Girl fed fatal overdoses, court told

HINGHAM -- In the days before her death, 4-year-old Rebecca Riley wandered the family home disoriented and sick. Her parents simply reacted as they often did: by feeding her powerful prescription drugs, police said in court papers released yesterday.

But instead of helping her, the pills slowly destroyed her internal organs and filled her lungs with fluid, according to the police affidavit. Police found Rebecca lying dead on the floor of the Riley home in Hull on Dec. 13.

Michael Riley, 34, and Carolyn Riley, 32, of Hull pleaded not guilty yesterday to first-degree murder charges and were ordered held without bail. Prosecutors say they killed their daughter by regularly giving her drug overdoses, ostensibly to keep her calm and help her sleep. It was unclear yesterday how the family could have obtained so many psychotropic drugs for so long.

Carolyn Riley's lawyer, Michael Bourbeau, raised questions about the psychiatrist who prescribed the medication for Rebecca and diagnosed her at age 2 1/2 with attention deficit hyperactive disorder and bipolar disorder.

Prosecutors would not say whether Dr. Kayoko Kifuji of Tufts-New England Medical Center is a target of a criminal investigation, but have forwarded details from the case to state medical licensing regulators, who may take up the case as soon as today.

If the state Board of Registration in Medicine concludes that Kifuji violated medical standards in her treatment of Rebecca, she could lose her medical license or be suspended.

Kifuji had treated Rebecca since August 2004 and had also prescribed nearly identical drugs for similar disorders for her two siblings, a sister who is now 6 and a brother now 11, State Police say in the affidavit. It does not say how long Kifuji had been treating the other Riley children. Giving such drugs to children so young is controversial among mental health specialists.

Michael Riley's lawyer, John Darrell, said neither parent knew enough about appropriate treatment to have challenged Kifuji. "You've got two poor parents here of minor means financially, of minor education," he said.

Yesterday, Tufts-New England Medical Center stood behind Kifuji, who has worked there for four years and is board certified in adult and pediatric psychiatry. Her licensing record had no violations.

"Rebecca Riley's death is a terrible tragedy," the hospital said in a statement issued late yesterday afternoon. "The care we provided was appropriate and within responsible professional standards. The appropriate care of our patients is our greatest duty. Dr. Kifuji has outstanding credentials and is respected within her field."

The Rileys administered higher doses of the prescription drugs when Rebecca acted up or when they wanted her to sleep, police say in the 27-page affidavit. The affidavit says that investigators uncovered "an alarming pattern where the Rileys frequently seemed to run out of Rebecca's medication" and Carolyn Riley sought additional supplies, even when they didn't have a prescription.

Prosecutors allege that Rebecca's parents killed her by intentionally giving her too much of the drug clonidine, which was approved by the Food and Drug Administration as a high blood pressure medication for adults but is also sometimes given to children to help reduce aggressiveness and help them sleep.

However, a friend and a relative of the couple, who attended their arraignment in Hingham District Court, said the Rileys could never have intentionally killed Rebecca.

"I loved my daughter," Michael Riley said as he was led to the courthouse yesterday.

Prescription drugs and behavioral issues were a part of life in the Riley household, the affidavit indicates.

Carolyn Riley told investigators she was taking Paxil to deal with depression and anxiety, and Michael Riley admitted he often became verbally abusive with his children and once, a number of years ago, struck his wife. He blamed his temper on bipolar disorder and "intermittent rage disorder," conditions for which he said he took no medication, the affidavit says. Kifuji did not treat the couple, a Tufts spokeswoman said.

In 2005, the state Department of Social Services began investigating whether Carolyn Riley had neglected her children. In June 2005, DSS ordered Michael Riley out of the home following allegations that he had sexually abused his wife's daughter from another relationship and said he was only allowed to visit the children under supervision by a social worker.

After Rebecca's death, the agency put Rebecca's siblings in foster homes and started investigating why Michael Riley was at the home unsupervised when she died.

A therapist who treated the children last year told investigators she was concerned about the amount of medication prescribed for Rebecca because she never noticed symptoms of attention deficit or bipolar disorders.

In recent months, a preschool teacher and a nurse at Johnson Early Childhood Center in Weymouth noticed that Rebecca was often extremely lethargic, the affidavit said.

Her uncle -- James McGonnell, who was staying with the family -- was so alarmed by her sluggishness and her violent vomiting that he told Michael Riley the day before Rebecca died, "If you won't bring her to the hospital, then I'll beat you so that the ambulance will come and take both of you," according to the affidavit.

Instead, the Rileys gave Rebecca more clonidine and cough medicine, saying she only had a cold, the affidavit says.

Darrell, Michael Riley's lawyer, challenged McGonnell's account.

"Why the hell didn't he call an ambulance?" Darrell said during the arraignment yesterday. "Why the blazes didn't he call 911? Because it's not truthful, that's why."

The case highlights the controversial practice of prescribing psychotropic drugs to young children. Psychiatrists are divided between those who caution against prescribing to young kids and those who push for aggressive treatment. Local mental health specialists interviewed yesterday said that prescribing drugs for bipolar disorder at age 2 1/2 was unusual.

"It's not uncommon to have kids that are usually older than 4 on some of these medications, if they're severely aggressive or violent," said Dr. Sam Kelley, a child psychiatrist and medical director of the Massachusetts Society for the Prevention of Cruelty to Children. "But they really have to be off the scale."

The medical examiner's report indicates Rebecca died of intoxication caused by a combination of valproic acid, an antiseizure drug sometimes used in children to calm aggression; a cough suppressant; an antihistamine; and clonidine. She had also been prescribed Seroquel for bipolar disorder, but that was not found in her body.

Clonidine normally comes in tiny tablets, and a child might be started on a quarter of a tablet, said Kelley, who added that parents must very carefully administer the drug.

"It's a very small dose, highly monitored, because the drug can cause a dangerous drop in blood pressure, " he said. "And if you give two or three pills, it puts a child into coma."

Dr. Jennifer Harris, a child psychiatrist in private practice in Arlington and a clinical instructor at Harvard, said the early diagnosis in this case was striking.

"The danger . . . is that the medications are pretty serious and they have very serious potential side effects," she said.

Carey Goldberg of the Globe staff contributed to this report.