Detroit-Area Coroner Links Heart Attack Case to Ritalin
May or May Not Apply To Death of Boy, 13, at Ooltewah Middle
by Dean Arnold, Chattanooga Fax
The chief forensic pathologist for Oakland County, Michigan has ruled
that Ritalin use caused the heart attack death of Matthew Smith, 14, who
was riding his skateboard in the suburbs of Detroit one year ago.
Ooltewah Middle Schools Travis Neal, 13, had an enlarged heart, like
Matthew, when he collapsed from a heart attack and died after running
lapsin gym class on Nov. 24,1997. The Michigan coroner, after studying
Neals autopsy provided by CFax, says the students heart was twice the
normal size.
"This type of condition generally has a congenital link," Dr. L.J.
Dragovic told Chattanooga Fax. "Add a stimulant and you have a formula
for disaster...If he were on Ritalin, it certainly aggravated any pre-existing
conditions."
The exact amount of Ritalin involved, however, remains in question.
The day of Neals death, the Chattanooga Free Press quoted Ham.
Co. Emergency Services Spokesman Bruce Garner that the death was
from "cardiopulmonary arrest of unknown origen" and that "we dont have
any real indication of what happened....The teen had no history of
obvious medical conditions or drug use."
However, the local coroners report obtained this week by
Chattanooga Fax lists the following under Medical History: "Attention
Deficit Disorder, Rx Ritalin."
Garner told CFax his statements were based on the information
available to him that day. The Investigative Report listing Ritalin drug use
is dated the following day and was conducted by Medical Examiner F.K.
King, Jr. and Forensic Technical Specialist Karen Carter. Carter told
CFax the entry for medical history was based on interviews with family,
physicians, school officials, and others associated with the incident.
The citation of ADD and Ritalin was not reported after the investigation
was filed.
Anti-Ritalin activist Redd Howe first approached the Hamilton County
School Board one month after reading an 11/16/97 Free Press article
stating that "Hamilton County has the state's highest consumption of the
drug Ritalin" and that Tennessee "exceeds the national average by about
25 percent."
Reporter Ken Spear wrote that there is "an increasing fear that the
drug is being overprescribed to active children who don't need it, partly
as a result of pressure from harried teachers and parents."
TN Rep. Tommie Brown held special statewide hearings in Nashville
on the Ritalin concerns one week before Neals death and Howe
approached the Board with his concerns a week later. "Ritalin is being
prescribed and the long term effects have never been established for any
age group, especially children," said Howe, who believes officials are
"downplaying the seriousness of the drugs recommended. Schedule II
drugs include cocaine, morphine, and ritalin and are the most addictive
class of drugs known to pharmacology. We're rolling the dice - big time,"
he said.
Howe told Chattanooga Fax several parents at Ooltewah Middle "told
me it was common knowledge that Travis Neal was on Ritalin for years."
However, CFax has not obtained that information from any primary
sources.
The father, Mark A. Neal, told CFax that Travis was on Ritalin "one or
two months in the third grade" and had not taken the stimulant in four
years.
Dr. Dragavic, who also serves as a professor of Neurology at Wayne
State Medical School, was surprised by the fathers statement. "I have
reason to believe this entry was made for reasons other than casual
exposure over a couple of weeks," he said. "He must have been on it for
a longer period of time. He would have been on it for some time for it to
be listed."
Dr. Fred Baughman, a San Diego neurologist who testifies in national
ADD cases, also believes that an entry on a coroners report would be
based on harder evidence. "Its much more likely that it is a still-current
diagnosis for which there has been longterm treatment," he said, "rather
than just a diagnosis requiring brief treatment in the 2nd or 3rd grade."
Karen Carter with the Medical Examiners Office said no particular
criteria govern what is entered for someones medical history. She said
the report itself is public record and would not comment on whether the
"ADD Rx Ritalin" determination originated from one or several sources.
Dr. Dragovics ruling that links Ritalin to heart problems has caused a
national stir. He was interviewed recently opposite an APA critic on
Bryant Gumbels CBS This Morning and appeared in a French
documentary on the controversial subject.
Dr. Joseph Biederman, professor of psychology at Harvard University
and a longtime researcher of the use of stimulants, believes Dragovic's
conclusion is unfounded. Pediatrician Dr. James Shaya said he has
never heard of a similar case or similar side effect from Ritalin. Dr.
Shaya, co-author of the book What You Need to Know About Ritalin,
says "the use of Ritalin is well-known to be extremely safe. This doesn't
seem very likely or plausible. I would draw into question the diagnosis."
"We dont come to conclusions through a democratic process," said
Dr. Dragovic, who oversees five Forensic Pathogists in his labaratory.
"Theres no way we can reverse anything. We are in law enforcement.
We follow the facts."
Dragovic explained that stimulants work the heart muscles "like a car
revving at 6,000 revolutions a minute. Eventually, you wear out the
engine." He said Ritalin switches the heart to a higher gear. "When the
heart is exercised, that cardiac reserve is exhausted."
"If we dont consider these facts, there may be another around the
corner that will die from this," he said.
Matthew Smiths parents have filed a lawsuit and retained a nationally
prominent attorney. Dr. Baughman is involved in cases of several deaths
alleged to be connected to ADD prescription drugs.
Dr. Dragovic urges extreme caution to parents and educators. "Be
very careful. Monitor the child. Be sure the risk is justifiable. Be sure this
type of aggressive treatment -- the use of stimulants I must say is
aggressive -- is worth it."