Posts tagged ‘Death’
Some time around 6:30 am, two years ago today, Esmin Green was involuntarily admitted to Kings County’s psychiatric ER where she was ignored for 24 hours, the last of which she spent face down on the floor — writhing at first and ultimately dying in the presence of the staff members whose job it was to care for her.
Think about that as you glance at the clock, going about your day today — how far 6:30 in the morning seems from your lunch, the end of the workday, prime time television. Think about where you’ve spent your day and how it compares to where Esmin was all that time just two years ago.
I’m still outrageed, still disgusted that we live in a society that allows that and — as long as it’s just those mentally ill over there — accepts it. We’ve created a line and carefully keep who and what lies on the other side out of our sight –as if there really is an us and a them. There isn’t. As long as we have a class of people who can be treated by force we have a public that cares little about what happens to them behind closed doors but there is no class and public. There’s just us and what we do to others, we’re doing to one of our own.
The only real rarity in this story is that it was caught on video. If it hadn’t been you would never have known about it. It would just be another death in another psych hospital — with no one to cry foul. KCHC has been operating like this for decades and even now, in their costly new building, under federal monitoring and with new accountability policies in place — the abuses continue.
I’m going to Brooklyn today — to King’s County. I’m going in remembrance of Esmin Green and in protest of an institution beyond reform. I’m going to stand aside others who won’t accept the state of the system and are standing up in the streets, demanding change — and when I glance at the time, I’ll know I’m where I need to be. Will you?
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You may have heard — you should have heard — of a woman named Esmin Green. She was involuntarily admitted to the psychiatric emergency room of Kings County Hospital, a place already known for a long record of violence, sexual assault, abuses and neglect. Unfortunately for Ms. Green and countless others, when you are someone who is allowed be shoved into places against your will, you have no say about which places and what standards, if any, are upheld there. Esmin died face down on the floor of the psych ER after being neglected for more than 24 hours.
As a telling video of the staff’s complete and ultimately fatal disregard for her was released, they had little choice but to go into public relations overdrive. They agreed to make all kinds of policy changes and rules about accountability as if adhering to policy and truthfully recording their actions was something they were good at. Knowing that if you throw money at a problem people read it as care, they also built a $153 million replacement for the notorious G building where all of these abuses were happening. Not surprisingly, the horrors continue — even under federal monitoring. Kings County’s Building R is little more than a multi-million dollar snake pit.
Last year, I attended a vigil in Esmin’s memory and a protest of the hospital’s neglect and continued abuses against people labeled mentally ill. It was organized by We The People and was as successful as we might have hoped, though the work is not done. Survivors of psychiatric abuses had an opportunity to speak out — and what some of these survivors had to say is not to be missed. I heard from several people that have helped inform and shape my approach toward activism and human rights.
This year, two years after her death, We The People will not let it drop as the problem clearly continues and I intend to stand with them in protest of a place that, for all their talk and money, is clearly beyond reform. We need to stand in solidarity with those behind locked doors and let the ones with the keys know we’re watching. Come out June 18th – 19th and demand justice, choice and human rights in mental health, voice your disapproval of the current standard of care and show them that there is a growing opposition in the public. Human rights are universal and a diagnosis cannot be allowed to erode that or even worse — invite abuse. When we look back in the light of hindsight at an era that saw basic human and civil rights denied people labeled ill and how many times we’ve collectively turned a blind eye to staggering amounts of abuse, we will look back in disgust. At least I’ll know which side I was on.
See below fliers for details and feel free to copy, repost and display them in support of the event.
The controversial Dr. Kifuji, prescribing psychiatrist for Rebecca Riley, appears to have evaded any criminal responsibility by exchanging her testimony for immunity. She is, however, up against a malpractice suit and some of the things that have come up are startling in terms of just how Rebecca’s very early death transpired and the role Kifuji played in all of it. I know I’ve brought up the doctor’s role in this before but every new fact that comes out is more frightening and infuriating than the last.
The Patriot Ledger ran an article that covers many of the almost too-bad-to-be-true circumstances that point to the fact that if Rebecca and Dr. Kifuji had never met, Rebecca might still be here. Regardless of your opinions on children and drugs, this case was wrong all around and the result of at least three people’s indefensible actions. Kifuji was more a drug dealer than a psychiatrist and while that’s not particularly uncommon, the young ages of her patients makes her a standout, even among the over-drugging crowd and the predictable end result in Rebecca’s case shows her to be both reckless and ill qualified.
From the Patriot Ledger article:
Years before she became a board-certified psychiatrist, Dr. Kayoko Kifuji was diagnosing children as young as 2 as bipolar and hyperactive – and prescribing powerful cocktails of mood-altering drugs to quiet them.
By the time Kifuji finally passed the psychiatric board exam – on her fourth try – one of her youngest patients, Rebecca Riley, had a little more than a year to live.
The lack of involvement on Kifuji’s part was shocking. She saw Rebecca primarily for twenty minute sessions to adjust doses. Often she just used these sessions to put on paper her approval for the adjustments her mother was already making, having increased doses on her own and experimented with drug cocktails using drugs prescribed (also by Kifuji) to Rebecca’s siblings.
She relied almost exclusively on what Carolyn told her about the kids when diagnosing them and ordering increasing amounts of drugs for them.
Kifuji also trusted the mother to keep tabs on Rebecca’s heart rate and blood pressure for signs of problems with the four drugs she was on. Kifuji, a pediatrician who later became a psychiatrist, told Novotny during the deposition that she didn’t realize she had a blood pressure cuff in her office and could check the girl’s vital signs herself until after Rebecca was dead. She said she didn’t take Rebecca’s pulse with her fingers because Carolyn Riley told her the child’s pulse “was within normal range.”
Even a well intentioned mother shouldn’t be solely in charge of monitoring a child’s heart rate and blood pressure let alone a woman hell bent on gaining access to more and stronger drugs at the expense of her daughter’s health. Also, any pediatrician turned psychiatrist should think of performing such simple tasks as second nature. If not that, then what is a doctor for? How do you not even know you have basic medical equipment in your office? How does a doctor fail to check a child’s pulse? Oh, that’s right — her mother said. If that’s all there is to doctoring, it’s no wonder some might see her as just a drug dispenser. They can do the rest at home, it’s a mere technicality that you must be licensed to prescribe.
- Asked why she didn’t report Carolyn Riley to child welfare authorities after learning that the mother had increased the children’s doses at least twice without checking with her first, Kifuji said: “I just can’t report to the DSS. I need to … my role is to work with the parent and not judging them.”
- Asked if she ever told Carolyn not to give Rebecca cold medicine on top of all the drugs the child was on, Kifuji says no, “but it’s because Rebecca didn’t get sick, and I was never asked ”
Right — let a mother chemically abuse and experiment on a child but whatever you do, don’t judge and certainly don’t give them any more information than they asked for. The article goes on to point out other times that Kifuji refilled prescriptions before they should have run out, never asking for an explanation, just dishing out more and more drugs.
She prescribed clonidine – the drug that killed Rebecca – during the child’s first visit to control the “impulsivity” that Carolyn Riley described. Rebecca was 2 at the time.
Impulsivity at two hardly makes a child a psychiatric oddity but when you look at some of her notes regarding Rebecca’s apparently troubling behavior it’s easy to get the notion that Kifuji sees childhood as a disorder unto itself.
“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.”
Kifuji described the toddler as dysarthric, meaning she could not properly pronounce some words.
“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.”
“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.”
This child was drugged for one reason — she was stricken with a case of toddlerhood. Dr. Kifuji seems to see no distinction between behavior and disease. Now that psychiatry has largely gotten away from talk therapy, we’re supposed to see psychiatrists as doctors of the brain — linking behavior to dysfunction in the brain. If that’s the case, Kifuji doesn’t make it very well. She’s like a mad scientist but without the science.
She explained that some researchers believe the area of the brain called the amygdala is different in people with bipolar disease. But she admitted she didn’t know where the amygdala is in the brain.
Of course you don’t need to know the brain at all to dispense drugs in the manner that Kifuji had begun making a career of (there is a timeline of Rebecca’s “treatment” at the bottom of the article). You only need to know that if you sedate a child enough, you can drug the behavior out of them. Sure, that child may be a “floppy doll” sitting in the corner but a quiet floppy doll and certainly not disruptive and if enough people will pay you to drug the childhood out of their children to one extent or another, then you’re in business.
Yes, the parents physically gave the drugs to Rebecca but they were used as a weapon and that weapon was provided by Dr. Kifuji. If she had given them a blackjack instead and told them how many times you have to hit a kid for effective behavioral treatment, this would be a different case entirely. Our view of prescribed medicine as care makes us resistant to the notion that drugs can be poison but they clearly can be and often are, particularly with psych drugs. When this happens, we need to respond accordingly.
There are no less than three guilty parties here in a case of chemical assault that ended in a child’s death. It’s bad enough that Dr. Kifuji was granted immunity making it impossible to hold her criminally accountable, even as more facts come to light pointing to her role not in anything resembling care but in a death. If she is not held civilly and professionally accountable, we’re saying her actions are acceptable, even desirable and we’re signing off on a prescription for some seriously detrimental treatment. I’m relieved to see she’s at least going to be made to answer for her actions. She’s certainly got a lot to answer for in this suit. Now we’ll have to wait and see what passes as accountability these days.
I don’t have the time or energy to really delve into these intertwining stories so I’m just touching on them and providing links but I do think we should be paying attention to what is allowed to pass for care in this country and what is allowed to pass for accountability.
Florida has a terrible track record, pumping its youth and especially its children in foster care, full of pyschotropic drugs. Foster children in Florida are drugged about three times as much as children outside of the system. These drugs have serious negative effects on developing minds and bodies and one of those effects is suicidal ideation. With that many kids drugged down and such extreme responses, it’s painfully obvious that many of those children are going to suffer terrible outcomes.
This was never more true than in the heart breaking story of Gabriel Myers, a child just seven years old who committed suicide by hanging while on a cocktail of psychotropic drugs including Seroquel. Seven years old. Suicide at that age is unnatural. A child that age taking his own life has been failed by somebody — maybe everybody. It took a long time in my mind to get to even thinking about what this says about broken systems, medication, responsibility and social failure — all I could think about was what a terribly sad, troubled and short life Gabriel had.
Florida’s response? From a CBS News article that does go on to present some critical views of the use of psych drugs in children:
The apparent suicide of 7-year-old boy Gabriel Myers, who was taking several psychiatric medications, has led to the introduction of a bill in the Florida legislature, which would assure that powerful mental health drugs dispensed to Florida foster care children would be more closely monitored…
The bill requires caregivers and doctors to report any adverse side effects, which DCF must document.
The bill also requires children to have a mental health treatment plan that includes counseling for children prescribed such drugs.
Monitoring? We need more than paperwork. Keeping track of your failures and an immediate reversal of your direction are two different things. Gabriel’s prescribing psychiatrist, Sohail Punjwani, is tied to a string of kids drugged down on powerful psychotropics and having horrible negative effects — facing everything from sedation and dizziness to hallucinations, suicidal urges and death either at their own hands or from the drugs directly and while he’s not the only one, he’s certainly at the center of the situation. It’s okay though. He got a strongly worded letter: From the Miami Herald:
A South Florida psychiatrist who was treating a 7-year-old foster child before the boy committed suicide last year has received a warning from federal drug regulators who say he failed “to protect the rights, safety and welfare” of children enrolled in clinical drug trials.
In a strongly worded letter dated Feb. 4, regulators at the U.S. Food and Drug Administration said Dr. Sohail Punjwani over-medicated children who were enrolled in clinical trials for undisclosed drugs. One girl, the letter said, slashed her wrists while hallucinating.
A strongly worded letter? Strongly worded letters are written in response to bad stays in hotels not children dying at the hands of their reckless doctor. Surely, showing a complete disregard for the safety of your youngest patients warrants more than a letter. But then, it seems disregard for patient safety is just the tip of a particularly damaging iceberg. It would appear as though Punjwani, so far without interference from any overseeing agency, may have been using foster children in clinical trials. If that’s the case, the problem is systemic.
If experimenting on kids is the lowest of the low, I don’t even know what to say about hand selecting discarded or displaced children for a pseudo-science project. It is a clear use of a person’s social viability to define them as candidates for clinical trials. You will never see a news report of senators’ children being hand picked for psychiatric experiments. With or without the pretense of clinical trials, children in this country have become the little white mice in psychiatry’s living lab and all too often their real lives are the mazes we watch them stagger through. That’s not good enough.
In a break from the typical dismissive response to death by psych drugs, which is to assume everybody did their best and a bad but faultless thing happened, jurors in the Carolyn Riley case are outraged at the conduct of Dr. Kayoko Kifuji. Rightly so. Kifuji diagnosed children as mentally ill for exhibiting the defining behaviors of childhood. She Diagnosed a three year old child with pediatric bipolar disorder (which was absent from the DSM draft released the day after the conviction). She passed out cocktails of serious drugs to two year old children like they were Flintstone’s vitamins — drugs that aren’t approved for use in children and are usually used judiciously even in adults. She let the parents experiment on all of their kids with these drugs and, following their lead, prescribed per those experiments — so yes, the jury was outraged.
From the Boston Globe:
“Every one of us was very angry,’’ said one juror, who requested anonymity to avoid retaliation for her role in Tuesday’s second-degree murder conviction of Carolyn Riley. “Dr. Kifuji should be sitting in the defendant’s chair, too.’’
Another juror said that while the 12-member panel found that the 35-year-old mother was primarily responsible for Rebecca’s death, many jurors were “off the wall’’ when they heard the testimony of Dr. Kayoko Kifuji of Tufts Medical Center. She said they were struck by how quickly Kifuji diagnosed Rebecca with bipolar and hyperactivity disorders, as well as how little the doctor seemed to supervise the mother’s dispensing of medications.
“It blew me away,’’ said that juror, who asked to remain unidentified for fear of reprisals.
Rebecca’s psychiatrist was the focus of some of the most powerful reactions from the jurors after a three-week trial that left them emotionally and physically exhausted.
Not only has she not been convicted of a crime, she will go undisciplined by courts and the medical establishment even outside of the criminal trials surrounding the Rebecca Riley case which can only add to the frustrated outrage of the jurors.
Other than the nationwide publicity given to the Riley case, in which Kifuji is mentioned repeatedly, the only overt sign that Kifuji had potentially questionable conduct is on the Board of Registration of Medicine’s website…Still, when asked if the board’s investigation concluded that Kifuji acted within acceptable medical standards, spokesman Russell Aims responded by saying that the board “closed the complaint against Dr. Kifuji without discipline.’’ He said the board, however, “reserves the right to reopen a case if new information comes to light.’’
The psychiatrist will not face criminal prosecution. A grand jury last summer declined to indict her, and Kifuji testified in Carolyn Riley’s trial only after being granted immunity from prosecution.
Prosecutors contend the Rileys “duped” Kifuji into authorizing the drugs but that doesn’t say much for her as a doctor does it? “Duped” doesn’t begin to explain diagnosing toddlers as bipolar, her cavalier approach to diagnosing and prescribing in general or her indifference to the misuse of drugs like depakote and clonidine. Kifuji had access to Rebecca herself, providing ample opportunity to make her own assessments. She chose instead to go on the word of the parents in brief and drug centered visits. She admitted that she found the Rileys’ actions unsettling. Maybe they were just not unsettling enough to interfere with business. While the prosecution and Kifuji’s lawyers tried to paint her as the good and upstanding doctor who got fooled, in the end she comes out looking like the prime example of psychiatrist-as-drug-dealer — not unlike the physician in every town that addicts know to visit for his liberal dispensing of narcotics — and the Rileys were repeat business. If you’re going to hand out drugs that easily, without concern for how they’re being used and on whom, you don’t get to claim ignorance.
In a country where a gun manufacturer or salesperson can be held responsible for the crimes of someone who legally buys or even steals a handgun (which I’m against), it’s shocking that Kifuji is able to walk away from this without penalty. She is a doctor and with that paycheck and perceived authority comes an obligation to think past the drugs that keep you in business and consider the well being of the people in your care. I sincerely hope her other child patients fare better but it doesn’t seem likely. The only things that seem to have changed for Kifuji since Rebecca’s death are the amount of attention she’s received and a new sense of impunity.
Well, the verdict is in. Carolyn Riley has been found guilty of second degree murder in the prescription drug induced death of her four year old daughter, Rebecca. I don’t know where to begin or what to say, really. We’re not talking about a child who had a freak reaction to a medication. Rebecca was a child abused with massive amounts of powerful drugs as a result of scheming parents and a negligent doctor and ultimately given an overdose of a sedative she never should have had. The Riley parents fabricated lists of symptoms for their children in order to get drugs to sedate them and when one of them, Rebecca, got pneumonia, they responded with more sedatives to quiet her complaints. When you have two parents who put all of their kids on heavy psych drugs at the age of two in order to control them, a doctor who sees diseases in the most basic childhood behaviors but not abuses when they are laid out in front of her and almost nobody paying attention, things turn horrible in no time at all — and that’s just the overview. The closer you look, the uglier it gets. I don’t even know how to approach some of the things that came to light during the trial but I have to wonder how many red flags have to be ignored before it all comes down to the death of a toddler diagnosed first as having attention deficit disorder, then at three, bipolar disorder — all for acting her age.
Boston Globe on the conviction: (emphasis mine)
A South Shore mother was found guilty today of second-degree murder in the death of her 4-year-old daughter who never woke up one night in December 2006 after ingesting toxic levels of psychotropic drugs…
The case had drawn national attention to the growing use of psychotropic drugs on very young children. When Rebecca died, she and her two older siblings were all on three potent psychiatric medications for bipolar and hyperactivity disorders. All of them went on those medications at age 2…
Prosecutors…depicted Carolyn Riley as an unusual type of child abuser, a woman who routinely overused sedating psychiatric pills to control her energetic toddlers and induce sleep. Prosecutors said she went to a lethal extreme in the hours before her daughter died on Dec. 13, 2006, dispensing as much as twice the girl’s daily dosage of clonidine at once as the girl was already battling a respiratory illness…
Prosecutors said the mother also had a scheme to obtain federal disablity checks through fraudulent claims that her children were mentally disabled…The state asserted that Carolyn Riley always put her husband’s needs over her children’s, and the night Rebecca received her fatal overdose, the husband was irate about the sick child’s repeated efforts to enter her parents’ bedroom, moaning, “Mommy … Mommy.”
and on the doctor: (who is still practicing and faced no charges)
Dr. Kayoko Kifuji acknowledged that when she first met Rebecca Riley, at age 2, she had initially diagnosed her with having attention-deficit hyperactivity disorder after only a one-hour meeting. She authorized the mother to give one prescription tablet of clonidine, a sedative, each night. But within a few days, Carolyn Riley acknowledged she was giving the girl two full tablets.
“Did she ask for you to authorize the double dose?” asked Plymouth First Assistant District Attorney Frank J. Middleton Jr.
The relationship between Kifuji and Carolyn Riley was portrayed today as relatively minimal and business-like, resulting in the psychiatrist exhibiting a high degree of trust in the mother’s account of her children’s behavior, as well as a willingness to look past obvious transgressions committed by the mother in her dispensing of medication.
And what transgressions they were. While the whole situation speaks volumes about the Riley parents, Kifuji is no saint in all of this. Diagnosing toddlers as mentally ill and putting them on adult psychotropics is disturbing enough but to turn a blind eye to blatant chemical abuses against children is reprehensible. It could have all been over if she had put the brakes on then — but that’s not how she does things.
…the two met each other for the first time in April 2003 when Carolyn Riley brought her older daughter, Kaitlynne, then 2, to see Kifuji who was then practicing at a clinic a Bay State Medical Center in Springfield.
After a one-hour meeting in her office, the psychiatrist diagnosed Kaitlynne as having bipolar illness and immediately prescribed Depakote based largely on the mother’s depiction of the girl as physically aggressive to her older brother, and the girl saying she sometimes saw “monsters” and “ghosts.”
Over the next several months, as the mother reported Kaitlynne having continued problems, including sleep issues, the psychiatrist raised the possibility of adding clonidine. At that time, the mother acknowledged she had already been trying out clonidine on Kaitlynne, having taken some of these prescription pills from a bottle designated for her oldest son, Gerard.
“Did that concern you?” the prosecutor asked.
“Yes,” Kifuji replied.
While Kifuji told Carolyn Riley that a parent cannot just introduce new medications without a doctor’s approval, the psychiatrist went ahead and added clonidine to Kaitlynne’s regimen of prescription pills.
What more can I say? This child didn’t stand a chance. Her father, Michael (another saint) will be tried separately for the same charges.
Further on the topic of Zyprexa and diabetes, Alaska lawyer Jim Gottstein of the Law Project for Psychiatric Rights is heading to court today to face down the drug’s maker, Eli Lilly in a lawsuit they brought against him for “conspiring to steal” documents that show the company suppressed information regarding the dangers of their star drug.
For those who don’t recall, Gottstein…was accused along with two others by US District Court Judge Jack Weinstein of violating a court order by scheming to leak and publish sealed Zyprexa documents. The Zyprexa documents, which detailed hidden side-effect data and improper marketing, were published by The New York Times (Gottstein provides documents and related background here), setting off a feverish debate over the public’s right to know about concealed side effect data.
As a result of Jim going public with the information, Lilly agreed to plead guilty and pay a 1.415 billion dollar fine for promoting Zyprexa off label. $515 million of that was in the form of a criminal fine — the largest single corporate criminal fine in history. The rest was paid out as civil settlements to the states and the FDA. I don’t know how exactly anyone can pay out a record breaking fine and no one notices but then, the lack of media coverage regarding pharma’s indiscretions and outright deceit is always pretty puzzling. At least the important information was taken to the public and to a degree that has made people aware and force Eli Lilly to take some accountability.
As for Gottstein, he maintains innocence. ‘Ever since Judge Weinstein ruled against me on February 13, 2007, Lilly has threatened me with civil and criminal contempt sanctions and going after my license to practice law,’ Gottstein writes to supporters. “I believe I did nothing wrong – that when Lilly failed to object after being given a reasonable opportunity to do so and then Dr. Egilman sent the Zyprexa Papers to me, they had lost their secrecy protection. I hope the Second Circuit will agree.”
Forget for a moment that Gottstein is an outspoken advocate for informed choice in mental health. He’s a human being. If you know a company is suppressing the fact that its product is directly leading to thousands of deaths from children right up through our elderly and all stops between, don’t you have an obligation to let those people know? It takes people like Jim Gottstein to bring this level of systemic deceit to light because if recent history shows us anything, the corporate conscience isn’t going to do it and a judge who see this as a “trade secrets” issue and not a public safety issue isn’t going to do it.