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Girl's Overdose Death Raises
Questions
March 23, 2007
By Denise Lavoie
HULL, Mass. (AP) - 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?"
Valerie Berio, Rebecca's grandmother
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.
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