Lawsuit puts scrutiny on ADHD diagnoses

May 12--VIRGINIA BEACH -- Rick Fee had a question for the psychiatrist who last prescribed ADHD medication for his son:

How, exactly, had Dr. Waldo Ellison diagnosed him with attention deficit hyperactivity disorder?

According to Fee, a colleague of Ellison's sitting in on the conversation asked how his son, Richard, was doing.

"He's not doing so well," Fee responded. "He's dead. He killed himself."

Ellison offered his psychiatric services to the family -- but that's not what Fee wanted.

"I wanted him to know it could have been prevented," Fee said. "I was looking for an apology, some kind of human emotion. I wanted him to say he was sorry."

More than two years later, Rick and Kathy Fee are still coming to grips with the discovery of their son, 24, hanging in his apartment. One step in that journey is a $2 million malpractice lawsuit the Virginia Beach couple has filed against Ellison, Dr. Charles Parker and their firms.

The Fees allege the two Virginia Beach psychiatrists misdiagnosed Richard with ADHD, failed to monitor him, prescribed inappropriate medications, failed to wean him off those drugs, and did not communicate with each other to flag his addiction.

"We don't want this to happen again, to anybody," Rick Fee said.

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The Fees' story gained national attention last year when a front-page New York Times report highlighted Richard with the headline: "Drowned in a Stream of Prescriptions."

At the time, the Fees had no intention of taking legal action. But after the story was published, there was such an outpouring from other families with similar experiences that the couple felt they needed to do more. They filed suit in August.

Both psychiatrists declined to comment, on advice of their lawyers, who issued statements saying their clients were not at fault.

If the case reaches the courtroom, difficult questions are likely to be addressed:

How much, if at all, did the doctors contribute to Richard's death? Was he addicted to the medication, and what impact did that have? If he was showing signs of schizophrenia, as one diagnosis said, did that play a role?

Suicide is inherently complex and is often the result of many factors. Judith Cofield, a local malpractice attorney not involved in the case, said lawsuits that concern mental conditions tend to be especially difficult.

"Past medical history plays a big role," she said. "You must prove two things: One, was there a breach in the standard of care; and two, did that breach cause or contribute to the ultimate injury?"

Ellison, Parker and their firms responded in Norfolk Circuit Court in April that Richard Fee was of sound mind when he took his own life in November 2011 and was responsible for his own death. In court documents, they deny all allegations of negligence and malpractice.

Lawyers for the psychiatrists asked that the lawsuit be moved from Norfolk, where Richard died, to Virginia Beach, where he lived most of his life and received treatment. A May 20 hearing is set for that request.

At the center of the suit is ADHD, a disorder that an increasing number of children and adults have been diagnosed with. The condition, which makes it difficult to focus and pay attention, was found in 11 percent of children ages 4 to 17 in 2011, according to the Centers for Disease Control and Prevention. It varies substantially by state, from 5.7 percent in Nevada to 18.7 percent in Kentucky.

A report released in March by drug management company Express Scripts showed that the number of Americans using ADHD medication rose 36 percent between 2008 and 2012, with the biggest increase among young adults.

Huge controversy has arisen over the issue. Some claim the condition is vastly overdiagnosed; others say the medications used to treat it are being vilified. Diagnosis is not clear-cut, like blood tests for diabetes or X-rays for broken bones. Instead, it involves using a rating scale, psychological tests, a physical exam and childhood history of behavior and school work.

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A complicating issue is that ADHD medications, such as Ritalin and Adderall, have been misused by high school and college students who don't have the condition but want a stimulant to stay up and study or to improve their focus.

A 2011 University of Maryland School of Public Health report showed that 6.5 percent of high school seniors used Adderall, and that 31 percent of college seniors used prescription stimulants for no medical reason. Health advocates have cautioned against such abuse, as the drugs can become addictive and can lead to sleeplessness and hallucinations.

The Fees think their son was addicted to a drug he never needed in the first place. They say he did not exhibit any ADHD symptoms as a child, that he was an honor roll student at First Colonial High School and a successful athlete.

"Things came easy to him," said Rick Fee, who owns ski shops in Virginia Beach and Newport News. "He was the typical all-American kid."

Richard received a scholarship to Greensboro College, where he studied biology. After graduating with honors in 2008, he wanted to go to medical school and began studying for the admission test.

Rick Fee said he was aware his son had used a friend's ADHD medication when he was a college sophomore to pull an all-nighter. Fee said he warned Richard then and again in 2009, when he discovered Richard had gotten his own prescription from a Greensboro health provider.

"He saw it as a study aid to help him with the MCATs, but it turned into a habit and then a full-blown addiction," Fee said. "He was different. His mindset was different. His mannerisms were different. Our relationship was different."

After Richard moved home, he got a prescription from a family practice doctor, who referred him to Ellison, who began prescribing Adderall. As time went on, the Fees say, the dosage steadily increased.

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Fee remembers telling his son on many occasions that he didn't need the medication, that he didn't have ADHD and that taking Adderall was dangerous. This is how he recalls his son's response:

"Dad, look, the doctor thinks I need it, I think I need it. He wouldn't give me anything that was bad for me, and I'm taking it."

Their relationship grew rockier, and Richard's routine careened between staying awake days at a time and then crashing. He lost weight and would sweat profusely even in the winter.

His behavior turned erratic. He grew obsessed with maps. He'd climb on the roof of their house and talk about how the moon looked. He'd leave in the middle of the night, saying voices were telling him to drive until they told him to go home.

On the last day of 2010, the Fees confronted Ellison, going to his office unannounced. Fee said Ellison told them that because Richard was an adult, he would need to request an appointment with all three of them before Ellison could talk about his treatment.

Fee said he became angry and replied: "You keep giving Adderall to my son, you're going to kill him."

In February 2011, the Fees persuaded Richard to see a neuropsychologist, who concluded that he was showing signs of schizophrenia and should not be on Adderall. Rick said that he went directly to Ellison's office to give him the report, and that Ellison scheduled a family meeting for the four of them.

Fee said Ellison wouldn't back off the ADHD diagnosis but did agree to stop prescribing Adderall because Fee said he would not allow Richard to live at home while continuing to take the medication.

During the next few months, Richard continued to have problems, and at one point he attacked his father. That led police to respond and later prompted crisis intervention services involving Parker, the other psychiatrist named in the lawsuit.

The Fees said that they called and left messages saying Richard should not be prescribed Adderall, but that Parker prescribed it, increasing the dosage at one point.

Richard also spent a week at Virginia Beach Psychiatric Center, where he was prescribed an antidepressant and medication to treat schizophrenia, but no Adderall.

According to Fee, his son went back to Ellison in July 2011, telling the psychiatrist he was living on his own again and had a job that he thought Adderall would help him keep. He didn't tell Ellison about the stint at the psych center or the treatment by Parker, who had stopped prescribing him Adderall.

Ellison gave him three prescriptions that would last 90 days. Fee confronted Ellison about it, and Ellison said he would no longer prescribe the medication.

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In November, two weeks after his last prescription expired, Richard was living in a Norfolk apartment paid for by his parents. He phoned them and left a message for them to call. Kathy did, but got no answer.

They went to his apartment the next day. His car was there, and the apartment lights were on.

They knocked on the door. No answer.

Rick climbed through the kitchen window. The TV and stereo were on.

Richard wasn't in the kitchen, living room or bedroom. The Fees felt a sense of relief. Maybe he had gone for a walk.

Then Fee realized he had not checked the closet. That's where he found his son.

He started screaming as he tried to keep Kathy away.

"It was the most horrific thing I have seen in my life," he said.

Both still cry at the memory.

"Our world ended," Kathy said.

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In June 2012, Fee was at work when he saw New York Times reporter Alan Schwarz being interviewed on national TV about ADHD and abuse of prescription drugs.

Rick agreed with what Schwarz was saying and was angry that the interviewer was pushing back: "I couldn't believe her nonchalant, cavalier attitude."

So he sent Schwarz an email of support and described his son's experience.

Schwarz decided to write about Richard's death. It ran in February 2013 and led to the Fees appearing on the "Today" show and "Dr. Oz."

The Fees received calls and emails from across the country. Kathy said some asked: "What are you going to do? How will you fight this?"

They have several ideas for change.

They want parents and guardians with children on their insurance to be able to see what drugs the children are taking, even if they're over 21. Currently, patients like Richard have a right to confidential treatment unless they authorize the information to be shared with their parents.

The Fees also want changes to the state's Prescription Drug Monitoring Program, a database in which pharmacists enter all medications they dispense that could be addictive. Doctors and other health care providers can check on patients to see whether they are filling prescriptions from several doctors. The Fees want to require doctors to check the database before prescribing medications; some states have that requirement, but not Virginia.

Robert Moreland, lawyer for the Fees, said a trial date won't be set until the change-of-venue request is settled. The couple hope a trial will serve as a lesson for doctors and families.

"The main thing is to bring awareness," Rick Fee said. "If it could happen to Richard, it could happen to anyone."

Elizabeth Simpson, 757-222-5003, [email protected]

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