BOY DIED FROM MEDICATION OVERDOSE, FINDINGS SHOW

STEVEN GOLDSMITH

Seattle Post-Intelligencer

Six-year-old Domico Presnell died from an overdose of the anti-depressant drug Elavil that a doctor had prescribed for his emotional outbursts, authorities said yesterday.

Those laboratory findings, however, did not put to rest other investigations into the boy's death April 21 at his Seattle foster home.

The state Department of Social and Health Services will convene a fatality review panel of experts to look into the tragedy, including whether Domico's foster mother was given enough information by doctors and support from state caseworkers to properly handle Domico's medications.

``We're looking at how much help we can get to foster parents in terms of looking at prescriptions,'' said Kikora Dorsey, DSHS regional administrator.

The death comes during a time of national debate over the growing use of medications to treat children's behavioral and attention problems.

Dr. Daniel Stowens, the Seattle child neurologist who prescribed Domico's Elavil, the brand name of amitriptyline, said he was shocked when the boy died.

Stowens said he had been prescribing amitriptyline to children for at least 13 years without serious ill effects.

``This is the first time I've ever had a child have a problem with that amount of amitriptyline,'' Stowens said.

Because of that apparent safety, Stowens said, he was ``very comfortable'' with prescribing amitriptyline, even to children in unsophisticated or temporary households when there could conceivably be mistakes in administering it.

Such drugs, however, are controversial.

``Amitriptyline is known for its lethality,'' said Dr. Peter Breggin, a Maryland psychiatrist and the author of ``Toxic Psychiatry,'' a book critical of drugs used in mental treatment.

Amitriptyline is an older tricyclic anti-depressant drug that, for depression, often has been replaced by drugs such as Prozac and Zoloft.

When it was in more common use in 1980s, amitriptyline overdoses and deaths were one of the leading causes of emergency-room overdose admissions, according to the Drug Abuse Warning System network.

Larry Zalin, spokesman at Harborview Medical Center, said the hospital's emergency room had 17 admissions for amitriptyline overdose between January and June 1995 - fewer than the hospital had for overdoses from common analgesics.

Stowens, however, said many children in his care have benefited from the drug without ill effects.

He began treating Domico about a year ago, in hopes medications could help the boy cope with fierce mood swings and nightmares that were making him more and more sleepless.

``He'd get really angry, so angry that it was hard to take care of him,'' Stowens said.

Domico's natural mother said yesterday that she believes the medicine made the boy's behavior worse.

``The doctors got him all strung out on that stuff,'' said Carolyn Presnell, a self-described former drug addict who said she has been clean for seven months.

Carolyn Presnell said she and the foster mother had been cooperating in trying to get more information about the medications, with little success. She said she believes the foster family followed the doctor's instructions.

``They did all they could for that boy,'' she said.

Domico's foster mother could not be reached yesterday.

A letter written three days after Domico's death by a manager at Seattle Mental Health, where the boy had attended a therapeutic program, said staffers there were worried about signs of overmedication but were rarely able to reach either Stowens or a state caseworker to discuss the boy's situation.

The letter writer, program manager Alysone Warren, complained that state family-welfare caseworkers did not respond to messages from her agency's mental health professionals. Warren could not be reached for comment.

However, Warren's letter was a draft that never was sent to the state agency, according to her boss, Dr. David Stone, director of Seattle Mental Health.

Stone said he did not know who leaked the letter to the news media, and emphasized that its release was not authorized by his agency.

Stowens said yesterday that he was not aware of anyone trying to contact him about Domico, whom he estimates he saw in his office six or seven times.

Stowens said he had reduced the medication at one point because of the foster mother's concerns, and Domico's behavior had worsened.

``It was clear he functioned better when he was taking amitriptyline,'' Stowens said.

The doctor said the foster mother also told him that Domico would sometimes shake or shudder, but Stowens said he never directly saw signs of a seizure disorder.

The King County Medical Examiner's Office said amitriptyline caused the boy's death, but made no determination on who might be responsible.

``Whether there's culpability or not, that's not our ballgame,'' said chief investigator Jerry Webster. The case has been forwarded to the Seattle police and Child Protective Services.

A prescription history for Domico obtained by the Post-Intelligencer indicated an increased dosage, from 25-milligram tablets to 50-milligram tablets, for amitriptyline in March. In addition, the boy was prescribed the drug clonidine, a blood-pressure drug that acts as a depressant and could counteract the effects of the amitriptyline.

In March, Domico was also prescribed a psychotropic medication called Cylert (pemoline) that stimulates the central nervous system and is frequently used to treat children diagnosed with attention-deficit disorder.

The drug Tegretol (carbamazepine) was prescribed April 11, after the amitriptyline dosage had been increased. Tegretol is an anti-convulsant and anti-seizure drug.

Presnell, Domico's mother, said the tragedy occurred as she was taking steps to reclaim her son and his 4-year-old sister, who is in another foster home.

She said she has been drug-free for seven months, and was attending a Narcotics Anonymous meeting the Sunday morning in which Domico failed to wake up at his foster family's home.

Presnell, 25, said she was addicted to drugs while she was pregnant with Domico. She said she started drinking heavily and smoking marijuana when she was 10 years old.

Now clean and living at a residential recovery center on Capitol Hill, Presnell was visiting her son one hour each week and was in close phone touch with the foster mother.

``I completely take responsibility for my own part in this,'' she said. ``This never would have happened if I could have kept him. But it's like, I'm doing all this work now, and who's there to help me?''

P-I reporter Tom Paulson contributed to this report.