Whether the diagnosis was correct or not is another separate debate. My point of view - maybe in children as young as this, there should be a compulsory independent second opinion, or some sort of registration of diagnosis so some sort of supervision CAN take place. It is too easy for a diagnosis like this to be used as an excuse to over-medicate an otherwise 'normal' child whose parents simply don't understand how to parent. Just because the older kids also had BiPolar (BP) diagnosis doesn't mean that they actually DO have BiPolar (BP), just that the same (now suspect) doctor said so.
I'm not saying that diagnosing BiPolar (BP) in a child this age is wrong, only that it is open to abuse and that this definitely sounds like an example where the system went wrong.
I also think the Aussie medication system would work well - drugs like this, even for adults, are "Authority"scripts. In order to prescribe a restricted drug to a particular patient the doctor has to fill out an application form FOR THAT PATIENT to receive THAT DRUG. Even if he has other patients on the same drug, it doesn't matter. Each patient requires their own lot of paperwork, which must be resubmitted every two years. The applications are scrutinised by a team of specialist doctors answerable to the government bodies and with close ties to the Aussie equivalent of FDA and also the national health service, Medicare. This is Federal, not State.
Each time the patient goes to the doctor for a new prescription, the doctor has to ring up Medicare and request the prescription. Some can be issued with repeats; others must be reissued every month. And in some cases where the doctor suspects inappropriate use of the drugs, the pharmacist has to administer the medication one dose at a time.
Each time the doctor rings up he gives his authority number, his prescriber number and the unique number of the prescription generated by his computer. In turn he is given an authority number by Medicare. Any previous prescriptions are then cancelled. Also, there is no other doctor the patient can go to, not even another in the same practice. Any other doctor they go to would be discovered when the paperwork gets submitted to Medicare.
So you take your prescription to the pharmacy. In some cases you have to always use the same pharmacy, just as you have to use the same doctor. The doctor and the pharmacist talk to each other if they need to. The pharmacist administers the medication. If the patient asks for a repeat to be issued too soon, the pharmacist is not permitted to do this. To get permission in extraordinary circumstances ("I've lost the bottle of pills"; "the dog ate the pills"; "water got into the bottle") the pharmacist ring both the doctor and Medicare. Where possible, corroborative evidence must be provided, such as the vet bill for the dog or the water-contaminated bottle of pills. If a patient tries this on too often without proof, they get investigated and often charged. Some nasty cases get uncovered, such as granny being bullied out of her pain medication by a junkie grandson who sells the drugs to buy more. And the case I was involved in a few weeks ago, when I found some empty packets which had been dispensed the day before, then emptied out and dumped in the bin. By taking the empty packets to the pharmacist data on this patient (and also the prescribing doctor) has at the very least been entered on the pharmacist's data base. And probably more - he's probably reported it to Medicare, who will investigate if they already have other similar reports on either the GP or the patient.
With a lot of authority scripts, a GP can prescribe but only on authority from a higher specialist. For example, I'm on strong pain medications for which I get scripts from my GP, but only because he gets regular letters from a pain specialist authorising him to continue, and telling him what dosage is approved. When my GP redoes the paperwork he has to include copies of those letters in the application.
It all sounds very Big Brother, but it helps cut down on many forms of abuse.
But unless you can put something this draconian in place, there will still be cases like this little girl.
Marg
