Natchez doctor takes stand in Fayette Ritalin trial

Published 12:00 am Wednesday, June 26, 2002

The Natchez Democrat

FAYETTE &045;&045; Natchez pediatrician Dr. Brian Stretch took the stand Wednesday in Jefferson County Circuit Court in the case of a mother who said Stretch incorrectly diagnosed her son and prescribed him Ritalin.

Brenda Doss said her son, Roderick Frye, was misdiagnosed with attention deficit hyperactivity disorder (ADHD) in September 1996.

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Doss said Stretch prescribed Frye Ritalin without warning of side effects or the dangers of stopping the drug abruptly. Frye said he became addicted to crack cocaine after his mother took him off Ritalin in March 1997 in order to imitate the drug’s effects.

Stretch said Wednesday that he talked with both Doss and Frye during the September 1996 office visit. At that point, Stretch said, he had enough information to diagnose ADHD and prescribe Ritalin without looking at school records.

&uot;I felt I had input from the school&uot; from talking with them about Frye’s school performance, Stretch said. He said Doss told him Frye had attention and behavior problems at both home and school.

Stretch said he asked Doss to supply him with a copy of a learning evaluation a Jefferson County school had done of Frye in 1995, but that Doss never brought the report.

Stretch said by questioning Doss and Frye during a visit that lasted at least 30 minutes, he determined that Frye had nine of 14 criteria used to diagnose ADHD.

Ritalin is effective in 75 to 80 percent of ADHD cases, said Stretch, adding he prescribed 15 milligrams twice a day for Frye, a dose consistent with his weight.

Doss and Frye returned for a follow-up visit in October 1996 and reported no problems with the drug then or since, Stretch said.

If they had reported problems, &uot;I could have reevaluated (him), prescribed him a different dosage or medication, or referred him to someone else&uot; for help, Stretch said.

When Doss said she would prefer a drug that only had to be given once a day, he prescribed 20 mg sustained-release Ritalin pills, with one-and-a-half pills to be given to him once a day.

Medical texts say the pills should not be crushed or chewed, but Stretch testified that cutting a pill in half would not diminish its time-release effect.

Stretch said parents are told to take their children off Ritalin altogether whenever they’re not in school &045;&045; but that if there are side effects, they should contact their doctor.

But Dr. Peter Bregan, a psychiatrist who specializes in the effects of stimulants, testified that &uot;you always want to take them off a stimulant carefully, under supervision.&uot;

Otherwise, he said, the patient could become depressed and look for an alternative high.

Frye said he started using crack cocaine three weeks after his mother stopped giving him Ritalin.

Bregan testified that halving a Ritalin pill would dump the drug into the bloodstream all at once, resulting in a quicker, intense high.

&uot;When you give a bigger jolt, you change the brain in a way that makes the person more susceptible to the drug,&uot; Bregan said.

Bregan testified that Ritalin is a &uot;cross-addicting&uot; drug to cocaine and said the recommended starting dose of Ritalin for children is 5 milligrams twice a day.

&uot;You’re dealing with an 11-year-old who weighs less than 100 pounds,&uot; Bregan said. &uot;You don’t want to give half the adult dose.&uot;

Bregan also said Stretch erred in not evaluating school records, such as earlier learning evaluations, and in not communicating closely with the school, child and parents to monitor Frye’s situation.

And proper diagnosis can only come from spending more time with a patient, Bregan said. &uot;Difficulty paying attention, talking out of turn, … that can come from almost anything,&uot; he said.

But Bregan said he does not believe in ADHD as a diagnosis and does not believe in prescribing Ritalin as a first resort.

Testimony in the civil trial continues at 9 a.m. today before Judge Lamar Pickard.