BOY'S DEATH SPURS OREGON TO ACT
PEOPLE IN CHILD'S CIRCLE OF CARE MUST BE TOLD ABOUT DRUGS
April 3, 1997
When God speaks to Mary Jackson, she hears the voice of her son Bobby.
It's a voice frozen in a 7-year-old's chirp, the voice of Bobby four years ago, when he died.
Bobby had been in a foster home with seven other children for nearly a year. The longer he was there, the worse he behaved. A psychiatrist came every six weeks and gave Bobby stronger and stronger doses of the anti-depressant imipramine.
Lethal doses, the coroner said, which made Bobby collapse and stop breathing after running three blocks home from school.
Six months later, Jackson, a woman of limited education and years lost to heroin, entered the state Capitol in Salem. Her shaky voice persuaded Oregon lawmakers to pass the Bobby Jackson Law, which requires government workers to notify a foster child's parents, advocates and lawyers when the child is given psychotropic drugs.
Legislators passed it unanimously, despite resistance from the Children's Services brass and the Oregon Psychiatric Association.
"That made me feel like my son's death wasn't for nothing," Jackson said recently at her son's hilltop grave, where she sometimes leaves Ninja Turtles and other small toys behind.
Though long divorced, Bobby's father, Roger Jackson, is proud of his former wife's crusade. However, he wasn't in a position to help; when his son died Jan. 5, 1993, he was in jail on a failure-to-appear warrant.
"The chaplain came over and said, `Bobby's dead,"' Roger Jackson recalled. "I just couldn't imagine what a 7-year-old boy (would have) died from."
Toxic doses of imipramine, it turned out - more than twice the dose recommended by the Food and Drug Administration for Bobby's weight of 51 pounds.
Bobby was taking the drugs for sleeplessness and erratic behavior. He had lived in nine foster homes since he and his two brothers entered the system in 1991, his parents said.
The Eugene Register-Guard, whose stories about Bobby's death helped spur the new law, reported that Bobby had been sexually abused in two of the foster homes - information never passed on to the psychiatrist who prescribed the drugs.
Bobby's last residence was the Eugene foster home of Norman and Doris Bolden. He was started on imipramine the month he moved in, March 1992.
The Boldens, who had been the subject of a dozen previous complaints about possible overmedication, declined to be interviewed for this article. They told investigators they had been following doctor's orders; they were cleared of any wrongdoing in Bobby's death and remain licensed foster parents in Oregon.
Bobby's paternal grandparents, Morris and Joleen Jackson, wanted Bobby out of the foster home. They felt the boy was looking worse during the twice-monthly visits they were allowed.
"Bobby, he'd just get inside of you," Morris Jackson recalled of his grandson. "When he smiled, it was like it was with his whole body."
Bobby's grandmother contends that the foster parents "just wanted to quiet him down." She believes Bobby thought that if he threw tantrums at the foster home, the state would send him to live with his grandparents.
"He was upset that he wasn't able to live with his family, who cared for him and loved him," Joleen Jackson said. "He was a real happy kid when he was with us."
Records show he was doing well at school, even while in foster care.
Nonetheless, Bobby's dose of imipramine was steadily increased to 150 milligrams, along with 75 mg a day of the anti-psychotic drug Mellaril. The diagnosis on his last prescription, written Dec. 11, 1992, was "extreme agitation."
Three weeks later, Bobby collapsed on the floor of his foster home and could not be revived by paramedics. The medical examiner later listed the cause of death as imipramine intoxication.
Bobby's psychiatrist, Dr. Sue Colasurdo, was reprimanded for overmedicating the boy and fined $5,000 by the state medical board. Bobby's parents received a settlement of about $18,000 from the state.
Both parents admit their own responsibility. Mary Jackson said she has undergone drug treatment and job training. Roger Jackson is out of prison and living with his parents.
"I made a mistake," he said, "and it cost Bobby his life."
Bobby wasn't the first child in Oregon to pay that price. Five months before, a grieving father on the opposite side of the state believed that the biggest mistake he had ever made was allowing his son to go into foster care.
A strapping 14-year-old, Carl Cleveland collapsed and died next to a public swimming pool on a fall afternoon in 1992 while on an outing with a specialized foster care program for sexually aggressive youths.
Desipramine was the culprit, an anti-depressant cousin of imipramine.
"To me, Carl didn't die," said his father, John Cleveland. "They killed him."
As a toddler, Carl was sexually abused by a relative. As a youth, he in turn molested the sons of a preacher in his Eastern Oregon hometown of Ontario. State doctors diagnosed him with conduct disorder and attention deficit-hyperactivity disorder and in July 1991 started him on desipramine.
But the doctor who later said he planned to give Carl a follow-up blood test lost track of the youth when he transferred to Camp Florence, a work-study program in coastal Lane County. He'd grown to 6 feet, 2 inches tall, had a girlfriend and was preparing to move back home.
"Carl was a handsome young man with a twinkle in his eye and a warm smile," wrote teacher Adele Keaton.
But the Clevelands noticed tremors when they visited him.
"We bought the boy a can of pop," said his stepmother, Denise, "and he was shaking so bad he would shake the pop out of the can."
On Aug. 1, Carl sat down by the side of a pool and had what witnesses described as a seizure.
Medical Examiner Brent Kehn concluded that Carl's desipramine blood level was within the lethal range. The physical activity of diving might have hastened the drug's effects on the heart and helped send it into an irregular beat that proved fatal.
After his death, Carl's case was featured in the winter 1995 Journal of Child and Adolescent Psychopharmacology. Journal authors Drs. Charles Popper and Brian Zimnitzky warned of "inconclusive but mounting evidence surrounding desipramine" and called for "guarded" use of it in young people.
Publicity surrounding the two deaths spurred Portland Republican Mary Alice Ford to introduce state legislation, dubbed the Bobby Jackson Bill, to increase oversight of drug prescriptions for foster children.
Ford discovered that foster children had far fewer safeguards against improper medication than senior citizens and the developmentally disabled.
The bill she wrote, which was signed by Gov. Barbara Roberts, promised not only notification of adults with a legal interest in a child's welfare, but also the right to challenge the psychotropic prescriptions in a juvenile court.
Bob Crawford, the state's foster care program coordinator, said he wrote the regulations implementing the Bobby Jackson Law, but has no way of knowing how widely they are used. Each of Oregon's four social services regions and 36 county courts handles the matter in its own way, he said.
Ford, who is no longer in the Legislature, said she hopes her law is being zealously implemented. But she admits she does not really know if child welfare officials are keeping track of the drugs.
"They're underpaid," she said. "It's all really very difficult."
However, some foster parents say the law is making a difference.
Sherry Stevens, a longtime foster mother who lives not far from where Bobby Jackson died, recently made her home the 24th stop for a 17-year-old who had spent most of his life in foster care.
The teenager takes lithium, resperidol and imipramine for learning problems and depression, and Stevens said social workers and doctors are working as a team to monitor the drugs and taper him off.
A social worker sent Stevens a sheet on which she charts his daily doses. Meanwhile, the state pays for therapy, vitamins and acupuncture to help the teen tackle his ailments in non-pharmaceutical ways.
"All the kid wants is to be listened to and cared about, so he can build some trust," Stevens said. "Maybe he'll find it here."
Since the Bobby Jackson Law went into effect, said Stevens, who is a nurse, social workers seem to be offering more support and information.
"This kid's lucky," she said. "They're doing everything right."
-- Steven Goldsmith can be reached by phone at (206) 448-8322 and by e-mail at firstname.lastname@example.org
`BOBBY JACKSON LAW'
The sudden deaths of two boys from antidepressants spurred Oregon lawmakers to pass the "Bobby Jackson Law" in 1993. It requires that caseworkers, parents and other adults be notified when a child in state care gets behavioral drugs.
Some highlights of the law:
-- Defines psychotropics as medication intended to affect or alter thought processes, mood or behavior.
-- Orders foster parents to notify the state's Children's Services Department of any new psychotropic prescription within one working day.
-- Orders the state to notify, if available, the child's parent or guardian, parent or guardian's attorney, child's attorney and child's court-appointed special advocate.
-- Information must include the dosage prescribed, the manufacturer's recommended dosage, the reason the medicine was prescribed, and the expected benefits and side effects.
-- Gives all parties the right to petition juvenile court for a hearing if there is an objection to the prescribed dosage. The court may order an independent evaluation or have the medication modified or stopped.