”

She explained that some researchers believe an area of the brain called the amygdala is altered in people with bipolar disease then admitted she didn’t know where the amygdala is in the brain.

Here are some of her treatment record and notes from the malpractice trial – it’s a rare chance to see what a child psychiatrist is really doing with a patient.

  • A week before her first appointment with Rebecca, Dr.Kifuji wrote: “Called mother. Two years old. Very hyper. All over. Last couple of week, not sleeping but keep going like her brother who was not sleeping when he was small.”
  • Aug. 27, 2004: First office visit 20 minutes

“Two-and-half-year-old female with history of colic and not sleeping much in her    infancy developed sleep disturbance again. Hyperactivity on and off since four months ago. Then consistently hyper all the time. Climbs up to top of jungle gym without any fears and thinking. Gets into everything. Just walk up to someone and smack them. Never gets aggressive. Hits kicks and spits when she’s being disciplined and laughs. Started to say things scared her. Whines and fusses a lot.”

During the same visit when Rebecca was 21/2 years old, Kifuji described the toddler as dysarthric, meaning she could not properly pronounce some words. She also described Rebecca as a “happy” child with a “bright affect.”

Within  20 minutes of meeting Rebecca she is labeled ADHD and prescribed clonidine

  • Sept. 1, 2004: Carolyn tells Kifuji over  the phone that she has increased  Rebecca’s clonidine dosage. Kifuji  approves.
  • Oct. 1, 2004: Second office visit lasts 20  minutes.

During her second 20-minute visit with Rebecca, in October 2004, Kufuji wrote: “Doing okay. A bit tired since yesterday. Coming down on flu. Fine as long as she takes clonidine. Sleeps throughout. Without clonidine gets very hyper and impulsive.”

She also wrote: “(Rebecca) is loud and silly at times while she was playing with her sister but redirectable.”

  • Nov. 9, 2004: Refills clonidine prescription.
  • Dec. 9, 2004: Refills clonidine prescription.
  • Jan. 3, 2005:  Kifuji increases clonidine  dosage over the phone.
  • Jan. 5, 2005: Third office visit. Kifuji reports  Rebecca’s hyperactivity has worsened  from mild to moderate. Increases  clonidine dosage for the third time.
  • March 11, 2005: Carolyn tells Kifuji over the phone that Rebecca is having “lots  of headaches,” a common side effect  of clonidine.
  • May 3, 2005: Diagnoses 3-year-old  Rebecca with bipolar disorder after  mother tells her the girl has become  “moody” and cries “over very small  things easily.” Prescribes Depakote, an  antiseizure drug.

Kifuji described Rebecca as “very impulsive.” She explained that Rebecca’s mother said the girl: “Climbs up on top of bureau. Tantrums or sobbing when she was told to clean up her toys” and “she wasn’t listening to her mother.” Rebecca was 3.

  • June, July, August 2005: Refills prescriptions for clonidine and Depakote.
  • Aug. 4 and Aug. 31, 2005: Sees Rebecca in the office. No changes in diagnoses or dosage.
  • Oct. 27, 2005: Carolyn tells Kifuji she has  increased Rebecca’s clonidine dosage  again. Kifuji tells her to decrease it and threatens to report Carolyn to the state. Kifuji increases Depakote dosage and  prescribes Zyprexa, an antipsychotic.
  • Nov. 16, 2005: Increases Depakote  dosage.
  • December2005: Increases Zyprexa  dosage.
  • Jan. 9, 2006: Increases Zyprexa dosage  again. Writes, “Present dose working well. No changes.”
  • Jan. 31, 2006: Increases Depakote dosage again after Carolyn reports  that 3-year-old Rebecca is wetting  the bed.
  • Feb. 16:, 2006 Prescribes Seroquel, an antipsychotic. Decreases Zyprexa.  Notes Rebecca is gaining “too much weight and she’s still very  aggressive and impatient.”
  • March 8, 2006: Increases Depakote  dosage. Carolyn reports Rebecca is still having problems sleeping, is defiant and having tantrums.
  • May 24, 2006: Receives letter from a  social worker concerned about the  amount of drugs being given to the  Riley children.
  • June 22, 2006: Increases Rebecca’s  Seroquel dosage after 20-minute  office visit.
  • July 20, 2006: Increases Depakote  dosage after mother reports  Rebecca was “getting into  everything.”
  • Aug. 16, 2006: Tells Carolyn Riley she can increase or decrease drug dosages on her own. Changes clonidine prescriptions to 10-day  supplies instead of month’s supply  after Carolyn Riley says the last  prescription was destroyed by water.
  • Aug. 21, 2006: Pharmacist tells Kifuji  over the phone that Carolyn came in  for pills but didn’t have doctor’s authorization. Kifuji gives it over the phone. Riley cannot explain 20 missing clonidine pills.
  • Sept. 15, 2006: Increases Rebecca’s  Seroquel dosage again, the 13th  drug increase she’s approved in two years. Tells mother that she can increase it even more.
  • Nov. 3, 2006: Returns call from the nurse at Rebecca’s preschool in Weymouth who says the 4-year-old  is like a “floppy doll” and is so tired she can barely walk up the stairs.  Nurse says she is concerned about how much medication Rebecca is  on.
  • Nov. 10, 2006: Kifuji notes that mother says Rebecca’s sleep is improved and attributes it to Michael Riley  (the father) having moved back in with the family at their new apartment in Hull.
  • Dec. 7, 2006: Sees Rebecca for the last time. Tells mother she’ll begin decreasing clonidine dosage if  Rebecca continues to do well.
  • Dec. 13, 2006: Rebecca dies of clonidine overdose. Kifuji calls the Rileys and leaves a message for Carolyn.
  • Dec. 14, 2006: Carolyn calls Kifuji at  6:45 a.m. and leaves a message. Kufuji calls back at 4:45 p.m., 5:15  p.m., 6 p.m., 6:30 p.m. and at 7:20  p.m. when she reaches Carolyn.  Kufiji says she called to ask what happened to Rebecca and see how Carolyn is doing.

The lawsuit against Dr. Kifuji was settled for $2.5 million dollars the money going to the two surviving siblings. However, the doctor again escaped any real penalty for her crimes. Under the settlement terms, she admitted no wrong doing. The money came from her malpractice insurance policy paid for by Tufts Medical Center not from her pocket. She is still working there in 2013; the parents are still in jail.

As a final irony, the trial settlement included language requiring Tufts to set up “educational and outreach programs to help provide more mental health services for children.”

It’s an upside down world – criminal psychiatrists and drug company executives getting rich by ruining the lives of our children and the victims parents ending up in jail instead.

http://www.alternet.org/drugs/toddler-3-different-psychiatric-meds-how-drugging-kids-became-big-business

http://www.patriotledger.com/news/x905416295/Rebecca-Riley-s-doctor-on-the-defense

http://www.boston.com/news/local/breaking_news/2010/01/_brockton_-_tes.html

http://www.boston.com/news/local/massachusetts/articles/2011/01/25/tufts_settles_suit_against_doctor_in_girls_death_for_25m/