Parity Likely to Increase Wholesale Sedation of Children

Over the years, as he witnessed the wholesale practice of sedating young children with powerful toxic, psychotropic drugs and drug cocktails, and as he witnessed the damage done by psychiatrists who prescribed these drugs, Dr. Lawrence Diller has become an outspoken critic.

In his latest Commentary in the Patriot Ledger (below) he focuses on the twin murder trials of the parents of Rebecca Riley, who was killed by psychotropic drugs irresponsibly prescribed by her child psychiatrist–who also prescribed these drugs for Rebecca’s older siblings.   

Dr. Kayoko Kifuji, a child psychiatrist at Tufts University who stated that she followed the clinical practice guidelines recommended by Harvard University psychiatrists, was granted immunity in both trials in exchange for her cooperation for testifying.

According to her own testimony, her "diagnoses were based entirely on reports coming from the children’s mother, Carolyn, herself diagnosed with mental illness and at times heavily medicated to the point of falling asleep in Kifuji’s office."

"Kifuji essentially ignored late warnings from a school nurse about possible sedating over dosages to Rebecca and from a mental health counselor for Rebecca whom the mother fired after the counselor alerted the local child protective service agency about potential child abuse. Kifuji believed testimony from the children as young as 3 regarding “hallucinations” about monsters to support the bipolar diagnosis while discounting any other information reported by the children as “unreliable.”

Perhaps the strongest evidence against mental health parity is evidence that psychiatry’s drug-focused paradigm of care leads to worsened–even fatal–outcomes:

Rebecca at age 3, gained nine pounds in two months on the first antipsychotic drug, Zyprexa, she was prescribed by Kifuji.

"Kifuji repeatedly allowed, without drawing any effective limits, Carolyn Riley to increase the doses of clonidine she gave her children. For her last month of life, Kifuji overall prescribed 835 pills to Rebecca."
 
The Riley trials brought out evidence showing that "the children’s symptoms literally disappeared overnight when the mother was out of the home for four days and the father [who did not give them their prescribed drugs] was left in charge of the children."

Rebecca’s older sister by two years, who is in a foster care home since her sister’s death, "is reported to be symptom- and drug-free…"

Even as doctors and healthcare experts acknowledge that the Obama healthcare legislation will do nothing to curb unnecessary, harmful "care ,"  today’s New York Times report about mental health parity includes inflated unsupportable statistics promulgated by the National Institute of Mental Health:
"one in four adults suffers from a diagnosable mental disorder in a given year, or about 58 million people."

The Times reports that

"mental health advocates were getting ready to celebrate parity….Now mental health advocates are almost giddy. The law signed by President Obama last week expands parity to a much wider pool, making it possible for millions more people to get the same coverage for substance abuse and illnesses like bipolar disorder, major depression and schizophrenia as they would for, say, diabetes or cancer."

The Times quotes Michael Fitzpatrick, executive director of the National Alliance on Mental Health: "[the new law] can change the mental health system in America and really give families and individuals an opportunity to get a level of access to care we could only fantasize about before this became law.”

The Times neglected to inform readers that Fitzpatrick / NAMI and the NIMH are financially dependent on the pharmaceutical industry–they are, therefore, stakeholders in the business of mental health. The Times also neglected to inform readers that NAMI and NIMH are under Senate investigation for financial conflicts of interest.
"Drug Makers Are Advocacy Group’s Biggest Donors" By GARDINER HARRIS, NYT.
"Letters from Grassley : Phone Records and Emails from NIMH" Policy and Medicine ,Jan. 26, 2010:

The Boston Globe reported:

"After the verdict, Plymouth District Attorney Timothy J. Cruz said he believes the psychiatrist, Dr. Kayoko Kifuji, who prescribed the drugs to Rebecca, should not be allowed to practice medicine in Massachusetts, and he will ask the Board of Registration to reopen an investigation into her medical care."

"Dr. Kifuji is unfit to have a medical license," he said after the verdict was announced. "If what Dr. Kifuji did in this case is the acceptable standard of care for children in Massachusetts, then there is something very wrong in this state." 

Given the absence of credible, untainted, evidence-based standards of diagnosis and practice in psychiatry; given the appalling record of psychiatry’s irresponsible, corporate-driven practices that have resulted in profound harm rather than clinical benefit; mental health parity is a prescription for massive harm.

Even before parity, the number of children Rebecca Riley’s age prescribed antipsychotics by child psychiatrists was rising fast.
 
"It is a worrisome trend, partly because very little is known about the short-term, let alone the long-term, safety of these drugs in this age group," said study author Dr. Mark Olfson, a professor of clinical psychiatry at Columbia University.

Dr. Olfson indicated that: "Prescribing antipsychotics to children in the upper range of that age span — ages 4 and 5 — is justifiable only in rare, intractable situations in which all other treatments, including family and psychological therapy, have been tried and are not working. And it’s questionable whether 2- and 3-year-olds should ever be prescribed antipsychotics."

See: Olfson M, Jensen P. Journal of the American Academy of Child & Adolescent Psychiatry, January 2010.

Without rational restraints, mental health parity is a financial give-away-to industry and its lackyes that will likely exponentially increase healthcare expenditure.

Vera Hassner Sharav

 Wholesale sedation of young children medically, morally indefensible
The Patriot Ledger

Posted Mar 27, 2010 @ 07:42 AM
COMMENTARY BY LARRY DILLER —

The twin murder trials of the parents of Rebecca Riley, who died at age 4 of an overdose of the psychiatric drug, clonidine, have cast a spotlight on the beliefs and practices of the doctor who prescribed the drug.

Kayoko Kifuji was granted immunity in both trials in exchange for her cooperation for testifying. Reactions from jurors, comments online and letters to the editor based on newspaper accounts of Kifuji’s testimony range from confusion, shock, and outrage directed at the doctor’s role in the tragedy.

Kifuji did go before a grand jury and was not indicted, avoiding any criminal prosecution for her actions. Massachusetts’ medical licensing board, the Board of Registration in Medicine (BRM) initially suspended Kifuji’s license to practice medicine. But after conducting an investigation the BRM fully restored Kifuji’s privileges. She is now back at Tufts Medical Center practicing child psychiatry without any restrictions, penalties or supervision.

Kifuji did not literally place the extra lethal doses of clonidine in Rebecca’s mouth which may explain why she was not criminally charged. Ironically, from testimony at the father’s trial, neither did Michael Riley. Still the jury found him guilty of murder. What’s more disturbing is the BRM’s decision to take no further actions and allow Kifuji unfettered practice.

The testimonies offered at the grand jury and BRM hearings were kept secret so the Riley trials offer the public the first details of Kifuji’s management of the Riley children. Here are some of the facts extracted from the trial transcripts:

Kifuji’s diagnoses were based entirely on reports coming from the children’s mother, Carolyn, herself diagnosed with mental illness and at times heavily medicated to the point of falling asleep in Kifuji’s office.

Kifuji essentially ignored late warnings from a school nurse about possible sedating over dosages to Rebecca and from a mental health counselor for Rebecca whom the
mother fired after the counselor alerted the local child protective service agency about potential child abuse.
Kifuji believed testimony from the children as young as 3 regarding “hallucinations” about monsters to support the bipolar diagnosis while discounting any other information reported by the children as “unreliable.”

Kifuji repeatedly allowed, without drawing any effective limits, Carolyn Riley to increase the doses of clonidine she gave her children. For her last month of life, Kifuji overall prescribed 835 pills to Rebecca.

Rebecca at age 3, gained nine pounds in two months on the first antipsychotic drug, Zyprexa, she was prescribed by Kifuji.

Kifuji continues to insist her diagnosis was correct even when it was pointed out that the children’s symptoms literally disappeared overnight when the mother was out of the home for four days and the father was left in charge of the children. Kaitlynne, Rebecca’s older sister by two years, in a foster care home since her sister’s death, is reported to be symptom- and drug-free carrying a diagnosis of Post-Traumatic Stress (which implies she was emotionally damaged by her experiences).

The Massachusett’s BRM in allowing Kifuji to practice again without any penalties or restrictions has essentially told doctors and the public that this kind of management of children’s behavior problems is “within the standards of current medical practice” – a phrase that comes up both in licensing and malpractice cases.
It has sent a message that the psychiatric child abuse of children through drugs will be tolerated in the state of Massachusetts.

A recent survey has reported a doubling in five years of the number of children between ages 2 and 5 receiving anti-psychotic medications like Zyprexa and Seroquel. Many are likely receiving the kind of care the Riley children experienced. It is very difficult to address the behavior and emotional problems of very young indigent children. Non-drug resources are often meager or unavailable. Follow through by overwhelmed parents is inconsistent. Nevertheless, the wholesale sedation of young children condoned and supported by mainstream psychiatric practice is both medically and morally indefensible. Unfortunately it appears more Rebecca Rileys will have to die before these practices change.

Lawrence Diller practices behavioral-developmental pediatrics in Walnut Creek California. He is on the clinical faculty of the University of California, San Francisco and the author of The Last Normal Child.