ADHD Depakote & Clonidine Cocktail Settlement: No Cheers Heard

January 27th, 2011. By LucyC

Remember Rebecca Riley? The four-year old who died of a clonidine overdose at the hands of her parents, Michael and Carolyn Riley, on December 13, 2006? This utterly tragic cautionary tale reached its final conclusion this week, with the announcement of a $2.5 million settlement to be paid by the Tufts Medical Center psychiatrist Dr. Kayoko Kifuji, who prescribed the clonidine and depakote cocktail as treatment for Rebecca’s attention deficit hyperactivity disorder (ADHD) and bipolar disorder. Most settlement announcements can have an air of the bittersweet coupled with a sense of vindication—but in this case, the settlement was for a cocktail that would never be followed by a “cheers!” from anyone—so there is only the sense of sadness all around.

When this case broke, Dr. Kifuji’s role ignited quite a controversy around her having prescribed these drugs in the first place. Clonidine is a high blood pressure medication that can be used as a sedative in children—for ADHD. Depakote was prescribed for bipolar disorder—it is an anti-convulsant also known as valproate semisodium or divalproex sodium. 

According to the state medical examiner in Massachusetts, the four-year-old girl’s death at her family home was indeed the result of a drug overdose. Dr. Elizabeth Bundock, who served as the deputy chief medical officer in Vermont, concluded in her autopsy that Rebecca died from intoxication after being administered a combination of clonidine, Depakote and two over-the-counter cold and cough medications. Bundock testified during the trial that the drugs affected Rebecca’s brain, heart and lungs, leading to “a pump failure of the heart,” overworked lungs filled with bloody fluid, coma and death. 

In 2007, the father, Michael Riley, and mother Carolyn Riley were charged with first and second degree murder respectively. They were found guilty. During those trials, in the summer of 2009, Dr. Kifuji was cleared of the criminal charges. Consequently, she had her medical licence reinstated and she returned to her practice at Tufts. 

Dr. Kifuji had voluntarily surrendered her medical licence in 2007—when the Riley’s were charged with murder. Even though she was cleared of any wrongdoing, she decided to settle the lawsuit, according to a report in the Patriot Ledger, “in part because of public outcry and questions about the medical care Rebecca Riley got.” According to Benjamin Novotny, a lawyer involved in the case, the amount is the limit for Kifuji’s malpractice insurance with Tufts, where she practices today. 

Tufts has also agreed to launch an awareness program, so young doctors know the dangers of over-prescribing these types of drugs. Tufts declined comment on that but said the hospital will be looking for ways to expand education programs for caregivers who treat “psychiatrically ill children in troubled homes.” (Patriot Ledger)

So where does this leave things? It would seem the onus lies with the health care consumer, yet again—to get educated. Know what’s being prescribed, and understand what the side effects might be. In Rebecca’s case, one of the drugs, depakote, while a useful medication in the treatment of epilepsy, has been linked to birth defects resulting from in-utero exposure during pregnancy—it’s a category D drug because it can cause serious and potentially life-threatening birth defects such as spina bifida, underdeveloped heart, nerve problems and fetal death.  

Making the problem more complicated is that Depakote has been found to affect the patient’s brain chemistry, leading doctors to prescribe it “off-label” for migraines, mania and bipolar disorder—even in children. 

This final chapter in Rebecca Riley’s story—the multi-million dollar settlement—is considered a satisfactory outcome. At least her siblings will benefit from it, with the money placed into Rebecca’s brother and sister’s trusts. Her brother is reportedly in foster care, while her sister may soon be adopted. Rebecca is dead and her parents are in jail. A satisfactory outcome, but not a happy one.

Tags: ADHD, depakote, Rebecca Riley

This was posted on Thursday, January 27th, 2011 at 10:08 am and is filed under Drugs/Medical . Feel free to respond, or trackback. Read our comments policy.