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Girl Killed with Drugs
March 24, 2007 permalink
The death of Rebecca Riley has been in the news for three months, finally there is a thoughtful article dealing with her case. She died from prescribed psychiatric drugs. The parents were the kind who took advice from doctors uncritically, and may even have tried to help their child by giving her more than the doctor ordered. Rather than deal with the failings of the drug-pushing system, prosecutors have taken the easy route and blamed the hapless parents.
Girl's overdose death raises questions
By DENISE LAVOIE, Associated Press WriterFri Mar 23, 7:02 PM ET
In the final months of Rebecca Riley's life, a school nurse said the little girl was so weak she was like a "floppy doll." The preschool principal had to help Rebecca off the bus because the 4-year-old was shaking so badly. And a pharmacist complained that Rebecca's mother kept coming up with excuses for why her daughter needed more and more medication. None of their concerns was enough to save Rebecca.
Rebecca — who had been diagnosed with attention deficit hyperactivity and bipolar disorder, or what used to be called manic depression — died Dec. 13 of an overdose of prescribed drugs, and her parents have been arrested on murder charges, accused of intentionally overmedicating their daughter to keep her quiet and out of their hair.
Interviews and a review of court documents by The Associated Press make it clear that many of those who were supposed to protect Rebecca — teachers, social workers, other professionals — suspected something was wrong, but never went quite far enough.
But the tragic case is more than a story about one child. It raises troubling, larger questions about the state of child psychiatry, namely: Can children as young as Rebecca be accurately diagnosed with mental illnesses? Are rambunctious youngsters being medicated for their parents' convenience? And should children so young be prescribed powerful psychotropic drugs meant for adults?
Dispensing drugs to children diagnosed with mood or behavior problems is "the easiest thing to do, but it's not always the best thing to do," said Dr. Jon McClellan, medical director of the Child Study and Treatment Center in Lakewood, Wash. "At some level, I would hope that you'd also be teaching kids ways to control their behavior."
According to the medical examiner, Rebecca died of a combination of Clonidine, a blood pressure medication Rebecca had been prescribed for ADHD; Depakote, an antiseizure and mood-stabilizing drug prescribed for the little girl's bipolar disorder; a cough suppressant; and an antihistamine. The amount of Clonidine alone in Rebecca's system was enough to be fatal, the medical examiner said.
The two brand-name prescription drugs are approved by the Food and Drug Administration for use in adults only, though doctors can legally prescribe them to youngsters and do so frequently.
Rebecca's parents, Michael and Carolyn Riley, say they were only following doctor's orders. Rebecca, they told police, had been diagnosed when she was just 2 1/2, and Rebecca's psychiatrist prescribed the same potent drugs that had been prescribed for her older brother and sister when she diagnosed them with the same illnesses several years earlier.
But Rebecca's teachers, the school nurse and her therapist all told police they never saw behavior in Rebecca that fit her diagnoses, such as aggression, sharp mood swings or hyperactivity.
Prosecutors say the Rileys intentionally tried to quiet their daughter with high doses of Clonidine. Relatives told police the Rileys called Clonidine the "happy medicine" and the "sleep medicine."
Through their attorneys, Michael Riley, 34, and Carolyn Riley, 32, have accused Rebecca's psychiatrist, Dr. Kayoko Kifuji, of over-prescribing medication.
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 2 1/2 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, and 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 disabilty 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 that 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. And 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 mommy, 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, 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 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.
Source: Yahoo news
Addendum: A comment published in the Boston Globe suggests that the power of the phamacological establishment is so great it is a threat to the career of any of its critics.
Misguided standards of care
AS A doctor, I did the nearly unthinkable at a recent conference on bipoloar disorder in children. I charged another doctor with moral responsibility in the death last December of Rebecca Riley, a 4 -year-old girl from Hull. Naming names in medicine is just not done very often -- and I knew the personal and professional risks I was taking. Yet I felt compelled to name Joseph Biederman, head of the Massachusetts General Hospital's Pediatric Psychopharmacology clinic, as morally culpable in providing the "science" that allowed Rebecca to die.
Rebecca's parents have been jailed and charged in her death. They are accused of intentionally overdosing her with clonidine, an anti hypertensive and sedative drug -- one of three psychiatric medications prescribed by a Tufts-New England Medical Center child psychiatrist. Rebecca had been treated with these medications since the age of 2 1/2 for the purported diagnosis of bipolar disorder -- the new name for manic-depression.
While the psychiatrist involved has withheld comment on the case, both her lawyer and the medical center have defended her actions as "within the standards of care." Biederman and his colleagues at Harvard are the professionals most responsible for developing and promoting those standards of care -- which include diagnosing preschool children as young as 2 with bipolar disorder and treating them with multiple medications.
Biederman shocked the child psychiatric world in 1996 by announcing that nearly a quarter of the children he was treating for attention deficit hyperactivity disorder also met his criteria for bipolar disorder. Up until then bipolar disorder was rarely diagnosed in teenagers and unheard of in prepubertal children. Biederman could justify his findings by simply broadening the semantic definitions of a previously more circumscribed condition contained within American psychiatry's bible -- the "Diagnostic and Statistical Manual of Mental Disorders."
Biederman has produced a number of studies and papers purporting to demonstrate the validity of his diagnosis and treatment. His research has always epitomized the best of what the DSM model of psychiatry could expect. But the diagnoses in the manual, in concept, are closely linked to the medical model of biologically based psychiatric disorders and focus exclusively on the individual.
While the manual provides helpful clinical guidance in adults, it begins to unravel with its assumptions about discrete and specific disorders in children and ignores the families and environments in which children live. The ultimate absurdity of this scientific model is diagnosing bipolar disorder in 2 year olds and linking it to the adult disorder with the same name -- in the process saddling young children as chronic mental patients condemned to a lifetime of psychiatric drugs.
Even the American Academy of Child and Adolescent Psychiatry -- in its recent parameters on the diagnosis in children -- eschews the bipolar diagnosis and its consequent medical treatment in children under 6. Still there are thousands of potential Rebecca Rileys being treated with multiple psychiatric drugs because Biederman has said it's OK and necessary. Supported by millions of dollars of drug industry promotional funding, Biederman and his colleagues circle the globe offering professional medical "education" for their singular point of view.
Finally, it's sad but true -- the field of child psychiatry is afraid of Biederman. One can hear the worries and fears whispered in the academic halls and clinics over where Biederman has taken the profession. Yet to politely challenge Biederman in public is to risk public retribution and ridicule from him and his team. Also academic researchers in child psychiatry risk losing their funding if they criticize this darling of the pharmaceutical industry, which provides most of the money these days for psychiatric research.
The silence was deafening -- and Rebecca's death pushed me over the edge -- because for over a decade I've have been uncomfortable about these practices in young children. I am not against psychiatric drugs for children. I've written prescriptions for children for 30 years in a clinical practice not tied to the drug industry.
I risk personal censure and loss of credibility in an advocacy for a broader concept and treatment for children with behavior problems in naming this doctor. But this time, Dr. Biederman, you have gone far.
Dr. Lawrence Diller practices behavioral/developmental pediatrics in Walnut Creek, Calif., and is the author of "The Last Normal Child: Essays on the Intersection of Kids, Culture and Psychiatric Drugs."
Source: Boston Globe
Addendum: The judicial system has run its course, convicting mother Carolyn Riley, and not even touching the pharmacological establishment that armed the mother with the deadly drugs. The jury was probably not told that once a doctor prescribed medications, failure to administer the drugs was medical neglect, justification for taking custody away from the mother. Charges are still pending against the father, who was court-enjoined from living with his doomed daughter.
The Boston Globe
Mother convicted in girl’s drug death
Gets life sentence, possibility of parole
By Patricia Wen, Globe Staff / February 10, 2010
A South Shore mother was found guilty yesterday of second-degree murder in the death of her 4-year-old daughter, Rebecca, who went to sleep one night after being given toxic levels of psychotropic drugs and never woke up.
Carolyn Riley, 35, showed no visible emotion when the 12-member jury returned the verdict after 19 hours of deliberations in Plymouth Superior Court. Riley, her upper chest displaying a “Rebecca 12-13-06’’ tattoo that reflected her daughter’s date of death, was handcuffed as soon as the word guilty was uttered by the jury forewoman.
Before sentencing, Judge Charles Hely permitted the reading of a letter from Ashley Davidson, 17, Riley’s first biological daughter, who as a toddler was removed from her mother’s care, placed in a foster home, and eventually adopted. The teenager condemned her mother for the cruel fate she delivered Rebecca, as well as the tormenting memories left for her and Rebecca’s two other siblings, ages 14 and 9, now both in foster homes.
“When I think that you are my biological mother, I sometimes wonder if it is in my blood. Will I grow up to be a mother like you?’’ said the letter, read by her adoptive father, Bob Davidson.
Riley, who has an additional tattoo on her arm with the name Ashley, listened and stared at the floor.
The judge sentenced her to life imprisonment, with the possibility of parole after 15 years, the mandatory punishment for a second-degree murder conviction. It was one of the lesser offenses that the jury of eight women and four men was allowed to consider in this first-degree murder case.
As officers led Riley out of the courtroom, she looked at her mother, Valerie Berio, a constant presence in the 3 1/2-week trial who was sobbing among the spectators. Riley quietly wept as she was taken our to be transported to MCI-Framingham.
While Plymouth District Attorney Timothy J. Cruz praised the verdict as “a small measure of justice for Rebecca,’’ the mother’s defense lawyer, Michael Bourbeau, said the decision, which he plans to appeal, reflects the jury’s judgment of “what kind of a mother she was,’’ as opposed to the evidence in the case.
He had argued to jurors that medical evidence showed that Rebecca died of fast-acting pneumonia, not drugs, and that the mother gave medications based on the sometimes-flexible instructions of her child’s psychiatrist.
Riley’s husband - Michael Riley, 37 - will be tried separately on the same charges, and his case is scheduled to go to trial next month unless yesterday’s result leads to a plea bargain.
Rebecca’s case attracted national attention to the expanding use and potential abuse of giving psychotropic drugs to very young children. When Rebecca died, she and her two older siblings, Gerard and Kaitlynne Riley, were each on three potent psychiatric medications for bipolar and hyperactivity disorders. Each of them went on the drugs at age 2.
Prosecutors say Carolyn and Michael Riley, Weymouth High School graduates who had been living briefly in Hull when Rebecca died, deliberately sought the psychiatric drugs for their three children to scam their local Social Security office into approving disability benefits.
But behind the twists of the case is the all-too-familiar tale of a deeply troubled, financially strapped couple whose capacity to harm their children became catastrophically evident - to their many doctors, psychiatrists, teachers, and social workers - only when it was too late.
The prosecutors, Frank J. Middleton Jr. and Heather Bradley, depicted Carolyn Riley as an unusual form of child abuser, a woman who used three sedating medications, including Depakote, Seroquel, and clonidine, to control her energetic toddlers and induce sleep.
Remarkably, prosecutors said, Carolyn Riley managed to obtain the drugs routinely through prescriptions from Dr. Kayoko Kifuji, a Tufts Medical Center psychiatrist who faces a medical malpractice lawsuit in the death and agreed to testify only after being granted immunity from prosecution.
On the night Rebecca received her fatal overdose, her father, who had been prone to violent outbursts, became irate about the child’s pleas to be with her mother. Rebecca had been battling a respiratory illness for days, and that night, according to housemates, Rebecca kept trying to enter her parents’ bedroom, moaning, “Mommy, Mommy.’’
Prosecutors said that the mother, whom they portrayed as routinely putting her husband’s needs above her children’s, went to the pill dispensers in their Hull home. That night, the state said, Carolyn Riley gave the coughing and feverish child as much as twice the girl’s daily dosages of clonidine at once, the equivalent of seven tablets of .1 milligram each.
Rebecca’s lifeless body, clad only in a pull-up diaper with a teddy bear beneath her head, was discovered by her mother around 6 a.m. on Dec. 13, 2006, next to her parents’ bed.
Her defense lawyers, however, portrayed Carolyn Riley as an overwhelmed mother deserving of sympathy, a former foster child who was doing her best to raise a family in which the adults and children all had mental health problems.
If the mother had some lapses, her lawyers said, they had to be viewed in light of the difficult choices of a woman struggling with poverty and a domineering husband.
In the year before Rebecca died, Michael Riley saw the children sporadically. He was barred from living with the family in a Weymouth housing development because he had been charged with trying to sexually assault and show pornographic pictures to Ashley during one of her visits with the family.
The father, who was convicted of only the pornography charge and served a 2 1/2-year prison term that ended this year, remains behind bars awaiting his trial in the death of Rebecca.
The attachment of Carolyn Riley to her husband was a recurring theme in the lengthy trial. As the mother waited over three days for a verdict, sitting on a bench reading a romance novel and playing games on her cellphone, she responded readily to reporters’ questions.
When asked about the prosecutor’s argument that she and her husband wanted only to maximize their disability benefits, the mother, who speaks with a soft, girlish voice, disputed that point. She said that Social Security awards more money in total to a couple who file as unmarried singles.
But, she said that she and Michael, together for more than 15 years, chose to remain true to their status as a wedded couple.
“We would have gotten more money if we weren’t married,’’ she said.
Patricia Wen can be reached at firstname.lastname@example.org.
Source: Boston Globe
Addendum: The father gets convicted also.
Father convicted of 1st-degree murder in death of Rebecca Riley
BROCKTON – A South Shore father of three was convicted today of first-degree murder for killing his 4-year-old daughter with an overdose of a psychotropic drug that he and his wife had nicknamed "happy medicine."
Michael Riley, 37, faces a mandatory sentence of life in prison without parole for the murder of his daughter Rebecca. In a separate trial in the same case, his wife, Carolyn, 35, was convicted Feb. 9 of second-degree murder.
The preschooler's body, clad only in a pull-up diaper, was found lifeless on the floor next to her parents' bed during the early morning hours of Dec. 13, 2006. Prosecutors said the girl was given a lethal overdose of clonidine the night before when the child kept crying out “Mommy! Mommy!" while battling a severe respiratory illness.
The jury rejected the father’s defense that he and his wife simply followed the dosage advice of Rebecca’s child psychiatrist and that the girl’s death was due to a fast-acting pneumonia.
After the verdict, Plymouth District Attorney Timothy J. Cruz said he believes the psychiatrist, Dr. Kayoko Kifuji, who prescribed the drugs to Rebecca, should not be allowed to practice medicine in Massachusetts, and he will ask the Board of Registration to reopen an investigation into her medical care.
"Dr. Kifuji is unfit to have a medical license," he said after the verdict was announced. "If what Dr. Kifuji did in this case is the acceptable standard of care for children in Massachusetts, then there is something very wrong in this state."
Shortly after Rebecca died, Kifuji had entered into a voluntary agreement with the board to halt her practice. But two years later, after a grand jury declined to indict her and the board conducted its own inquiry, the board last fall allowed her to return to practice. She is currently seeing patients at Tufts Medical Center.
Cruz said he will collect all the information involving Kifuji that surfaced during both trials -- she was called as a witness in both cases -- and forward it to the state board in hopes they will act against the doctor.
The case drew national attention to the use of psychotropic drugs in young children, and the way parents can exploit the medical and social service system designed to help indigent families.
When Rebecca died, she and her two siblings, then 11 and 6, were each diagnosed by Kifuji with bipolar and hyperactivity disorders and put on three mood-altering drugs.
Prosecutors said Rebecca’s parents wanted the children prescribed psychiatric drugs so the children could be quieted down at will, and to help them qualify for federal benefits to help low-income families with mentally or physically disabled children. Neither of the parents worked, and they also qualified for adult disability benefits.
While she faces a medical malpractice suit filed by the administrator of Rebecca’s estate, Kifuji has resumed practicing at Tufts Medical Center with no restrictions.
In closing arguments in Michael Riley’s trial, both sides lambasted Kifuji for her careless attention to Rebecca. The father's attorney, John Darrell, said that Kifuji “authorized every piece of that poison” that killed Rebecca; and prosecutor Frank J. Middleton referred to her as a “quack” and a “disgrace” to the medical profession.
Darrell declined comment after the verdict.
But prosecutors emphasized to jurors that it was the parents who actually delivered the lethal dosage of medication to Rebecca, acting as a team devoted more to each other than to their children.
In both trials, the medical examiner and other toxicology experts said the girl’s dead body contained a toxic level of clonidine – a blood-pressure medication that is also used as a sedating drug for children with hyperactivity disorder. Other medical experts did testify that the girl also had an aggressive pneumonia at the time of her death.
Both parents, who graduated from Weymouth High School around the same time and last lived in Hull, have alleged that they simply followed Kifuji's instructions in dispensing medications, and that the doctor allowed some flexibility in dosages.
They said the science of measuring clonidine in a dead body is unreliable. Their lawyers have also argued that the girl died of a fast-acting pneumonia, and her death could not have been anticipated by any reasonable parent.
But the prosecutor told jurors that Michael and Carolyn Riley were far from loving parents and instead were callous individuals who turned to psychiatric pills to silence their children when they made inconvenient requests.
“It’s such an outrageous case of child abuse,” Middleton said.
Before the father was sentenced by Superior Court Judge Charles Hely, Ashley Davidson, a high school student and the half-sister of Rebecca, delivered a victim impact statement, faulting both parents.
"Knowing I will never see Rebecca again – you don't know how much that hurts,'' she said.
Michael Riley's conviction will automatically be reviewed by the Supreme Judicial Court.
Source: Boston Globe