Psychiatric Meds Eyed After Girl's Death

4-Year-Old's Fatal Overdose Raises Questions About Psychiatric Prescriptions For Kids

(AP) 
Kifuji did not return calls for comment and declined to be interviewed. But Kifuji has vehemently denied any role in Rebecca's death. She has agreed to a suspension of her license while the state's medical board investigates.

Kifuji told police Rebecca had been her patient since August 2004, when she was 2. She said she based her diagnoses of ADHD and bipolar disorder on the family's mental health history, as described by Carolyn Riley, and Rebecca's behavior, as described by Carolyn and briefly observed by her during office visits.

Kifuji told police she became alarmed in October 2005 when Carolyn Riley told her she had increased Rebecca's nighttime dose of Clonidine from 2 to 2½ tablets, and warned Carolyn the increased dose could kill Rebecca.

But Carolyn told investigators Kifuji told her she could give Rebecca and her sister extra Clonidine at night to help them sleep.

Tufts-New England Medical Center, where Kifuji worked, issued a statement supporting Kifuji, saying her care of Rebecca "was appropriate and within responsible professional standards."

In the months leading up to Rebecca's death, others noticed there was something wrong.

Teachers and staff members at the Johnson Early Childhood Center in Weymouth, about 20 miles south of Boston, say they called Rebecca's mother repeatedly to tell her that Rebecca was "out of it," but her mother said the girl was tired because she wasn't sleeping well.

A neighbor who lived next door to the family in the last month of Rebecca's life said Rebecca and her siblings seemed listless.

"They looked like little robots. They looked very lethargic," Phyllis Lipton said. "I said, `Wow, they don't look right,' but who knew?"

Pharmacists at Walgreens in Weymouth called Kifuji twice to complain that Carolyn Riley was asking for more Clonidine, even though her prescription was not due to be refilled yet, according to state police.

Once, Riley said she had lost a bottle of pills; another time, she said water had gotten into her prescription bottle and ruined the pills, according to police.

Kifuji authorized refills, but after the second incident, she began prescribing Clonidine in 10-day refills instead of 30-day supplies, investigators said.

On Aug. 16, a prescription for 35 Clonidine tablets — a 10-day supply — was filled at Walgreens, even though the Rileys had obtained a 10-day refill only the day before, investigators said.

Walgreens spokeswoman Tiffani Bruce said: "The scrip was filled as written, as it was prescribed by the doctor, and all the appropriate information on the medications was given to the family."

After Rebecca's death, police found only seven Clonidine tablets in the family's medicine tray; the pharmacist said there should have been 75. All together, prosecutors say, Carolyn Riley got 200 more pills in one year than she should have.

The Rileys' lawyers call them unsophisticated people who did not question their children's doctors.

Both were unemployed; they collected welfare and disability benefits and lived in subsidized housing. Michael Riley, who is also awaiting trial on charges of molesting a stepdaughter in 2005, claimed to suffer from bipolar disorder and a rage disorder; his wife told police she suffered from depression and anxiety.

"They are not the sort of people who go on the Internet and look on WebMD. These are the sort of people who, when they go to a doctor, the doctor is God and they do what the doctor says," said John Darrell, Michael's lawyer.

Carolyn's lawyer, Michael Bourbeau, said because the Rileys' three children were all taking Clonidine, Rebecca's prescription may have come up short at times when her siblings were given some of her pills. Also, some of the pills may have been lost when they were split in half, he said.

In July, after a therapist filed a complaint with the state Department of Social Services, social workers met with the family's doctors and other medical professionals and were assured that the medications Rebecca was taking were within medical guidelines.

"There were lots of medical eyes on this case and none of them seemed to say there was an issue of over-medication in this case," said Social Services Commissioner Harry Spence, who has come under fire for the agency's handling of the case.

Still, there were lingering concerns. When social workers tried to make a home visit in November, Carolyn "resisted and evaded," Spence said. Weeks later, workers resolved to make a surprise check, but Rebecca died the very next day, before they could visit.

Rebecca was found dead on the floor of her parents' bedroom wearing only a pink pull-up diaper and gold-stud earrings, on top of a pile of clothes, magazines and a stuffed brown bear.

Rebecca's uncle, James McGonnell, and his girlfriend, Kelly Williams, who lived with the Rileys, told police that the Rileys would put their kids to bed as early as 5 p.m. Rebecca, they said, often slept through the day and got up only to eat.

When Michael Riley decided the kids were "acting up," he told Carolyn to give them pills, McGonnell and Williams told police.

According to McGonnell and Williams, Rebecca spent the last days of her life wandering around the house, sick and disoriented. But the Rileys told police they were not alarmed. "It was just a cold," Carolyn repeatedly said during police interviews.

The medical examiner said Rebecca died a slow and painful death. She said the overdose of Clonidine caused her organs to shut down, filling her lungs with fluid and causing congestive heart failure.

Williams told police that the night before she died, Rebecca was pale and seemed "out of it." At one point, the little girl knocked weakly on her parents' bedroom door and softly called for her mother, but Michael Riley opened the door a crack and yelled at her to go back to her room, Williams said.

Later that night, McGonnell told police, he heard someone struggling to breathe and found Rebecca gurgling as if something was stuck in her throat. McGonnell told police he wiped vomit from his niece's face, then kicked in the door to her parents' room and yelled at the Rileys to take Rebecca to the emergency room.

Instead, Carolyn Riley said, she gave her daughter a half-tablet of Clonidine.

Carolyn's mother, Valerie Berio, said that when she visited the kids the night of Dec. 11, Rebecca seemed congested but not seriously ill. In a photograph Berio said she took that night, about 18 hours before the girl's body was found, Rebecca is smiling slightly as her mother holds a new green velvet dress in front of her.

Berio said that shows that her daughter and son-in-law could not have known how sick Rebecca was.

Rebecca's death has inflamed a long-running debate in psychiatry. Some psychiatrists believe bipolar disorder, which was traditionally diagnosed in adolescence or early adulthood, has become a trendy diagnosis in young children.

"As a clinician, I can tell you it's just very difficult to say whether someone is just throwing tantrums or has bipolar disorder," said Dr. Oscar B. Bukstein, a child psychiatrist and associate professor at the University of Pittsburgh.

A study of mentally ill children discharged from community hospitals, published in January in the Archives of General Psychiatry, found the proportion of children diagnosed with bipolar disorders jumped from less 2.9 percent in 1990 to 15.1 percent in 2000.

A report released by the Centers for Disease Control and Prevention in 2002 estimated that about 7 percent of elementary school-age children — or approximately 1.6 million youngsters ages 6 to 11 — have been diagnosed with ADHD.

The annual number of U.S. children prescribed anti-psychotic drugs jumped fivefold between 1995 and 2002, to an estimated 2.5 million, according to a study published last year by researchers at Vanderbilt Children's Hospital in Nashville, Tenn.

Some child psychiatrists say bipolar disorder may have been under-diagnosed in children for years, partly because several key symptoms are also symptoms of ADHD, including hyperactivity, distractibility and talkativeness.

Dr. Janet Wozniak, director of the Pediatric Bipolar Disorder Research Program at Massachusetts General Hospital, said early diagnosis and treatment are critical because the illness can cause social and academic problems, and lead to drug abuse, crime and suicide.

"What's commonly overlooked when considering diagnosing and treating children at such an early age is the risk of not treating and not intervening," Wozniak said.

[leidhold]

that's right, be angry with the medical profession.
they are EVIL!!!

dr's are EVIL, just like the MEDS ARE EVIL!!!

[daiseylu]

Why didn't the family members or the teachers or the doctor, or Walgreens, DO SOMETHING. How could this little girl, stumbling around, looking lethargic go undetected? Did no one think her heart could stop? If she re acted this way over an asprin, wouldn't anyone be alerted? The uncle kicked the door, when he should have taken her to the hospital, the authorities, should have been called, someone, should have helped this girl, no one did, it's that simple.

[oleander8]

I am enraged at the medical profession and their overuse of bipolar disorder and ADHD labels.
"hyperactivity, distractibility and talkativeness" ...these are also signs of healthy children who require attention and guidance. This is a scandal.

[leidhold]

maybe some kids don't like their teachers and they don't shut up or they don't stop banging on their desk to just irritate the teacher or therapist. gosh, adults do this, too, just to **** people off. look at what our president says and does. pass the meds to bush, too.

give our whole sociry meds because most people don't behave.

leave it to the dr's and we will all be zombies passing them our money to their bank account that they don't pay taxes on to the gov't.

leidhold

[leidhold]

children need meds because their parents stink at parenting....

don't go to the dr's, parents, go to class to learn how to parent....

learn how to not trust dr's because they are evil people!!

quacks = dr's...

leidhold

[leidhold]

dr's just want to pass out meds like candy so they can have patients come back and give them insurance or medicaid money. our society is all about MEDS AND MONEY!!! give them some more meds because the child cries or the woman complains.


maybe the dr's need the meds and to be sent straight to JAIL!!!

dr's should not be trusted. they are in it for money and prestige....

they go to work just liek a garbage man or a store clerk. convenience store clerk.... that's what dr's equal... no better, no worse...

leidhold

[lambofgoth]

A lot of people don't understand neurological/behavioral issues that show up in young children... hence Tom Cruise aka drivinhome makes comments like they do.
That being said, I agree the parents here just "suck". Obviously once the child hits the "terrible twos" it's time to drug them so perhaps dad can molest them easier... or at least so you don't have to hear from them.
I hope the other kids are taken from the home... and never returned.

[linfinster]

Raising a child with either a mild, moderate or severe mental disorder takes the cooperation of both the Dr and the parents. Clonidine is a controlled substance and, I beleive, can only be prescribed in 1 month quanities. How much was prescribed for this girls? Did the parents use more from the other children to give to the younger sibling?
My son is ADHD, took meds for school only until he was in 11th gr and then didn't want to anymore. I didn't push it. He was given plenty of opportunity to play, extra curricular activities, AND CONSISTANCY at home made him able to cope with what can be a very disabling problem.
If parents can't parent ... and it sounds like they had other children to deal with .. MAN! I hope the other kids have been removed from the home.

[siktadeth]

I was a psychology/counseling major in college, and back then(20 yrs ago) I arrogantly thought you could fix most of these problems with therapy.
Now, after being a teacher for years, I see that for some reason, many kids really do have "something" wrong with them. Their hand writing changes, they drum incessantly on desks, they can't keep their mouth shut. I have come to agree that some kids need medication.

But what happened to this little girl was the fault of her slovenly, abusive, i.diot parents who apparently knew enough to have children and seek welfare, subsidized housing and social services for them, but didn't want to hear a peep out of them. The overwhelming evidence points to the fact that these parents, frankly, suck. Bipolar, rage disorder, accused of molestation, anxiety and depression? Way to go guys...good gene pool. Keep havin' kids, okay? Sheesh...

[lucyfeo]

I have ADHD, and was diagnosed in the early 60's. I have four children, three of which have been diagnosed as having ADHD. I teach and have had to fill out physicians forms to help diagnose the children for learning disabilities, ADD or ADHD being among them. Contrary to what this physician says, I do not believe a four year old could be correctly diagnosed with ADHD, or Bipolar disorder. All four year olds have an attention deficit....that is called being a four year old. Bipolar is what was once called Manic Depression. How would one ever know this child is manic if she is listless. No child, no matter how severe the disorder, should ever be listless. Based on this article, it is obvious the father is abusive and the mother was using all the usual tricks to get more meds than what was prescribed. She had to have known what she was doing, everyone knows healthy four year olds do not sleep all day and all night. She wasn't even potty trained, which shows she wasn't developing appropriately, and that is not a symptom of ADHD, but of neglect.

[lucyfeo]

I have ADHD, and was diagnosed in the early 60's. I have four children, three of which have been diagnosed as having ADHD. I teach and have had to fill out physicians forms to help diagnose the children for learning disabilities, ADD or ADHD being among them. Contrary to what this physician says, I do not believe a four year old could be correctly diagnosed with ADHD, or Bipolar disorder. All four year olds have an attention deficit....that is called being a four year old. Bipolar is what was once called Manic Depression. How would one ever know this child is manic if she is listless. No child, no matter how severe the disorder should ever be listless. Based on this article, it is obvious the father is abusive and the mother was using all the usual tricks to get more meds than what was prescribed. She had to have known what she was doing, everyone knows healthy four year olds do not sleep all day and all night. She wasn't even potty trained, which shows she wasn't developing appropriately, and that is not a symptom of ADHD, but of neglect.

[petesis]

That is truly wrong to be giving these drugs (that have never been proven to even be effective any better than placebo) to children. The vast world of mental illness is divided up between spoiled, useless attention seekers, and those with organic brain damage that gets lumped in as mental illness. (schizophrenia).

[candida1976]

What is wrong with pepole? How could any one give there child that kind of meds. That child could not even known day from night. How could anyone do that to a child I do not understand. I hope and pray that these pepole get death or at least never see the light of day again. The people that was suppose to love and protect this child murdered her. I do not understand this. I have two kids and I could never imagine hurting them. These pepole are messed up.

[drivinhome]

WHAT ?

Why on earth would anyone put a child on powerfull mind altering psychotrophic drugs that studies show cause permanent brain damage ( they burn out the receptors in the brain - causeing irriversible damage )?

Would you put a kid on dope ?

Well what do you think these drugs are? They are in the same classification as heroin and cocain. Any doctor can tell you that.

What is wrong with these people?

Doesn't anyone research anything anymore?

Ever heard of love and understanding, nurturing a child, educating?

If your doctor said jump off that bridge, you would think twice?

Why throw your kids life away like that then?

Makes no sense. Unless they've been grossly missinformed, or are just bad persons.

[mdc76082]

It wasn't a major failure of what we have coined "the system". A system didn't fail this girl, her parents failed her. As for the diagnosis, I have 2 sons who have been diagnosed the same and were on the same meds as this little girl. I still feel today, there is no such diagnosis, but rather children today are so absorbed by modern "conveinences" that they have become lazy and don't channel their energy as we did (I'm 44) by playing baseball, soccer, football, running around the neighborhood, bicycling, etc. (it's uncool), instead they plop in front of the tv with the coolest video games or hang around with other "useless" peers and with all the built up energy they simply wigout and have their tantrums and mood swings. The parents failed this little girl. I've always said, we as adults & parents are our kid's worst enemies. There's too much of this kind of wasteful death, and unnecessary dying every single day when we pick up a paper, watch the news, or get on the internet. Don't you think it's time to say ENOUGH is ENOUGH. There's no "system let down". It's adults that do the letting down. Wakeup America & grow some. Get proactive and get your kid's life back from the bottom of a medicine bottle.

[olebd]

Who's the quack that diagnosed a 4 year old with these ailments and prescribed this heavy-duty medicine. He/she should be hauled in too.

She more than likely was just a energetic little girl and the parents couldn't/didn't want to put up with her.

What a shame. This little girl's whole world failed her.